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Transcript of Economos
Christina Economos, PhDAssociate Professor
New Balance Chair in Childhood NutritionDirector, ChildObesity180
October 10, 2013
Catalyzing Communities to Prevent Obesity:
A Systems Approach
• Learn from other movements (tobacco, recycling, seat belts,
breastfeeding)
• Call for a Crisis• Build on a sound scientific base• Nurture spark plugs• Recognize the importance of economics• Develop coalitions and advocacy• Use government strategically• Employ mass communication
• Create environmental and policy changes
• Develop a clear plan
How do you spark social change?
Economos, C, Brownson, S, DeAngelis, M, Foerster, S, Tucker Foreman, C, Kumanyika, S, Pate R. What Lessons Have Been Learned From Other Attempts To Guide Social Change? Nutrition Reviews 2001; 59(3):40-56
• A community-based, participatory, environmental approach to prevent childhood obesity (2002-2005)
• A 3 year controlled trial to study 1st – 3rd grade culturally and ethnically diverse children and their parents from 3 cities outside Boston
• Goals: – To examine the effectiveness of the model on
the prevention of undesirable weight gain in children
– Transform a community and inform social change at the national level
Shape Up Somerville: Eat Smart. Play Hard.
R06/CCR121519-01 from the Centers for Disease Control and Prevention.Additional support by Blue Cross Blue Shield of Massachusetts, United Way of Mass Bay, The US Potato Board, Stonyfield Farm, and
Dole Foods
Early MorningEnvironment
During School Environment
Afternoon Environment
At HomeSafe Routes to School Maps
Walking to School (-30 kcals)Healthier Home Breakfast
Fiber, Sugar, FatAppropriate Portion Sizes
Before School ProgramHealthier School Breakfast
Fiber, Sugar, FatAppropriate Portion SizesIncreased Fresh Fruits Breakfast Coordinator
Reinforcing Environments
Home Environment (~15 kcal)Parent Newsletter w/ couponsGrowth Reports Screen TimePromotional Gifts
Community EnvironmentCommunity “Champions”Restaurant ParticipationPediatrician Training & SupportCommunity TV AppearancesEthnic Group OutreachCommunity PA Resource GuideCommunity Events
At homeSafe Routes to School Maps Walking Home (-30 kcals)Healthy Home Snack Fiber, Sugar, Fat
After School ProgramCurriculum:
Cooking LessonsPhysical Activity (-30 kcals)Nutrition EducationProfessional Development
Classroom Micro UnitsPhysical Activity (- 25 kcals) 5 days/wk (10 min)Nutrition & Physical Activity Education 1 day/wk (30 min)
Healthier Fundraising Alternatives
Professional DevelopmentTeachersAdministratorsFood Service StaffPE Teachers
Physical Activity Equipment for Recess Physical Activity (- 25 kcals)
Healthier School LunchFiber, Sugar, Fat
Increased Fresh Fruits & VegetablesAppropriate Portion SizesImproved Presentation and AtmosphereSocial Marketing in CafeteriaAlternative “Healthier” A La Carte ItemsNew Food Service Equipment
(~25 kcals)
Home:Parent, Child, Family
Home:Parent, Child, Family
Home:Parent, Child, Family
School:Child, teachers, administration, staff
School:Child, teachers, administration, staff
School:Child, teachers, administration, staff
Community:After school programs
Community: Ethnic groups
Local Government
Health Care System
Community: RestaurantsMedia
RESULTS: BMI z-score at 4 time points
N = 922
Year 1 Change
Intervention vs. Control 1 + 2
Estimate -0.1005
P = 0.0011
N = 1178
Fall 2004
Spring 2005
Fall 2003
Spring 2004
BMI z-score
Year 1 Change
Intervention vs. Control 1 + 2
Estimate -0.1005
P = 0.0011N = 1178
Obesity 2007;15:1325-
1336
2 Year Change
Intervention vs. Control 1 + 2
Estimate -0.0573
P = 0.0054N = 1028
Prev Med 2013
Oct;57(4):322-7
Table 2-Adjusted differences in behaviors between intervention and combined control communities after 2-year intervention period Baseline After Intervention
Pre–Post Change: Adjusted Difference1
Model Properties Behavior Control
Group Intervention
Group Control Group
Intervention Group
n
Mean (SD)
n Mean (SD)
n Mean (SD)
n Mean (SD)
Effect (95% CI)
p-value additional covariates
R2
Fruit & vegetable (servings/day)
317 3.1
(1.5) 103
3.5 (1.6)
317 3.4
(1.6) 103
3.7 (1.8)
0.16 (-06,0.38)
0.09 parental foreign born status, # siblings 0.18
Sugar-sweetened beverages (ounces/day)
265 6.5
(6.0) 72
6.1 (6.3)
265 7.6
(7.0) 72
5.5 (6.7)
-2.00 (-3.76,-.25)
0.04 # rules 0.21
Sports (# per year)
343 2.9
(2.8) 111
3.6 (2.9)
343 3.4
(2.7) 111
4.0 (2.9)
0.20 (0.06,0.33)
0.02 0.21
Walk to/from school (# trips per week)
248 2.7
(4.0) 87
3.5 (4.1)
248 2.6
(3.9) 87
3.9 (4.2)
0.65 (-0.53,1.82)
0.14 parent marital status, maternal BMI 0.20
TV time (hrs/day)
325 2.2
(1.1) 104
1.6 (1.1)
325 2.2
(1.0) 104
1.7 (1.2)
-0.24 (-0.51,0.04)
0.06 # rules 0.27
Total screen time (hrs/day)
332 3.8
(1.8) 106
2.7 (1.6)
332 3.9
(1.9) 106
3.0 (2.2)
-0.24 (0.42,0.06)
0.03 parent marital status, # siblings, #
rules 0.22
TV in bedroom2 (% yes)
250 50.4% 85 29.4% 250 54.8% 85 31.8% 0.39
( 0.11,0.89) 0.13
child weight category, # siblings, maternal BMI
--4
Dinner with TV3 (% not very much/never)
337 61.4% 110 73.6% 337 62.0% 110 71.8% OR 0.94
(0.88, 1.00) 0.06
--4
Folta S, Kuder J, Goldberg J, Hyatt R, Must A, Naumova E, Nelson M, Economos C. Changes in diet and physical activity resulting from the shape up Somerville community intervention BMC Pediatrics.2013, 13:157.
RESULTS: 2 Year behavior Change
• Developing an understanding of the whole system is a critical first step in tackling the problem more effectively
• A systems perspective recognizes that a complex, reciprocal, interdependent, and interactive relationship exists between individuals and their environment
• The complex, multifaceted etiology of obesity necessitates comprehensive systematic approaches to obesity prevention
• Highlights the importance of the circumstances in which an event occurs (the context), in order to understand the potential implementation and impact
• Maps out the processes and mechanisms that are needed to change and alter the social relations that are damaging to health
Using a Systems-Oriented Approach
The Dynamics of Community Change:The Shape Up Somerville Experience
• To describe the key aspects and dynamics of social change within the community of Somerville over 10 years
• Retrospective examination of the SUS model using a systems perspective in an effort to create a framework that may help guide future community-based childhood obesity prevention interventions– qualitative systems analysis informed by individual and group
interviews with key SUS stakeholders and researchers
• To illustrate through the integration of the socio-ecological model (determinants) and community-based participatory research methods (approach) by visualizing the process using a systems perspective (process).
Catalyst and drive the necessary systemic changes to reverse the
trend of childhood obesity within one generation’s time
Improve children’s energy balance by 150 calories per day
Mission Goal
• Engage high-level leadership across sectors, using the best evidence, to design and implement large scale initiatives
• Blend the rigor of science with the urgency and innovation of business to spur lasting change at a national level
Approach
Diverse and impactful initiatives
Healthy Kids Out of School
Restaurant Initiative
Healthy School Breakfast
Active Schools Acceleration
Project
Implement nutrition and
physical activity
principles
Increase quality physical
activity in schools
Reduce excess calories
consumed in restaurants
Evaluate impact of
breakfast in the classroom
Key Criteria
Evidence Base
Scale Equity Impact Feasibility
Multi-Sectoral
Contribution
Time to Results
ChildObesity180 helps to improve a child’s energy balance by 150 calories per day
Systems modeling – ROI (cost effectiveness) – Collective Impact: confirms direction
Accelerating the MovementIncrease quality physical activity
in schools as a means to combat childhood obesity and evoke the beneficial health, behavioral, and academic outcomes that follow.
4-Phase Approach:> identify> replicate (we are here)
> scale> sustain
PhysicalActivityInnovationCompetition
> UNCOVER the very best approaches to school-time physical activity CELEBRATE & REWARD
champions for the cause from around the country Partnered with
Where do you find innovation?
Fresh Approaches to All School Activity
Students at Red Hawk Elementary participate in an all-school movement break.
Where do you find innovation?
In the ClassroomStudent at PS 102 in East Harlem demonstrate a Just Move classroom break.
Where do you find innovation?
Before SchoolStudents from Simon Elementary, Ward 8, Washington DC enjoying the BOKS program before the bell.
Where do you find innovation?
Fresh ChallengesKids in Corona, CA accept the challenge to run or walk 100 miles over the school year in the 100 Mile Club.
Where do you find innovation?
Inspired ChampionsMom Apryl Krakovsky leads Overland Elementary students through a daily 15 min. morning energizer.
> 23K unique visitors
> 2063 schools registered
> 1203 completed, submitted applications
> 6500 new champions added to ASAP network
1002 grant recipients named in all 50 states
- $1000 each = $1 million
Campaign Outcomes
Program Mix
Just
Mov
e
0
100
200
300
400
500
600
700
100
Mile
Clu
b
BOKS
Adm
inis
trat
or
Campaign Outcomes
Champion Mix
PE Tea
cher
Teac
her
050
100150200250300350400450500
Pare
nt
Nur
se
Oth
er
> 23K unique visitors
> 2063 schools registered
> 1203 completed, submitted applications
> 6500 new champions added to ASAP network
> 1002 grant recipients named in all 50 states
Evaluating Impact
OBJECTIVE: Gain understanding of PE/PA environment before / after ASAP program implementation
STUDY DESIGN:• Survey among all 1000 ASAP schools: baseline,
mid-course, year-end
• Physical Activity questions related to:• Support / Policy• Opportunities / # minutes/day• PE teacher professional development• Implementation of ASAP program• Student fitness assessment
Evaluating Impact
OBJECTIVE: • Evaluate impact 100 Mile Club & Just Move have on
school-time & daily MVPA
STUDY DESIGN:• 6 100 Mile Club, 6 Just Move & 6 control schools
• 20-40 students/school (grades 3-5)
• Two evaluation periods: Fall ‘13 & Spring ’14• Height/Weight • Accelerometry (7 days)• MCAS scores (May ‘13 & May ‘14)
What’s Next?
Create 10X impact
From 1,000 to 10,000 schools
www.childobesity180.org