Lake County Assessment and Community Focused

Interventions for Obesity Among 7th-9th Grade

ChildrenTeam C Presentation

Stephanie Daus, Kelly DeRop, Emily Wasilco, Cassandra Kotlarczyk, MiSuk Robinson, & Landon Smith

•Poverty Level:–Lake County 19.4%–State of Michigan 10.5%Almost twice as many residents experience

poverty in the County when compared to the rest of the state.

(Citydata, 2012)

Assessment & Analysis of the Lake County Community

•UnemploymentIn Lake County 11.3% of residents are

unemployed, or just over one out of every ten

(State of Michigan, 2012)

Assessment & Analysis of the Lake County Community

Assessment & Analysis of the Lake County Community

Percentage of children with risk factors by grade for Mason and Lake County

Analysis of Assessment Findings

Analysis of Assessment Findings

Analysis of Assessment Findings

Analysis of Assessment Findings

Analysis of Assessment Findings

Analysis of Assessment Findings

Pender’s Health Promotion Model is helpful in explaining the cause of disparity in the population of Lake County 7th – 9th graders. Pender states that “prior behavior and inherited and acquired characteristics influence beliefs, affect, and enactment of health promoting behavior.”

(Pender, Murdaugh & Parsons, 2010)

Analysis of Assessment Findings

Based on the data current culture or belief systems being passed on to children do not effectively encourage healthy behaviors. This could be for a number of reasons including actual and perceived barriers such a lack of accessibility to whole foods to knowledge deficits regarding nutrition and exercise.

(Pender, Murdaugh & Parsons, 2010)

Analysis of Assessment Findings

Risk of Obesity among 7th-9th graders of Lake County, Michigan.

Nursing Diagnosis

• Educational Background• Socioeconomic Level• Family Lifestyle• Recreational Resources

Related To

o Unhealthy Eating Habits o Obesity in one or both parentso Lack of sleepo Lack of parental supporto Decreased knowledge o Low income householdso Inactivityo No access to a gymo No access to parkso Ageo Gendero Genetics

As Evidenced By

o Unhealthy Eating Habits o Obesity in one or both parentso Lack of sleepo Lack of parental supporto Decreased knowledge o Low income householdso Inactivityo No access to a gymo No access to parks

Changeable Indicators

o Ageo Gendero Genetics

These causes cannot be changed. However, they can be supported by healthy lifestyles.

Direct Causes

o Unhealthy Eating Habits o Obesity in one or both parentso Lack of sleepo Lack of parental supporto Decreased knowledge o Low income householdso Inactivityo No access to a gymo No access to parks

Each of these factors can change to support a healthy lifestyle.

Indirect Causes

According to the American Heart Association the dietary recommendation for children age 9-13 are:

Female: Calories 1600/dayMale: Calories 1800/dayFat: 25-35%Milk/Dairy: 3 cupsLean Meat/Beans: 5 ozFruits: 1.5 CupsVegetables: 2-2.5 cupsGrains: 5-6 oz

Healthy Diet

• Increase activity levels in Children• Increase knowledge base about health and

nutrition• Decrease calorie intake• Provide assistance to low income households• Promote family support• Decreased BMI

Goals

The number of obese children grades 7-9 in Lake County will be reduced by 10% in 2013.

The activity level of child grades 7-9 in Lake County will increase by 30% in 2013.

85% of Lake County students grades 7-9 will successfully pass a nutrition course.

70% of Lake County students grades 7-9 will successfully pass the FIT test.

SMART Objectives

Primary Community Interventions

Primary community prevention is essential when it comes to tackling childhood obesity. Screening of those who are most at risk and educating children and parents plays a key role in the prevention process. Evidenced based practice indicates healthcare professionals should focus their counseling on:

· Decreasing sweetened beverages such as soda or juice· Increasing daily physical activity to 30-60 minutes daily

· Making healthier food choices such as increasing fruits, vegetables and whole grains; limiting consumption of energy-dense foods such as high fat or

sugar laden snacks· Decreasing screen time and other sedentary behaviors

· Limiting portion sizes and amount of times per week eating out at fast food restaurants

· Eating meals together as a family and making healthy changes

together

(Rausch, Rothbaum Perito & Hametz, 2011)

Secondary prevention is more specific and focuses on the issues within a targeted population. There are a multitude of programs and studies that have been utilized for children from preschool to high school level.

The next few slides will highlight the most successful evidenced based practice (EBP) based programs for 7th-9th graders. These interventions may be compounded with what already exists in Lake County, Michigan to improve childhood obesity statistics.

The three EBP programs include the following:

· The Dutch Obesity Intervention in Teenagers or DOiT· Health in Motion· Intervention Centered on Adolescents' Physical Activity and

Sedentary Behavior (ICAPS)

Secondary Community Intervention

The Dutch Obesity Intervention in Teenagers:

· Students aged 12-14 years. Purpose was to increase awareness of the energy input and energy output equation.

· Behavioral interventions: • surveying consumption of high sugar snacks and beverages, physical activity

level and screen time. ·Educational interventions: • Educational courses in biology and physical education, altering cafeteria

food options, additional choices for physical activity classes

·Results: • A decrease in skinfold thickness measurements, with greater success for girls

than boys. Overall reduction in the amount of high sugar beverages consumed by both sexes (Singh, Chin A Paw, Brug, & Van Mechelen, 2009).

Analysis of Evidenced Based Practice Programs/Interventions

Health in Motion:An interactive computer based obesity prevention program developed for high school aged students.

Computer messages deliver tailored feedback on progression.

Interventions: • 60 minutes of physical activity 5 days per week, 5 servings of fruits/vegetables daily, 2 hours

or less of screen time daily.• Individualized plans were based on the Transtheoretical Model of Behavior Change.

Results: • According to Mauriello, et al (2010) the program ”initiated behavior change across energy

balance behaviors and also helped students who were already doing the behaviors to maintain their healthy behavior” (p. 453).

Intervention Centered on Adolescents Physical Activity and Sedentary Behavior or ICAPSStarted with younger adolescents (aged 12-16) and lasts four years; focuses on a socioecological model

perspective to prevent obesity.

Interventions included education on benefits of physical activity, additional in-school opportunities for physical activity and parental support of behavioral changes.

Results:

• According to Haynos and Donohue (2011) after four years of implementation, “the intervention group demonstrated significantly smaller increases in BMI and lower incidence of overweight than the control groups” (p. 395).

The DoIT program would be the best because...

• it is a lifestyle change not just an intervention.• it really educates the students to think about

what they are eating and how they are exercising.

--> this is very important because there are 17 fast-food restaurants in Lake County and only three full-service sit-down restaurants.

--> there are also only two grocery stores in Lake County and ten convenience stores .

• the age groups are closely related • the geopolitical communities are different

Which EBP intervention would best suit the 7-9th graders of Lake

County?

(Lake County Michigan Obesity, 2008)(Lake County, Michigan, 2012)

What Local Resources Are Lacking in Lake County?• No fitness centers• No farmer's markets• Very few parks

What Local Resources Does Lake County Have?• Many different campgrounds in the area• Manistee National Forest with many different hiking

trails and outdoor activities-bicycling -hiking-water activities -winter sports-horse riding -fishing

(Huron-Manistee National Forest Recreation, 2013)

Successful community focused interventions decreasing obesity in children requires understanding of family systems and the motivation to adopt healthier behaviors. Family-based conceptual models are often utilized for childhood-obesity research.

(Sung-Chan, Sung, Zhai, & Brownson, 2012)

Theoretical Support for Community Focused Intervention

Darling & Steinberg's Integrative Model of Parenting

• conceptual framework for understanding family systems

• parent-focused interventions for healthy weight development in school-aged children

(Ward et al., 2011)

Theoretical Support for Community Focused Intervention

Darling and Steinberg's Integrative Model of Parenting

Parent practices and style is influenced by the integration of parents' goals, values, child behaviors, and character qualities.

(Ward et al., 2011)

Theoretical Support for Community Focused Interventions

Darling and Steinberg's Integrative Model of Parenting

Parent variables affect child behaviors:• value• parenting practices: strategies or behaviors

used to help child achieve goals and directly affects child outcomes• parenting style: moderates the influence of

parenting practices on child behavior (Ward et al., 2011)

Theoretical Support for Community Focused Interventions

Ryan and Deci's Self-Determination Theory

Theory of self-motivation for improving intrinsic motivation to adopt healthy behaviors.

(Ward et al., 2011)

Theoretical Support for Community Focused Intervention

Ryan and Deci's Self-Determination Theory

Self-motivation can be reinforced by fulfillment of 3 innate psychological needs:a. competence b. relatednessc. autonomy (Ward et al., 2011)

Theoretical Support for Community Focused Interventions

Ryan and Deci's Self-Determination Theory

Competence can be increased by:a. positive feedbackb. communicationc. rewards (Ward et al., 2011)

Theoretical Support for Community Focused Interventions

Ryan and Deci's Self-Determination Theory

Relatedness is enhanced by having behaviors modeled or valued by parents, family, friends, and society. Support for healthy drinks and food choices by movie or sports stars encourage similar choices by kids.

(Ward et al., 2011)

(Ward et al., 2011)

Theoretical Support for Community Focused Interventions

Ryan and Deci's Self-Determination Theory

Autonomy can be enhanced by:a. providing choicesb. acknowledging feelingsc. opportunities for self-direction

(Ward et al., 2011)

Theoretical Support for Community Focused Interventions

SummaryPrimary and Secondary Interventions:

a. Community focused interventions should recognize the importance of parents' role and influence in childhood obesity.

b. Understanding theories of self-motivation for behavior change must be integrated in EBN interventions within the family unit, school, and community.

c. Implementation of evidence-based programs to monitor obesity in children and effectiveness of programs in meeting national health goals to reduce childhood obesity.

Theoretical Support for Community Focused Interventions

• 1/3 of all American children are overweight or obese• obese children 70% more likely to be obese as

adults• greater risk for chronic disease: type 2 diabetes,

hypertension, heart disease, sleep apnea, and psychosocial disorders• $150 billion spent annually on health care related

to childhood obesity (NCSL, 2011)

Policy Implications

Many factors contribute to childhood obesity. Policies need to address nutrition, physical activity, and monitoring pediatric growth/wellness. Community policies must acknowledge the role of parents' values and behaviors impacting childhood obesity. Communities and states must also address barriers to physical activity through purposeful urban planning. National policies must promote healthy nutrition and access to health care.

(Birch, Parker, & Burns, 2011)

Policy Implications

Nutrition Access to healthy foods at home involves educating

parents/families to model healthy food choices, age appropriate portion size, and variety of new food intake. Federal support of food assistance programs is needed to meet the needs of low-income families. • Supplemental Nutrition Assistance Program (SNAP) provides

debit cards to buy food: currently does not restrict purchases to healthy food choices• Special Supplemental Nutrition Program for Women, Infants,

and Children (WIC) provides vouchers to purchase nutritious food, nutrition information, and health care referrals• Emergency Food Assistance Program: distribute to local

food pantries (Birch et al, 2011)

Policy Implications

NutritionFederal funding for school lunch programs should promote

school menus meeting USDA food guidelines, restricting vending machine options of high caloric drinks & snacks, and access for low-income children to have nutritional needs met at school.• National School Lunch Program: provides cash subsidies to

school districts, free/reduced meals to eligible children, meets USDA nutritional guidelines• Summer Food Service Program: provides nutritious meals to

low-income children during the summer when not in school• Healthy Hunger-Free Kids Act: snack and beverage options

from school vending machines cannot exceed 200 calories (Birch et al., 2011; USDA, 2013)

Policy Implications

Physical Activity• educate, support, and encourage physical

activities throughout the entire school system• government incentives to improve health and

wellness of society affected by obesity• economic incentives to remove barriers to

physical activity

(NCPPA, 2013)

Policy Implications

Media and Marketing PoliciesWatching television, playing video games, and surfing the

internet has shown to increase the risk of obesity. Increase screen time contributes to inactivity, snacking, and exposure to advertising that influences food choices. Policies must address marketing standards for advertising of food and beverages to children. Media also has the opportunity to provide healthy nutritional information and promote physical activity. Successful social marketing interventions for health behavior change include smoking cessation, seat belt use, and oral health promotion.

(Birch et al., 2011)

Policy Implications

Media and Marketing Policies

• Target parents/families promoting good nutrition:a. 1% Or Less Milk Campaign: encourage intake of milk and dairy products

with fat content of 1% or lessb. 3-A-Day of Dairy Campaign: National Dairy Council and American Dietetic

Association educate about nutritional value of dairy products (milk, cheese, yogurt)

• Promoting physical activity:a. VERB: USDA and CDC campaign to increase physical activity among

youths age 9-13: increase knowledge, improve attitudes & beliefs, increase parental support of physical activity

b. NFL Play 60: supported by the NFL encouraging 60 minutes of daily physical activity, sponsors in-school and after-school programs, $200 million

donated by the NFL to support youth health and wellness (Birch et al., CDC, 2010; NFL, 2012)

Policy Implications

National Physical Activity Plan (NPAP): Make the Move

• promote physically active lifestyles by implementation and evaluation of policies & programs at the local, state and national level:

a. engage business and industry to develop and financially support policiesb. nutrition and health educationc. health care policies related to obesity, reduce health disparitiesd. mass media utilization to promote healthy societal behavior change e. support parks, recreation, and sports programsf. public health policies promoting healthy nutrition, increasing physical

activity, and decreasing morbidity related to obesityg. transportation, land use, and community design to increase physical activityh. partner with volunteer and non-profit groups to implement programs

(NPAP, 2010)

Policy Implications

What is the goal of the evaluation plan:o To initiate changes that will decrease

the obesity rate among 7th-9th graders of Lake County, Michigan over the next 10 years

o To provide a guideline of changes, interventions, & education to decrease the obesity rate

Evaluation Plan

Timeline:• Short term goal (1st year)

a. Collect BMI see BMI chart at the end of presentation

b. Conduct standard fitness test see standard fitness test guidelines end of presentation

c. Partner with local physician & dietician conduct HgbA1C, cholesterol screening, and baseline

nutrition screening

Evaluation Plan

Short term goal continued...d. Introduce interventions and education to decrease obesity rateo Collaborate with staff to lead by example and make the

school a healthy environmento Decrease the amount of sugary beverages & unhealthy

snacks in vending machines by 50% & replace with non-caffeinated beverages & healthy snacks

o Create a nutritional & physical education area for parents & students to participate in during parent-teacher conferences. Encourage them to set health goals together

Evaluation Plan

Intermediate Goals (2-5 years)a. Introduce additional healthy interventionso Discuss/organize having a garden that the students tend to

and learn how to grow healthy fruits, vegetable, & herbso Remove the remaining unhealthy items from vending

machines & replace with healthy itemso Create a Walk 12 Trails in 12 Months Challenge using the

Manistee National Forest o Develop School Health Advisory Council made up of

students, parents, a variety of staff & community members. Guide process on implementing healthy eating & physical activity policies/environment using CDC's Make a Difference at Your School: Key Strategies to Prevent Obesity.

Evaluation Plan

Midway CheckPoint (5 year mark)a. Assess & document BMI trends b. Reassess standard fitness testc. Reassess HgbA1C, cholesterol, and

nutritional screeningsd. Continue to implement healthy

changese. Evaluate the need to make changes to

the program

Evaluation Plan

Long term goals (5-10 years)a. Create a greenhouse to allow for a garden year round.b. Partner with Manistee National Forest to have a contract

that allows students to have a reduce admission fees or a free "student day"

c. Incorporate nutritional and physical education into the yearly curriculum.

d. Create a food co-op/farmers market at the school where the students & other community members can sells their crops

e. Encourage the Health Advisory Council to sponsor 5K run/walks. Donate the funds to help needs in the community

Evaluation Plan

Long term goals (10th year)

o Collect final BMI resultso Conduct final standard fitness testo Final assessment of HgbA1C, cholesterol, and

nutritional screeningo Analyze data collectedo Re-evaluate current program and make changes

as needed to continue to improve obesity rate

Evaluation Plan

Normal HgBA1C

Normal Cholesterol Levels

FITNESS TESTFitnessGram assesses three general components of health-related physical fitness, which have been identified as important to overall health and function. The components are listed below, with links to general descriptions of these tests if available. Many test items offer multiple options to choose from.

• aerobic capacity (one of these): PACER test — a 20 meter progressive, multi-stage shuttle run set to music (the PACER is also available in a 15 meter distance) (this is a version of the beep test) One-Mile Run— complete one mile in the fastest possible time, either walking or running. Walk Test— for secondary students ages 13 or greater• body composition (one of these):

Percent body fat (calculated from skinfolds of the triceps and calf ) Body mass index (calculated from height and weight)• muscular strength and endurance, and flexibility:

Curl Up— Abdominal strength and endurance test. Trunk Lift— Trunk extensor strength, flexibility and endurance. Push Up— Upper body strength and endurance (alternates = modified pull-up and flexed arm hang)• Flexibility (one of these)

back-saver sit-and-reach shoulder stretch(http://www.topendsports.com/testing/fitnessgram.htm)

American Dairy Association & Dairy Council (ADADC). (nd). Retrieved from http://www.adadc.com

American Heart Association. (2012). Dietary recommendations for healthy children. Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/Dietary-Recommendations-for-Healthy-Children_UCM_303886_Article.jsp

Birch, L. L., Parker, L., & Burns, A. (Eds.). (2011). Early childhood obesity prevention policies. Washington, DC: The National

Academies Press.

Center for Disease Control. (2012). A growing problem. Retrieved from http://www.cdc.gov/obesity/childhood/problem.html

Center for Disease Control. (2012). About BMI for children and teens. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

Centers for Disease Control and Prevention (CDC). (2012). School health policy. Retrieved from http://www.cdc.gov

Centers for Disease Control and Prevention (CDC). (201). VERB: It's what you do. Retrieved from http://www.cdc.gov

Citydata.com. (2012). Lake County, MI. Retrieved from www.citydata.com: http://www.city-data.com/county/Lake_County-MI.html

Deci, E. L. & Ryan, R. M. (2012). Self-determination theory in health care and its relations to motivational interviewing: a few comments. International Journal of Behavioral Nutrition and Physical Activity. doi: 10.1186/1479-5868-9-24

Food Research and Action Center. (2010). Why low-income and food insecure people are vulnerable to overweight and obesity. Retrieved from http://frac.org/initiatives/hunger-and-obesity/why-are-low-income-and-food-insecure-people-vulnerable-to-obesity/

Haynos, A. & Donohue, W. (2011). Universal childhood and adolescent obesity prevention programs: Review and critical analysis. Clincal Psychology Review, 32. p. 383-399. doi: 10.1016/j.cpr.2011.09.006

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