How can we make our programs more effective?
Three years ago the Institute of Medicine (IOM) issued a call to action in response to the rapidly escalating problem of childhood obesity in the United States. It challenged all stakeholders—the federal government, industry and media, state and local governments, healthcare professionals, community and nonprofit organizations, schools and families—to take significant measures to prevent childhood obesity (Koplan 2005). That same year, IDEA challenged you—the fitness professionals on the frontlines in the United States and around the world—to get involved and “shape a healthier future for America’s children.” Recently, the IOM assessed the nation’s progress in preventing childhood obesity. We thought it also appropriate to see how we are measuring up and to share the stories of individual, facility and industry-wide efforts underway to reverse the alarming trend of obesity among our youth.
It is no secret that the United States faces an epidemic of childhood obesity. Obesity prevalence among children increased from 5% in the 1960s to 17% in 2004 (Ogden et al. 2006). African American girls (24%), Mexican American boys (22%) and children from lower-income communities (≥ 40% in some cases) with little access to healthful foods and physical activity opportunities suffer the highest rates (Ogden et al. 2006; Yancey & Kumanyika 2007). But the problem is not limited to American children. If we don’t do enough, over 20% of kids worldwide will be overweight or obese by 2010 (Kosti & Panagiotakos 2006). While genes and environment both contribute to obesity risk, the increasing prevalence of childhood obesity has occurred too rapidly to be explained by a genetic shift; rather, changes in physical activity and nutrition are responsible (Barlow 2007).
As with adults, behavior-based weight loss and subsequent weight maintenance prove to be extremely challenging for children. In fact, obesity in childhood, especially among older children and those with the highest body mass index (BMI), is likely to persist into adulthood (Whitaker et al. 1997). Social marginalization, type 2 diabetes, cardiovascular disease and myriad other morbidities are real threats for overweight children during childhood and into their adult years (Lobstein, Baur & Uauy 2004). Alarmed by these sobering statistics, stakeholders—including fitness professionals—have responded by developing numerous policies, programs and interventions designed to prevent childhood obesity.
Individuals and groups at every level, from state and federal governments to academia, communities and industry, have developed innovative programs for preventing childhood obesity. For example:
- Last fall the United States Office of the Surgeon General launched the Childhood Overweight and Obesity Prevention Initiative to coordinate and expand the government’s existing programs for preventing childhood obesity and to launch the National Center for Physical Development and Outdoor Play, which will help Head Start programs evaluate their playgrounds and educate children and families about healthful nutrition and regular physical activity (U.S. Department of Health and Human Services [HHS] 2007).
- Researchers from Tufts University partnered with community leaders in three cities in Massachusetts to launch “Shape Up Somerville.” Various community-wide improvements such as repainting crosswalks to encourage walking and adding healthier menu choices in school cafeterias and at local restaurants led to a decrease in BMI in children in first through third grades in the intervention community compared to controls. This successful program is currently being adapted to reach children in both urban and rural communities (Friedrich 2007).
- Founders of Overtime Fitness Inc., in Mountain View, California, launched a fitness facility tailored to the special interests and needs of teens. The gym offers a mix of conventional training equipment and teen-friendly features, such as a rock-climbing wall, cheerleader conditioning sessions, academic tutoring and a surplus of active video games similar to Dance Dance Revolution (Associated Press 2007).
- The article “Kids in Motion Stay in Motion” in the February issue of IDEA Fitness Journal (Williams 2008) offered many more examples of creative interventions led and inspired by fitness professionals, as well as tips for starting your own program.
These programs are simply a miniscule sampling of the thousands of programs and initiatives underway in communities across the U.S.
Where We Stand
Here’s the problem: we don’t know which of the thousands of efforts really work. In its report “Progress in Preventing Childhood Obesity: How Do We Measure Up?” (2007), the IOM Committee on Progress in Preventing Childhood Obesity concluded the following:
- While the country is starting to recognize the problem of childhood obesity, the current level of investment by the public and private sectors—including the fitness industry—is insufficient.
- Current data and evidence are inadequate to allow a comprehensive assessment of the progress made in the prevention of childhood obesity in the United States.
- Evaluation is a critical component to any intervention in that it helps to guide improvements and fosters collective learning, accountability, responsibility and cost-effectiveness.
- Government, industry, communities, schools and families have responded to the epidemic by implementing a variety of policies, programs and interventions, but it is unclear which programs are most effective, as few include an evaluation component.
- Stakeholders should conduct evaluations to assess and stimulate short-term, intermediate-term and long-term progress in reversing the childhood obesity trend and improving the health of the nation’s youth.
So what does this mean for fitness professionals and the efforts—both big and small—of the fitness industry to make a difference?
A Call to Action
First, we need to keep doing what we’re doing. That is, we must continue to invest time, energy and resources in helping our children move more, eat better and participate in maintaining their own health. But we can do more, and we can do it more effectively, if we heed the advice of the IOM and maximize the quality and effectiveness of our efforts at the industry, community and personal levels.
The IOM recommends that industry “utilize the full range of available resources and tools to create, support and sustain consumer demand for products and opportunities that support healthy lifestyles, including healthful diets and regular physical activity” (Committee on Progress in Preventing Childhood Obesity 2007). The increasing trend among fitness facilities to design programs and initiatives to prevent childhood obesity is encouraging. However, more important than the quantity of programs offered is the quality of the programming. If you are involved in an obesity prevention activity, the IOM recommends that you ask yourself the following questions to help guide your program design (Committee on Progress in Preventing Childhood Obesity 2007):
- How does the activity contribute to preventing childhood obesity? What are the rationale and supporting evidence for this particular action as a viable obesity prevention strategy, particularly in a specific context? How well does the planned program or intervention match the specific setting or population being served?
- What are the quality and reach or power of the action as designed?
- How well is the action carried out? What are the quality and the reach or power of the action as implemented?
- What difference has the activity made in terms of increasing the availability of foods and beverages that contribute to a healthful diet and providing opportunities for physical activity? Are there other indicators that this program encourages a healthful diet and physical activity and improves health outcomes for children and youth?
Further, industry is encouraged to partner with government, academia and other interested stakeholders to develop effective programs and to evaluate progress in preventing childhood obesity and promoting healthy lifestyles. IDEA’s collaboration with the Alliance for a Healthier Generation is an example of such a partnership. (See the sidebar “IDEA Teams With Alliance for a Healthier Generation” for more information on how you can get involved.) Beyond forging partnerships and evaluating programs, industry can help maximize the reach and impact of programs by loudly broadcasting program findings, successes and opportunities for improvement.
Facility owners, fitness professionals and health advocates all should feel empowered to get involved in community efforts to prevent childhood obesity. Work with your community leaders to strengthen local policies, coalitions and collaborations to make the community a haven for physical activity and healthful nutrition.
For instance, you and other community stakeholders can pursue one or more of the following advocacy efforts. In a commentary in The Journal of the American Medical Association, Risa Lavizzo-Mourey (2007) of the Robert Wood Johnson Foundation recommended these steps as crucial ways to combat childhood obesity:
- Demand that schools offer healthier nutrition options and physical activity opportunities.
- Campaign your local politicians for sidewalks, playgrounds, bike paths and recreational facilities.
- Call for adequate numbers of supermarkets in local low-income neighborhoods.
- Insist that nearby hospitals eliminate fast-food outlets.
- Advocate healthy lifestyles and healthy communities using public venues.
Many communities throughout the country have started childhood obesity prevention coalitions that are well positioned to advocate these changes. A list of some of the largest ones is included in the sidebar “Large-Scale Childhood Obesity Prevention Efforts”; a quick Internet search or call to local stakeholders may help you locate one in your community. Challenge your local coalition to spend as much time in the community taking action as it spends in meetings making plans.
Evaluate the programs that you pursue. Consider developing partnerships with government agencies, foundations and academic institutions that have the resources and know-how to conduct comprehensive and reliable assessments of the program’s effectiveness. Share your results with members of your own and other communities. The IOM also strongly advises communities to develop a validated community self-assessment tool to identify strengths and gaps in childhood obesity prevention efforts (Committee on Progress in Preventing Childhood Obesity 2007).
As a parent or relative, you can set an example for the children in your life by promoting healthful eating and regular physical activity. Are the foods and beverages available in your home healthful and served in reasonable proportions? Is physical activity a family priority? Do you have rules in place limiting screen time? Don’t underestimate your influence—programs that specifically target parents as the exclusive agent of change have demonstrated superior outcomes (Golan & Crow 2004). You can take it to the next level by organizing a coalition of parents to initiate “walking school buses” along safe routes in your community and by taking a proactive role in promoting healthy practices at your children’s schools.
Consider evaluating your efforts by arranging a system to assess your family’s progress in achieving positive lifestyle changes. This could mean simply keeping track of weekly physical activity, fruit and vegetable consumption or television viewing. Then, share your “findings” along with what works and what does not with all of your friends and relatives so that they, too, may implement family changes to foster healthier living.
To be sure that the best programs and innovations spread and reach the most children, it is important (1) to incorporate some evaluation component to assess whether an intervention works and (2) to share with anyone who will listen what has worked for you and what has not.
While health and quality-of-life projections for our youth are grim, these projections are not yet reality. We still have the chance to reverse the childhood obesity epidemic and its ugly consequences. Whether you choose to team with IDEA and the Alliance for a Healthier Generation, join your local obesity prevention coalition, start and evaluate a youth fitness program at a gym or limit screen time for your own children, as a fitness professional—the exercise expert of the team—you play a vital and essential role in preventing childhood obesity. But to be successful, we must act now and we must be effective. Together we can help shape a healthier generation.
SIDEBAR: IDEA Teams With Alliance for a Healthier Generation
“Fitness professionals have the desire, knowledge base and expertise to be at the forefront of solving this national crisis, and IDEA members are ready to show their support by providing time, resources and leadership.”
—Peter Davis, chief executive officer of IDEA Health & Fitness Association
To combat the growing epidemic of childhood obesity, the American Heart Association and the William J. Clinton Foundation joined together in 2005 to form the Alliance for a Healthier Generation (www.healthiergeneration.org/). The Alliance is working to stop the nationwide increase in childhood obesity by 2010 by taking bold, innovative steps to help all children live longer and healthier lives.
The Alliance formed a partnership with IDEA, creating numerous opportunities for IDEA members to take part in preventing childhood obesity. Here is an update on some of the Alliance’s achievements so far and how IDEA members can get involved.
Two of the Alliance’s initiatives include the Healthy Schools Program, which aims to improve schools in the areas of nutrition, physical activity and staff wellness, and the Kids’ Movement, which is a “by kids for kids” effort working with youth to help them take control of their health and actively strive to make their communities and families healthier.
IDEA members can get involved with the Alliance in various ways, including
- recruiting kids to pledge to Go Healthy at www.igohugo.org;
- offering group exercise or personal training services at Alliance events or offering these services—including before- or after-school programs—at schools enrolled in the Healthy Schools Program;
- donating fitness equipment to schools enrolled in the Healthy Schools Program; offering discounted membership rates to staff and students in schools enrolled in the Healthy Schools Program;
- and offering personal training services to students who are identified as overweight or obese in school-based health centers associated with schools enrolled in the Healthy Schools Program.
More than 1,000 IDEA members have pledged to contribute their time and expertise to improve physical activity opportunities in their communities. You can join them, and this industrywide effort, to prevent childhood obesity. Go to www.ideafit.com and click on the Alliance for a Healthier Generation icon to learn more, to find out about classes you can provide in schools and to sign up. You will receive a webinar training on how to best work with the schools and then you will be matched with a local school that is a member of the Healthy Schools Program, or you can recruit schools to join the Healthy Schools Program.
SIDEBAR: Large-Scale Childhood Obesity Prevention Efforts
The following organizations and coalitions can help you make a difference in the lives of children. See what these groups are already doing in your community or how you can start new local efforts.
- Action for Healthy Kids, www.actionforhealthykids.org. This national nonprofit organization is devoted to optimizing school-based efforts to address childhood obesity. Chapters are active in all 50 states and the District of Columbia.
- Alliance for a Healthier Generation, www.healthiergeneration.org/. Founded by the American Heart Association and the William J. Clinton Foundation, and collaborating with IDEA, the Alliance created the Healthy Schools Program to improve school nutrition and physical activity. It has also played a key role in convincing food and beverage companies to institute healthier guidelines for snacks and beverages sold in schools.
- Arkansas Center for Health Improvement, www.achi.net/. Arkansas was the first state to require all its schools to measure and report body mass index. The Arkansas Center for Health Improvement oversees the program and supports several evidence-based, health-related policy efforts.
- Center for Weight and Health, University of California, Berkeley, cnr.berkeley.edu/cwh/resources/childrenandweight.shtml. The Center for Weight and Health offers myriad resources including a “how-to” guide offering technical assistance to community leaders who wish to launch a local task force dedicated to preventing overweight in children.
- Coalition for Healthy Children, www.adcouncil.org/healthychildren/about.html. The Coalition for Healthy Children is the Ad Council’s partnership with industry, media, nonprofit organizations, government and foundations. All member organizations agree to incorporate strategic messages related to nutrition, physical activity and role models into marketing materials.
- The Food Trust, www.thefoodtrust.org. The Food Trust works on initiatives to expand food access, education and marketing campaigns aimed at improving health. It also supports public policies to advance these initiatives.
- Girls on the Run, www.girlsontherun.org. This program offers women an opportunity to coach girls between the ages of 8 and 13 as they develop self-respect and healthy lifestyles through running.
- Kids Walk to School Initiative, www.walktoschool-usa.org. Part of the International Walk to School program, this initiative has sponsored Walk to School events in all 50 states. Get a step-by-step guide to starting a neighborhood walking program.
- National Coalition for Promoting Physical Activity (NCPPA), www.ncppa.org. The NCPPA provides legislative updates and news related to nutrition, physical activity and obesity.
- We Can! (Ways to Enhance Children’s Activity & Nutrition), www.nhlbi.nih.gov/health/public/heart/obesity/wecan/. We Can! is a valuable resource for all stakeholders to gain information, discover opportunities for involvement and connect with local resources.
- Community-Based Obesity Prevention Coalitions. Below is a sampling of active and innovative obesity prevention coalitions that are community based:
- Chicago—CLOCC: Consortium to Lower Obesity in Chicago Children, www.clocc.net/
- Lexington, Kentucky—Lexington Tweens Nutrition and Fitness Coalition, www.fitky.org
- South Carolina—SCCOPE: SC Coalition for Obesity Prevention Efforts, www.sccope.org/
- San Diego—Coalition on Children and Weight San Diego, www.ccwsd.org
Natalie Digate Muth, MPH, RD, CSCS, is a fourth-year medical student at the University of North Carolina at Chapel Hill. She is planning to pursue a residency in pediatrics.
Associated Press. 2007. Private gym for teens aims to address obesity. www.msnbc.msn.com/id/19806500/print/1/displaymode/1098/; retrieved Mar. 20, 2008.
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Friedrich, M.J. 2007. Researchers address childhood obesity through community-based programs. The Journal of the American Medical Association, 298 (23), 2728–29.
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Whitaker, R.C., et al. 1997. Predicting obesity in young adulthood from childhood and parental obesity. The New England Journal of Medicine, 337 (13) 869–73.
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Yancey, A.K., & Kumanyika, S.K. 2007. Bridging the gap: Understanding the structure of social inequities in childhood obesity. American Journal of Preventive Medicine, 33 (Suppl. 4), S172–S174.