Julio`s report - Mobile United

Leadership Mobile 2007
Involving the Whole Family in Addressing
Obesity among School Children
A Project on Health Issues Affecting the Mobile Area
Janée Bonner, Paul McLendon, Alex Pate, Firdaus Rahman,
Barbara Shaw, Julio Turrens, and Alison Walker
Introduction:
The study carried out by the Health group focused on the high incidence in our state of
Type II diabetes and obesity. Studies carried out by the CDC (Behavioral Risk Factor
Surveillance System, Centers for Disease Control and Prevention) indicate our state ranks
number one and number two in incidence of these diseases, respectively.
There are various programs designed to increase awareness concerning obesity among
the population. In other words, the problem is NOT a lack of available information, but rather
how to disseminate existing information in a condensed, easy to use format. This project
addressed the need to design user-friendly tools to communicate existing information concerning
caloric content, exercise and diet to parents in order to complement existing programs designed
to fight childhood obesity.
Review Existing Programs
The Health team researched and contacted various area agencies and organizations to
learn what was already being done to address the problem of childhood obesity and what was
still needed. The contacts included:
• Faculty in the USA College of Education
• USA Children’s and Women’s Hospital
• City of Mobile Parks and Recreation Department.
• Mobile County Public School System
• Mobile United Health Committee
• KidFit America
• Alabama Department of Education
One of the most useful pieces of information was a report to the Alabama State Board of
Education entitled “Statewide Committee to Review the State of Health of America’s Youth with
Particular Emphasis on Alabama’s Youth”. The report pointed out that Alabama adults lead the
country in overweight, obesity, lack of physical activity, hypertension, cardiovascular disease
and diabetes and unless modifications are made in our children’s lifestyles, they are headed in
the same direction. Height and weight data collected across the state indicate that 44 percent of
Alabama students are at risk for being overweight or are overweight (see Figure 1, copied from
that report). One in three children is expected to develop diabetes unless changes are made in
their diet and exercise levels. The report refers to this as a health crisis and emphasized a need
for schools to promote lifestyle changes and behaviors that will improve the health of our
students.
The study was developed by two subcommittees: one looked at physical education, the
other at nutrition in our schools. The recommendations in the area of Physical Education
included:
•
Full funding for certified P.E. teachers and programs, including appropriate teacher to
pupil ratios.
•
Doing away with P.E. waivers. No student should be excused from P.E.
•
More involvement from the State Dept. of Education in monitoring the program
•
More incorporation of P.E. into the academic curriculum
•
P.E. testing
•
Making P.E. opportunities available before, during and after school
The subcommittee on nutrition stressed a need for healthier foods, not only in the
cafeteria but in school stores and vending machines. Their recommendations included:
•
Fundraising activities that involve the selling of food should reinforce food choices
that promote good health.
•
Training and development for teachers
•
School environment health assessments – having each school develop a plan to
improve student health on their campus.
•
They also want Channel One, the television programming that comes into the
classrooms, to refrain from advertising high sugar, high fat or foods with low
nutritional values.
One initiative that grew out of this report was the KidFit program. Nearly 350,000
elementary students received a take home packet with a DVD containing a half-hour long TV
show and an informational brochure on nutrition and fitness. The message was aimed not only at
children, but parents as well. The focus is on changing unhealthy lifestyles.
In Mobile County Schools, a pilot program to address the issue is being tested. It is called
WAY, which stands for Wellness, Academics and You. It is a program designed to teach
students how to make healthier choices that can impact their future health.
The program is geared towards fourth and fifth graders and is being piloted in 18 schools in
Mobile County and in Jefferson and Opelika. The goal is to help students develop healthy habits
that will last a lifetime. This age group was targeted because they are the ones who bring home
the message and will insist that parents make changes at home to help them meet their goals.
Teachers underwent special training for the pilot program to incorporate fitness and nutrition into
every subject. The program is grant funded through the State Department of Education with
plans to use it in all schools within the next few years.
While the program is school based, school officials felt the program could be more
effective with more involvement from the parents. Kids can make choices, but parents are the
ones buying the groceries and controlling the menus. They needed to know what their kids were
learning so they can be supportive.
This topic became the focus of the Health team. First, the team contacted a doctoral
candidate in the USA College of Nursing, Veronica Hudson, who was planning parent meetings
for the WAY program at various schools in the area. After taking with Ms. Hudson and other
school officials, the Health team decided to develop resource materials for parents to
complement the information already distributed to both parents and children.
Development of a tool to inform parents about healthy dietary choices
As mentioned above, the Health team realized that there is no shortage of information
available to help people make healthy choices about diet and exercise. The information is either
not reaching families, or it is not being utilized. Therefore, the team sought to provide
information in a simple, convenient, and easy to use format. The team concentrated in three
areas where parents can make educated decisions to provide a balanced diet to their children: the
home kitchen, a restaurant, and the grocery store. Consequently, the information was adapted to
formats useful in those settings.
For the home kitchen, the team developed cards with information about family exercise,
food portions, and calorie content. The second set of information is designed to use in
restaurants and grocery stores. The information cards may not prevent someone form making a
bad choice, but they will make it easier to select good choices.
Specific tools designed by the Health team (see addenda):
The team designed a refrigerator magnet for the house and a visor sleeve for the car.
The refrigeration magnet is composed of helpful reminders of proper food portions and easy
convenient exercises that the family can do together daily. Exercising goes hand in hand with
proper nutrition in order to maintain a healthy body. Children spend most of their leisure time
inside playing video and computer games, rather than being physically active outside. Physical
activities help to prevent and treat life threatening conditions, such as high blood pressure,
obesity, heart disease, diabetes, depression. Exercise increases energy and the metabolism level.
Research shows that you should exercise 3-5 times per week or 1 hour daily. Examples listed in
the magnet include:
•
walking after lunch or dinner/riding a bike
•
raking the yard
•
walking fifteen minutes before shopping in the mall
•
playing ball
For portion control, we reviewed existing information on the food pyramid and other
guidelines that help determine what is needed for a healthy diet. One of the cards shows easy
ways to estimate portion size without using spoons or measuring cups, to give parents a quick
tool to estimate caloric content. Not wishing to overwhelm them with too much information, the
team chose to include broad food groups that are popular with both adults and children.
The visor includes various sheets with additional information about nutrition, caloric
content and helpful hints. Since the ratio between daily caloric intake and utilization ultimately
determines weight gain or loss, the team developed a variety of tools to stress the need to look at
caloric intake (see addendum). Again, the team concentrated on tools that can be used at a
restaurant, in the kitchen or while shopping for food. These tools include tables depicting:
•
amount of calories burned while performing various activities for 1 hour
•
the amount of time and type of exercise needed to burn the calories ingested with
different meals
•
How much foods provide 100 calories
•
What meals have the lowest caloric content in various fast-food restaurants and how
many calories do these meals involve
Additional information was provided in the form of nutritional hints and information on
reading nutrition labels on food packages and containers (for example, serving size, number of
servings per container, etc).
Evaluation
To gauge the value of the information cards and their ease of use, we worked with the
Mobile School System’s WAY Program personnel who were conducting nutrition information
meetings for parents at three schools. Team members attended the meetings at Baker and
Satsuma High Schools and used the opportunity to obtain comments from parents concerning the
information cards.
Although very few parents attended these meetings, all who did gave a positive review of
the information and the method of delivery. Of the two types of cards (those used for
refrigerators, and those used for car visors) the parents preferred the cards for auto visors.
Implementation:
As a first step to implement this plan, the Health team will contact the Mobile County
Public School System to request that the information be added to their website, making
itaccessible to all parents.
The Health Committee of Mobile United also expressed interest in the ideas proposed in
this study, and will receive a copy of this report to see if they want to adapt it to their specific
projects.
The production and distribution of both the visor sleeve and the refrigerator magnet
designed by the team will require financial resources. Possible sources of funding include local
sponsorship by philanthropic organizations or grants from national agencies. In this regard, the
Robert Wood Johnson Foundation has recently announced that it has allocated $500 million for
grants to address childhood obesity.
Acknowledgements:
The Health team wishes to thank the following individuals and organizations for their input and
suggestions during the preparation of this study:
• Mobile United/Leadership Mobile
• Veronica Hudson (WAY, USA College of Nursing)
• Raye Hanks, RN (MCPSS)
• Suzanne Yates, RD (MCPSS)
• Dr. Richard Wood (USA Libraries, Mobile United Health Committee)
• Dr. Abbie Baxter and Dr. Steve Pugh (USA College of Education)
Addenda
Examples of cards and information included in the refrigerator magnet and in the Envelope
for the car visor
Fast foods with lower caloric content
Exercise Needed to Burn Calories Associated with Common Foods
Physical activity
(calories per hour for a 100, 150 or 200 lb person)
100 lb
150 lb
200 lb
Aerobics (medium)
227
340
454
Biking (10 mph)
249
374
499
Canoeing (2.5 miles/h)
150
224
299
Golf (carry clubs)
227
340
454
Golf (ride in cart)
113
170
227
Housework
181
272
363
Jog (12 min/mile)
385
578
771
Swimming
385
582
780
Walking (20 min/mile)
159
238
317
Water skiing
317
476
635
How Much is Enough?
Quick Guide to Portion Control
One serving
equal to
think about
Bread
one slice
hockey puck
Cooked rice
_ cup
cupcake wrapper/one hand,
cupped
Cooked pasta
_ cup
ice cream scoop/one hand, cupped
Fruit/vegetable
_ cup
tennis ball
Tomato/spaghetti sauce _ cup
one hand, cupped
Cooked or canned beans
_ cup
one hand, cupped
Mashed potatoes
_ cup
one hand, cupped
Cottage cheese
_ cup
one hand, cupped
Chinese food
1 cup
two hands, cupped
Cooked meats
3 oz.
palm of one hand
Canned tuna
3 oz.
palm of one hand
Peanut butter
1 tbsp.
two thumbs together
Sour cream
1 tbsp.
two thumbs together
to 100
calories?
Salad dressingHow much
1 food
tbsp.is equivalent
two
thumbs
together
Cream cheese
1 tbsp.
two thumbs together
Meats










Poultry (no skin, grilled) 3 oz
Fried chicken (with skin) 1 oz
Beef, pork (lean)
1.9 oz
Spareribs, pork sausage
1 oz
Fish
3 oz
Fish (fried)
1.3 oz
Peanut butter
1 Tbsp
Hotdog
1 unit
bologna, salami
1 oz
turkey ham
3 oz
Dairy products

Cheese (3 gram fat/oz)
1.9 oz
4 Tbsp
 Grated parmesan
1.3 oz
 Mozzarella
 American cheddar, Swiss 1 oz

Refrigerator Magnet