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Community centered approach to combat childhood obesity through family-based strategies in a low-income community


Title: A Community Centered Approach to Combat Childhood Obesity through Family-Based Strategies in a low-income community Author: Stephanie McNerney – PowerPoint PPT presentation

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Title: Community centered approach to combat childhood obesity through family-based strategies in a low-income community

Community centered approach to combat childhood
obesity through family-based strategies in a
low-income community
  • Stephanie B. McNerney, BSN
  • July 20th 2010

  • Childhood obesity is a national health crisis and
    is at the forefront of our national health agenda
  • Childhood obesity is reflective of many other
    health problems in that conspicuous health
    disparities exist between non-minority and
    minority children
  • Due to the complexity and gravity of this health
    issue public health professionals must design
    innovative, sustainable, tailored, and
    multi-faceted programs
  • It is the interest of this reviewer to explain
    what is currently known about family based
    strategies and childhood obesity and to offer
    recommendations for program design,
    implementation, and evaluation
  • A community centered program design
    recommendation will be highlighted using THRIVE
    planning model in the a low income community in
    Charlottesville, VA

Documented Burden of Obesity
  • Children who are overweight have a greater risk
    of developing cancer, heart disease, as well as
  • Along with physical consequences, childhood
    obesity has been linked with mental health issues
    such as depression, and eating disorders
    (Childhood Obesity Report to the President, 2010)
  • Detrimental to individual as well as family,
    community and national health. Estimated that
    nearly 147 billion per year is being spend on
    treating obesity-related medical conditions
    (Childhood Obesity Report to the President, 2010)
  • Our youth represent our future caregivers,
    workforce, military personnel, and leaders!

National Agenda
  • In line with the national agenda of decreasing
    obesity to just 5 percent by 2030 the Task Force
    on Childhood Obesity is now focusing on policies
    and programs that (1) create a healthy start on
    life from pregnancy through early childhood (2)
    empower parents and caregivers to make healthy
    choices (3) serve healthier food in schools (4)
    ensure access to healthy affordable food (5)
    increase opportunities for physical activity
    (White House Task Force on Childhood Obesity
    Report to the President, 2010, p. 3).

Literature Summary What theories have been used?
  • The determinants and underlying mechanisms of
    childhood obesity are less understood, therefore
    theories can give investigators a construct for
    behavior and behavior change
  • At the intrapersonal level, the transtheoritical
    model/stages of change, social cognitive theory,
    and health belief model have been used (Sorenson,
    G., Hunt, M.K., Cohen, N., Stoddard, A., Stein,
    E., Phillips, J., Baker, F., Combe, C., Hebert,
    J., Palombo, R., 1998).
  • At the interpersonal level social support, social
    network theory, and cognitive theory are useful
    (Sorenson et al, 1998)
  • One qualitative study in England assessed
    parental modeling and social support activity in
    underserved adolescents, which resulted in
    positive themes of tangible support and parental
    engagement (Wright et al, 2010)

Literature Summary Early Childhood
  • Observational studies have supported the
    hypothesis that the early periods of a childs
    life as a key target for preventing childhood
    obesity (Anzman, S.L., Rollins, B.Y., Birch,
    L.L., 2010)
  • The prenatal, postnatal, and early childhood time
    has newly emerged has a very influential (some
    posit most important) time for interventions and
    programs to decrease risk factors for children
    becoming obese or overweight.
  • Holes in research exist including the need for
    quasi-experimental and experimental designs that
    investigate relationship between genetic makeup
    and environment (Anzman, 2010).

Early Childhood
  • By school entry, more than 20 percent of 3-5 year
    old children are already at risk for being
    overweight (BMIgt84percent-94percent) or are
    overweight, which suggests that often we have
    missed the opportunity to intervene and now face
    an uphill battle (Birch et al, 2009).
  • To improve childrens health, the Surgeon General
    recommends prenatal counseling including focus on
    education regarding maternal weight gain,
    importance of breastfeeding, relationship between
    obesity and diabetes, and avoiding alcohol,
    tobacco, and drug use during pregnancy (White
    House Task Force on Childhood Obesity Report to
    the President, 2010).

Literature Summary School-Aged
  • To date most programs and interventions for
    decreasing childhood obesity, and affecting
    deleterious lifestyle behaviors have been
    directed at school-aged children in the context
    of their school.
  • However, to date school based programs have been
    minimally successful. Birch et al (2009) reports
    that only about half of school based programs
    produce significant change in eating behavior,
    physical activity, or weight status. Birch et al
    (2009) makes a poignant point that these results
    are not keeping up with the magnitude of the
    problem and prevalence.

Literature Summary Adolescent
  • The Wright et al (2010) study expands on previous
    research by focusing on gender differences and
    parental support.
  • Barriers for adolescent boys include feeling
    unsafe in their neighborhoods, while girls
    reported physical activity as not fun, no one to
    play with, too much homework, and being too tired
    (Wright et al, 2010).
  • Factors in the home environment (presence of
    siblings, role modeling by parents or siblings,
    and parents participation in physical activity)
    were positively associated with changes in
    childrens physical activity (Crawford, D.,
    Cleland, V., Timperio, A., Salmon, J.,
    Andrianopoulos, N., Roberts, R., Giles-Corti, B.,
    Baur, L., Ball, K., 2010).

Community Based Programs
  • Community Based programs offer a more promising
    approach then school-based programs, and lend
    itself to sustainability due to community
    investment and root cause evaluation. An
    example, is Health Kids Healthy Communities, a
    national program whose goal is to implement
    healthy eating and active living policies and
    programs especially on those at higher risk due
    to race/ethnicity, income and/or geographic
    location (Robert Wood Johnson Foundation, 2010)
  • In 2004, Habitat for Humanity of Greater
    Charlottesville, purchased South wood trailer
    park and launched an innovative program called
    the Sunrise Project, that includes affordable,
    green, and a mixed-income community. This
    project also included plans to improve the built
    environment of the community.

Project Objectives
  • Form community coalition with key stakeholders
    and utilize the THRIVE process to plan, implement
    and evaluate a multifaceted approach to
    increasing community physical activity and diet
  • Utilize community center to offer education,
    planned activities, and family-based services for
    health and wellness
  • Partner with UVA academics to start community
    garden that will be sustained by the community

  • THRIVE is a tool to help communities understand
    and prioritize the factors within their own
    communities. It is helpful in identifying key
    factors and roots causes of health disparities,
    and gives planners the tools to plan in
    addressing the issues (THRIVE, 2010)
  • Health disparities are well documented but the
    determinants are less understood and this tool
    digs deeper to uncover root factors
  • Southwood is an ideal community for THRIVE due to
    its well defined community borders, momentum for
    improvement, and the multitude of service
    providers that are invested in this community

Community Assessment
  • In 2008, a needs assessment was performed by
    Communitas Consulting for Habitat for Humanity of
    Greater Charlottesville to better understand the
    needs, strengths, and resources of the Southwood
  • Data reported from interviews of 28 individuals
    at 14 different local human services and public
    agencies, Southwood residents including one
    representative from each trailer, and secondary
    data analysis (Saphira, B. Fedoravicius, N,
  • Needs assessment revealed necessary demographic
    information and community, health, and human
    services that serve the Southwood community

Community Assessment
  • Assessment revealed that the majority of
    community members view the addition of the
    community center, playground, and presences of
    the boys and girls club as the most positive
    contributions made by HHGC
  • Creciendo Juntos, a network of organizations and
    people working together to support and strengthen
    the integration and development of its
    Latino/Hispanic members has created a Southwood
    working Group and Health Promotors (lay health
    Promoter program)

Implementation Plan
  • Community coalition forms including
    representatives from Habitat, social services,
    Southwood residents, boys and girl club, and
    Creciendo Juntos Health Promotors
  • Collectively decide mission, goals, and timeline
    for addressing family nutrition and activity
  • Research curriculum and sample programs for the
    training of Health Promotors
  • In conjunction with Habitats planning and
    implementation of Southwood rebuilding, launch
    health programs run by Health Promotors and
    community partnerships

Innovative Program Planning
  • This program is innovative in its use of THRIVE
    planning model, and its active investigation into
    the root causes of health disparities.
    Coalitions have been an influential vehicle over
    the course of history for collective voice and
    change. Access to services is not the key to
    decreasing disparities, public health
    professionals must work together with communities
    to identify risk and resilience factors. Due to
    the current involvement of many service agencies
    and groups in Southwood it makes more sense to
    collaborate with the already trusted voices. Lay
    health promoters offer an innovative solution to
    decrease health disparities and reach
    marginalized groups

  • A survey similar to the one conducted by
    Communitas Consulting would be beneficial to
    gather more detailed health information of
    residents and perceptions and perceived barriers
    to health eating and physical activity.
  • Ongoing evaluation to ensure goals and objectives
    were met as defined by Coalition
  • Bi-annual surveys conducted to get a pulse on
    community perceptions, suggestions for
    improvement and health information

  • Key questions for outcome evaluation
  • Did the coalition form?
  • Did the coalition write mission and decide on
    goals and objectives?
  • Is the community participating? (Indicators
    include numbers of participants in activities and
    community garden plans, and survey results)

Budget Considerations
  • Habitat for Humanity of Greater Charlottesville
    has allotted funds for the rebuilding of the
    Southwood Trailer park and voiced commitment to
    community involvement, leadership, and input
  • Health Promotors currently are voluntary position
    however it would be beneficial to seek grant
    monies to offer compensation and options for
    academic credit
  • Community garden would need start up money but
    the goal would be to have the community maintain
    and sustain efforts
  • Boys and girls club already works in Southwood
    through the community center

  • Literature reveals many future opportunities in
    the investigation of childhood obesity, health
    disparities, and family-based strategies
  • Strategies designed to aid disparate communities
    should involve, empower, and develop ownership by
    the community to increase likelihood of success,
    benevolence, and sustainability

  •  Ball, K., MacFarlane, A., Crawford, D., Savige,
    G., Andrianopoulos, N., Worsley, A., (2009).
    Can social cognitive theory constructs explain
    socio-economic variations in adolescent eating
    behaviours? A mediation analysis. Health
    Education Research, 24(3) 496-506
  • Baquero, B., Ayala, G.X., Arredondo, E.M.,
    Campbell, N.R., Slymen, D.J., Gallo, L., Elder,
    J.P., (2009).Secretos de la Buena Vida process
    of dietary change via a tailored nutrition
    communication intervention for Latinas. Health
    Education Research, 24(5) 855-856
  • Birch, L.L., Ventura, A.K. (2009). Preventing
    childhood obesity what works? International
    Journal of Obesity,33, S74-S81
  • Baker, S.M. Fedoravicous, N., (2009). Southwood
    Mobile Home Community- An Assessment of
    Community Needs and Resources For Habitat for
    Humanity of Greater Charlottesville. Commnitas
    Consuling. Published August 2009
  • Crawford, D., Cleland, V., Timperio, A., Salmon,
    J., Andrianopoulos, N., Roberts, R.,
    Giles-Corti, B., Baur, L., Ball, K. (2010).
    The longitudinal influence of home and
    neighborhood environments on childrens body
    mass index and physical activity over 5 years
    the CLAN study. International Journal of
    Obesity, doi10.1038/ijo.2010.5 

  • Creciendo Juntos (2008). Southwood Working Group.
    Retrieved on July18th , 2010 from
  • Goldberg, J.H., Keirnan, M. (2004). Innovative
    techniques to address retention in a behavioral
    weight-loss trial. Health Education Research,
  • Kelsey, K.S., Kirkley, B.G., De Vellis, R.F.,
    Earp, J.A., Ammerman, A.S., Keyserling, T.C.,
    Shannon, J., Simpson, R.J. (1996). Social
    Support as a predictor of dietary change in a
    low-income population. Health Education
    Research, 11(3) 383-395
  • Prevention Insitute THRIVE (2010). Community
    health approach. Retrieved July 16th
    from http//

  • Robert Wood Johnson Foundation. (2008). Healthy
    Kids Healthy Communities An Annotated Resource
    Book for Built Environment and Physical
    Activity Talking Points Childhood Obesity.
    Retrieved June 16th, 2010, from
    /default/files/FOR20HKH C20Grantee20Meeting20B
    uilt20Environment20and20Physical20A ctivity-An
    20Annotated20Resource20Book- HKHC2003.26.09_MM
  • Sorenson, G., Hunt, M.K., Cohen, N., Stoddard,
    A., Stein, E., Phillips, J., Baker, F., Combe,
    C., Hebert, J., Palombo, R., (1998). Worksite
    and family education for dietary change the
    Treatwell 5-a-Day program. Health Education
    Research, 13(4) 577-59 
  • The TODAY Study Group. (2010). Design of a
    family-based lifestyle intervention for youth
    with type 2 diabetes the TODAY study.
    International Journal of Obesity, 34, 217-226

  • White House Task Force on Childhood Obesity
    Report to the President (2010). Solving the
    Problem of Childhood Obesity within a
    Generation. Retrieved June 16th 2010
    from http//
  • White, M.A., Martin, P.D., Newton, R.L., Walden
    H.M., York-Crowe, E.E., Gordon, S.T., Ryan,
    D.H., Williamson, D.A. (2004). Mediators of
    weight loss in a family-based intervention
    presented over the internet. Retrieved from
    U.S. National Library of Medicine, National
    Institute of Health. Obesity Research Archive,
    12(7) 1050-105 
  • Wright, M.S., Wilson, D.K., Griffin, S., Evans,
    A. (2010). A qualitative study of parental
    modeling and social support for physical
    activity in underservedadolescents. Health
    Education Research, 5(2) 224-232