1. Tackling Obesity With HEALTH By Lindsay Bennett, Carly Macklin, Patti Moon, Dawn Platt, & Cheryl Shapiro Healthy Eating And Lifestyle Transformation Hour An After School Program for Kent County Youth

3.  In 2007-2008 17% of U. S. children ages 2-19 were obese (increase: 1971-1974 to 2007-2008 of 5% to 16.9%) (CDC.gov, 2010) Compare & Contrast Data In 2009 12% of Michigan children were obese (increase: 2001-2009 of 10.7% to 11.9%) (MiNPAO, 2011) Children who are obese between the ages 10-13 have an 80% chance of becoming an obese adult (NCCOR, 2012) In 2008, globally 35% of adults were overweight and 11% were obese (WHO, 2013) http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/Figures1.png

4.  The Kent County 2011 Health Needs Assessment revealed 10.5% of children were obese (accesskent.org, 2011)  From 1993 to 2008 the rate of overall obesity in Kent County increased from 17% to 29% (Kent County Health Connect, n.d.)  Kent County residents have 3% less access to healthy foods compared to National Benchmark which is 0%. (National Benchmark in 2012: 21%)  52.4% of youth in Kent County report being physically inactive (National Benchmark in 2012: 21%)  12% of Kent County residents have access to recreational facilities (National Benchmark in 2012: 16%) Compare & Contrast Data

5.  All youth are at risk; in Michigan the percentage of children ages 10 – 17 who are overweight or obese is 30.6% ( Michigan.gov, 2011)  Michigan ranks 25 th for overweight or obese children ( Michigan.gov, 2011)  Black youth (grades 9 – 12) have a higher obesity rate (18.5%) compared to white youth (11.2%) (Michigan.gov, 2011)  Boys (15%) have a higher prevalence of obesity than girls (9.8%) ( Michigan.gov, 2011)  Kent County American Indian youth and those receiving Ds and Fs also have a higher rate of obesity ( Kent CountyCHNA.org, n.d.) What groups are particularly affected?

6. Children ages 10-14 years old, growing up in the community of Kent County, Michigan, are at heightened risk for obesity-related health deficits. This is evidenced by the 10.5% obesity prevalence rate among these children as of 2011, a 12% rise since 1993 (Kent County 2011 Health Needs Assessment). Research has shown that in this community, the rise of childhood obesity is due in part to poor diet, inadequate access to nutritional food and insufficient physical activity. Educational measures in the school setting, for both children and parents with the goal for community change will seek to reduce these rates, resulting in a reduced prevalence of this concerning condition. Kent County Health Department. (2011) Problem Statement for Community Change

7.  “All processes occurring within individual people and their environment should be viewed as interdependent” Behavior change in people, including youth, includes developmental, history, psychological characteristics, interpersonal relationships, physical environment, and culture. Harkness & DeMarco, 2012 Ecological Model

8.  Ontogenetic Influence – Attitudes and beliefs that influence decisions.  Microsystems Influence – family, school, neighborhood, or childcare environments.  Exosystem Influence- socioeconomic and social network such as parent’s workplace, schedules and community-based family resources.  Macrocultural Influence – Customs, social norms and cultural values. Harkness & DeMarco (2012) Levels of influence

9.  HSAT Resource Guide (accesskent.org, n.d.)  Healthy School Toolkit: Local Wellness Policy (accesskent.org, n.d.)  Michigan Healthy School Success Story (accesskent.org, n.d.)  Student Health Survey (SHS) (accesskent.org, 2013)  FitKids 360: healthy lifestyle family education (fitkids360.org,2013)  Helen DeVos Children’s Hospital Pediatric Obesity Collaborative ( helendevos childrens.org, 2013)  Kent County Coordinated School Health Program (accessKent.org, n.d.)  Healthy Kids Healthy Michigan (HealthykidshealthyMichigan.org, 2013) Existing Resources

10.  Availability of high-calorie foods and sugary drinks  Advertising of less healthy foods  Lack of daily, high quality physical activity  Lack of safe places to play or be active  Limited access to healthy affordable foods  Increased portion sizes  Television and media  Parental influence or lack of parental involvement ( CDC, 2013) With so many programs, why is there still a problem?

11.  Teachers  Parents  Physicians and Nurses  School officials and Staff What community groups could be resources in addressing the issue?  Sisters Taking Action Reversing Statistics - S.T.A.R.S. (Chang, S.)  Churches  Service Clubs like the Elks Club, Kiwanis Club and American Legion Other organizations and businesses  Grocers and restaurants  MI Association of Food Producers Other Disciplines Involved

12. Government Michigan Parent Teachers Association Michigan Association of Principals Michigan Department of Education Kent County Public Schools Kent County Health Department Kent County and Various City Parks Established Programs Available Project WILD (Project WILD, n.d.) HealthierUS School Challenge (HealthierUS School Challenge, n.d.) Let’s Move program (initiated by Michelle Obama) (Let’s Move, n.d.) Fuel Up to Play 60 program (Fuel Up to Play 60 Program, n.d.) What Existing Agencies Are Likely Partners?

13. 1.Limited evidence as to how effective childhood obesity prevention efforts are in the United States. 2.Potential setting specific barriers: the cooperation of the school and teachers for example. 3.Lack of agreement regarding childhood obesity being a family/individual vs. a societal issue. 4.The speed at which the issue of childhood obesity is growing. Stroup D.F., Johnson V.R., Proctor D.C., & Hahn R.A. (2009) Potential Barriers to Childhood Obesity Interventions

14. School Nurse Childhood Obesity Prevention Education (S.C.O.P.E.) from the National Association of School Nurses (NASN) encourages the following: o Education: risk factors & health risks o Diet: nutrition, school lunches & fluids o Physical Activity: programs such as “Let’s Move”, “SPARK”, “Fit Kids 360” (NASN, 2010) Guidance for an intervention

15.  The school taught grades 6-8 but no more than grades 6-9 to meet our target population.  Schools were located in a city for accessibility and possibility of walking to school.  Minority population of at least 55%  At least 55% of the students qualified for free lunch program Public Schools Review. (2013) Who? Middle School students School Criteria

16.  A collaboration of best practice interventions to allow students to make choices  Meetings at 5 Kent County Middle Schools that occur three times a week; open to any student in grades 6 – 9  Integrating national, state, and county programs to provide direction and incentives for healthy lifestyle changes for youth WHAT? Introducing - TEAM H.E.A.L.T.H. Healthy Eating And Lifestyle Transformation Hour

17.  Gerald R. Ford Middle School  Grand Rapids University Preparatory Academy  Riverside Middle School  Valleywood Middle School  Westwood Middle School Where? Public Schools Review. (2013)

18.  Students to meet 3 days per week - Monday, Wednesday & Friday  After final dismissal from school: 3:30pm – 4:30pm When? Team Health

19.  Parental permission is required for participation.  Students will be participating in healthy physical activities  1 hour a day for 3 days a week  Education  Nutrition  Exercise How?

20.  Contact Local Corporations for donations  Meijer, Amway, McDonald’s for scholarships  Sears, JcPenney, Dick’s, Dunham’s for athletic gear  Barnes & Noble for book donation: “Happy Feet, Healthy Food”  Local grocers and farmer’s markets for gift certificates These items can be used to implement the program or for initiatives for success. How?

21. Michigan Health and Wellness 4x4 Plan  Health initiative that aims to reduce the obesity rates of Michiganders by providing access to tools and education for adults and children alike.  In 2011, under the direction of Governor Rick Snyder, the state heightened its focus on childhood obesity prevention and began tracking children’s body mass index (BMI) as recorded by their pediatricians at well check visits.  This anonymous data is entered into Michigan Care Improvement Registry.  Goal is to encourage health care providers to review and acknowledge BMI’s indicating risk or presence of childhood obesity. Hutchison, C. (2011) State of Michigan. (2012). Michigan Health and Wellness 4x4 Plan. Michigan Established Tracking Measures

22.  The Centers for Disease Control (CDC) Children’s BMI Tool For Schools.  Program that is offered in the format of an Excel spreadsheet document, available on the CDC website.  Schools may track up to 2,000 children and is designed to track BMI-by-age.  Using the height, weight, sex, date of birth and date of measurement information entered, the excel program provides BMI and BMI percentiles for each child.  Group summaries are constructed, with available graphs which showcase the prevalence of overweight and obesity within the group, as well as the prevalence of overweight and obesity by gender.  Document file with instructions: www.cdc.gov/healthyweight/downloads/BMI_group_calculator_English.xls www.cdc.gov/healthyweight/downloads/BMI_group_calculator_English.xls Centers for Disease Control. (2013). Assessing your weight: Children's BMI tool for school CDC Established Tracking Measures

23.  Weekly evaluations to build on positive change  Minutes of exercise  BMI or Weight  Proven healthy choice making  Monthly evaluations to award the A.C.E. Award  Positive attitude  Team competitions to show effective learning Evaluating Team HEALTH

24.  The financial cost is unknown  Supportive programs are already in place What else might be needed?  Grants  Volunteers Would this intervention fit with community interests?  Absolutely yes, War has been declared on obesity by the State of Michigan with its Health and Wellness 4x4 plan (State of Michigan, 2012).  Grand Rapids, the center of Kent County has proven its support of fitness by planning 100 miles of bike lanes in the city (Experiencing Grand Rapids, 2013). Are There Adequate Local Resources To Carry Out This Intervention?

25.  Center for Disease Control and Prevention. (2013). Childhood overweight and obesity. Retrieved from: www.cdc.gov/obesity/childhood/ ‎  Centers for Disease Control and Prevention. (2010). Prevalence of obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. Retrieved from: www.cdc.gov/obesity/childhood/index.html  Centers for Disease Control and Prevention. (2013). Assessing your weight: Children's BMI tool for schools. Healthy Weight. Retrieved from: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/tool_for_schools.ht ml  Chang, S. (2012). Exercise group aims to challenge minority obesity statistics, serve as support to others. Mlive. Retrieved from: http://www.mlive.com/news/grand- rapids/index.ssf/2012/10/support_group_in_west_michigan.html  County Health Rankings & Roadmaps. (2012). 2012 national benchmarks. Retrieved from: www.countyhealthrankings.org/sites/default/files/2012%20National%20Benchmarks2. pdf  Experiencing Grand Rapids. (2013). Things to do. Retrieved from: http://www.experiencegr.com/things-to-do/biking/  Fitkids360. Creating healthier communities. One fit kid at a time. Retrieved from: http://www.fitkids360.org/ References

26.  Fuel Up to Play 60 Program. (n.d.). Home. Retrieved from: http://www.fueluptoplay60.com//  Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing, evidence for practice. Philadelphia, PA: Wolters Kluwer, Lippincott Williams & Wilkins.  HealthierUS School Challenge. (n.d.). Retrieved from: http://teamnutrition.usda.gov/healthierus/Michigan.html  Hutchison, C. (2011). Data is power: Michigan fights childhood obesity by tracking it. ABC News. Retrieved from: http://abcnews.go.com/Health/Diet/michigan-track-kids-weight- statewide-registry/story?id=14518613  Kent County Administration. (2013) Kent County coordinated school health program (KCCSHP). Retrieved from: http://www.accesskent.com/Health/HealthPromo/school_wellness.htm  Kent County Health Connect. (n.d.) In Kent County: Obesity. Retrieved from: www.kchcct.com/thefacts.asp  Let’s Move. (n.d.). Learn the facts. Retrieved from: http://www.letsmove.gov/  Michigan Department of Community Health. (2011). Overweight and obesity among Michigan youth. Michigan’s Nutrition, Physical Activity and Obesity Program. Retrieved from: http://www.michigan.gov/documents/mdch/Overweight_and_Obesity_in_Michigan_Survei llance_Update_2011_387768_7.pdf References (Cont’d)

27.  Michigan Department of Community Health. (2013) Healthy kids healthy Michigan. Retrieved from: http://www.healthykidshealthymich.com/  Michigan Public Health Institute. (2011). Kent County: 2011 community health needs assessment and health profile. Retrieved from: www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf  National Association of School Nurses. (2010). Arkansas school nurses take action against childhood obesity and diabetes. Retrieved from: www.nasn.org  Project WILD. (n.d.). About us. Retrieved from: http://www.projectwild.org/  Public Schools Review. (2013).Kent County. Retrieved from: http://www.publicschoolreview.com/county_schools/stateid/MI/county/26081#!middle.  State of Michigan. (2012). Michigan health and wellness 4x4 plan. Retrieved from: http://www.michigan.gov/documents/healthymichigan/Michigan_Health_Wellness_4x4_Plan_3 87870_7.pdf  Stroup D.F., Johnson V.R., Proctor D.C., & Hahn R.A. (2009). Reversing the trend of childhood obesity. Preventing chronic disease 6(3):A83. Retrieved June 16, 2013 from http://www.cdc.gov/pcd/issues/2009/jul/08_0255.htm.  World Health Organization. (2013). Obesity and overweight. Retrieved from www.who.int/mediacentre/factsheets/fs311/en/ References (Cont’d)