Columbus Project

L i ve H e a l t hy Co l u m b u s a n d C h i l d re n â&#x20AC;&#x2122;s H e a l t h c a re o f At l a n t a

Childhood Obesity Prevention needsassessment f o r C o l u m b u s - M u s co g e e C o u n t y, G e o r g i a

January 2012

January 2012 Prepared by: Fanning Institute, University of Georgia Carolina Darbisi, M.Ed., M.S. David Meyers, M.S.W. Lori Tiller, M.A. Courtney Tobin, J.D. Whitney Bignell, M.S., R.D., Fanning Doctoral Fellow

Contributors: Jan Coyne, M.A., cartographer Tyler Reinagel, M.P.A., Senior Doctoral Fellow Eleonora A. Machado, graphic designer Kathleen Cason, Ph.D., editor

Prepared for: Live Healthy Columbus Childrenâ&#x20AC;&#x2122;s Healthcare of Atlanta

Obesity Prevention

Table of contents 04

Introduction from the Chair

Live Healthy Columbus members

Executive Summary

review of literature

The Problem in Muscogee County

Scope of the Problem

Best Practices: School-Based Interventions

Best Practices: Prevention Strategies

Best Practices: Policy Initiatives

Objectives and Research Methods

Findings

State Trends in Childhood Obesity

Factors that Affect Childhood Obesity in Columbus-Muscogee County

Perceptions and Ideas of Local Residents on Childhood Obesity

Individual Interviews

Focus Groups

Online Survey

Existing Food and Nutrition-Related Programs in Muscogee County

Case study 1

case study 2

Gaps and Recommendations

Summary and Next Steps

References

Appendices

photo credits

Obesity Prevention

INTRODUCTION FROM THE CHAIR The number of obese children in our community, state and country is staggering. Nearly 40% of all children in the United States are overweight or obese; this percentage is higher among certain ethnic groups. Even more alarming is the fact that the overall rates of obesity in our country have skyrocketed over the last 25 years. Childhood obesity has become one of the most serious health risks of a generation — in one generation’s time. The risks for children who are obese are significant. Obese children are at a greater risk for both short and long term health problems such as sleep apnea, bone and joint problems and pre-diabetes symptoms. In addition to an increased risk of becoming an obese adult, children who are obese often suffer significant emotional problems such as low self-esteem and are at a greater risk for being bullied by their peers. Whether or not you have children, childhood obesity is a community issue that affects all of us. Besides the obvious — that our children are less healthy and therefore may suffer from health related problems throughout their lives — there are societal impacts. We can expect that health care costs will be driven even higher by greater demand from a younger population. We can expect to see higher rates of disability claims. There is a greater risk for obese parents to raise obese children; therefore we can expect that a cycle has begun. We must act together as a community to reverse this trend. Live Healthy Columbus is a community coalition founded a little more than a year ago. In a very short time, our group has assembled a large group of leaders in

Columbus dedicated to addressing the issue of childhood obesity. The goal of Live Healthy Columbus this year is to share information, and coordinate services, community education and advocacy around the issue of childhood obesity. We have already launched the Strong4Life initiative, which is designed to teach our children and their families how to be healthier by eating right and being active. We know that this is a significant issue nationally; but we knew that we needed to get a handle on the issue here in our community. That’s why we hired the Fanning Institute at the University of Georgia to complete this community needs assessment specifically about childhood obesity in our community. In addition to gathering data specific to Columbus, we wanted to hear from the citizens of our community in hopes of learning what the community feels about the issue, identifying local strategies that fit with our local resources, and how we can best move ahead with plans in our community to reverse this startling trend. As a part of the needs assessment process, we heard from over 200 community members through an online community survey, focus groups, and individual interviews. Thank you for your input. What we found is that we have much work to do, but we also have many resources already in place to reverse this trend. We hope to work together to implement some of these strategies as soon as possible. We need to continuously hear from each other as we move ahead. We hope you will all continue to work together in this effort to make Columbus a LIVE HEALTHY CITY.

Respectfully,

Joseph Zanga, MD, FAAP Chair, Live Healthy Columbus

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Childhood Obesity Prevention Needs Assessment Report

Obesity Prevention

Live Healthy Columbus members NAME/Organization Joseph Zanga, Chief of Pediatrics Columbus Reg. Healthcare System(CRHS)

Dr. Edward Bayne Sibley Heart Center

Eva Appiah Enrichment Services Program, Inc.

Mary Stranger, Director of Benefits Synovus

Joanne S. Cavis, MBA, CFCS UGA Corp Extension Columbus Office

Tara Redmond, Health Science Program Columbus State University

Larry Crane, Chamber of Commerce Greater Columbus, GA

Taryn Whittlesey, Project Coord., HR Aflac

Kelly Bowman Columbus Research Foundation

Brenda Forman, Nutrition Director Columbus Health Dept.

Celsa Muniz, District Supervisor Columbus Parks and Recreation

Mark Thorne Sr., Health Sciences Program | Columbus Technical College

Dr. Paula Walker, Health Sciences Columbus State University

David Steele YMCA Executive Director

Sara Lang Valley Healthcare System, Inc.

Jim Zacharias, CEO Columbus Clinic/CRHS

Sherri Mitchell, Director Growing Room Inc.

Diane Thurman, RN Valley Healthcare System, Inc.

Karen Davis Muscogee Co. School Dist.

Lisa Roberts, PE Coordinator in the Elementary Schools

Tamika Janas| Dept of Behavioral Health Office of Prevention

Darlene Shirley, Lead Nurse Muscogee Co. School Dist.

Joe Kieta, Editor Ledger Enquirer

Deloris Doleman Pauline T. Wright Education Foundation

Keith Higgins, Director of Childrenâ&#x20AC;&#x2122;s Services | CRHS

Dr. Michael Beres Beres Chiropractic Center, Inc.

Valencia Evans, Director Hope Harbour

Al Eaton,Ph.D., Director of Behavioral Science | CRHS

LaVerne Jackson Holsey Chapel CME Church

Julia Franklin Public Health/WIC

Royce Ann Adkins, Exec. Director Cols Research Foundation

Tiffany Ingram, Director River Valley Area Agency on Aging

Virginia Peeples, Director Coalition for Sound Growth

Ed Saidla, District Program Manager Columbus Health Dept.

Beverly Townsend, MD, Exec. Director Columbus Dept of Public Health

Marion Scott, Director Corporate Communications, CRHS

Sheila Mayfield, Ph.D, Manager Columbus Health Dept.

Yanci See Healthcare Consulting

Dorothy Hyatt, Executive Director Girls, Inc.

Eileen Albritton, Clinical Director W. Central Health Dist.

Debbie Littleton, Director Columbus Community Center

Terri Bolger, Diabetes Coordinator Health Matters, St. Francis

Karon Bush W. Central Health Dist.

Cheryl Johnson, Exec. Director West Central Ga Cancer Coalition

Marie Peterson Housing Authority

Kelly Smith American Heart Association

Michelle Sabol, MPA,RD,LD Shasta County Public Health

Toya Winder, Director Girl Scouts

Dr. Kathryn Cheek Rivertown Pediatrics

Dayton Preston, Exec. Assistant CRHS

Lawanda Gray, Director IT Security/ Privacy | CRHS

Dr. Peter Resnick CRHS

Lisa Venable, Managing Editor Muscogee County Medical Society

Cathy Phillips, Director Maxx Fitness

Mark Ellis, Health Promotions Consultant | W. Central Health Dist.

Mike See Coldwell Banker Realtor

Holly Browder, Division Manager Parks & Recreation

Sara Dismuke Community Member

Carol Coakley Hall West Central Ga Cancer Coalition

Terry Cone, MD Family Practice

Candice Wayman, Coordinator Coalition for Sound Growth

Patricia Dismukes, Director Enrichment Services Program, Inc.

Karen Davis Muscogee County School District

The University of Georgia | Fanning Institute

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Obesity Prevention

EXECUTIVE SUMMARY “Fast food is easy for both wealthy and poor; nutritional foods are available to all income levels, but they take more time to prepare.” These words from a Columbus resident accurately describe what the research surrounding childhood obesity implies: no single person or community is exempt from the issue. The state of Georgia has one of the highest obesity rates for children and adults in the country. Over the past decade, the rate of obese adults has risen from an average of 22% in 2001 to 29.6% in 2010. According to the most recent data available, 26% of Georgia high-school students are overweight or at risk of becoming overweight, and 33% of Georgia middle-school students are overweight or at risk of becoming overweight. In partnership with Children’s Healthcare of Atlanta, Live Healthy Columbus (a community coalition focused on obesity prevention) recently launched Strong 4 Life, a local childhood obesity education initiative. Additionally, the partnership engaged the University of Georgia’s Fanning Institute in a three-month childhood obesity prevention needs assessment during the fourth quarter of 2011. The purpose of the assessment was to conduct a literature and best practices review, to update secondary census and other data, to collect primary data from local residents regarding perceptions and existing programs, and to provide recommendations and strategies for targeting and focusing efforts to reduce childhood obesity in Muscogee County. According to available research, a child’s body weight is influenced by many factors including genetics; individual, family and community characteristics; cultural PAGE 6

norms; and national policies and funding. Numerous articles describe how community and school-based programs have attempted to curb childhood obesity, with mixed results. Research shows that school-based programs that have been associated with positive outcomes have included the following factors: § Universal implementation (all children vs. only overweight children); § Longer duration (more than 12 weeks, optimally 28 weeks); § Encouragement of nutrition change rather than mandated system-wide changes; § Focus on reducing sedentary behaviors; § High level of parental involvement; § Collaboration with teachers (rather than training teachers as implementers); and § Incorporating a mind-body approach.

Similarly, research shows that community-based programs associated with positive outcomes include the following factors: § Using the media to promote healthy behaviors; § Ensuring access to healthy foods and physical activity opportunities; § Encouraging point of purchase promotion of healthy items; § Using price initiatives to increase the competitiveness of healthy items and make physical activity opportunities affordable; and § Increasing the support resources in a community.

Childhood Obesity Prevention Needs Assessment Report

Local data suggests that Muscogee County is not immune to this national epidemic, and the area has a number of programs and services that directly or indirectly combat childhood obesity. However, more can be done, including coordination of such programs. A list of 29 organizations or initiatives in Muscogee County with efforts to help curb childhood obesity is listed in Table 1 of this report, along with maps showing the county’s extensive park and greenspace infrastructure. Muscogee County has 10 census tracts that are considered to be food deserts, meaning that a substantial number of residents has low access to a supermarket or large grocery store and the census tract meets certain low-income thresholds. The assessment looks at a number of indicators in these tracts as compared to non-food desert tracks, including (1) percent of population under 18; (2) percent of population under 18 and below the poverty level; (3) racial make-up; (4) owner versus renter occupied housing; (5) highest degree or schooling attained; and (6) housing rent versus median percent gross income.

habits. All agreed the most important next step in curbing childhood obesity is education of parents, students and the community as a whole. However, participants were united in insisting that education efforts not stop at telling parents and children what to eat to be healthy. It must also show them how to obtain and easily prepare healthy food on a budget and with limited time. Ninety-two percent of survey respondents believe childhood obesity is a growing problem in Columbus, and 96% of respondents are worried about the future health of children in the Columbus community. Three key themes emerged from the assessment: 1. Increased Physical Activity; 2. Education of Parents and Youth; and 3. Access and Knowledge of Healthy Foods

“It has to be a culture change where the family and the community are all involved.” Local opinions were assessed through an online survey (121 participants), four focus groups (34 participants), individual interviews (22 participants), and conversations with Live Healthy Columbus members. (Team members also reviewed the conclusions specific to Columbus from the day-care focus groups conducted by the Haystack Group on behalf of Children’s Healthcare of Atlanta.) Participants agreed that parents have the number one responsibility to help curb childhood obesity. Most of the participants did not identify their children as obese, but did comment that as an adult they did not make healthy choices regarding food and were not teaching their children proper

The CDC’s 2009 report, “Recommended Community Strategies and Measurements to Prevent Obesity in the United States,” provides 24 strategies in six categories for obesity prevention. This needs assessment makes recommendations and action steps for Muscogee County within that framework and based on research, literature review, data analysis and local input. Within each strategy, measurements are included to help the community achieve its goals. The efforts for this assessment focus on nine of these strategies. Table 2 lists each strategy with local data, quotes and literature references to support why each strategy was selected for focus and the action steps recommended for each. Table 3 is a companion document — a draft action plan for Live Healthy Columbus to serve as the convening and data collecting organization around childhood obesity issues and initiatives in the Columbus area. This action plan is the starting point for a community effort to move forward with a goal of significantly reducing childhood obesity in Muscogee County. The University of Georgia | Fanning Institute

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Obesity Prevention

review of literature Childhood obesity has been a growing epidemic in the United States for the past three decades. Nationwide, nearly one in three1 2- to 19-year-olds are considered obese or overweight2 [1]. Being overweight or obese puts children at greater risk for bone and joint problems, sleep apnea, pre-diabetes or type 2 diabetes, and social and psychological issues related to poor self-esteem [2]. Obesity in children and adolescents also increases the risk for heart disease (stroke, coronary heart disease, and hypertension), disability in later life [3], adulthood obesity [4], and even premature death [3]. Nearly 40% of obese children had at least two of the following risk factors: high serum triglycerides, LDL cholesterol, high blood pressure, or low HDL cholesterol [5]. Having three of those factors increases the risk of mortality and morbidity [6]. If this trend continues, the expectation is that the current generation will likely have a shorter lifespan than their parents [7]. Across the nation, communities are taking action to reduce the negative effect of childhood obesity on health and longevity as well as the long-term costs for the related chronic diseases. Live Healthy Columbus and Childrenâ&#x20AC;&#x2122;s Healthcare of Atlanta have formed a partnership to address childhood obesity in Columbus-Muscogee County, Georgia. As part of that effort, the partners asked the Fanning Institute at the University of Georgia to conduct a childhood obesity prevention needs assessment to find out what the scope and perception of the problem is, what factors contribute to childhood obesity in Columbus, and what resources are available or needed to address the issue.

The Fanning Institute previously completed an 18-month assessment of the eight-county region including Columbus in 2004-2005 (the Community Assets and Critical Issues Assessment). That community assessment, which was broad in scope, provided a foundation from which organizations, residents and donors could determine community strengths and weaknesses, review gaps in services, and focus limited resources. The assessment also provided demographic and economic information, as well as direct perceptions and feedback from more than 3,000 people in the region. This Childhood Obesity Needs Assessment will update key data sets from the 2004-2005 study using 2010 county-level census information and will gather data from the community on perceptions of childhood obesity and local factors that contribute to childhood obesity, including access to healthy, affordable food. This assessment was conducted between October and December 2011.

The Problem in Muscogee County Because childhood obesity increases the risk for several chronic diseases in adulthood that result in increased healthcare costs and potential loss of productivity, the U.S. Department of Health and Human Services (DHHS) has placed increasing emphasis on helping children maintain a healthy weight through the national Healthy People initiative. Healthy People sets goals with 10-year targets that aim to improve the health of all people in the United States. In 2000,

National Center for Health Statistics and Health Indicators Warehouse, Obesity in children and adolescents aged 2-19 years (percent). 2011.

According to the Centers for Disease Control, overweight for ages 2 to 19 is defined as a body mass index (BMI) at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex. Obesity for that age group is defined as a BMI at or above the 95th percentile for children of the same age and sex. The definition for children is based on height and weight and not actual body fat. The definitions for adults are based on actual body fat.

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Childhood Obesity Prevention Needs Assessment Report

Healthy People 2010 established a goal of reducing obesity in the 2-19 year age group to 5% by 2010 [8]. Unfortunately, that target was not reached in any state in the country and has since been revised to 14.6% in Healthy People 2020 [9]. Goals to reduce obesity in subsets of this age group have also been established and include the following targets: ages 2-5 (from 10.7% to 9.6%), ages 6-11 (from 17.4% to 15.7%), and ages 12-19 (from 17.9% to 16.1%) [9].

Communities, such as Columbus-Muscogee County, are working to understand the factors associated with obesity in their own area and determine which strategies and programs will best fit their needs to implement a childhood obesity prevention plan. Obesity, or excess body fat, results from an energy imbalance (intake exceeds output) [10] that is caused by a variety of individual, environmental, and policybased factors [11-15].

“Many factors contribute to childhood obesity, including the social and physical environment.”

nutritional status such as purchasing inexpensive, energy-dense but nutrient-poor foods. In addition, parents in food insecure households may not practice positive parenting skills that are associated with obesity prevention (for example, listening to infant’s hunger and satiety cues) [18] [17]. Media usage also plays a large part in the obesity trends in today’s environment. According to a 10year Kaiser Family Foundation study of children aged 8-18 years old, media usage has increased from a little over six hours a day to almost eight hours a day over the past decade [20]. Media usage, according to this study, includes TV, computers, iPods, print and movies. Gender, race and ethnicity have indirect correlations to the prevalence of obesity. Mexican-American adolescent boys had the highest prevalence of obesity (26.8%) compared to non-Hispanic black males (19.8%) and non-Hispanic white males (16.7%) (NHANES, 2007-2008) [1]. Non-Hispanic black females had the highest prevalence of obesity (29.2%) compared to their non-Hispanic white (14.5%) and Mexican-American (17.4%) counterparts [1]. For some ethnicities, cultural norms that accept a larger body size may also play a role [21].

Scope of the problem A child’s body weight is influenced by many factors, including genetics; individual, family and community characteristics; cultural norms; and national policies and funding [11]. Understanding the situational context of weight status will be critical before targeting which behaviors to change. Generally, families that do not have adequate access to healthy foods and lack opportunities for physical activity are at greater risk of having overweight or obese children. Prevention (CDC) reports that 1 of every 3 low-income children below the age of five is obese or overweight [16]. Lack of a large grocery store nearby and inadequate income reduce access to healthy foods. A lack of sidewalks and a perception that recreational areas are not safe reduce opportunities for physical activities. Additionally, parents’ definitions of “healthy eating” play a role in the childhood obesity epidemic [17]. Not having access to enough food to support an active and healthy life contributes to obesity [18]. In 2009, approximately 27.9% of Georgia children were food insecure, meaning that access to adequate food is limited by lack of money or other resources [19]. Food insecurity tends to impact populations at highest risk for obesity and may be associated with family coping strategies that promote poorer

The built environment may play a role in prevention or promotion of childhood obesity, although its effect on BMI is limited, and results related to the outcomes of physical activity and dietary behaviors are conflicting [13, 14, 22]. Young people are more physically active when school and neighborhood facilities are available [23]. However, no built environment factors were consistently associated with improved dietary behaviors [13]. On the other hand, increased access to supermarkets and limited access to fast-food restaurants near schools (> 0.10 mile) have been found to be associated with a decreased risk of obesity [15]. Urban sprawl is associated with decreased physical activity, as residents spend a longer period of time in automobiles rather than walking or biking. Mixeduse spaces, with sidewalks, safe intersections, and adequate public transportation may encourage increased physical activity [15]. In other words, built environments are positively correlated with increased activity, which in turn is positively correlated with reduced obesity, but there is no direct correlation. Many factors contribute to childhood obesity, including the social and physical environment, and those factors often influence each other and can change over time [11]. For example, a mother may choose not to breastfeed her child (a family factor) because The University of Georgia | Fanning Institute

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her workplace (a community factor) does not provide adequate support for pumping and storing milk, even though breastfeeding is associated with lower fat mass at age 4 compared to non-breastfeeding [11, 24]. As children develop, they are better able to control their own eating and physical activity contexts, demanding a sugar-sweetened cereal that was advertised on television, for example. Interventions to prevent childhood obesity must be multidimensional, seeking to change multiple spheres of influence and responding to the developmental context of the child. Many interventions are aimed at the familial and community spheres and may include some of the following targeted behaviors and opportunities and resources: parental encouragement of healthy eating and child activity, food traditions, family meal climate, family media use, accessibility and proximity of food outlets, local transportation, school activity requirements, and peer food choices [11].

Best Practices: School-Based Interventions A number of interventions have been implemented in schools with mixed results. Many programs aim to increase students’ nutrition knowledge and may change behaviors related to maintaining a healthy weight (i.e., increase consumption of fruits and vegetables, decrease intake of sugar-sweetened beverages). However, most interventions have not demonstrated a direct reduction in childhood obesity [25].

effect on reducing the body mass index (BMI), a measure of body fat [26]. In addition, incorporating the intervention into existing curricula was more effective than a stand-alone intervention [26]. One study recommends using school policy change to facilitate improved nutrition and physical activity behaviors, and assessing the total school environment using the School Health Index [27][28]. Finally, the CDC released a set of nine guidelines for promoting healthy eating and physical activity in schools in 2011, based on the results of these studies [29].

“Interventions to prevent childhood obesity must be multidimensional, seeking to change multiple spheres of influence and responding to the developmental context of the child.” Best Practices: Prevention Strategies Successful prevention strategies must target multiple factors to be effective since childhood obesity is related to a number of personal, family, community, environmental, and cultural factors [11]. Multidisciplinary treatment efforts should include:

• Nutrition education; • Increasing physical activity; and

School-based programs that have been associated with positive outcomes have included the following factors:

• Cognitive-behavior components to address the psychosocial barriers to adopting healthy behaviors [30].

• Universal implementation (all children vs. only overweight children);

• Longer duration (more than 12 weeks, optimally 28 weeks);

• Encouragement of nutrition change rather than mandated system-wide changes;

• Focus on reducing sedentary behaviors; • High level of parental involvement; • Collaboration with teachers (rather than training teachers as implementers); and

• Incorporating a mind-body approach [25]. Another study showed that nearly half of schoolbased interventions that incorporated both dietary change and physical activity showed significant

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Children may also benefit from individualized approaches, such as counseling [31]. Because school-based interventions have shown mixed results, interventions should also build a child’s healthy eating habits before enrolling in school by focusing on developing good parenting skills [32]. The American Dietetic Association (2006) recommends use of multi-component interventions focusing on parent training, nutrition education and counseling, increasing physical activity, reducing sedentary behaviors, and behavioral counseling to treat overweight children [33]. Communities have an important role in creating an environment that enables strategies to increase physical activity and healthy eating. The Healthy Kids, Healthy Communities initiative provides a number of resources for community leaders [34].

Childhood Obesity Prevention Needs Assessment Report

Best Practices: Policy Initiatives The CDC recommends that communities focus on the following priority areas to address childhood obesity:

• increase physical activity; • increase fruit and vegetable consumption; • reduce energy-dense food and sugar consumption;

• increase rates of breastfeeding initiation and duration; and

• decrease television viewing [16]. To effectively influence these behaviors, the CDC recommends using the media to promote healthy behaviors, ensuring access to healthy foods and physical activity opportunities, encouraging point of purchase promotion of healthy items, using price initiatives to increase the competitiveness of healthy items and make physical activity opportunities affordable, and increasing the support resources in a community [35].

Prevention of childhood obesity is a priority for communities across the United States. To combat this growing epidemic effectively, communities must use a multidisciplinary approach to target behaviors and environmental factors at the individual, familial, community, and policy levels. Communities should assess their available resources and strengths and look for opportunities to strengthen their weaknesses. Building consensus for priority areas is essential, as well, to facilitate cooperation among competing organizations and agencies. While evidence from research studies has provided inconsistent results related to potential factors associated with obesity, such as food insecurity and inhabiting a food desert, it is often flawed research design that makes the evidence difficult to analyze. Therefore, communities should also include strategies to address poverty, food insecurity, and food deserts in order to increase knowledge about the potential mediating role of these factors in the development of childhood obesity. By utilizing community resources and building consensus for childhood obesity prevention, communities may be able to develop effective programs and policies to help the country achieve the reduction in childhood obesity goals set forth in Healthy People 2020. The University of Georgia | Fanning Institute

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Obesity Prevention

OBJECTIVES AND RESEARCH METHODS “Our goal is to transform communities into places where healthy lifestyle choices are easily incorporated into everyday life.” Live Healthy Columbus and Children’s Healthcare of Atlanta requested that the following objectives be addressed in this childhood obesity prevention needs assessment:

The research methodology used in this assessment includes a review of key data from the U.S. Census Bureau, Annie E. Casey Foundation’s Kids Count, the CDC, USDA maps, and other relevant sources, as well as primary data collection in the community through interviews, focus groups, an online survey, and meetings with leaders of Live Healthy Columbus. Existing programs in Muscogee County that are already addressing issues related to childhood obesity were identified. Recommendations are pre-

1. Update key 2010 census data from the 2005 Community Assets and Critical Issues Assessment and include additional relevant data from Kids Count, the CDC and other sources. 2. Conduct a literature review and a review of best practices. 3. Identify food deserts in Muscogee County. 4. Obtain input from parents and other community members on their perceptions of childhood obesity, opportunities and barriers to physical activity and healthy food choices, and suggestions for addressing the factors that contribute to childhood obesity in Muscogee County. 5. Map the current food environment, physical access and recreational facilities in Muscogee County. 6. Identify gaps and provide recommendations on which to focus resources and funding. 7. Provide a draft vision, goals, strategies and outcome measures for community implementation.

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sented using the framework provided by the CDC’s 2009 guide “Recommended Community Strategies and Measurements to Prevent Obesity in the United States” [36]. The goal of the strategies guide is to “transform communities into places where healthy lifestyle choices are easily incorporated into everyday life.”

Childhood Obesity Prevention Needs Assessment Report

Obesity Prevention

FINDINGS

State Trends in Childhood Obesity

Similar to other parts of the country, Georgians have become more obese over the past decade, with the rate rising from between 20% and 24% of adults categorized as obese in 2001 to 29.6% in 2010, the latest year for which data is available. The figure on the right shows that at least 30% of residents in the southern part of the state, including Muscogee County, are categorized as obese, a rapid change in just nine years. Data figures for Muscogee County in 2007 show an adult obesity rate of 30.6%, already higher than the current state average.

“According to CDC, nearly half (43%) of all third graders qualify as either overweight or obese.” Children in Georgia have been similarly affected. The figure below illustrates the percentages of children and youth in Georgia that were overweight or obese in 2009, with nearly half of all third graders (43%) qualifying as either overweight or obese. In fact, the CDC’s original goal to reduce the percentage of overweight and obese children to 5% by 2010 has been revised sharply upward to 14.6% for 2020 in recognition of the severity and scope of the problem.

Georgia

2001-2003

Trends in Obesity %Percent of Obese Adults:

19-23 24-26 27-29 30+

2004-2006

2007-2009

Figure 1. Georgia Trends in Obesity, CDC Georgia 2010 Data Summary

Obese Overweight

50 40

Percent

“Georgians have become more obese over the past decade.”

30 20 10 0

WIC children

Third grade

Middle school

High school

Figure 2. Percent of Children and Youth that are Overweight or Obese in Georgia, CDC Georgia 2010 Data Summary

The University of Georgia | Fanning Institute

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Data from the Center for Disease Control and Prevention’s Behavior Risk Factor Surveillance System (BRFSS) shows that in 1991, four states had obesity prevalence rates of 15%-24%, and four states had rates of 25% or more. Georgia is one of the later. Clinically based reports and regional studies suggest that type 2 diabetes in children and adolescents is being diagnosed more frequently, particularly in African Americans, American Indians, and Hispanic/ Latino Americans. The following statistics are specific to Georgia and illustrate the scope of the issue:

• 59% of Georgia adults were overweight or obese in 2004. (CDC BRFSS, 2004)

• 23% of non-Hispanic white adults, 32% of non-Hispanic black adults, and 17% of Hispanic adults in Georgia were obese in 2004. (CDC BRFSS, 2004)

be obese. Living in a food desert is one of those indicators, although the research is not directly causal. The Healthy Food Financing Initiative working group3 defines a food desert as “a low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store”:

• To qualify as a ‘low-income community,’ a census tract must have either: 1) a poverty rate of 20 percent or higher, OR 2) a median family income at or below 80 percent of the area’s median family income;

• To qualify as a ‘low-access community,’ at least 500 people and/or at least 33 percent of the census tract’s population must reside more than one mile from a supermarket or large grocery store (for rural census tracts, the distance is more than 10 miles).”

• 26% of Georgia high-school students were overweight or at risk of becoming overweight in 2003. (CDC YRBSS 2003)

• 33% of Georgia middle-school students were overweight or at risk of becoming overweight in 2003. (GA YRBSS 2003)

• 27% of low-income children between 2 and 5 years of age in Georgia were overweight or at risk of becoming overweight in 2003. (CDC PedNSS, 2003)

The USDA requirements for a grocery store include the following three criteria:

• Accept SNAP • Generate at least 2 million in revenue • Contain all typical grocery store departments, including fresh produce, meat, dairy etc.

• About 30% of infants of obese mothers are in the 90th weight percentile for age. Overweight or obese mothers have children that are 3 times more likely to be overweight by 7 years of age (AAP).

WHAT ARE FOOD DESERTS? Food deserts are areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up the full range of a healthy diet4.

• According to 2007 obesity rate data (collected annually but the latest available) for WIC participants in Muscogee County, 9.12 % of the 3,976 children enrolled in 2007 were overweight, with 10.56% at risk of being overweight (WIC database).

Factors that Affect Childhood Obesity in Columbus-Muscogee County Results from recent national research on childhood obesity point to several indicators that have been demonstrated to affect the likelihood that a child will

According to the USDA’s Food Desert Locator4, Muscogee County has 10 census tracts that have been identified as food deserts. In four of these tracts, children under the age of 18 comprise at least 20% of the population, with one of those tracts comprised of nearly 40% children. The tracts and their respective under 18 populations are illustrated in Figure 3.

“Part of the First Lady’s Let’s Move! Initiative, the proposed Healthy Food Financing Initiative (HFFI) will expand the availability of nutritious food to food deserts — low-income communities without ready access to healthy and affordable food—by developing and equipping grocery stores, small retailers, corner stores, and farmers markets with fresh and healthy food. The HFFI is a partnership between the Treasury Department, Health and Human Services, and the Agriculture Department (USDA). An Interagency Working Group from the three departments, along with staff from the Economic Research Service (ERS/USDA), developed a definition of food deserts to be used with other data to determine eligibility for Federal funds.”

http://www.ers.usda.gov/data/fooddesert/fooddesert.html

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Childhood Obesity Prevention Needs Assessment Report

Figure 4 below illustrates the location of supermarkets and grocery stores as those are defined by the USDA. This does not include smaller grocery stores that may

offer fresh produce and healthier food options but donâ&#x20AC;&#x2122;t meet the USDAâ&#x20AC;&#x2122;s definition.

Percentage of children age 0-17 with low access to a supermarket or large grocery store 6.7 - 20.0 20.1 - 37.5

Fort Benning Water Muscogee County 0

2 Miles

Figure 3. Food Deserts in Muscogee County, 2000. This map shows where food deserts are located in Muscogee County and the percent of children living in those areas. U.S. Census Bureau, 2000. Data downloaded on 2 Dec 2011 from www.ers.usda.gov/data/fooddesert/downloadData.html

185

27 80

Percentage of children age 0-17 with low access to a supermarket or large grocery store 6.7 - 20.0 20.1 - 37.5

Grocery store Fort Benning Airport Water Muscogee County Limited access highway Highway Major road 0 1 Railroad

2 Miles

Figure 4. Grocery Stores in Muscogee County, 2011. These are businesses whose self-reported primary NAICS description is Supermarkets & Other Grocery Stores, not convenience stores. Source: ReferenceUSA U.S. Businesses database via Galileo@UGA, accessed Dec. 2011

The University of Georgia | Fanning Institute

PAGE 15

As highlighted in Figure 5 below, Census data shows that areas categorized as food deserts in Muscogee County have a slightly higher percentage of children overall than non-food desert tracts in Muscogee County and the population of Muscogee County as a whole. 100

Percent

While race and ethnicity alone have not been identified as contributing factors to childhood obesity, research has shown that both Latino males and AfricanAmerican females have higher rates of obesity than youth of different ethnic and racial backgrounds, prompting some researchers to argue that both cultural attitudes toward body size and behavioral traits in those groups directly affect a childâ&#x20AC;&#x2122;s chances of becoming obese. An analysis of food deserts by race reveals that, while the racial makeup of Muscogee County overall is approximately 42% white and 49% African-American, far more African-Americans live in food desert tracts in Muscogee County than whites. Food deserts in Muscogee County collectively are comprised of 61.1% African-Americans, 31.5% whites and 7.1% Latinos. African-Americans, and females in particular based on research highlighted in the literature review, are arguably at greater risk for obesity and poverty in a food desert than outside one [18].

100 All tracts Non-food desert tracts

All

Non-food desert

Food desert

Food desert tracts

Tracts

Children living in food deserts in Muscogee County also experience poverty at higher rates than their counterparts in other areas of the country. Figure 6 illustrates that 42.4% of children under 18 living in a food desert in Muscogee County live at or below the poverty rate, nearly double that of children living outside a food desert in Muscogee County. That percentage jumps to 59.2% of children living in poverty when we look at children in single parent households in food desert census tracts compared to those in non-food desert census tracts (approximately 36%).

Percent

Figure 5. Percent of Muscogee County Population 17 and Under, US Census Bureau 2010

White

Black

Latino

Other

Figure 7. Racial Makeup of Census Tracts, US Census Bureau 2010 (Note: The percentage total adds up to over 100% due to the fact that Latinos can self-identify as white, black or Latino).

100 All tracts 80

Non-food desert tracts Food desert tracts

Percent

Total

Two-parent

Single-parent

Households

Several housing indicators may be important when considering childhood obesity in Muscogee County. Overall in Muscogee County, more people rent their homes than own them - 55.1% of the population renting vs. approximately 45% of the population owning. That difference widens significantly in food deserts, with nearly 70% of residents in food deserts being renters. Home ownership is often indicative of overall income levels in an area, highlighting in another way the lower income levels in the food desert census tracts in Muscogee County.

Figure 6. Percent of Population under 18 Living Below Poverty Level, US Census Bureau 2010

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Childhood Obesity Prevention Needs Assessment Report

100 All tracts Non-food desert tracts

Food desert tracts

Percent

a lower educational attainment rate compared to those not living in food deserts, and to Muscogee County as a whole. Nearly 68% of residents in food deserts in Muscogee County have only a high school diploma or less, and over 1 in 3 residents have not graduated from high school. However, the situation is extremely complex and it is difficult to determine cause versus correlation in mapping and responding to food deserts. All tracts

Less than 9th Grade

Non-food desert tracts Food desert tracts

9-12 Grade, No Diploma

HS Degree (Including Equivalency) 0

Owner-Occupied

Renter-Occupied

Housing Figure 8. Home Ownership in Muscogee County, US Census Bureau 2010

Not only are more low-income residents in Muscogee County renters, they also spend a higher percentage of their income on housing costs. As the following figure demonstrates, residents in food desert census tracts in Muscogee County spend a higher percentage of their gross income on housing costs (renting) than the average renter in Muscogee County.

Bachelor's Degree Graduate or Professional Degree 0

Percent

Crime was not identified in the literature review as a factor affecting childhood obesity, but based on interviews, online survey results and focus groups in the community, it is clearly an issue affecting childhood obesity in Muscogee County. As discussion from the qualitative data suggests, many residents noted concerns about crime and safety as reasons that they do not use the communityâ&#x20AC;&#x2122;s trails, parks and green spaces as much as they would if safety was not an issue. Figure 11 below illustrates the numerous opportunities available within the existing built environment, along with areas that have been identified as high crime areas.

Percent

Associate Degree

Figure 10. Educational Attainment in Muscogee County, US Census Bureau 2010

100

Some College, No Degree

All

Non-food desert

Food desert

Tracts Figure 9. Percentage of Income Spent on Housing Costs, US Census Bureau 2010

Finally, educational attainment is related to income levels and may be an additional consideration in developing strategies to combat childhood obesity. Residents of food deserts in Muscogee County have

In Muscogee County, violent crimes peaked in 2007 and have been falling slightly ever since, while property crimes reported in 2010 dropped substantially from 2009 rates after climbing steadily since 2005. Although reported crimes in Muscogee County decreased overall and in both violent and property crime categories between 2009 and 2010, the crime rate â&#x20AC;&#x201D; overall crimes per 100,000 people - was still nearly double that of the state of Georgia (Federal Bureau of Investigation, Crime in the United States, 2010) and may help explain why the perception of crime is so high. The University of Georgia | Fanning Institute

PAGE 17

In 2010, the Muscogee County crime rate was 7,827 crimes per 100,000 people, while the rate in the state of Georgia was 4,043 per 100,000 people. The overall crime rate represents a drop to levels not seen since

before 2006, following a steep climb in rates between 2006 and 2009, but it is still significantly higher than rates experienced in other areas of the state.

185

Map Extent

Parks and recreation Columbus Housing Authority apartment complex Girls Inc. Goodwill Industries The Salvation Army YMCA Boys & Girls Club Pre-school Primary school Middle school High school Consolidated school Post-secondary institution Fall Line Trail Riverwalk High crime area Fort Benning Airport Water Muscogee County Limited access highway Highway 0 1 2 Miles Major road Railroad

Figure 11. Parks, Recreation, Schools and Crime Sources of data for Figure 11: Parks and trails: Georgia Statewide Comprehensive Outdoor Recreation Plan parks database, 2008; Columbus Parks and Recreation Department, 2011; Columbus Consolidated Government Engineering Department, GIS Division, 2011 Schools: Georgia Department of Community Affairs facilities inventory, 2008; Muscogee County School District, 2008 United Way agencies (Boys & Girls Clubs, Girls, Inc, Goodwill Industries, The Salvation Army, YMCA): Boys & Girls Club of the Chattahoochee Valley, 2008 Columbus Housing Authority apartment complex: The Housing Authority of Columbus, GA, 2008 High crime area: Crime Analysis Unit,â&#x20AC;¨Columbus Police Department, 2011. Definition: the two police beats with the highest number of total Part-One crimes 1 Nov. 2010 â&#x20AC;&#x201C; 31 Oct. 2011. Part-One crimes are: homicides, rape, robbery, aggravated assault, burglary, larceny, and motor vehicle theft. Larceny is the most common crime with numbers well above any other type. Police beats do not correspond with census population units; therefore, it is difficult to compute a small area crime rate for the county.

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Childhood Obesity Prevention Needs Assessment Report

Perceptions and Ideas of Local Residents on Childhood Obesity Because secondary data from the Census, Kids Count, the CDC and other sources only tells part of the story, perceptions, ideas and beliefs of local residents are essential to compare and contrast with that data, determining where they match, where they do not, and why they do not. The information reported below represents results from four focus groups, 22

individual interviews and over 120 responses to an online survey (Appendix A). The primary purpose of the qualitative data collection was to understand community perceptions and to enhance understanding of the community’s need for current and future childhood obesity programs and activities in Muscogee County.

Individual Interviews Twenty-two interviews of key community leaders were conducted (Appendix B, Appendix C) during October and November of 2011. Participants included 13 members of the Live Healthy Columbus Coalition and nine participants identified by Live Healthy Columbus members and/or highlighted by other community members specifically for their knowledge of and involvement with childhood obesity. Participants work in areas related to children’s health including exercise, education, childhood obesity and overall well-being. Interviews were semi-structured and allowed for probing and were conducted by telephone. Each interview lasted approximately 30 minutes. The most common perception among those interviewed is that childhood obesity is a significant problem in Muscogee County. While a number of those interviewed believe that it is a severe problem, most feel that Columbus is similar to many other areas of the country in terms of how severe and widespread it is. Almost all agreed that this problem has worsened over the past decade. Many of the individuals interviewed highlighted lowincome residents as a segment of the population particularly affected by childhood obesity. Several others referred to childhood obesity as an “epidemic”

that touched all socioeconomic levels, including affluent whites. Two (2) of those interviewed noted that this does not appear to be a problem within the Latino community, where cultural practices tend to protect children. Finally, several focused on those living in rural areas, where a lack of transportation choices often prohibits access to fresh fruits and vegetables. Interview data shows that there are many programs available in Columbus that help target childhood obesity, particularly those related to fitness and activity which may not be directly focused on childhood obesity but which have the direct result of encouraging children to move and engage in a healthy, active lifestyle. Many of the existing programs documented and a number of factors leading to the recommendations (both discussed below) arose during these one on one interviews. However, several respondents were concerned that efforts locally have been disjointed and therefore not nearly as successful as they might be if they were better coordinated. They also noted that education on healthy eating habits alone will not help reduce childhood obesity, even if the parents are also targeted for education with their children. Several participants emphasized that intervention must show people how (and where) to select and prepare healthy food on a budget.

The University of Georgia | Fanning Institute PAGE 19

Focus Groups Four focus groups were conducted in November 2011. Each focus group lasted one hour and was facilitated by a member of the project team who had no contact with participants prior to the assessment. In addition to the facilitator, one observer recorded direct transcriptions of the discussion, while another team member wrote concept ideas on poster paper to discuss key points raised during the course of the meeting. Focus group participants were self-selected based on their affiliation with the organization hosting the meeting. Focus groups were convened at neutral locations throughout the Columbus/ Muscogee County area to encourage openness during discussion. Focus groups had 5-15 participants each; a total of 34 people participated, and 28 of them were female. Of the 34 participants, 15 were Caucasian, 13 were African American and 6 were Latino. Of the 34 participants 32 identified themselves as parents of school aged children. Most of the participants did not identify their children as obese, but did comment that as an adult they did not make healthy choices regarding food and were not teaching their children proper habits. Different community agencies and organizations were represented, in addition

to unemployed participants. Reasons for non-attendance included work commitments, scheduling conflicts within the short timeframe and difficulty in arranging transportation. Participants valued the opportunity to engage with one another as they shared their experiences with and observations of childhood obesity, and facilitators ensured that they discussed how the issue is perceived in Muscogee County. Participants also suggested a wide range of suggestions and methods that parents, school, churches and the community at large could use to help curb the childhood obesity issue in Muscogee County (discussed later in the recommendations section). Participants were consistent in their views that parents hold the most responsibility for keeping their children healthy and at an appropriate weight, and that education is the key to eating healthier. Grocery stores are not accessible by foot for most areas of the community, and participants felt that the stores need to showcase healthier options instead of always having junk food on sale. If given a magic wand, most participants agreed they would eliminate television and fast food access.

Online Survey A community survey (Appendix A) was available in the Columbus-Muscogee County area from November 4 through November 21, 2011 via the internet, and paper copies were made available at libraries and through Live Healthy Columbus. The survey was circulated throughout the community

PAGE 20

in a variety of avenues, including the Live Healthy Columbus website and Facebook pages, the email listserv developed by Live Healthy Columbus, and numerous community distribution lists. The email that accompanied the survey requested that recipients forward the message to others, so it is not

Childhood Obesity Prevention Needs Assessment Report

Online Survey contâ&#x20AC;&#x2122;d possible to know how many recipients received the email. The survey gathered 121 responses, all of which were received through the Internet link. Participation in the survey was voluntary, given that a respondent would have to choose to go to the link to complete the survey. The respondents were 66% White, 25% Black/African American, and 2.5% Hispanic/Latino. Seventy percent of the respondents were married, and 69% had children under the age of 18 at home. Ninety-two percent of participants said childhood obesity is a growing problem in Columbus, and 96% of respondents were worried about the future health of children in the Columbus community. These responses demonstrate a consensus among respondents that this issue represents a significant risk to the children in the community. Although there is a strong consensus that the issue of childhood obesity is growing and represents a significant risk to the community, only 29% of respondents were aware of programs that address childhood obesity. Thirty-six percent were unaware of programs, and 35% responded that they did not know. When asked about participation in programs, 18% had attended programs to address childhood obesity, 73% had not attended, and 9% responded that they did not know. Similarly, when asked about participation in events

How far from where you live is the nearest full service grocery store? Less than 1 mile

that address childhood obesity, 20% had attended events, 69% had not attended, and 11% responded that they did not know. Seventy-four percent of all respondents reported that they eat family dinners together at least three times per week. Many of the â&#x20AC;&#x2DC;empty nestersâ&#x20AC;&#x2122; who responded indicated that they ate dinner together as a family when their children were at home. With respect to the distance to the nearest grocery store, fast food restaurant or park, one quarter of participants reported that they live a walkable distance to the nearest grocery store (less than one mile), although it is not known how many of those who live within one mile of a grocery store do walk to buy groceries. More participants live closer to fast food than a full service grocery store, highlighting the ubiquity of fast food in the community (as in many communities). According to the survey results, there are numerous parks and recreation opportunities, including organized sports, greenspace, trails and 5Ks throughout the community; any lack of use of parks and recreation appears to be a usage issue, not an availability or awareness issue. No respondents reported that Columbus has a significant lack of parks and recreation opportunities. Figures 12, 13, and 14 below illustrate some of these local findings.

How far from where you live is the nearest fast food? Less than 1 mile 1-2 miles

1-2 miles

More than 2 miles

Figure 12. Distance to Full Service Grocery Store, Online Survey, Appendix A, November 2011

Figure 13. Distance to Nearest Fast Food, Online Survey, Appendix A, November 2011

Fifty-seven percent of the respondents agreed that diabetes is the main risk of childhood obesity for children in Columbus, while 16% selected high blood pressure and health overall. Eleven percent of the respondents were concerned that bullying was the main risk. As illustrated in Figure 15, when asked about the leading cause of childhood obesity in Muscogee

County, 36 of the respondents agreed that families do not have time to cook and eat together. Fifteen and fourteen respondents, respectively, noted that a lack of safe places to play and exercise, and a lack of information on how to stay healthy were the second and third causes in Muscogee County. The University of Georgia | Fanning Institute

PAGE 21

the community needs to understand that changing this mindset will be a long-term process. Fast food is cheaper Parents are at fault Lack of information to stay healthy Lack of safe places to play and exercise Families have no time to cook/eat together 0

10 15 20 25 30 35 40

Number Figure 15. Leading Cause of Childhood Obesity in Columbus, Online Survey, Appendix A, November 2011

Respondents had a number of ideas on how childhood obesity can be prevented, as illustrated in Figure 16.

How can childhood obesity be prevented in your community?

Access was another issue mentioned by most participants. Two components of access received particular focus during discussions with community members: access to healthy, affordable food, and transportation. First, people emphasized the difference between access to food and access to affordable, healthy food that is nutritious and not just energy dense. The latter is critical in how the community thinks about food deserts, for example. Where Columbus has a food desert, how should the community address that? A major grocery store is not going to locate just because the community needs it in a particular place unless the market drives it there, so traditional incentives may not always work. The third top priority to preventing childhood obesity according to the participants is physical activity. The community wants to see physical education required in all schools and in all grades, each day. They want the ability to bike and walk to school. Recess needs to be active and not just students sitting on picnic tables chatting with each other. Physical activity needs to be a focus within the curriculum and supported by parents at home.

Other Access to healthy food Physical activity

Education of parents and students

Figure 16. How to Prevent Childhood Obesity in Your Community, Online Survey, Appendix A, November 2011

Collectively, all of the interview, focus group and survey data shows that education must be in the top three priorities for addressing childhood obesity in Muscogee County. However, most participants cautioned that education, particularly education that only focuses on children, is doomed to fail without (1) educating parents about how to eat healthfully, AND (2) showing them how to eat healthfully on a budget: “You can’t just lecture on the virtues of healthy food. You have to talk about how to shop inexpensively.” In all of the options and ideas offered with respect to education, parents were the constant variable. Parents and children need to think about food differently, and PAGE 22

Transportation was listed as a barrier to obtaining healthy food and to getting to programs to learn about healthy food choices and participate in many physical activity programs. Participants noted, “Columbus has a good mass transit system, but it does not extend to the rural areas.” This will need to be a consideration in any strategy development. Finally, most participants mentioned crime and the perception of high crime in the Columbus area at some point during the interview or focus group. In the eight county needs assessment conducted in the Columbus area in 2004-2005, residents in the region offered repeated anecdotal stories of crime and friends affected by crime. The statistics at the time showed a high non-violent crime rate for Muscogee County, where one in every 14 people was affected by a non-violent crime in the mid-2000s. As highlighted above, this statistic persists, where in 2010, the most recent year for which data are available, the non-violent crime rate was nearly double that of the state’s. Despite the hiring of 100 new police officers in Columbus recently, nearly every person who discussed the widespread availability of parks and walking trails also expressed substantial concerns about the safety of those areas, particularly at night alone and for children any time.

Childhood Obesity Prevention Needs Assessment Report

Existing Food and Nutrition-Related Programs in Muscogee County The following list of organizations and programs were identified through interviews, focus groups, the online survey, Live Healthy Columbus members and independent research as either directly or indirectly related to addressing childhood obesity in Muscogee County.

Many residents also acknowledged Live Healthy Columbus’ initiative in trying to bring all of these organizations and resources together around the issue of childhood obesity. All said it was critical that Live Healthy Columbus have a good understanding of existing initiatives so efforts are not duplicated and limited resources can be targeted and focused.

Participants noted that there are many programs available in Columbus that help target childhood obesity, particularly those related to fitness and activity. The programs may not be directly focused on childhood obesity but encourage children to move and engage in a healthy, active lifestyle. However, several respondents were concerned that the efforts have been disjointed and therefore not nearly as successful as they might have been if they were better coordinated. With respect to Strong 4 Life, one interviewee knew about it but said that it “felt like it was a one-off, like it was yet another thing they’re trying, not permanent…Safe routes to school is another program that is trying to encourage walking, but it doesn’t seem connected to the Strong 4 Life program or anything else.”

Organization/ Resource

Strategy

Existing Food and NutritionRelated Program in Muscogee Co.

Boys and Girls Club

Education

Cooking classes for kids in partnership with Cooperative Extension

Chattahoochee Cub Scouts Camp

Access

• • • •

Children’s Healthcare of Atlanta (CHOA)

Education

Scouting for Food (2/05/2011 – 2/12/2011): Annual event that addresses food insecurity in the area by collecting food for the food bank Cub Family Camp (10/1 – 10/2, 10/8 – 10/9, 10/22 – 10/23): Many activities available – may also incorporate food opportunities Cub Scout Summer Camps: Many activities available – may also incorporate food opportunities Annual Yellow Jacket Freeze-O-Ree (end of January): Many activities available – may also incorporate food opportunities

Strong 4 Life web site (www.strong4life.org) • • •

Raises awareness about obesity Provides quick tips to increase healthy behaviors Billboards raise awareness about obesity

CHOA activities • Sponsor many activities/health fairs throughout the year, some may be in the Columbus area, since they are a pilot city for this initiative

City of Columbus “Blue Zone Project”

Activity

Seeks to connect biking, walking trails in the city

Columbus Cottonmouths

Access

•

Education

• •

Columbus Department of Public Health

Access Education

Lunch Buddies Program at Matthews Elementary School: 1 lunch per month; opportunity to encourage healthy eating Fit In the Pit/Trim Down Columbus: 1/17/2011 (may become an annual event); Cost of ticket is $0.01/lb. (encourages losing weight before the event) Food drive in November: Addresses food insecurity

Cooperative Extension/WIC demo kitchen • Cooking classes teach WIC and other participants how to eat well on a budget • Offered 2X per month

The University of Georgia | Fanning Institute PAGE 23

Organization/ Resource

Strategy

Existing Food and NutritionRelated Program in Muscogee Co.

Columbus Forward

Activity

Crime prevention program, but offers young men basketball and tournaments

Columbus Parks and Recreation

Access

•

Activity

•

• •

Before and After School Program: 25 sites, Pre-K through Grade 5; Healthy snacks are offered Senior Centers: 4 sites available; Gardening at Fox Senior Center (10/28/2011); Prime site to reach grandparents who raise grandchildren; Galops Center has an annual picnic in October – can target healthy eating here New bike and walking paths; extensive parks Soccer, baseball, football leagues

Columbus Regional Medical Center

Education

• • • • •

Breastfeeding “Back to Normal” Program New Moms Nursing Support Group Cooking school for kids Partners with Housing Authority to do healthy cooking classes La Leche League: Encouraging breastfeeding is one of the ways to fight obesity according to the CDC model.

Columbus Research Foundation

Education

•

Be Well Columbus: program for 4th and 5th graders in Muscogee County Schools Educational programs, glucose testing and blood pressure screening, all in Spanish, including translating bus schedules

Cooperative Extension

Education

•

Activity

• •

•

Extended Food and Nutrition Education Program – classes on food selection Healthy Kids Georgia 4-H Nutrition Program – includes childhood obesity prevention program, with grants available for healthy eating programs, cooking classes and kitchen techniques classes Walk Georgia

Early Head Start and Head Start

Education

Offer nutrition programs at a variety of sites

Farmers Market Nutrition Program

Access

WIC vouchers are available to encourage buying more fresh produce

Food Bank

Access

Kids’ Café (hot evening meal)

Girl Scouts

Access

Ideas from other troops around the state: • CANstruction (Athens, GA) - Addresses food insecurity by collecting canned food to donate; • Pumpkin Patch (Lizella, GA) - Make pumpkin treats; • Amazing Journey Race (Cumming, Cuthbert, Martinez, GA) – • Campfire cooking – good site to target healthy cooking behaviors; • Swim, bike, run (Savannah, GA) - Includes making healthier food choices

Activity Education

PAGE 24

Childhood Obesity Prevention Needs Assessment Report

Organization/ Resource

Strategy

Existing Food and NutritionRelated Program in Muscogee Co.

Girls, Inc.

Education

• •

Economic literacy education programs offered Junior chef classes with Strong 4 Life budgeting for healthy snacks

Growing Room Child Development Center

Access

• •

After-school program with breakfast Cooking projects

Junior League of Columbus

Access

•

Several things as part of their ‘healthy child’ platform, including Run for the Kitchen 5K Kids In the Kitchen (online resource): http:// kidsinthekitchen.ajli.org

Education

Activity

Midtown, Inc.

Activity

•

• • •

Muscogee County School District

Access

•

Activity

Walk and bike to school days in Midtown area Midtown Bikearound – annually promotes fitness and focus on historic preservation Infrastructure project to connect schools with Midtown neighborhoods

6 schools have received the Fresh Fruit and Vegetable Grant - Fruit and vegetable consumption have increased at these schools, and parents are asking about the produce served P.E. has been reinstituted “Fitness Gram” where food is discussed in all areas of classrooms

Education

• •

Muscogee County Health Department

Education

Health fairs and programs

River Valley Regional Commission

Education

• •

Safe Kids Coalition

Data

Already measuring height and weight of young kids to find right car seat – data collection source

Trees Columbus

Access

Community gardens

YMCA

Access

•

Education

•

Activity

• •

http://www.kidsfit4real.com/Welcome Offers the WeCAN! program (Ways to Enhance Children’s Activity and Nutrition) http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/

•

The Center Helping Obesity In Children End Successful (www.choicesforkids.com) Sisters in the LITE (Lifestyle Intervention Teaching Exercise) Uses Bodyworks – A Toolkit for Healthy Girls and Strong Women

Kids Fit 4 Real

Education

Programs Available

Education

• •

Area Agency on Aging Kinship Care Program – Grandparents Raising Grandchildren: 2nd Tuesday of every month, 10:30 a.m., North Columbus library

Eat Healthy section of web site (http://www.ymca.net/healthy-family-home/eat-healthy.html) Before and After-School Program: Includes meals and snacks

The University of Georgia | Fanning Institute PAGE 25

casestudy

Shape-Up Somerville: Eat Smart, Play Hard. Somerville, Mass. [42, 43, 44, 45, 46]

In 2003, the city of Somerville, Mass., partnered with Tufts University to see if childhood obesity could be address by making systemic changes that encourage healthy eating and physical activity. More than 45% of 1st to 3rd graders were at risk for being overweight or obese in 2003. The city has a 13% poverty rate and about half of public school students belong to racial or ethnic minority groups and more than 60% are eligible for free or reduced lunch.

“Today, fresh produce replaces canned fruits and vegetables in the schools...” This intervention has involved every aspect of community life: schools, workplaces, city planning, the recreation department, restaurants, and more. Today, fresh produce replaces canned fruits and vegetables in the schools, the high school retired its fryolator, local restaurants serve healthy options, the streets are friendlier to pedestrians and bicyclists, and 1st to 3rd graders have slimmed down.

“Redesigning school meals — breakfast, lunch, and afterschool snacks — was the first step...” Redesigning school meals — breakfast, lunch, and afterschool snacks — was the first step, took one year of planning and two years of implementation. Tufts researchers conducted focus groups and interviews with school employees, students, parents and guardians as well as key informant interviews with school representatives and community members. Information was collected about dietary behaviors, feelings about school food and feedback on potential initiatives. The new food service plan has three components: school PAGE 26

meal changes, professional development and capacity building, and communication strategies. Students and food service employees generated ideas, developed recipes, sample items and provided feedback. Food service cooks adapted recipes for large scale. All children were exposed to the new meal plan but only those in grades 1 to 3 whose parents gave permission were evaluated for the study. After eight months, third graders in the Shape Up Somerville reduced about one pound of weight gain compared to similar groups in two other cities. While that may seem like a small decrease for an individual, this result moved a large number of children out of the overweight category and is a significant public health gain.

“The city also has addressed walkable, safe routes to school...” The success of the school meal program led to other interventions. A “Parks Designed by Youth for Youth” program engages youth in planning and design processes for new parks and renovations to existing parks. The city’s restaurants offer enhanced food options through the “Shape Up Approved” restaurant program. The city also has addressed walkable, safe routes to school; extension of the community bike path; policies that support pedestrians and bicycles; school nurses trained to collect height and weight on elementary students and to counsel families of children at-risk of or overweight; and more. The federal “Let’s Move” program was modeled after Shape Up Somerville. In 2011, the U.S. Department of Health and Human Services selected the city as winner of a National Healthy Living Innovation Award, beating out Denver, Color., and Brownsville, Tex.

Childhood Obesity Prevention Needs Assessment Report

casestudy

The Food Trust, Philadelphia, Pa

[47, 48, 49, 50]

“The Food Trust offers a number of school-based programs including school nutrition education, school food and beverage reform, and farm-to-school programs.” The Food Trust began in 1992 by teaching inner-city children about nutrition. After the nonprofit opened a farmer’s market in a public housing development, its focus shifted to working with communities to help ensure that healthy and affordable foods are available. The Food Trust offers a number of schoolbased programs including school nutrition education, school food and beverage reform, and farm-to-school programs. In addition, community-based programs

increase access to fresh foods in underserved neighborhoods and include healthy food financing, a supermarket campaign, farmers markets, and more. The Food Trust has also conducted research on environmental factors of obesity and overweight issues and environmental interventions. Their data led the city to ban soda from all public K-12 schools in the Philadelphia and documented the connection between poor neighborhoods, poor access to healthy foods and poor health outcomes. The Food Trust partnered with other groups and the state to support the Pennsylvania Fresh Food Financing Initiative to increase number of supermarkets in underserved communities. The website provides many resources related to increasing access to healthy foods and evaluations of their programs (www.thefoodtrust.org).

The University of Georgia | Fanning Institute PAGE 27

Obesity Prevention

GAPS and RECOMMENDATIONS In July 2009, the Centers for Disease Control issued a report called “Recommended Community Strategies and Measurements to Prevent Obesity in the United States.” The goal of the strategies guide is to “transform communities into places where healthy lifestyle choices are easily incorporated into everyday life.” Ultimately, by adopting the strategies included in the document, communities will begin to reverse the obesity trend that is consuming the United States. The CDC recommends 24 strategies in six categories for obesity prevention. Each strategy includes measurements that can be used by communities to determine their progress. While all of the strategies are worth pursuing and might add significant value to a community, the recommendations made in this assessment for the Columbus-Muscogee County community are organized around nine of these

strategies and are based on the themes and information identified through data that was collected locally during the needs assessment process. Not only are these strategies identified as priorities, the strategies prioritized as recommendations herein are thought to be the most attainable based on infrastructure already in place in the community. As indicated earlier, the three primary themes that emerged from analysis and consideration of the literature review, the Census Bureau, Kids Count and CDC data and public input from the Columbus community were (1) Increased Physical Activity; (2) Education of Parents and Youth; and (3) Access and Knowledge of Healthy Foods. Based on these themes, the following strategies (table 2) are recommended for immediate action by the coalition represented by Live Healthy Columbus and its partners. Each strategy is supported by data collected locally, and each activity is supported through the research related to best practices.

PAGE 28

Childhood Obesity Prevention Needs Assessment Report

Table 2. Recommended Approaches for Achieving CDC Strategies Related to Childhood Obesity.

CDC Strategy

Strategy 4: Promote

incentives to food retailers to locate and/ or offer healthier food and beverage choices in underserved areas

Local Data and Input

Potential/ Recommended Activity 1. Offer tax incentives and zoning waivers to full service grocery stores to locate in food desert census tracts

• 10 census tracts located in a food desert • 42% of residents in the 10 census tracts live below the poverty level

2. Incentivize retailers to offer discounts on healthy foods for SNAP participants

• Community input from food desert areas indicates less healthy options available

3. Explore partnerships with businesses and local organizations where grocery stores locating in food deserts can rely on a base of support 4. Provide lower cost financing by using a coalition of local banks to engage in a loan participation for developers and stores willing to invest in a food desert.

Strategy 7: Restrict

availability of less healthy foods and beverages in public service venues

• Define standards for food options available in public service venues such as lunchrooms, vending machines, etc.

1. Define standards for food options available in public service venues such as lunchrooms, vending machines, etc.

• Remove vending machines from public service venues or require healthier food options in machines

2. Remove vending machines from public service venues or require healthier food options in machines

Strategy 10:

• Community input suggests children are offered sugar sweetened drinks too freely at day care centers and schools

Remove soft drink vending machines from public service venues or require healthier food options in machines.

Strategy 12:

• is required to curb obesity (citation)

All schools in Muscogee County should achieve Standards 3 & 4 of the Georgia Performance Standards for Physical Education: a. Standard 3 – Participates regularly in physical activity b. Standard 4 – Achieves and maintains a health enhancing level of physical fitness

Discourage consumption of sugarsweetened beverages

Require physical education in schools

• 37% of respondents to community survey believe that school children lack enough physical activity • Public input said that P.E. was removed from public schools for 12 years • According to survey, focus groups and interview data, P.E. was reinstated but is not currently required every day in all grades, K-12 in Muscogee County

Focus Group Comments

“Grocery stores target the people on food stamps by placing the unhealthy foods at the front of the store the day the EBT cards are loaded.”

“Need to offer healthier options, offer a salad bar.”

“Fast food is easy for both wealthy and poor.”

“Take vending machines out of schools…I don’t care how much the soft drink companies pay the schools to have their drinks in there; we will all pay later with bad health. Water and milk is all they should have.”

“Children need to learn portion control and drink less sugary drinks.”

“Return physical education in elementary and middle schools as a mandatory course requirement.”

“Establish phys ed in every grade, even if it means keeping children an extra period.” “We have to encourage ways for youth to reduce screen time and increase opportunities for youth to be active.”

The University of Georgia | Fanning Institute PAGE 29

CDC Strategy

Local Data and Input

Strategy 15: Reduce screen time in public service venues

Potential/ Recommended Activity

• On average, 8-18 year olds nationally have 7 hours, 38 minutes of screen time per day

1. Eliminate unnecessary screen time in schools and after school programs

• Due to usage of multiple media, total media exposure is 10 hours, 45 minutes

2. Schools eliminate personal media devices during the school day 3. Educate parents on the rewards of reducing screen time (higher grades & greater personal contentment)

• Consensus among public input is that Columbus youth get too much screen time

4. Offer options through after school programs that reduce screen time and involve non-screen related activities

Strategy 16: Improve

access to outdoor recreational activities

• 44% of survey respondents live within 1 mile of a park or playground; 32% of survey respondents live more than 2 miles from a park or playground • Focus group data suggests that ample opportunities exist but that residents do not take advantage of those options • Research has not demonstrated a direct correlation between an improved built environment and adolescent physical activity; but research does suggest that low income youth face more barriers to utilizing outdoor recreation areas than their wealthier peers

Strategy 18:

Enhance infrastructure supporting walking

PAGE 30

• Sidewalk statistics have been requested. • Research shows improving access to the built environment (i.e. sidewalks) can be a long term solution to prevent childhood obesity (15)

Focus Group Comments

“Getting kids off the sofa and involved in outside activities who hopefully would help influence their parents to live a healthier lifestyle.” “I think if we had safe programs where children could go outside and do fun things for free with plenty of adult supervision, then more children would enjoy being outside and choose that instead of video games and other media.”

“Build in the day to day infrastructure that supports walking, biking to school, play areas, shopping and work. It’s not just childhood obesity, this is an all ages issue.”

Create partnerships to develop ways to make playgrounds, trails and parks safer, utilizing police, retired volunteers, youth and businesses. This may look different in each neighborhood.

Aggressively market the existing recreation network that is well developed, including ways to make children safe when using it.

“The lack of sidewalks makes it impossible to walk to school or other destinations.”

Identify and secure funding for promotion of a wide range of recreational activities such as yoga, community and/or school gardening, and other non-traditional activities to attract a broader range of participants.

“There is no silver bullet, but revitalizing the interior of the city would be a good start. Higher density, mixed use areas when properly designed, make walking and biking possible and bring healthier services within reach.”

Spotlight walking trails (marketing and education)

Increase total miles of paved sidewalks:

Childhood Obesity Prevention Needs Assessment Report

“Public parks are great, but after working 8 hours, getting homework done, eating dinner, getting ready for the next day at work and school, parks are not the safest place to be at 8:30 at night.”

CDC Strategy

Strategy 18: cont’d

Strategy 22:

Enhance personal safety in areas where people are or could be physically active

Local Data and Input

• Several programs already exist to support walking to school – some funding is available for this.

Potential/ Recommended Activity 3.

Examine and revise zoning and development requirements for new and existing development

Adopt a community plan that includes ‘universal access’ for walkers and bikers

Explore SPLOST expenditures on sidewalks.

• Focus group data indicates the perception that parks, trails and playgrounds are not safe

1. Engage law enforcement to step up police presence in recreational areas

• Crime rate has been steady in Muscogee County since 2005, only falling last year

2. In partnership with law enforcement, identify local crime trends, develop partnerships to address crime and safety perceptions in the area, and market the results.

• Interview data suggests that new bike trails are not well lit and are perceived to be unsafe; crime has been an issue in Columbus and some parents are afraid to send children outside

Strategy 24

Local governments participate in community coalitions or partnerships to address obesity

• State and local governments committing to use public health policy initiatives to decrease the overall obesity rate (cite)

3. Increase lighting and police presence in recreational areas to improve safety

2. • Survey results suggest increased education and taxation on foods that promote obesity

LHC should engage the mayor’s office to become a strong presence in LHC Educate elected officials on the topic of childhood obesity so that their decisions can be informed, including School Board members

Focus Group Comments

“(We need) stats about the safety of the community to combat a sensationalist news focus on crime.” “There is a lovely library within a half-mile of my house and I would love to walk there, but there is no crosswalk across Macon Road to facilitate that.” “I live directly across the street from Lakebottom Park which has great facilities for physical activity – but I do not let my children go by themselves to the park due to the busy traffic they would have to cross on 13th Street and the concern about their safety and protection from stranger danger.”

“Make residents aware of the issues; instead of posting billboards, educate the community on how to reverse the issue of childhood obesity.”

“It has to be a culture change where the family and the community are all involved.” “Provide after school programs that incorporate play time and group activities that do not involve TV or video.”

The University of Georgia | Fanning Institute

PAGE 31

Obesity Prevention

SUMMARY AND NEXT STEPS Education was by far the strongest theme

expressed throughout all means of public input, with increased physical activity and healthy food access highlighted within that theme. Live Healthy Columbus should undertake a comprehensive education initiative focused on the following: •

The benefits of eating healthy foods (in appropriate portions) combined with regular exercise;

•

Strategies for finding and preparing healthy foods on a budget;

•

Nutritional information and the health effects of eating a low nutrient, high calorie diet.

Coordination of all existing and new efforts is critical for Live Healthy Columbus to significantly impact the prevalence of childhood obesity in Muscogee County. Live Healthy Columbus should serve as the convener for this topic and figurative umbrella organization for all related programs, initiatives, data collection and activities relating to childhood obesity prevention in Muscogee County.

According to current research, education has the greatest likelihood of being effective in a schoolbased environment when the following factors are part of the implementation: 1. Universal implementation (all children vs. only overweight children); 2. Longer duration (more than 12 weeks, optimally 28 weeks); 3. Encouragement of nutrition change rather than mandated system-wide changes; 4. Focus on reducing sedentary behaviors; 5. Encouraging a high level of parental involvement; 6. Collaboration with teachers (rather than training teachers as implementers); and 7. Incorporating a mind-body approach.

Utilizing the CDC’s framework for obesity prevention and the strategies identified in Table 2, the following is a proposed draft plan of action for Live Healthy Columbus. This proposed plan focuses on the three most common themes from the public input and research — education, increased physical activity and healthy food access — combined with a fourth theme, data collection. It offers a draft vision, topical vision statements, goals, key strategies, outcome measures and potential partners and resources. It is a starting point for a conversation among Live Healthy Columbus members and the community for how to best focus limited resources to truly impact childhood obesity in Muscogee County.

The University of Georgia | Fanning Institute PAGE 33

Table 3. Live Healthy Columbus (LHC) Draft Framework 2012

Education

Physical Activity

Statement of Vision

LHC will educate parents, students and the public on how they can: 1. Gain access to healthy food and 2. Become more physically active

LHC will advocate for all youth to be physically active and for safe places to be active

Goals

1. Require physical education in schools 2. Improve access to outdoor recreational activities 3. Enhance personal safety in areas where people are or could be physically active

Identify and clarify the LHC message Develop educational outreach plan with a focus on how to be physically fit while living within their means Engage community partners and begin public forums

Key Strategies

Define community message by March 2012 2. Engage 20 key partners to disseminate the message 3. Hold 5-10 educational forums by September 2012

Outcome Measures

All engaged partners will agree to an MOU with LHC to enhance educational goals of LHC 2. Pre-post evaluation with 6 month follow up on knowledge retention from public forums

Potential Partners

• • • •

LHC Coalition members MCSD Faith Community Others as determined by LHC Cooperative Extension

• • • • •

MCSD Parks and Recreation MCPD PTAs Afterschool programs: o Boys and Girls Club o Girls, Inc.

CHOA Columbus State (for evaluation) Local government AFLAC

• •

GA Department of Education Strong for Life

•

Potential Resources

• • • •

Costs/Funding (See Appendix E

PAGE 34

Minimal Requires time and energy of partners

All students participate regularly in physical activity (Georgia Performance Standard 3) 2. Student achieves a health enhancing level of physical fitness (Georgia Performance Standard 4) 3. Market existing recreational programs in the community more effectively 4. Expand program offerings to include more ‘non-traditional’ activities

2. 3. 4. 5.

Regular communication from schools to home regarding opportunities for physical activity Schools offer daily physical activity for all students Partner with police to identify and reduce crime trends Increase lighting and police presence in recreational areas Track usage of community programs – look for a 15% increase over a period of time

Lets Move CHOA

Childhood Obesity Prevention Needs Assessment Report

Healthy Food Access

Data

LHC will work with community partners to strive for healthy food access within a 2-mile radius of all citizens by 2022

LHC will become the central point of local data collection related to childhood obesity in Columbus and Muscogee County

Promote incentives to food retailers to locate and/ or offer healthier food and beverage choices in underserved areas 2. Restrict availability of less healthy foods and beverages in public service venues

LHC will develop and implement a confidential and systematic method of collecting local health measures in partnership with local pediatricians, schools and the health department

Offer incentives to grocery stores to locate in current food desert census tracts 2. Public service vendors will contract with healthy food option vending machine operators

Collect data on the following measures: a) BMI by age, blood pressure and diabetes in all public school children in grades 1,3,5,7 and 9 b) Percentile indicators of weight and height of preschool age children c) Develop relationships with CDC pilot sites in Richmond and Colquitt Counties

Food desert census tracts will be reduced by 50% over the next 10 years 2. 100% of unhealthy vending machines will be eliminated in public school locations by 2014

Childhood obesity in Columbus will be reduced to 14.6% by 2022 (aligned with the CDC target rate)

• • •

Chamber of Commerce Local government MCSD

• • •

Local Pediatricians Health Department MCSD

• •

Local grocery store managers USDA

• • • • •

Columbus State University Live Healthy Columbus membership Columbus Research Foundation CDC AFLAC

Incentives

Requires long term investment CHOA Columbus State Columbus Research Foundation Robert Wood Johnson Foundation

The University of Georgia | Fanning Institute PAGE 35

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Pocock, M., et al., Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies. Obesity Reviews, 2010. 11(5): p. 338-353. 18. Robert Wood Johnson Foundation. Food insecurity and risk for obesity among children and families: Is there a relationship? Healthy Eating Research 2010 [cited 2011 November 30]; Available from: http://www.rwjf.org/files/ research/herfoodinsecurity20100504.pdf. 19. Gundersen, C., et al. Map the Meal Gap: Child food insecurity 2011. 2011 [cited 2011 November 30]; Available from: http://feedingamerica.org/hunger-in-america/hunger-studies/map-the-meal-gap/~/media/Files/research/map-mealgap/ChildFoodInsecurity_ExecutiveSummary.ashx. 20. Rideout, V.J., U.G. Foehr, and D.F. Roberts. Generation M2 media in the lives of 8- 18-year-olds: A Kaiser Family Foundation Study, 2010. 2010 [cited 2012 January 18]; Available from: http://www.kff.org/entmedia/upload/8010.pdf. 21. Doolen, J., P.T. Alpert, and S.K. Miller, Parental disconnect between perceived and actual weight status of children: A metasynthesis of the current research. Journal of the American Academy of Nurse Practitioners, 2009. 21(3): p. 160-166. 22. Fleischhacker, S.E., et al., A systematic review of fast food access studies. Obesity Reviews, 2011. 12(501): p. e460-e471. 23. Gordon-Larsen, P., et al., Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics, 2006. 117(2): p. 417-424. 24. Robinson, S.M., et al., Variations in Infant Feeding Practice Are Associated with Body Composition in Childhood: A Prospective Cohort Study. Journal of Clinical Endocrinology & Metabolism, 2009. 94(8): p. 2799-2805. PAGE 36

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25. Cook-Cottone, C., et al., A Meta-Analytic Review of Obesity Prevention in the Schools: 1997-2008. Psychology in the Schools, 2009. 46(8): p. 695-719. 26. Brown, T. and C. Summerbell, Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Reviews, 2009. 10(1): p. 110-141. 27. Centers for Disease Control and Prevention and Division of Adolescent and School Health. School Health Index: A self-assessment and planning guide. 2005 [cited 2011 December 7]; Available from: http://www.cdc.gov/HealthyYouth/ SHI/. 28. Minyard, K.J., et al. Preventing overweight children in Georgia: Opportunities for foundations and grantmakers. 2004 [cited 2011 December 7]; Available from: http://ays.issuelab.org/research/listing/preventing_overweight_children_in_ georgia_opportunities_for_foundations_and_grantmakers. 29. Centers for Disease Control and Prevention. School health guidelines to promote healthy eating and physical activity. 2011 [cited 2011 November 30]; Available from: http://www.cdc.gov/mmwr/pdf/rr/rr6005.pdf. 30. Merlo, L.J. and H.L. Yardley, Pediatric Obesity Epidemic: Problem and Solutions. Current Pharmaceutical Design, 2011. 17(12): p. 1145-1148. 31. Stroup, D.F., et al., Reversing the trend of childhood obesity. Preventing Chronic Disease, 2009. 6(3): p. 1-5. 32. Birch, L.L. and A.K. Ventura, Preventing childhood obesity: what works? International Journal of Obesity, 2009. 33: p. S74-S81. 33. Ritchie, L.D., et al., Position of the American Dietetic Association: Individual-, family-, school-, and community-based interventions for pediatric overweight. Journal of the American Dietetic Association, 2006. 106(6): p. 925-945. 34. North Carolina Institute for Public Health, et al. Healthy Kids Healthy Communities (HKHC) annotated resource book for built environment and physical activity. 2009 [cited 2011 December 7]; Available from: http://www. healthykidshealthycommunities.org/resources/hkhc-annotated-resource-book-built-environment-and-physical-activity. 35. Centers for Disease Control and Prevention. Nutrition and physical activity information for American Recovery and Reinvestment Act (Recovery Act) Communities Putting Prevention to Work. 2010 [cited 2011 November 30]; Available from: http://www.cdc.gov/chronicdisease/recovery/PDF/N_and_PA_MAPPS_strategies.pdf. 36. Centers for Disease Control and Prevention. Recommended community strategies and measurements to prevent obesity in the Unites States. 2009 [cited 2011 November 30, 2011]; Available from: http://www.cdc.gov/mmwr/pdf/rr/ rr5807.pdf. 37. American Academy of Child & Adolescent Psychiatry. Facts for Families: Obesity in children and teens. 2011 [cited 2011 November 30]; Available from: http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens. 38. Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System - Georgia. 2009. 39. National Center for Health Statistics and Health Indicators Warehouse, Obesity in children and adolescents aged 2-19 years (percent). 2011. 40. Spruijt-Metz, D., Etiology, Treatment, and Prevention of Obesity in Childhood and Adolescence: A Decade in Review. Journal of Research on Adolescence, 2011. 21(1): p. 129-152. 41. Troiano, Richard P., Flegal, Katherine M. Overweight Children and Adolescents: Descriptions, Epidemiology, and Demographics. Official Journal of the American Academy of Pediatrics. 1997. 42. Burke, N.M., Chomitz, V.R., Rioles, N.A., Winslow, S.P., Brukilacchio, L.B., and Baker, J.C. 2009. The path to active living: Physical activity through community design in Somerville, Massachusetts. Amer. J. Preventitive Medicine 37 (6) Supplement 2: S386-S394. [http://dx.doi.org/10.1016/j.amepre.2009.09.010] 43. Economos, C.D., and Irish-Hauser, S. 2007. Community interventions: A brief overview and their application to the obesity epidemic. J. Law, Medicine & Ethics 35 (1): 131-137. 44. Economos, C.D., Hyatt, R.R., Goldberg, J.P., Must, A., Naumova, E.N., Collins, J.J., and Nelson, M.E. 2007. A community intervention reduces BMI z-score in children: Shape Up Somerville first year results. Obesity 15: 1325-1336. 44. Economos, C.D., Folata, S.C., Goldberg, J., Hudson, D., Collins, J., Baker, Z., Lawson, E., and Nelson, M. 2009. A communitybased restaurant initiative to increase availability of healthy menu options in Somerville, Massachusetts: Shape Up Somerville. Prev Chronic Disease 6 (3): A102 45. Friedrich, M.J. 2007. Researchers address childhood obesity through community-based programs. JAMA 298 (23): 2728-2730. 46. Goldberg, J.P., Collins, J.J., Folta, S.C., McLarney, M.J., Kozower, C., Kuder, J., Clark, V., and Economos, C.D. 2009. Retooling food service for early elementary school students in Somerille, Massachusetts: The Shape Up Somerville Experience. Prev Chronic Disease 6 (3): 1-7. [www.cdc.gov/pcd/issues/2009/jul/08_0172.htm] 47. Foster, G.D., Sherman, S., Borradaile, K.E., Grundy, K.M., Vander Veur, S.S., Nachmani, J., Karpyn, A., Kumanyika, S. and Shults, J. 2008. A Policy-Based School Intervention to Prevent Overweight and Obesity. Pediatrics 121: 794-802. 48. Giang, T., Karpyn, A., Laurison, H.B., Hillier, A., and Perry, R.D. 2008. Closing the grocery gap in underserved communities: The creation of the Pennsylvania Fresh Food Financing Initiative. J Public Health Management & Practice 14 (3): 272279. 49. Grier, S. and Bryant, C.A. 2005. Social marketing in public health. Annual Review of Public Health 26: 319-339. 50. Karpyn, A., Manon, M., Treuhaft, S., Giang, T., Harries, C., and McCoubrey, K. 2010. Policy solutions to the â&#x20AC;&#x2DC;grocery gap.â&#x20AC;&#x2122; Health Affairs 29 (3): 473-480. 51. U.S. Government Accountability Office. 2005. Most experts identified physical activity and the use of best practices as key to successful programs (78 pp). GAO Report GAO-06-127R: 70-72. The University of Georgia | Fanning Institute PAGE 37

Appendix A: Online Survey Instrument

A total of 121 people responded to the online survey. 1.

I perceive childhood obesity as a growing problem in my community.

a. Agree b. Disagree c. Don’t know 2.

I am worried about the future health of my children and/or the children in my community.

a. Agree b. Disagree c. Don’t know 3.

How far from where you live is the nearest playground, park or other place for children to be active?

a. b. c. d.

Less than 1 mile 1 – 2 miles More than 2 miles Don’t know

In your opinion, what are the top causes of childhood obesity in your community?

I am aware of programs in my community that fight childhood obesity.

lack of safe places to exercise/play Fresh fruits and vegetable not close by l. No time to cook /eat together m. Lack of information to stay slim/ healthy

The following questions are optional; however, your responses provide important information about how we can best serve the community’s needs. 1.

What is your race/ethnicity ? o Black/African-American o Hispanic/Latino o White/Caucasian o Asian o Other

What is your marital status? o Single o Married o Divorced o Widowed o Other

How many people under the age of 18 reside in your household? a. 1 b. 2 c. 3 d. 4 e. 5 f. Other (5+)

Are you over 18 years of age? Yes/No

Are you a full time student? Yes/No

[open ended text box response]

4. I attend programs in my community that fight childhood obesity. d. Agree e. Disagree f. Don’t know My family has dinner together at home.

g. Agree h. Disagree i. Don’t know

10. In your opinion, what are the top risks of childhood obesity for children in your community? n. diabetes o. bullying p. cost of clothes q. high blood pressure [open ended text box response] 11. In your opinion, how can childhood obesity be prevented in your community? [open ended text box response]

How far from where you live is the nearest full service grocery store?

a. b. c. d.

Less than 1 mile 1 – 2 miles More than 2 miles Don’t know

How far from where you live is the nearest fast food?

a. b. c. d.

Less than 1 mile 1 – 2 miles More than 2 miles Don’t know

PAGE 38

Demographic Information (optional)

j. k.

a. Agree b. Disagree c. Don’t know

If yes, where are you in school? o High school or below o Technical college o Community college o 4 year University o Graduate School o Other 6.

Where do you live in Columbus? o Eastern Columbus o Western Columbus o North Columbus o South Columbus o Ft. Benning o Other

Have you seen media (television, computer/listserv/blogs/tweets, radio, newspaper, billboards) reports about childhood obesity? Yes/No Which one(s)

Have you (and/or your child or children) participated in a community program or event about living healthy? Yes/No

12. Is there anything else you would like us to know about the needs of your community? [open ended text box response]

Childhood Obesity Prevention Needs Assessment Report

Appendix B: Individual Interview Protocol 1. What is your perception of childhood obesity in Muscogee County? 2. Do you know any programs, initiatives or resources available in Muscogee County around childhood obesity? a.

If yes, please describe the program, who it is intending to serve and how often the program is available.

If no, what programs, initiatives or resources would you like to see available and why?

c. What barriers exist that would cause you to not utilize either programs you are aware of or new programs? What do you think the barriers for the intended participants would be? d. What do you think Columbus/Muscogee County is doing well to curb childhood obesity? 3. Where should we focus our data collection efforts outside of the city of Columbus? (districts, town, neighborhoods, etc.) 4. What do you see as the top three priorities to help curb childhood obesity in the Columbus/Muscogee County area? 5.

Is there anything else that you would like to share with me about your organizationâ&#x20AC;&#x2122;s needs?

Appendix C: Interview Participants

Fanning Institute faculty members interviewed 22 people in fall 2011; 13 were Live Healthy Columbus Coalition members.

PARTICIPANT Royce Ann Adkins*, Executive Director Marian K. Bone, School Nutrition Director Mary Brewer, 4-H Youth County Extension Agent Betsy Covington, Executive Director Owen Ditchfield, President Babbs Douglas, Executive Director Scott Ferguson, President and CEO Brenda Forman*, Nutrition Director

BUSINESS/ORGANIZATION Columbus Research Foundation Muscogee Co. School District Muscogee Co., Northwest District /UGA Coop. Extension Community Foundation of the Chattahoochee Valley, Inc. Citizens for South Columbus Feeding the Valley Food Bank United Way of the Chattahoochee Valley West Central Health District (Columbus) Georgia Department of Public Health Dorothy Hyatt*, Executive Director Girls Incorporated of Columbus and Phenix-Russell Cheryl A. Johnson, BSW, MPAH*, Executive Director West Central Georgia Cancer Coalition Anne King, Executive Director MidTown Inc. Virginia T. Peebles*, Director Coalition for Sound Growth Amanda Rees, Ph.D., Associate Professor Dept. of History and Geography/ Columbus State University Lisa P. Roberts*, Health and Fitness Instructional Specialist Elementary Education Dept./ Muscogee Co. School District Selby Rollinsonm, Deputy Chief of Staff Fort Benning Ed Saidla*, District Program Manager West Central Health District (Columbus) Georgia Dept of Public Health Marion Scott*, Director, Corporate Communications Columbus Regional Healthcare System Darlene Shirley*, Lead Nurse Muscogee County School District David Steele*, Executive Director YMCA of Metropolitan Columbus Mary Stranger*, Director of Benefits Synovus Mark Thorne, Sr.*, Coordinator School of Health Sciences/ Columbus Technical College Beverly Townsend, M.D., MBA, FAAFP*, District Health West Central Health District (Columbus) Director GA Department of Public Health *Live Healthy Columbus Coalition Member The University of Georgia | Fanning Institute PAGE 39

Appendix D: Focus Group Protocol and Highlights GROUP ONE Wilson Housing Authority Focus Group 13 participants Monday, November 7, 2011

Questions: 1. Tell us who you are, where you live, where you work. 2. What do you think about childhood obesity?

GROUP TWO Latina Mothers Focus Group Hispanic Community Neighborhood 6 focus group participants, 6 home visit participants Tuesday, November 8, 2011

GROUP THREE Healthcare Professionals Focus Group Columbus Chamber of Commerce 10 participants Monday, November 14, 2011

3. What have you observed regarding childhood obesity? 4. Has childhood obesity affected you? 5. What does food access mean to you? 6. What does food desert mean to you? 7. Whose role is it to develop healthy environments and behaviors in children and families? (School, family, community) 8. How does the school responsibility compare

GROUP FOUR Parent Teacher Association Network Focus Group Columbus High School 5 participants Monday, November 14, 2011

with parent and community responsibilities in developing healthy environments, attitudes and behaviors? (Should the parents be educated also? What role does the parent play in providing food?) 9. What has been done through the community at large do to encourage healthy environments and behaviors, especially those that may address childhood obesity? 10. What more can the community at large do to encourage healthy environments and behaviors, especially those that may address childhood obesity? 11. If you had a magic wand what would be the one thing you would do to curb childhood obesity?

PAGE 40

Childhood Obesity Prevention Needs Assessment Report

Table 1: Focus Group One

QUESTION What do you think about childhood obesity?

DISCUSSION POINTS • It causes self-esteem issues • More children are obese now due to the availability of fast food and the removal of physical education in schools • Young mothers need to be more educated on how healthy eating affects their children • Grandparents raising their grandchildren need to be as strict as they were on their own parents. • Children need to learn portion control and drink less sugary drinks

How has childhood obesity affected you?

• • •

What does the term “food access” mean to you?

• •

•

Southern cooking does not allow for healthy eating It is difficult to purchase healthy food on food stamps and have it last throughout the entire month Children are not participating in school sponsored activities because they are afraid of bullying Understand the term after explanation The grocery stores target the people on food stamps by placing the unhealthy foods at the front of the store the day the EBT cards are loaded The Piggly Wiggly is the closest grocery store, need to find transportation access if they want to shop anywhere else The closest place to purchase food though is a convenience store and the dollar store which do not have any fresh food

What does the term “food desert” mean to you?

• •

Understand the term after explanation The group agreed they can access food closer than a mile, but not healthy food unless they find transportation

Whose role is it to develop healthy environments and behaviors in children and families? (parents, school, community…etc.)

•

Overwhelmingly it was the mother, and or parents responsibility according to the participants Parents control the access to the healthy and nonhealthy foods Schools come second in responsibility Portion control for students School needs to have healthier options and allow the parents to have input in what is served Menu should be sent home weekly to the parents Community Get the churches involved Offer classes, post information about healthy food and build more playgrounds with safe accessible equipment

• • • • • • • •

If you had a magic wand what would be the one thing you would do to curb childhood obesity?

• • • •

Allow only healthy, nutritious food to be served in schools and at home Eliminate all fast food Eliminate access to television Build safe playgrounds outside everyone’s neighborhoods The University of Georgia | Fanning Institute PAGE 41

Table 2: Focus Group Two

QUESTION What do you think about childhood obesity?

DISCUSSION POINTS • Kids are getting larger because they have too much to eat • Kids are eating only fast food and fried food, they do not want homemade fresh food • Kids are unable to play because they are too large • Parents use food to encourage good behavior to keep children quiet

How has childhood obesity affected you?

•

Not affected this group personally

What does the term “food access” mean to you?

• • •

Needed an explanation of the term Do not have shopping within walking distance The closest stores with healthy food if they are able to find transportation are the Piggly Wiggly, Wal-Mart and several local ethnic stores

What does the term “food desert” mean to you?

• •

Needed an explanation of the term If they walk the only places to find food are fast food restaurants and gas stations A walk to the grocery store can take 15-20 minutes

•

Whose role is it to develop healthy environments and behaviors in children and families? (parents, school, community…etc.)

•

If you had a magic wand what would be the one thing you would do to curb childhood obesity?

• • • • •

PAGE 42

Parents and mothers specifically o The mother is who buys the groceries o Parents need to improve their eating habits and not pass bad habits down to their children Schools have the second responsibility o Schools need to talk to parents about what kind of food their children eat at home, could send out a survey for input o Need to send home the menu weekly to the parents Community is third o Doctors need to be more honest with parents and children o Offer more healthy cooking classes o Head Start and WIC need to provide recommendations for how cook healthier choices for children

Eliminate television and video games Eliminate junk food Parents would have more time at home to cook healthy meals Change parents’ eating habits Keep children active and foster good eating habits

Childhood Obesity Prevention Needs Assessment Report

Table 3: Focus Group Three

QUESTION What do you think about childhood obesity?

DISCUSSION POINTS • Children are more obese at a younger age, seeing Type II diabetes in elementary age children • Technology is playing a factor in children not being as active in the past decade, gaming devices like the Wii are great, but not everyone can afford that • Current environment not conducive to healthy eating, parents are not spending time at home and no one eats family meals together • Entitlement programs, while important, are abused because of lack of oversight • Physical Education has been removed as a mandatory class for all grade levels • Parents do not teach their children healthy eating habits like portion control

How has childhood obesity affected you?

•

• •

•

What does the term “food access” mean to you?

• • •

What does the term “food desert” mean to you?

• •

Whose role is it to develop healthy environments and behaviors in children and families? (parents, school, community…etc.)

• • •

If you had a magic wand what would be the one thing you would do to curb childhood obesity?

• •

• • •

Parents who come into doctors’ offices are no longer educated regarding healthy weight loss and nutrition, they are overweight and will not admit it to themselves Seeing children/infants who are tripling their birth weight by 3-4 months Difficult to always provide a healthy meal when it is so easy to pull through a fast food restaurant on the way home from scouts, athletic practices or meetings Teachers are no longer role models for healthy living, they are some of the worst offenders The participants agree they must drive to purchase healthy food Fast food is available everyone and on the way home from everything, dollar menus are cheap and easy More fast food and convenience stores than grocery stores Wealthiest neighborhoods in Columbus would all be considered food deserts Build housing projects and retirement communities where there is no access to healthy food unless you are able to drive Parents first and foremost: Education at home, eating together, proving healthy food Schools: The participants think the schools are doing what they can Churches: The youth in this community are more likely to listen to their pastor than teachers and parents Mandatory fitness program in the school system for all ages and all grades EVERYDAY Parents should pay penalties on their health insurance if they are overweight or their children are overweight, just like smoking penalties Entitlement programs would give less food stamps if you are overweight Campaign to end obesity just like the stop smoking campaigns in the 80’s Keep a consistent message at home, in the schools and throughout the community The University of Georgia | Fanning Institute PAGE 43

Table 4: Focus Group Four

QUESTION What do you think about childhood obesity?

DISCUSSION POINTS • Greater level of low-income students who are heavy and lethargic in the school system • It is not a problem in the private schools or wealthier communities • No time for home cooking, fast food is cheaper and easier than purchasing healthy food

How has childhood obesity affected you?

•

It is not a problem in their social circle

What does the term “food access” mean to you?

• •

Must drive to purchase healthy fresh food Whole Food stores are expensive and not as prevalent

What does the term “food desert” mean to you?

• • •

No state farmers’ market anymore Commissary is affordable, but not easily accessible South Columbus has less options, four Wal Marts in the area, but they are all in North Columbus

Whose role is it to develop healthy environments and behaviors in children and families? (parents, school, community…etc.)

•

Parents number one responsible o Educate parents on nutrition Schools o Need a nurse in each of the schools to help educate students and parents o Need to serve healthier options, offer a salad bar o Find a way to get parents to the school for educational sessions on healthy eating and food preparation Community o Plenty of recreational activities and runs being offered, but people are not talking advantage of them o Reach people through their churches o Need money to offer more programs

•

If you had a magic wand what would be the one thing you would do to curb childhood obesity?

• • • •

PAGE 44

Rewards at work and school for healthy eating Slim Down Columbus, Biggest Loser for the entire county Obesity coaches and mentors at the workplace and in schools Fast Food chains only offering healthy options

Childhood Obesity Prevention Needs Assessment Report

Appendix E: Potential Funding Sources Foundations Aetna Foundation, Inc.

W.K. Kellogg Foundation’s Healthy Eating, Active Living

(formerly Aetna Life & Casualty Foundation, Inc.) 151 Farmington Ave., RC31 Hartford, CT 06156-3180

Food & Fitness Collaboratives: The Kellogg Foundation has made investments in the food and physical activity environment in nine communities: Boston, Detroit, Holyoke, Mass., Northeast Iowa, New York City, Oakland, Philadelphia, Seattle/King County, Wash. and the Tohono O’odham Nation in south central Arizona.

The Humana Foundation, Inc. 500 W. Main St., Ste. 208 Louisville, KY 40202-2946

CVS Caremark Charitable Trust, Inc. (formerly CVS/pharmacy Charitable Trust, Inc.) 1 CVS Dr. Woonsocket, RI 02895-6146

CDC’s Steps to a HealthierUS

WellPoint Foundation, Inc. (formerly Anthem Foundation, Inc.) 120 Monument Circle Indianapolis, IN 46204-4906

Federal Grants

Sponsor: Centers for Disease Control and Prevention (CDC) Title: Affordable Care Act (ACA): Childhood Obesity Research Demonstration - RFA-DP-11-007 Due Date: April 8, 2012 Sponsor: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Title: Community-Based Partnerships for Childhood Obesity Prevention and Control: Research to Inform Policy (R21) Due Date: Ongoing

Additional Resources Robert Wood Johnson Foundation’s Healthy Kids, Healthy Communities

This program supports community action to prevent childhood obesity. Grantees in 50 communities promote healthy eating and active living, including two in Georgia (Cook County and Milledgeville). http://www. healthykidshealthycommunities.org/

The CDC funded this program from 2003 to 2009 to reduce obesity, diabetes and asthma by targeting three related risk factors: poor nutrition, insufficient physical activity, and exposure to tobacco. Forty communities participated in the program, including DeKalb County. Within each community, interventions were delivered across multiple sectors including community settings, schools, work sites, and health care settings. http://www.cdc.gov/ healthycommunitiesprogram/communities/ steps/index.htm

California Department of Public Health CX3 program Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention (CX3) was developed by the California Department of Public Health. The program offers a rich array of tools to assess communities and monitor progress. Criteria include access, price, availability, exterior advertising, interior advertising and promotions, and walkability. http://www. cdph.ca.gov/programs/cpns/Pages/CX3_ Main_Navgation.aspx

The University of Georgia | Fanning Institute PAGE 45

Appendix F: 51 Programs Identified by Surveyed Experts • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Action for Healthy Kids, Skokie, Illinois America On the Move, Boston, Massachusetts Apache Healthy Stores Project, New Mexico Balance First, TM Ontario, Canada Be Active North Carolina Bienestar, California Bright Bodies Weight Management, Yale University School of Medicine - New Haven, Connecticut Brocodile the Crocodile, New York California Project LEAN (Leaders Encouraging Activity and Nutrition) Cardiovascular Health in Children and Youth Study (CHIC), University of North Carolina – Chapel Hill, North Carolina Cartographic Modeling Laboratory, University of Pennsylvania - Philadelphia, Pennsylvania *Childhood Weight Control Program, University of Buffalo Buffalo, New York Children’s Optimal Weight for Life Program, Children’s Hospital Boston, Massachusetts Color Me Healthy, North Carolina Consortium to Lower Obesity in Chicago Children (CLOCC), Illinois Department of Defense’s (DOD) Fresh Produce Program Department of Education’s Carol M. White Physical Education Program Department of Health and Human Services (HHS) - National Institutes of Health’s (NIH) Coronary Artery Risk Development in Young Adults (CARDIA) study Eat Well & Keep Moving, Baltimore City Public Schools and Harvard School of Public Health – Boston, Massachusetts Farm Fresh Choice, University of California – Berkeley, California Farm to Schools Program, Occidental College - Los Angeles, California Fitkid Project, Medical College of Georgia – Augusta, Georgia FoodChange, New York, New York Healthy Children Healthy Futures Healthy Living in the Pacific Islands, Honolulu, Hawaii Healthy Start HHS – Centers for Disease Control and Prevention (CDC) School Health Index HHS – CDC’s VERB TM *HHS – NIH’s Child and Adolescent Trial for Cardiovascular Health (CATCH) HHS – NIH’s Girls Health Enrichment Multisite Study (GEMS) HHS – NIH and the National Recreational and Park Association’s Hearts N’ Parks HHS and Environmental Protection Agency’s National Children’s Study HHS’s Head Start HHS’s Steps to a HealthierUS Hip-Hop to Health Program, Chicago, Illinois Ho-Chunk Community Development Corporation, Walthill, Nebraska incentaHEALTH Program, Denver, Colorado Kaiser Permanente’s Kid Shape®, Oakland, California LEAP: The Live, Eat and Play Study, Royal Children’s Hospital, Melbourne, Australia M-SPAN (Middle-School Physical Activity and Nutrition), San Diego State University, California

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• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

New Moves, University of Minnesota – Minneapolis, Minnesota NikeGO / PE2GO, Beaverton, Oregon Northwest Schools Obesity Prevention Consortium, University of Washington - Seattle, Washington Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC), University of North Carolina - Chapel Hill, North Carolina Nutrition Education Aimed at Toddlers (NEAT), Michigan State University – East Lansing, Michigan Packard Pediatric Weight Control Program, Lucile Packard Children’s Hospital at Stanford, California Pathways study, University of New Mexico - Albuquerque, New Mexico Physical Best Program, Champaign, Illinois *Planet Health, Harvard Prevention Research Center - Boston, Massachusetts Positive Coaching Alliance, Stanford University, California *Reducing Television Viewing to Prevent Childhood Obesity study, Stanford Prevention Research Center Shape Up America! SHAPEDOWN®, University of California – San Francisco, California SPARK, San Diego, California Strategies for Metropolitan Atlanta’s Regional Transportation and Air Quality, Atlanta, Georgia Student Centered Web-Based Communities: Multi-Disciplinary Approach for Adolescent Obesity Prevention, Purdue University - West Lafayette, Indiana TACOS Study, University of Minnesota - Minneapolis, Minnesota Take 10!,TM Atlanta, Georgia The California Endowment’s Healthy Eating, Active Communities Initiative The Food Trust, Philadelphia, Pennsylvania The National Black Church Initiative, Washington, D.C. The Nutrition and Fitness for Life Program, Boston Medical Center, Massachusetts The Robert Wood Johnson Foundation’s Active Living by Design / Healthy Eating by Design, University of North Carolina - Chapel Hill, North Carolina U Move with the Starzz, University of Utah - Salt Lake City, Utah U.S. Department of Transportation’s Safe Routes to School United Way, Alexandria, Virginia Urban Nutrition Initiative (UNI), University of Pennsylvania Philadelphia, Pennsylvania US Department of Agriculture’s (USDA) Breastfeeding Promotion and Support USDA’s Community Supported Agriculture USDA’s Eat Smart. Play Hard.TM USDA’s Fit WIC USDA’s Food Stamp Program USDA’s Fruit and Vegetable Pilot Program USDA’s Loving Support Makes Breastfeeding Work USDA’s National School Lunch Program USDA’s Team Nutrition Weight Management Program, Louisiana State University Baton Rouge, Louisiana What’s for Lunch? program, Brookline, Massachusetts WIN the Rockies (Wellness IN the Rockies) YMCA Activate America

Childhood Obesity Prevention Needs Assessment Report

Photo Credits:

Cover and Page 2: Strong4life Urban Adventure Event in Columbus, Ga; Strong4Life Garden project and the Cooking project Page 3: Georgia Department of Economic Development Page 6: Georgia Department of Economic Development Page 7: Strong4life Urban Adventure Event in Columbus, Ga; Strong4Life Cooking project Page 8, 11: Georgia Department of Economic Development Pages 12-13: Strong4life Urban Adventure Event in Columbus, Ga; Page 20: Strong4life Garden Project Page 28: Strong4Life Garden project and Strong4life Urban Adventure Event in Columbus Pages 32-33: Strong4life Urban Adventure Event in Columbus, Ga