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Healthy & Fit: A Community Action Plan for Franklin County Children & Families E X E C U T I V E S U M M A R Y

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Healthy & Fit:A Community Action Plan forFranklin County Children & Families

E X E C U T I V E S U M M A R Y

Commissioned by:

Osteopathic Heritage Foundation

Richard Vincent, President & CEO

Terri Donlin, Director of Programs

1500 Lake Shore Drive, Suite 230

Columbus, OH 43204

www.osteopathicheritage.org

Community Planning Conducted by:

Children’s Hunger Alliance

William J. Dolan, Chief Executive Officer

Dianne Radigan, Chief Operating Officer

J.D. Beiting, Special Projects Manager

370 South Fifth Street

Columbus, OH 43215

www.childrenshungeralliance.org

The Ohio State University

College of Human Ecology

Dr. Gail Kaye, PhD, RD

1787 Neil Avenue

Columbus OH 43210

Vision Franklin County children, especially those most

at risk, will be fit and have healthy weights as a result

of long term, dynamic communitywide efforts to

create effective, child focused and family centered

programming and environments.

Mission To create an environment that supports life-long,

healthy food and fitness behaviors in Franklin County

children through the efficient and effective coordination

of community resources.

Healthy & Fit:A Community Action Plan forFranklin County Children & Families

Acknowledgements i

Guiding Concepts 1

Prevalence Data 2

The Process 4

The Findings 5

Strategies for Providing 7

a Healthy Food and Fitness

Environment for Children

Continuing the Effort 9

Conclusion 10

Logic Model 11

T A B L E O F C O N T E N T S

Leadership Council

• Lisa Courtice PhD, The Columbus Foundation

• William J. Dolan, Children’s Hunger Alliance

• Terri Donlin, Osteopathic Heritage Foundation

• Jewell K. Garrison, Columbus Medical

Association Foundation

• Janet Jackson, United Way of Central Ohio

• John Jackson, Cardinal Health

• Gail Kaye PhD, The Ohio State University

• Teresa Long MD, Columbus Health Department

• Robert Murray MD, Children’s Hospital

and Abbott Laboratories

• Dianne Radigan, Children’s Hunger Alliance

• Arlene Shoemaker, Franklin County Commissioner

• Charleta Tavares, Columbus City Council

• Susan Tilgner, Franklin County Health Department

• Richard Vincent, Osteopathic Heritage Foundation

Key Stakeholder Survey

Design and Adult Focus Groups

• Gail Kaye PhD, The Ohio State University

• Ana Claudia Zubieta PhD,

Consultant to The Ohio State University

• Claudia Byrne, The Ohio State University

Extension Office

Child Focus Groups

• Leesa Martin, Abbott Laboratories

• Nancy Fritz, The Fritz Group

Survey Design Expert Committee

• Michelle Vander Stouw, United Way of Central Ohio

• Lynnette Cook PhD, United Way of Central Ohio

• Roberta Garber, Community Research Partners

• Kathy Cowen, Columbus Health Department

Nutrition Expert Committee

Facilitated by: Gail Kaye PhD,

The Ohio State University

• Robert Murray MD, Children’s Hospital

and Abbot Laboratories

• Angie Norton, Ohio Department of Health

• Gina French MD, Children’s Hospital

• Shelly Roth, Children’s Hunger Alliance

• Misty Davis, Columbus Public Schools

Physical Activity Expert Committee

Facilitated by: Diane Barnes,

Columbus Public Schools

• Jackie Goodway PhD, The Ohio State University

• Michelle Park, Ohio Parks and Recreation

• Dannell Haines, The Ohio State University

• Monica Turner, YMCA of Central Ohio

Cultural Diversity Expert Committee

Facilitated by: Manisha Maskay PhD,

Columbus Health Department

• Olivia Thomas MD, Children’s Hospital

• Eric Troy, Eternal Sports

• Sylvia Wooden, New Fellowship of

Christians Church

• Hannah Dillard, The Mayor’s Office –

City of Columbus

• Hugo Melgar Quinonez, The Ohio State University

Marketing and Media Expert Committee

Facilitated by: Ray Caruso, The Center

for Participative Leadership

• Pete McGinty, Experience Columbus

• Kim Kelly-Bartley, White Castle System, Inc.

• Julie Carrier, Ohio Food Industry Foundation

• June Wedd, American Dairy Association

& Dairy Council

Acknowledgements

The Osteopathic Heritage Foundation and

Children’s Hunger Alliance thank those who helped

contribute to the community planning process:

i Healthy & Fit: A Community Action Plan for Franklin County Children

Strategy Team Members• Mary Beth Arensberg, Abbott Labs-

Ross Products Division

• Cresha Auck, American Heart Association

• Lynne Ayres, Foundation for Healthy Communities

• Gail Baker, Central Ohio Restaurant Association

• Diane Barnes, Columbus Public Schools

• Diane Bennett, Action for Children

• Andrea Cambern, WBNS-10 TV, Inc.

• Tom Carlisi, The Winners League

• Marie Carmen Lambea, Ohio Hispanic Coalition

• Julie Carrier, Ohio Food Industry Foundation

• Vonda Castro, Communities in Schools

• Suzanne Christman, Dietetics Association

• Diane Conley, Westerville City Schools

• Linda Day Mackessy, YMCA of Central Ohio

• Hannah Dillard, City of Columbus

• Rosalyn dePalo, Osteopathic Heritage Foundation

• Pam Early, South Western City Schools

• Mike Eiland, ClearChannel Radio

• Lynn Esselstein, Ohio Dietetic Association

• Mary Ey, Columbus Public Schools

• Josephus Foster, Fountain of Hope

• Chuck Gillespie, WSYX ABC 6

• Humberto Gonzalez, Legg Mason

• Cheryl Graffagrino, OhioHealth

• Jeanne Grothaus, Central Ohio Diabetes Association

• Peg Hanley, Metro Parks

• Sidney Hargro, The Columbus Foundation

• Sloan Harl, G & J Pepsi Co.

• Judy Hatcher, Columbus Metropolitan Area

Community Action Organization

• Dudley Hawkey, Columbus Public Schools

• Cheryl Hay, Greater Columbus Chamber of Commerce

• Laura Hill PhD, The Center for

Eating Disorders & Psychotherapy

• Alan Huff, Neighborhood House

• Mattie James, Child Development Council Head Start

• Saunie Jones, White Castle System, Inc.

• Kim Kelly-Bartley, White Castle System, Inc.

• Mary Kershaw, The Ohio State University

Extension, Franklin County

• Betsy Loeb, Action for Children

• Manisha Maskay PhD, Columbus Health Department

• Pete McGinty, Experience Columbus

• Pat McKnight, Mount Carmel College of Nursing

• Hugo Melgar-Quinonez, The Ohio State University

• Karen Morrison, OhioHealth

• Sara Neikirk, Communities in Schools

• John O’Meara, Columbus Metro Parks

• Joy Parker, Mount Carmel Outreach

• Kellee Patterson, Children's Hospital

• Dave Proctor, Columbus Metropolitan Area

Community Action Organization

• Nancy Rini, Columbus Public Schools

• Laura Rooney, American Cancer Society,

Ohio Division

• Shelly Roth, Children's Hunger Alliance

• Gary Serelson, Columbus Recreation & Parks

• Vicky Steck, Sanese Services

• Maggie Summers, United Way of Central Ohio

• Mari Sunami, Southside Settlement House

• Jason Tinch, Directions for Youth

• Carol Trowbridge, YWCA

• Eric Troy, Eternal Sports

• Michelle Vander Stouw, United Way of Central Ohio

• Steve Votaw, Directions for Youth

• Noreen Warnock, Greater Columbus Foodshed Project

• June Wedd, American Dairy Association

& Dairy Council

• Vanessa Williams, Greater Columbus

Chamber of Commerce

• Jerome Willis, Trinity Baptist

• Julie Winland, Columbus Public School Nurses

• Greg Winslow, American Heart Association

• Heather Witt, Columbus Medical

Association Foundation

• Sylvia Wooden, New Fellowship of Christians Church

• Sally Yurchuck, United Way of Central Ohio

iiHealthy & Fit: A Community Action Plan for Franklin County Children

1. Research and evidence-based,

effective programming will be at the

core of the efforts.

2. The plan will be guided by strong

leadership and provide for input from

a variety of community sources.

3. It is critical to remain sensitive to

the needs and beliefs of the varied

cultures in Franklin County.

4. The plan will build upon existing

services, expanding and enhancing

organizational capacities

where appropriate.

5. Collaboration is essential in this

multi-faceted, multi-sector approach

to influence policy, expand programs

and make a significant impact.

6. Community members, especially those

in under-resourced neighborhoods, must

be involved in the developmental and

interventional processes.

7. The role of parents must be recognized

and respected.

8. Communication efforts will be simple,

consistent and evidence-based.

9. The plan will be dynamic, evolving

as new evidence, models and

programs emerge.

10. An effective leadership structure

is necessary to sustain a unified,

consistent and successful community

wide effort.

11. Quality outcomes measurement

is necessary to demonstrate impact.

Executive Summary

G U I D I N G C O N C E P T S

The Osteopathic Heritage Foundation,

aware of and concerned about the growing

prevalence of overweight children in

Franklin County, earmarked foundation

funding to address the issue. Thus began a

process to create a comprehensive community

plan based on primary research and literature

review, as well as local leadership and

community input from a variety of sources.

A socio-ecological model was utilized to

identify and develop strategies to fully

engage those who are in the position of

influencing nutrition and fitness choices

of our youth and families.

A Leadership Council was convened to

provide insight, establish guiding concepts

and develop a vision and mission for the

effort. The Leadership Council included

representatives from the Osteopathic

Heritage Foundation, Columbus Medical

Association Foundation, Columbus

Foundation, United Way of Central Ohio,

Columbus and Franklin County health

departments, Cardinal Health, The Ohio

State University, Columbus City Council,

Franklin County Commissioners and

a pediatrician. Children’s Hunger

Alliance facilitated the process.

1 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

Franklin County

zip codes with

highest prevalence

of overweight adults.

Obesity has risen to epidemic levels in the U.S. It leads

to devastating and costly health problems and reduces life

expectancy. Obesity is a significant risk factor for serious

conditions such as type 2 diabetes,

heart disease, certain cancers and

is associated with depression and

several other medical conditions.1

The economic impact of obesity

has grown dramatically. In 2000,

the total cost related to obesity –

including both health care and

expenses and the loss of productivity

– was estimated to be $117 billion

($61 billion direct and $56 billion

indirect).2 This estimate of cost

is 9.1% of total US health

care expenditures.

According to the 2000 Franklin County/Columbus Health Assessment, the highest

prevalence of overweight adults is found in the following urban zip codes:

Downtown Columbus 43215 5. 43211 = 69.3%

3. 43219 = 70.0%

1. 43203 = 71.7%

43205 = 64.2%

43206 = 62.3%

6. 43232 = 66.4%

4. 43207 = 69.6%

2Healthy & Fit: A Community Action Plan for Franklin County Children & Families

The Prevalence Data: Health Implications for Obesity on the Rise

2. 43223 = 70.3%

Obesity in adults is stated in terms of body mass

index, (BMI), a measure defined as weight relative to

height (kg/(m2)). In adults, being overweight is defined

as a BMI ≥ 25, and obesity as a BMI ≥ 30.

A 5’10” man’s, healthy weight

would be 130-179 pounds (BMI of 19-24).

He would be considered overweight at

180-209 pounds (BMI of 26-29). At 210

pounds or more, he would be considered

obese (BMI 30 or higher). For Franklin

County adults in 2002, self reported

heights and weights indicated that 61.7%

of adults were overweight and 26% obese.

“I like to

jump rope,

jog, run,

play with

the dog.”

– 9 yr old female

The Prevalence Data: Health Implications for Obesity on the Rise

3 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

Over the past three decades, the rate of obesity has

more than doubled in pre-school children and adolescents.

It has more than tripled in children ages 6 to 11 years.3

The obesity trends are considered by many as

an epidemic.

The 2002 Franklin County Health Assessment

demonstrated that specific subgroups of children –

including girls, African Americans, inner city and

poor children – are disproportionately affected:

Determining overweight and “at risk” for overweight children

Age (in years)

4

8

12

16

Boys at 85thpercentile

(“at risk” foroverweight)

41 lbs.

68 lbs.

114 lbs.

165 lbs

Girls at 85thpercentile

(“at risk” foroverweight)

41lbs.

70 lbs.

118 lbs.

148 lbs.

Boys at 95thpercentile

(overweight)

45 lbs.

78 lbs.

130 lbs.

188 lbs.

Girls at 95thpercentile

(overweight)

45 lbs.

80 lbs.

135 lbs.

172 lbs.

In children, overweight and obesity (BMI) is calculated differently for boys than for girls.

Children are considered “at risk” for being overweight if they are at the 85-95th percentile

of children their age. Weight at or above the 95th percentile is considered overweight.

• 25% of Franklin County children are overweight,

compared to the national average of 16%

• 30% of Columbus children are overweight

• 41% of Columbus children living in the 100-200%

poverty range (household incomes of $18,850-37,700

for a family of four) are overweight

• 31% of girls in Franklin County are overweight

• 48% of Non-Hispanic African American

children are overweight

0

20%

40%

60%

80%

100%

18.4%

31.4% 29.1%33.2%

9.9%

35.6%41.3%

21.8% 20.9%

47.7%

BoyGirl

5/Under6 to 12

13 to 17<Pov

100-200% Pov>200% Pov

NH WhiteNH Afr. Am.

O V E R W E I G H T C H I L D R E N

Source: 2002 Franklin County Health Survey, Professional Research Consultants

Notes: 1. The definition of overweight is based on children’s Body Mass Index status above the 95th percentile of U.S. growth charts.

2. Asked among all parents of children under 18 at home.

3. It is important to use caution when interpreting the results since observed differences between demographic

groups may not be statistically different.

4Healthy & Fit: A Community Action Plan for Franklin County Children & Families

The Process: Developing a Community Action Plan

The collaborative effort brought together various service

providers and stakeholders involved in the nutrition and

fitness of youth in Franklin County. A Leadership Council

was formed, consisting of local foundation, corporate,

government and health leaders, to bring knowledge,

skills, and resources to the initiative. A Strategy

Team, with broad-based

membership across nine

community sectors, provided

additional advice and

knowledge to ensure an

assessment was conducted

in the most effective

manner. Expert Advisory

Committees provided

content in the areas of

survey design, nutrition,

physical activity, cultural

considerations, and social

marketing. The Ohio State University College of

Human Ecology provided faculty as well as undergraduate

and graduate student support for survey design, conducting

focus groups and interviews. The effort involved an

evaluation of community assets, best practices, model

programs and gaps in services. This led to the development

of a long-term strategic plan designed to overcome issues

and barriers contributing to the prevalence of overweight

children as well as to identify funding streams to support

strategic recommendations.

Assessment methodology included gathering data

and input from a variety of sources, including families,

schools, businesses, government, early childhood

providers, the food and fitness industries, the media,

the medical community and the faith-based community.

This was important as the intent was to identify major

contributing factors

from the perspective of

professionals, parents,

and kids. Results from

a Key Stakeholder Survey

revealed the actions various

community sectors can take

to address childhood over-

weight and the behaviors

contributing to the

trends. Parent Focus

Groups disclosed the

food and fitness behaviors

and barriers that contribute to the issue in various

neighborhoods. Sixteen Child Focus Groups provided

insight into youth food and fitness behaviors and

perceptions. National experts were interviewed, some

during visits to Chicago, San Diego, and Cleveland, to

learn more about successful strategies and programs used

in other cities. Also, a Literature Review assessing clinical

publications, quality evidence-based programming and

position papers provided substantial knowledge of the

contributing factors and potential opportunities for

addressing the childhood obesity epidemic.

“Raven said that it

is good for you to exercise.”

– 8 yr old female

5 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

The Findings: Behaviors Contributing to Overweight Prevalence

Addressing this health issue is complex

due to the genetic, cultural, socioeconomic,

psychological, and environmental factors

involved. Over several decades, these factors

have produced a gradual trend toward ‘energy

intake’ greater than ‘energy expenditure’,

resulting in more people being overweight.

The following findings are an indication

of this imbalance:

Nutrition• The average infant consumes 10-23% more calories

than the Estimated Energy Requirement 4

• Carbonated soft drinks account for more than 50%

of American children’s total beverage consumption 5

• In middle and high schools, 75% of the drinks and

85% of the snacks are of poor nutritional value 6

• The increase in portion size parallels the prevalence

of overweight and obesity 7

• When used as a reward, food usually tends

to be of low nutritional value 8

Physical Activity• Children attending daily physical education

dropped from 42% in 1991 to 32% in 2001 9

• 48% of girls and 26% of boys do not exercise

vigorously on a regular basis 10

• Children spend an average of five-and-a-half

hours a day watching TV and using media such

as computers and video games 11

• Exposure to media advertising and obesity

are positively correlated 12

• Televised advertising messages lead to

unhealthy eating habits, particularly for children

under eight years of age who are unable to

understand the difference between information

and advertised messages. 13

Environmental Findings• Many parents do not feel their children are safe

when they play outside 14

• Low-income families have limited access

to physical activity venues 8

• Low-income communities often have limited

access to nutrient-rich and low calorie foods 8

• Uninformed parents misjudge their children’s

weight status and misunderstand the health

implications of excess weight 14

• Children are more likely to have an active lifestyle

if their parents exercise with them 14

• Research confirms the need to deliver consistent

food and fitness messages that are positive, realistic,

make life easier and relate to alleviation of disease. 15

6Healthy & Fit: A Community Action Plan for Franklin County Children & Families

The Findings: Behaviors Contributing to Overweight Prevalence

From Vision to Resulting Key Behaviors:Once the factors and trends leading to

childhood overweight and obesity were understood,

a Socio-Ecological Model was applied to identify the

main sectors of the community that influence children’s

lives and behaviors. The model, used successfully by

other communities to achieve behavior change, identifies

groups that are key to achieving a change in youth and

family eating and physical activity habits.

Although the solution to the childhood overweight

epidemic may seem as simple as balancing the equation

of “energy in = energy out”, the issues are complex and

involve societal and individual behavior changes to

influence overfeeding and physical inactivity. Impacting

behavior changes throughout a community requires a

commitment from families, schools, faith organizations,

community organizations, the food and fitness industries,

the medical community, the media, and government.

Each sector must be involved in the sustained prevention

effort, providing programming and support as well

as communicating a consistent message about healthy

food and fitness behaviors.

A successful collaborative effort will result

in a widespread practice of six key behaviors for

maintaining a healthy and fit weight in children:

1. Children are active for at least 60 minutes every day

2. Infants and children gain motor skills for

lifetime activity

3. Children limit TV and video game/computer use

time to less than 2 hours a day

4. Parents and guardians provide infants and children

with nutritious, age-appropriate foods. Infants are

breastfed, when possible

5. Caregivers and schools provide children with

nutritious portions of food that meet energy needs

6. Children choose nutrient-rich foods and healthful

beverages that meet energy needs

Media Government

Food Industry

Neighborhood Environment

SchoolsMedical Community

Early Childhood Providers

AfterschoolTime/Faith-based

Societal Level

Community Level

Inter-personal Level

CHILD

Family

The Workplace

Policy

S O C I O - E C O L O G I C A L M O D E L

Following is a summary of how sectors identified in the Socio-Ecological Model

will fulfill their respective roles in ensuring Franklin County’s children are healthy

and fit. Detailed strategies are included later in this report.

7 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

LeadershipAn effective leadership infrastructure will sustain a

unified, consistent and community wide effort to provide

nutrition and physical activity resources for children.

This work will be done by a facilitating entity,

with guidance from the Leadership Council and support

from the Strategy Team, Expert Advisory Workgroups

and contracting strategic partnerships. This entity will

be instrumental in increasing awareness, engaging

stakeholders, generating

resources, implementing/

assisting others in

implementing programs,

and assessing and reporting

progress on food and fitness

behaviors. Work will include

creating a community wide

social marketing campaign

targeted at parents and youth

with positive messages from

many sectors; assessing the

cultural appropriateness

of programs; creating an

evaluation system to

measure effectiveness

of community programs; and continuing to

support consumer and best practices research

for effective programming.

The CommunityLocal government, food and fitness industries, and

community-based organizations will expand existing

efforts to provide healthy nutrition and physical activity

programs and venues.

Local government agencies have critical roles to

play and can make the health of children a priority by a)

helping to increase resources; and b) by supporting the

development of policies that promote access to healthy

food, and environments that foster physical activity.

Government agencies will partner to develop and

implement an integrated plan for Columbus and Franklin

County. The plan should be based on an assessment

of current status related to community access to

healthy food and opportunities

for physical activity.

The food industry will

increase access to and provide

information about healthy food

choices; develop educational

tools for grocers; provide

improved nutrition information

on restaurant menus; and

offer more nutritious foods

in restaurants, vending machines

and other food purchase venues.

The fitness industry will provide

convenient recreation and fitness

opportunities – especially to

underserved populations – by supplying resources

and in-kind support to communities.

By coordinating existing efforts and resources,

Community-based organizations, neighborhood

leaders and residents will improve access to food

sources, educate and deliver culturally appropriate

services to low-income families, and locally promote

a lifestyle of healthy nutrition and fitness.

Strategies for Providing a Healthy Food and Fitness Environment for Children

8Healthy & Fit: A Community Action Plan for Franklin County Children & Families

The Education SystemEarly childhood programs, schools, and after-

school programs will provide a positive environment

to help children gain skills, knowledge, and habits

for lifetime fitness.

Early childcare providers have a direct impact

at a critical age for developing life-long food and fitness

behaviors. Building on existing initiatives, childcare

providers will offer nutritious food, utilizing USDA

funded food and resources where possible, and will

schedule time for daily physical activity.

Schools will teach healthy eating and fitness

behaviors and will provide nutritious food and daily

physical activity, establish wellness councils, expand

federally funded school breakfast and lunch programs

and provide high nutritional valued foods in vending

machines. Schools will be encouraged to incorporate

BMI and related nutrition and fitness information in

routine health screenings, appropriately communicating

findings to parents and guardians. Schools will explore

the possibility of creating a “model school feeder system”

that bundles multiple interventions into one school

system. If successful, this feeder system can serve

as a model for future initiatives.

After-school programs, through existing initiatives,

will provide an environment and curriculum to support

nutrition education, healthy eating, utilizing USDA

funded food and resources where possible, and daily

physical activity.

FamiliesThe medical community, faith-based providers, and

employers will deliver effective programming, consistent

messages, and support to help families adopt healthful

food and fitness practices.

Physicians and other health providers have

significant influence and will offer families a broad

spectrum of advice, education and services. This will

include providing advice focusing on prevention and

education activities, intervention and referrals for the

co-morbid conditions of obesity including endocrine,

gastrointestinal, cardiovascular, nutritional, and sleep

conditions. Research will help identify best practices

in education, prevention, and intervention and these

best practices will be provided to physicians and they

will be encouraged to utilize family visits to promote

food and fitness behaviors.

Faith-based organizations will support the health

and fitness of their members by providing internal health

programs, group support services and positive messages

about the benefits of healthful food and fitness behavior.

Employers will provide information, incentives

and programs for workers to adopt healthful food

and fitness practices for their families. Employers

will be encouraged to adopt proven fitness programs,

supporting obesity prevention efforts with employee

incentives, and participating in the countywide

social marketing campaign.

Strategies for Providing a Healthy Food and Fitness Environment for Children

“Without family you

wouldn’t have any support.”

– 13 year old male

9 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

The future of this initiative has been

informed by the partners of the community

planning process over this past year. Their

recommendations describe an ongoing

leadership infrastructure to support the work

of all and facilitate funding, implementation

and evaluation of the effort. The key leadership

components of this community initiative

include the following:

Facilitating Entity• Each sector will be involved in the sustained

prevention effort, providing programming and

support as well as communicating a consistent

message about healthy food and fitness behaviors.

The facilitating entity will ensure that the effort’s

strategies stay focused, relationships are built

and maintained, additional funding is secured

and the evaluation and social marketing efforts

are informative as well as comprehensive.

Leadership Council• The role of the Leadership Council is to assure

the mission and vision are realized and to support

the initiative with time, influence and resources.

The Leadership Council will review progress, assure

resources and funding are utilized effectively and

a social marketing campaign, policy initiatives,

and evaluation are carried out.

Strategic Working Groups• Strategic working groups will develop more

specific plans for each sector, advise on plan content,

progress, additional needs, message/media, policy,

funding and evaluation components. Each committee

will be based on one of the following sectors:

• Government Agencies

• Education Systems

• Community and Faith Based Organizations

• Medical and Health

• Food and Fitness Industry and Corporations

• Marketing/messaging

Using the strategies from this report, the

leadership infrastructure will produce specific

and detailed actions aimed to promote positive fitness

behaviors. Collectively, the work of this infrastructure

will result in the engagement of the broader community

via a planned approach. It is a system that encourages

all sectors of the community to work in concert to

encourage good nutrition and physical activity and

to make resources available that support healthy

choices and quality lifestyles. Some of these actions

can occur immediately, while others will take longer

to implement. Overall, this leadership infrastructure

is adaptable to the ever changing needs of the

community effort to address obesity in

children and families.

Continuing the Effort

“… my kids are seeing it first hand now with

my mom being ill … then I had diabetes … I lost 30 lbs …

we are all more aware of what we eat.”

10Healthy & Fit: A Community Action Plan for Franklin County Children & Families

It is important to note the challenges

faced by the community in impacting

positive behavioral changes and reversing

the reported trends toward overweight and

obesity. Significant and measurable progress

will take years and will only occur with the

steadfast commitment of the partners that

have provided input into the definition of

the problem and requisite long-term strategies

to impact the health status of the community.

Just as changes in tobacco use have taken

generations, we believe to truly impact the

issue of obesity in children and families will

also take decades. This work, while well

planned and thoughtful, is a beginning

step in a long-term effort.

New partnerships, visions, and ideas are forming

as a result of the meetings of leadership and strategy

teams. A collective understanding of the severity of the

1 US Dept of Health and Human Services. Strategic plan for NIH obesity research. NIH publication no. 04-5493. August 2004.

2 DHHS (U.S. Dept of Health and Human Services). 2001a. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: Public Health Service, Office of the Surgeon General

3 Ogden CL, Flegal KM, Carroll MD, Johnson CL. 2002a. Prevalence and trends in overweight among US children and adolescents,

1999-2000. J Am Med Assoc 288(14): 1728-1732

4 Feeding Infants and Toddlers Study: What foods are infants and toddlers eating? J. Am Dietic Assoc. (2004) 104:S22-S30

5 Kennedy E, Powell R. Changing eating patterns of American children: a view from 1996. J Am Coll Nutr 1997;16:524-9

6 Carangelo C. Why are Americans so fat? Food Management. 1995; 30:63-68

7 Young LR, Nestle M. The Contribution of Expanding Portion Sizes to the US Obesity Epidemic.

American Journal of Public Health. 2002; 92:246-249

8 Chamberlin LA, Sherman SN, Jain A, Powers SW, Whitaker RC. The Challenge of Preventing and Treating Obesity

in Low-Income, Preschool Children. Arch Pediatr Adolesc Med. 2002;156:662-668

9 CDC, Youth Risk Behavior Survey, 1999

10 CDC, Youth Risk Behavior Survey, 1999

11 Roberts D, Foehr U., Kids & Media in America, (Cambridge, MA: University Press, 2004)

12 Kaiser Foundation. The Role of Media in Childhood Obesity. (Issue Brief, February, 2004: pg. 5)

13 Wilcox BL, Kunkel D, Cantor J, Dowrick P, Linn S, Palmer E. 2004. Report of the APA Task Force on Advertising and Children.

Washington, DC: American Psychological Association

14 The Robert Wood Johnson Foundation. Active Living, Diversity Project Report. 2003

15 The Robert Wood Johnson Foundation. Active Living, Diversity Project Report. 2003

problem, its impact on health, and mobilization of

the community to address it is realized now more than

ever. The common theme in key stakeholder gatherings

throughout this assessment process has been to shift the

social paradigm to a new direction, or create a “tipping

point” for healthier children and families. It is up to the

Franklin County community to advance the initiative

to the point where we can state with confidence that

our children and families are healthy and fit.

Contact Information:If you are interested in getting more information

about the content of this report and/or are interested

in participating in this community initiative,

please contact:

J.D. Beiting

Children’s Hunger Alliance

(614) 341 7700 x 219

[email protected]

Conclusion

11 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

L O G I C

Nutrition• The average infant consumes

10 to 23% more calories than theEstimated Energy Requirement16

• Carbonated soft drinks account for over 50% of American children’stotal beverage consumption17

• A survey of vending machines in middle and high schools reports 75% of the drinks and 85% of the snacks are of poor nutritional value18

• The trend toward larger portion sizes has occurred in parallel with increases inthe prevalence of overweight and obesity18

• Food is used as a reward, and usuallytends to be food of low nutritional value19

Physical Activity • The percentage of children attending

daily physical education dropped from 42% in 1991 to 32% in 200120

• A Centers for Disease Control andPrevention (CDC) survey reports 48% of girls and 26% of boys do notexercise vigorously on a regular basis.21

• Children today spend an average of five-and-a-half hours a day watching TV and using media.22

• At least 6 studies positively correlatemedia advertising and obesity 23

• The American Psychological Association recently concluded that televised advertising messages can lead to unhealthy eating habits, particularly for children under eightyears of age who are unable to criticallycomprehend advertised messages.24

Environmental Factors • Parents do not feel that their children

are safe when they play outside25

• Low income families have limited access to physical activity venues 26

• Low income communities often havelimited access to nutrient rich and low calorie food.25

• Uninformed parents misjudge their children’s weight status and misunderstand the health implications of excess weight 27

• Parents want their family to be healthy and do the right thing 27

• Children are more likely to have an active lifestyle if their parents exercise with them 28

• Research confirms the need to deliverconsistent food and fitness messages thatare realistic, make life easier, are positive,and related to alleviation of disease. 29

References for Contributing Factors are listed on following page

Leadership InfrastructureCreate an infrastructure representing all sectors to: • Sustain a unified, consistent communitywide effort• Increase awareness through a communitywide social

marketing campaign aimed at parents and youth• Engage stakeholders on an ongoing basis• Identify and generate resources to support the initiative• Evaluate the effort, and report progress on the food and fitness

behaviors of children• Continue and support research on best practices and

effective programming

The Community• Franklin Co., Columbus, and local municipal leaders:

• Increase resources and support policy to improve the food and fitness of children in schools and community

• Revise zoning and capital improvement plans for future developments to include spaces for recreation and physical activity

• Increase access to nutritious food venues, gardens, and markets• Increase access and program capabilities of parks, green space,

and recreation venues• Improve the safety of streets, sidewalks, and routes to school • Continue community health assessments• Provide resources for culturally appropriate services,

including social marketing • The food industry expands access to and delivers knowledge of healthy

food choices through industry and government educational programs• The fitness industry and government entities provides convenient

opportunities for regular recreation and physical activity for families • Community based organizations and neighborhood leaders expand

community gardens, educate and deliver services to help families develop a lifestyle of healthy food and fitness

The Education System• Childcare providers are trained using evidence-based nutrition and

physical activity programming, with assistance from content specialists.• Childcare providers offer nutritious USDA funded food and physical

activities on a daily basis• Schools, school agencies, parents and other stakeholders

form school wellness councils to guide food and fitness curriculum and environment in schools

• Schools teach healthy food and fitness behaviors and provide nutritiousUSDA funded School Breakfast, Lunch and physical activity daily.

• School Health Services incorporate BMI measurement, appropriate referrals and parent education into routine health assessments.

• Schools use evaluation tools to assess the quality of food they make available to students, and they offer nutritious choices.

• After school programs provide nutritious meals, nutrition education and physical activity programs that build skills, with assistance from content specialists.

• Explore possibility of creating a model school feeder system, that bundles multiple interventions into one neighborhood

The Family• Physicians and health professionals offer families a broad spectrum of

services including a primary focus on prevention and education programs• Expand medical treatment, intervention, referral and research

programs for childhood obesity • Faith-based organizations provide programs, support services and

positive messages about the benefits of healthful food and fitness behavior • The Workplace provides information, incentives and programs

for parents to adopt healthful food and fitness practices for their family

Contributing Factors Strategies

12Healthy & Fit: A Community Action Plan for Franklin County Children & Families

M O D E L

• All key sectors participate in influencing healthful food and fitness behaviors of children

• Multi-media messages result in healthy food and fitness behaviors of youth and families

• Continued assessment and evaluation leads to successful program interventions, and improved program outcomes

• Funding is secured to continue efforts that impact food and fitness of youth

1. Children are active

for at least 60 minutes

every day

2. Infants and children

gain motor skills for

lifetime activity

3. Children limit TV and

video game/computer

use time to less than

2 hours a day

4. Parents and guardians

provide infants and

children with nutritious,

age-appropriate foods.

Infants are breastfed,

when possible

5. Caregivers and schools

provide children with

nutritious portions

of food that meet

energy needs

6. Children choose

nutrient-rich foods

and healthful beverages

that meet energy needs

• The physical environment of Franklin County has safe neighborhoods for walking and exercising, accessible greenspace for recreation, free or low cost activity programs and venues, and access to nutritious food for all families

• Community coalitions and public health agencies use evaluation tools to measure the impact and availability of food and fitness activities and programs

• Grocery stores and restaurants sell healthy options, portion sizes equal to energy needs, and provide resources for nutrition and physical activity education for children

• Families receive neighborhood support and resources fromcommunity based organizations to live healthy and fit lifestyles.

• All Franklin Co. childcare centers and caregivers provide nutritious food and physical activity

• Wellness councils guide healthy school environments• Healthy breakfast and lunch programs are available

in all Franklin Co. schools • Competitive food venues offer nutritious options• Franklin County schools provide 30 minutes

of continual movement daily• Model school feeder system demonstrates multiple

interventions successfully improve the food and fitness behaviors of children

• All Franklin Co. after school programs provide nutritious food and healthy physical activity environment for children

• The medical community provides effective guidance to families to help children be fit

• Faith-based organization’s provide opportunities for healthy lifestyle activities

• The workplace becomes a supportive environment for parents to receive messages and programs about healthful food and fitness for their families

Future BehaviorsOutcomes

13 Healthy & Fit: A Community Action Plan for Franklin County Children & Families

16. Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers study: What foods are infants and toddlers eating?. JADA. January 2004, (S) 104:1

17. Kennedy E, Powell R. Changing eating patterns of American children: a view from 1996. J Am Coll Nutr 1997;16:524-9

18. Young LR, Nestle M. The Contribution of Expanding Portion Sizes to the US Obesity Epidemic. American Journal of Public Health. 2002; 92:246-249

19. American Institute of Cancer Research. New Survey shows Americans ignore importance of portion size in managing weight. Available at: http://www.aicr.org. Accessed October 27, 2000.

20. U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

21. CDC, Youth Risk Behavior Survey, 1999

22. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of physical activity and television watching with body weight and level of fatness among children: Results from the Third National Health and Nutrition Examination Survey. JAMA 1998;279:938-42.

23. Dietz, W and Gortmaker, S., “Do We Fatten Our Children at the TV Set? Obesity and Television Viewing in Children and Adolescents”, Pediatrics 75 (1985): 807-812

24. Kaiser Foundation. The Role of Media in Childhood Obesity. (Issue Brief, February, 2004: pg. 5)

25. The Robert Wood Johnson Foundation. Active Living, Diversity Project Report. 2003

26. Burdette HL, Whitaker RC. Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children. Preventive Medicine 38 (2004) 57-63

27. Crawford PB, Gosliner W, Anderson C, Strode P, Becerra-Jones Y. Counseling Latina Mothers of Preschool Children about Weight Issues: Suggestions for a New Framework. JADA (2004) 104:387-394

28. Chamberlin LA, Sherman SN, Jain A, Powers SW, Whitaker RC. The Challenge of Preventing and Treating Obesity in Low-Income, Preschool Children. Arch Pediatr Adolesc Med. 2002;156:662-668

29. Agrams WS, Hammer LD, McNicholas F. 2004. Risk factors for childhood overweight: A prospective study from birth to 9.5 years. The Journal of Pediatrics 145(1):20-25

R E F E R E N C E S T O L O G I C M O D E L C O N T R I B U T I N G F A C T O R S

“Our communities are going

to have to back each other up to make

a difference in the health of our kids.”

- Mother of 4 school age children