MCHB EPI Atlanta Conference
 
December 5 - 7, 2006

How to Meet the Challenge of Childhood Obesity

CATH Y THOMAS: Good morning. We’ve heard from Dr. Deets about the problem. We’re all too aware of the childhood overweight obesity epidemic, the loss of productivity, and the drain on our healthcare costs and the shortening lives of our youngest citizens. We believe at North Carolina, the time is now for action. Perhaps it was 10, 20 or 30 years ago, but certainly now it’s time for us to all get on the same page, and begin to really look at creating a landscape for eating smart and moving more works for not only our children, but with the families in which they live.

In North Carolina we have many people and partners working together, and I’m proud and pleased to share today with you for a few minutes some of that work. And to thank the conference for inviting me to be a part of this very esteemed panel. So a view from a state, how North Carolina addresses overweight.

In North Carolina, we have over 70 organizations focusing on eating smart and moving more. It is the collective brainpower of our state partners, healthcare, the universities and our locals. North Carolina has a 100 county structure, and we are reaching out to all 100 counties.

I would like to discuss with you this morning some of the programs that are hanging in their hat under the Eat Smart, Move More umbrella in North Carolina. And I’ll also capture for you some of the impact of those programs, and some of the collection data systems that we’re employing in North Carolina.

This is a copy of the cover of our state plan just released in August. Trust for America’s Health chose North Carolina to have their national summit. So we were pleased to release our newest state plan. It’s very unique, it’s a 28-page document, and we’ve actually had people say they actually read it. Imagine that, reading a state plan. It’s an odd shape, a shape like the logo and it’s bright green, and it’s hard to miss on your desk. But what is even more unique about the plan is that the partners who wrote the plan said, “You know what? We don’t need to put anybody’s logo on this state plan. If we really want everybody to pick up this plan and use it, then we don’t need to put anybody’s name on it, so everybody can put their name on it.”

So if you go to our website, eatsmartmovemorenorthcarolina.com, you can download the plan, and if you’re a partner, you can slap your logo on the state plan. We finally realized that a lot of organizations spend a lot of time planning the plan, and coming up with what they’re going to do. And we decided, wouldn’t it be great if we all just got our arms around one plan and just began pulling our resources and really began working on the issues.

We use a socio-ecological model in our plan and all of our work in North Carolina, and I’m sure you agree; this is the way to approach any of our intervention work.

Inside our plan we have evidence-based strategies that promote healthy way and reverse the obesity epidemic, and in the absence of evidence-based strategies, we point to what the research is suggesting are the best strategies. We have three categories: policy and environmental change; for the nice lady who ask about policy approaches. Individual and family strategies, as well as community and school.

Eat Smart, Move More looks at a number of settings and here they are today. Don’t panic. I’m not going to talk about all of these, but just the ones that really do relate to childhood overweight. But if you have an interest in any of these arenas, I invite you to go to the website and learn more. We have brand new resources in the faith arena, as well as work site.

So let’s begin with pre-school. NAPSAC stands for Nutrition And Physical Activities, Self-assessment for Childcare. A project has been funded via CDC, the work has been done with out partners over at UNC Chapel Hill, Dr. Alice Ammerman and Dr. Dianne Ward, and many partners from the Division of Public Health. It is simply what it says, it is an assessment tool for childcare providers to use to assess nutrition and physical activity settings, opportunities in their child care settings. Some of the results have been pretty simple, but quite astounding for the childcare providers who hadn’t really looked at these settings. For example, one childcare setting realized that the drink machine was sitting in full view of the kids. All they did was move it to the back of the childcare center. Another childcare center realized that on rainy days and bad weather days, they had nowhere for the children to play inside. Seems pretty simple, doesn’t it? Well guess what, they created a setting in the childcare facility so that the kids could play even on the bad weather days.

Our flagship program in North Carolina for working with the pre-school population is Color Me Healthy. It was developed for 4 and 5 year olds and it really looks at making physical activity and healthy eating fun for our pre-school population. It is carried out in North Carolina or delivered to our locals by a unique partnership. We in North Carolina have local health promotion coordinators in all of our 100 counties, and they team up with our local cooperative extension agent also in the county. So many of the programs you’re going to hear about today, we bring together those two county partners together, we train them, and then they go back to their communities and carry out the programs and deliver the tools.

To date, North Carolina has been delivered to over 6,000 childcare providers and Head Start and family daycare settings, and right now, Color Me Healthy is being used in over 40 other states.  Moving on to our school setting, couple of years ago some of the partners came together and said, “You know, we need to create standards for foods available in school” and we really want to target, those high fat, high calorie, ala carte items that seem to be dominating what our kids are buying in school. So we created the standards that you see here. What has happened, I think, is a result of those because these standards were voluntary only. But I’m proud to say that two months ago, the North Carolina State Board of Education passed its first child nutrition standards that are now being mandated as a result of this suggested standard document. The partners enjoyed the momentum of the Eat Smart standards on the hills, so they’ve got busy and created the recommended standards for physical activity, really looking at physical activity and physical education opportunities in our schools and really looking at the correlation between academic progress and physical activity. So we have another tool out there for parents, teachers, administrators; anyone interested in promoting more physical activity in schools can look at these recommended standards. These too are on the website, if you have an interest in seeing what we suggested to our local LEAs, please go to the website.

We’ve also created a tool called Cyber Shop. We realized several years ago that, you know there are those P.E. teachers that really did want to teach health education much less physical activity and healthy eating, and they really didn’t have anything. So we created a multimedia CD-ROM for high school students that really looks at nutrition and physical activity. It can be used in the classroom or in a self-pace setting. It has a virtual cafeteria, a virtual fast-food court, really looks at body dimensions, all the hot buttons that our kids really resonate with. We have an exciting new social marketing campaign. I bet a lot of you are hearing about social marketing in your states, really looking at school board members and PTA members that really have a sphere of influence over the new school wellness policies states had been told they must implement.

We in North Carolina also have SHAC chairs. These are school health advisory committees that are mandated as a result of a policy passed by our state school board. These SHAC’s, PTA members, and school board members can be very influential in passing school wellness policy. So we’re very excited about this campaign and we’re mimicking a study that was done in California with the Project Lane. Doing a few modifications in North Carolina, but look forward to sharing more results as we move through this campaign.

Now, taking a look at the home setting, these partners came together—oh gosh, I guess it’s been about a year ago to look at family’s eating smart, moving more. Realizing that we just needed those simple messages back out there. Some of us call this Curriculum Home Ec 101. Everything they never knew or everything they knew and they forgot. It looks at eating smart at home, families eating smart on the run, moving more everyday, everywhere, moving more and watching less. We are amazed at the way this curriculum is being used. It’s being used in Weight Clinics, Wise Woman Clinics, it’s being used out in communities, anywhere there’s a preformed group. And probably the most exciting group is using families or some family docs in the state that are piloting using the curriculum. They’re actually referring families, moms, family members to cooperative extension agents who are actually teaching the classes in the communities. So if the doc says it, that’s what they do. And so the curriculum has been very well received in that arena.

Families Eating Smart, Moving More was so popular our EFNP partners also and cooperative extension came to us and said, “The EFNP, Expanded Food and Nutrition Program, needed a new curriculum, and could we come and help?” So Families Eating Smart turned into a new 22-curriculum program that’s being used by our EFNP audience in North Carolina, also in Virginia and West Virginia.

So I thought it would be fun to show you one of the clips from one of the particular programs. Each of the lessons comes with a PowerPoint clips and collaterals that go with really teaching people to adopt healthy behaviors, reduce TV time and get moving. So here we go with one of the clips.

?FEMALE SPEAKER??: Welcome to the original fast-food place. The kitchen, that place in your own home. Most of us tend to think a fast food is food you get somewhere else. And there are times when the fun and convenience of having a meal out make perfect sense. But you want to talk fast. How is that for fast food? Often the reason we give for heading out to eat rather than preparing a meal at home is we don’t have time. But, in the time it takes to get out, get there, get parked, get in, get in line, get food, get there, and get home, you could prepare a satisfying, simple meal at home. You and your family can eat better with less fat, fewer calories, and more fruits and vegetables. Even if you try to choose wisely at a restaurant, it’s harder to eat healthy. And besides, it costs a lot less to eat at home.

??CHILDREN SPEAKERS: Come on. We’re ready to eat.

FEMALE SPEAKER: Moving on to the healthcare setting, we have a great relationship with the North Carolina Academy of Family Physicians who wanted to create a tool to give to their patients, kind of a starting-the-conversation tool. They liked what they saw in the cyber shop CD where it had a fast-food court of all your favorite fast-foods with the tote board where you could actually pick options. So we created fast food in families for those family docs to give to their patients. Not to say that they couldn’t eat fast food, but there were better ways to make healthier options. So this is also a part of our fast food and families curriculum and it’s very, very popular.

Speaking of those family physicians, we know--like I said earlier, if the doctor says it or the minister says it, people are more likely to do it. So we have a writeable PDF that our family docs in North Carolina can take and modify, and actually ask the parents and family members to adopt one of the big five behaviors, or they can wipe off the big five behaviors and write a prescription for the family member to go to one of the Families Eating Smart, Moving More classes. The physicians are having a lot of fun with it and we love the credibility behind the physician giving this message. State wide there’s a lot going on. We just are finding tremendous success around our website: eatsmartmovemorenc.com, if you choose to go there. We are averaging about 17,000 hits a month. Webmaster told me Monday, we had had recent hits from Siberia. So you just never know. It’s particularly popular right now because we can see up in the left corner, we have the holiday challenge that started three weeks ago. Eat smart move more maintain don’t gain because we know we all gain those five or six pounds around the holidays. And we’ve had over 2,000 people sign up, give us data Dr. Deets; of height and weight, and we’re collecting some great information and data on people who are signing up for the holiday challenge. And for 10 weeks, I get weekly emails and really motivating ideas and thoughts about maintaining and not gaining during the holidays. We have a tremendous communications campaign with the big six messages we call them. You can see the six messages. Prepare more meals at home, right size your portion, taming the tube, breastfeeding, rethinking your drink, and enjoying fruits and vegetables. So you see the billboards?

Print ads. Print ads have appeared everywhere from the North Carolina medical journal to church bulletins. Radio spots are available with the messages, TV ads as well. And I’m very excited to tell you that in February, when NASCAR starts, we’re going to be airing commercials brought to you by Kasey Kahne for Eat Smart, Move More.

You might go, “Why NASCAR?” Well, a couple of years ago we were approached by some leaders who said, “Hey, you guys need to get an athlete to really say an Eat Smart, Move More messages.” And we kind of bristled because we want Eat Smart, Move More to be something that everybody can do just not athletes, but we went and used our present data, and found out to really reach North Carolinians and a lot of you folks out there was to tag on with NASCAR. So quickly, I’m going to show you one of the quick ads that Kasey is going to do for us coming in February.

KASEY KAHNE: Everything moves fast in racing, but when we’re thirsty and in a hurry, we don’t cut corners on refueling. I’m Kasey Kahne asking you to make healthy decisions. Pass on the sugary stuff. Refuel with water instead. You’ve got a choice. Rethink your drink. Eat Smart, Move More, North Carolina.

FEMALE SPEAKER: So the men go, “Yes,” and the women go, “Isn’t he cute?” So in closing, and certainly not to speak that it’s insignificance as the way we collect data. And Dr. Paul Busher, who is head of our state center, is at the meeting and Najma Chouhdury with our Women and Children’s Health Program, our epidemiologists are here, and they can certainly answer questions for you throughout the conference. Our PAN Monitoring Form, it’s a 13-question, hardcopy questionnaire that can be used in multiple settings. It looks at behaviors like soft drink consumption, fruit and vegetable consumption, and we use this data in targeting our interventions and really making change in communities and responding to childhood overweight.

NCNPAS, the North Carolina Nutrition and Physical Activity Surveillance Study, collects height and weights from children seen in our public health clinics, child health clinics, and our school-based health clinics. It really, really begins to give you a thumbnail of what’s going on, and our counties is really like this because it’s really local data that they can really use.

CHAMP, Child Health Assessment Monitoring Program. The beauty of CHAMP is it provides us now with this seamless surveillance system in North Carolina where we can really look at all the kids. And so, CHAMP has been most interesting because it’s fascinating to see how parents really don’t perceive there’s a weight issue or that kids are watching too much TV.

PAN Progress Check, we use with our local health promotion coordinators. Once they devise their action plans, they report their data through PAN Progress Check.

And lastly, I want to tell you about our county profiles. We did these in August, and we pulled the data from our PAN Progress Check, and really put together a one pager for all the counties to use when they’re going to speak with decision makers about this is our problem, this our success, and we really do need you to engage in this conversation.

We, in North Carolina are all about partnership because we believe it’s going to take all of us working together. It’s been a privilege to be with you today, and anything I’ve talked about the day you could find more about on the Eat Smart, Move More website. Thank you.