Changing the Landscape to Prevent Childhood Obesity Kansas City’s Childhood Obesity Collaborative-Weighing In KC Capacity Inventory

Trends and Healthy People Targets HP 2010  to 5% HP % 

Past Year Activities and Accomplishments Published 11 Weighing In updates Hosted and expanded quarterly meeting attendance by 62% Increased number on list by 42% Launched WI Website - ( Conducted Member Survey Updated Strategic Plan Aligning Working Group and compiling action plans Adopted Operations Guide for Weighing In - November 2010.

Past Year Activities and Accomplishments, cont. Conducted review of capacity to address childhood obesity Compiled inventory of assets and resources Compiled report for recommendations for population groups—pregnancy, breastfeeding, early childhood and school-age and infrastructure supports Secured funding for core operations through 2013 Competed in pool of 200 applications to become designated as one of 10 Healthy Weight Collaborative Teams—representing Region VII

Childhood Obesity Prevention Capacity Conducted inventory of current capacity Population based –Prenatal –Early Childhood –School-age Identified current and sustainable capacity, information needs and priorities

KC Collaboratives Addressing Childhood Obesity Greater KC Food Policy Coalition Building a Healthier Heartland Mother and Child Health Coalition KC Childhood Obesity Collaborative -Weighing In

Agencies by Population Group Prenatal Mother and Child Health Coalition 0-5 years KC Childhood Obesity Collaborative- Weighing In Mid America Regional Council (MARC)- Head Start Mother and Child Health Coalition K-12 Alliance for a Healthier Generation Energy Balance for Kids Junior League of Kansas City, MO Kansas Coordinated School Health KC Childhood Obesity Collaborative- Weighing In PE4Life Score 1 for Health General Blue Cross/Blue Shield Children’s Mercy Family Health Partners Greater Kansas City Food Policy Coalition Health Care Foundation of Greater KC Independence City Health Department Jackson County Health Department Kansas City Health Department KC Healthy Kids Menorah Legacy Foundation Mid America Coalition on Health Care Mid America Regional Council (MARC) Public Health Department-Unified Government of Wyandotte Regional Office-US Department of Health and Human University of Kansas University of Missouri-Extension YMCA of Greater Kansas City

Information What you want: 1.What is effective 2.Obesity prevalence data 3.Programs and efforts in my area Distribution opportunities Half have constituent newsletters All had websites One-third used social media All willing to distribute information on childhood obesity

Number of Programs by Strategies Community Strategies to Prevent Obesity Programs by Strategy % CDC Recommended Community Strategy Categories Promote the availability of affordable healthy food & beverages 9 Encourage communities to organize for change 7 Create safe communities that support physical activity 6 Encourage physical activity or limit sedentary activity among children and youth 3 Support healthy food and beverage choices 1 Encourage breastfeeding 0 Total Programs within CDC Recommended Strategies2636% Other Strategies Schools-based programs 14 Research based efforts 8 Screening and treatment 9 Education programs and other activities 6 Early childhood and infant focused programs 6 Funding support 4 Total Programs within Other Strategies4764% Total Programs73

Agencies with which Interviewees (N=25) Collaborated Number of times reported Percent School(s)/School Districts 1144% KC Healthy Kids 1040% Building a Better Heartland 728% Food Policy Coalition 624% Weighing In 624% Children’s Mercy Hospital and Clinics 624% Mother and Child Health Coalition 624% Local Public Health Agency 520% University of Kansas 416% Mo Council on Activity and Nutrition (MoCAN) 416% MU Extension 313% Beans and Greens Program 313%

Priorities Setting Focus SchoolNeighborhoodCommunity-RegionOther General Provide technical assistance and resource supports Support after school programs Launch and maintain school-based programs, Secure school district support Conduct youth empowerment program Change school environments and policies Conduct school-based screenings and refer at risk for weight management treatment Provide counseling for overweight/ obese children and their families Support neighborhood based initiatives Increase community mobilization on HE/AL Conduct adult and youth HE/AL programs Increase community gardening Create sustainable corridors Support linkage between schools and worksites/ corporate support Work to align activities Increase and strengthen community health planning Collaborate with others on HE/AL activities Provide technical assistance and resource supports Establish enforceable policy Support Head Start and child care initiatives Educate employers on health plan design Collect and analyze data Increase public awareness of problem and solution Market services and provide rationale for use Seek and maintain funding to support activities Survive tight times Educate and provide resources to healthcare professionals Provide health coaching Advocate for insurance coverage for weight management services Healthy Eating (HE) Conduct nutrition education Establish school gardens Provide nutrition counseling Increase access to local, affordable healthy food Improve access to local foods Promote purchase of local foods in institutions Expand Beans and Greens program Establish Food Policy Coalition Change mindset on use of fresh fruits and vegetables Active Living (AL) Document impact of physical activity levels on academic success Increase physical activity opportunities Add walking trails Advocate for livable streets and improved parks Promote use of walking trails Support Metro Green Trail System

Anticipated Changes

Build on our current capacity and assets Population Recommendations Healthy weight pregnancies Infants and Early Childhood School-age General Recommendations Information Needs Capacity to Track Childhood Obesity Indicators Consistent messaging Systems Approach Governance Framework Treatment

School-age Recommendations Highlights 44 % collaborate with schools 10 interviewees had school- specific programs 15 of all 75 programs/initiatives for schools What’s happening on a broader scale New insights regarding what is effective to support healthy school environment

Healthy Hunger Free Kids Act, 2010 USDA will set nutrition standards for all foods regularly sold during school day Funding to meet updated nutritional standards Supports local farm to school networks, school gardens, local foods Expands access to drinking water Standards for local wellness policies Increase number eligible—direct certification Universal meal access in high poverty communities

School Recommendations  Compile list of agencies serving schools-build on current rich capacity  Bi-state policy inventory  Collaborate on 1-2 priorities regionally for action plan to support implementation of Healthy Hunger Free Kids Act, 2010  Link with broader community efforts  Position paper  Consistent Messages

Breastfeeding-Everyone Supports Breastfeeding rate at 6 months (CDC Report Card-2010) US:44.3% KS:41.0 MO:35.1 Strive to have Kansas City Hospital(s) on the Baby Friendly Designation Map: g/03.html White House Task Force on Childhood Obesity Healthy People 2020 Goals Surgeon General-Call to Action Healthy Hunger Free Kids Act, 2010 Health Care Reform Centers for Disease Control and Prevention White House Task Force on Childhood Obesity Healthy People 2020 Goals Surgeon General-Call to Action Healthy Hunger Free Kids Act, 2010 Health Care Reform Centers for Disease Control and Prevention

Much more …. Pregnant women Mothers’ pre-conception weight and weight gain during pregnancy are two of the most important prenatal determinants of childhood obesity. Early childhood Development is more rapid during these early years than at any other time after birth, and young children’s early experiences are “built into their bodies,” affecting neural, metabolic, and behavioral systems in ways that can influence the risk for obesity, health, and well- being through the life span.

…and still more. Information Needs –Track Childhood Obesity Indicators –Communication- impressive untapped capacity for coordinated communication Systems Approach –Childhood obesity is a large complex, multi- sector issue Treatment

Greater Kansas City Obesity Collaborative

HWC Phase One Teams Region 1: Massachusetts Region 2: New York Region 3: Virginia Region 4: Florida Region 5: Ohio Region 6: Arkansas Region 7: Missouri-Greater Kansas City Obesity Collaborative Region 8: Montana Region 9: California Region 10: Washington Kansas City is one of ten teams nationally selected to participate in the Healthy Weight Collaborative-created by the Affordable Care Act and supported through the Prevention and Public Health Fund

Who We Are Community Organizations Deborah Markenson, MS, RD, LD Team Leader KC Childhood Obesity Collaborative- Weighing In Children’s Mercy Family Health Partners: »Greg Hanley, FACHE, MBA »Beth McElwain, RD, LD, MPH YMCA: »Gail Vessels KC Healthy Kids: »Gretchen Kunkel, MBA, MHA »Erika Devore, MS, RD, LD Primary Care Weight Management Services, Children’s Mercy Hospital –Sarah Hampl, MD –Kerri Wade, PNP-BC –Shelly Summar, MSEd, RD, LD Public Health KC (MO) Health Department –Clyde Bolton, BGS, MSA –Christine Riederer, PhD

HWC Model for Improvement AIM: What are we trying to accomplish? MEASURES: How will we know if a change is an improvement? CHANGE: What changes can we make that will result in improvement? Plan DoStudy Act

Healthier Children and Families in Kansas City Community Primary Care Public Health

Kansas City HWC Target Population Children 2-5 years of age Targeted lower income zip code areas of Kansas City Preliminary targeted area: N – Missouri River W – Kansas State Line E – 435 (N-S) S – 435 (E-W) Overweight + Obesity Rates Adult = 63.1% (2007-Jackson Co BRFSS) Young Children = 30.7% (2009-Jackson Co PedNSS) CMH primary care clinic = 27.7% (2010, 2-5 year olds) CMH Primary Care Clinic-32.6% (2010, 2-12 year olds)

Baseline Data on Target Population Children Mercy Hospital Primary Care Clinic 2-5 year old Well Child Clinic (2010, n=4838) Percentage for 2-5 yr olds with BMI≥85 th %ile 2-5 year olds with BMI≥85 th percentile27.7 -African Americans40.4 -Hispanic25.9 -Caucasian20.7 -Medicaid recipients85.7 -Commercial insurance5.6 -Uninsured8.0

PUBLIC HEALTH: Review, strengthen, and reinforce nutrition and physical activity standards in inspected child care facilities State Collaboration Metropolitan Official Health Agencies of the KC Area COMMUNITY : Increase the number of settings that reinforce consistent message on feeding practices for children 2-5 CMFHPChild Care SettingsHead StartYMCACommunity CentersWIC ClinicsSafety Streets PRIMARY CARE: Increase proportion of primary care providers assessing, counseling and scheduling follow-up with families with children with BMI ≥85. Assess and DiagnoseCounselFollow-up Preliminary Targeted Changes for KC

STAY TUNED…. …we’ll keep you posted on what works and doesn’t work.

WE WELCOME YOUR COMMENTS AND SUGGESTIONS…. …we present at a national meeting 9/13-15/11 and would love your thoughts and questions.