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Pediatric providers practicing in safety net settings—such as community health centers, free clinics, and public hospitals—face multiple and unique challenges when it comes to childhood obesity. First, they tend to care for more kids from low-income families, and since poverty and obesity are connected in multiple and complex ways,^1-5 providers working in a safety net setting must address poverty-related barriers to healthy lifestyles. Second, safety net facilities are often themselves cash-strapped as a result of having to rely on uncertain federal grants and decreasing Medicaid payments, which makes sustaining obesity programming very difficult.

Pediatric providers and other healthcare professionals can have different roles within obesity programs.   Some working in safety net settings are actively involved in conducting such programs, while others in more mainstream settings might refer patients and their families to these programs. For example, a 5-year old child who is overweight, a US citizen, and enrolled in Medicaid may be eligible for a referral to a private hospital’s pediatric fitness program. But if his 12-year old sister, who is also overweight, was born in Mexico—and therefore not eligible for a referral to a private hospital through Medicaid—she could instead be referred to a community health center’s fitness program. 

Pediatric providers in mainstream settings can also collaborate with their safety net counterparts to meet the needs of a broader sector of the population beyond those normally seen in their clinics. So what can providers working in safety net settings do to support obesity programming for their patients? 

Some safety net facilities across the country are finding creative ways to implement childhood obesity programs in their neighborhoods and communities without relying on uncertain funding sources. These facilities are partnering with other organizations and groups to build on each other’s strengths, resources, and ability to reach kids and their families. Here are just a few examples of innovative childhood obesity programs being implemented at safety net facilities:

Educating Patients and Families:

• Petaluma Health Center (California) has a garden onsite and pediatric patients in the Petaluma Loves Active Youth program help raise plants and harvest the food. There are weekly cooking demos, and classes on healthy eating with exercise for the kids.
• Charles Drew Health Center (Omaha, NE) hosts a 12-week Healthy Families class so children and parents can learn about healthy eating and exercise, and benefit from the attention of multidisciplinary clinical teams. Incentives such as YMCA memberships are offered.
• Community Health Center, Inc. (Meridien, CT) offers a six-week program for teen girls and women concerned about weight called “Food Smart and Fit.”

Infrastructure Projects:

• The Community Health Centers Alliance (CHCA, Florida) plans to conduct electronic and chart surveillance of childhood obesity and to promote best practices among providers. They hope to create a Childhood Obesity Practice Manual with clinical guidelines and other resources.
• CHAMPS (Community Health Association of Mountain/Plains States) has a website of obesity resources for member CHC’s and their providers.

There’s no need to reinvent the wheel when trying to build up an obesity program! Both Be Our Voice and the American Academy of Pediatrics provide childhood obesity advocacy resources that are relevant in safety net settings.  The Obesity Society and the National Association of Community Health Centers also created a resource specifically for providers in safety net settings entitled Childhood Obesity Resource Guide. The National Association of Children’s Hospitals and Related Institutions (NACHRI) developed the Survival Guide to Planning, Building, and Sustaining a Pediatric Obesity Program as a tool for healthcare professionals who are ready to roll up their sleeves and move their weight management program to the next level.

References

1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among United States adults, 1999–2008. JAMA 303:235–41. 2010.
2. National Institutes of Health. Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-The evidence report. Obes Res 6 Suppl 2:51S–209S. 1998.
3. Sobal J, Stunkard AJ. Socioeconomic status and obesity: A review of the literature. Psychol. Bull 105:260–75. 1989.
4. McLaren L. Socioeconomic status and obesity. Epidemiol Rev 29:29–48. 2007.
5. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey. Available from: http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm

As the weather gets warmer and spring arrives, pediatric care providers and healthcare professional advocates like to tell patients and families to “go outside and play!”

Play—especially free and unstructured play—is vital to kids’ healthy development physically, socially, and emotionally. And the fact that playtime offers physical health benefits is of particular relevance for healthcare professional advocates fighting childhood obesity. According to a clinical report published in the January 2012 issue of Pediatrics, “Play enhances physical health by building active, healthy bodies. Physical activity beginning in early childhood prevents obesity. In fact, play may be an exceptional way to increase physical activity levels in children and, therefore, may be included as an important strategy in addressing the obesity epidemic.¹

Another reason why “go outside and play!” is good health advice has to do with the “go outside” part. According to the CDC, kids ages 8-18 spend an average of 7.5 hours a day using electronic media (e.g. TV, computers, video games, etc.) and 83% of kids six months to six years watch almost 2 hours of TV/videos per day. This sedentary time contributes to childhood obesity.² In contrast, when kids are outside, they’re usually active doing things like riding bikes, swinging, playing sports, etc.

So clearly “go outside and play!” is good health advice, but sometimes it’s not that simple for families and kids to follow through. Too many kids and families live in areas where going outside isn’t safe, there aren’t any good outdoor play areas nearby, or they can’t afford outdoor recreation programs.

This is where advocacy comes into play! There are many ways in which pediatric care providers and other healthcare professionals can advocate for more and better outdoor play and exercise options for kids and families. Below are resources that may be useful.

Now get out there and start playing!

Connect Children and Families with Nature

Program: Children and Nature Initiative
Organization: National Environmental Education Foundation
Website: Click Here
Description: Training for healthcare providers on “prescribing nature” and on connecting families to natural areas.

Program: Grow Outside: Tools and Resources for Pediatricians
Organization: Children and Nature Networks
Website: Click Here
Description: Links to “nature prescriptions” and sample educational materials, plus information for pediatricians.

Create Affordable, Accessible Outdoor Play/Exercise Options

Organization: KaBoom!
Website: Click Here
Description: A national organization that helps communities build playgrounds.

Program: RecreationRx
Organization: San Diego County Parks and Recreation Department
Website: Click Here
Description: A California program that allows doctors to prescribe recreation and link patients to low-cost recreation options.

Program: Portland Play
Organization: Oregon Parks and Recreation Department
Website: Click Here
Description: A program in the greater Portland metropolitan area that enables pediatricians to connect families with parks and recreation programs.

Program: Make Way for Play
Organization: Healthy Places (an initiative of Healthy Chicago)
Website: Click Here
Description: A Chicago collaborative program striving to make parks more accessible to local residents.

Program: Park Prescriptions
Organization: Institute at the Golden Gate
Website: Click Here
Description: A movement to create a healthier population by strengthening the connection between the healthcare system and public lands across the country.

Advocate for Outdoor Safety

Program: Walking School Bus
Organization: Partnership for a Walkable America
Website: Click Here
Description: This program promotes kids walking and biking safely to school with parents or other adults supervising.

Program: Bicycle Helmet Program
Organization: Bicycle Helmet Safety Institute
Website: Click Here
Description: Information on how to create and implement bicycle helmet programs, providing affordable helmets to patients.

Program: Interactive Demonstrations of Safe Play Areas
Organization: National Children’s Center for Rural and Agricultural Health and Safety
Website: Click Here
Description: For those in rural areas, safe play area demonstrations for farm families can promote active, safe outdoor play areas for kids. This guide outlines how to hold demonstrations.

Program: Safe at Play
Organization: Injury Free Coalition for Kids of Chicago
Website: Click Here
Description: This group, based at Children’s Memorial Hospital in Chicago, helps community organizations build and renovate playgrounds. The coalition is also involved in evaluating playground safety, through playground safety checks and other activities.

References

1. Ginsburg KR, Milteer RM, et al. “The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bond: Focus on Children in Poverty.” Pediatrics Vol. 129 No. 1, January 1, 2012, pp. e204 -e213. http://pediatrics.aappublications.org/content/129/1/e204.full

2. CDC Overweight and Obesity. “Childhood Overweight and Obesity: A Growing Problem.” http://www.cdc.gov/obesity/childhood/problem.html

In political and medical circles, the Medical Home is being called a critical part of the solution to our nation's healthcare system. While the term “medical home” may be newly in vogue, the idea of the medical home is nothing new, especially in pediatrics: the AAP started talking about medical homes in 1967¹. The current definition highlights the unique situation and needs of children: the medical home is a model of patient and family-centered, community-based care that provides continuity of care from childhood through adolescence and facilitates a smooth transition to adult services.² Implementing the pediatric medical home model is an ongoing focus for NICHQ and other pediatric care organizations in order to achieve higher quality care for kids.

One component of the medical home that is particularly important for childhood obesity is the community-based system:  a patient and family-centered coordinated network of community-based services designed to promote the healthy development and well being of children and their families.³ “Community-based” means services are available in the communities where children and families live, work, learn, and play—not just within the walls of the doctor’s office or hospital. A community-based system with nutrition and exercise programs to support children and families can help to combat and prevent childhood obesity.

Communities everywhere offer a plethora of potentially helpful obesity-related services and programs, ranging from YMCA sports to community gardens, but families may not know these exist and may not know how to access them. The most at-risk families are often the most isolated due to poverty, language barriers, lack of transportation, etc. When children are too young for school, their families lack the community connections that would be facilitated via the school system. 

For some families, the pediatric provider may be their only reliable, regular source of information about child growth and development—and about community resources—until their child starts kindergarten. This is unfortunate because most parents need, and want, good information. Yet it makes a strong case for the unique position healthcare professionals hold as both medical caregivers and providers of  practical information. Indeed, “parents expect their doctor’s office and the health clinic to be a place where they can get reliable community resource information⁴.” Thus, healthcare professionals working within a medical home are crucial links in the chain between families and community resources.

How can healthcare professionals best connect families to resources? There are several ways.

First, connecting families and community programs can, and should, take place in a clinical setting. Waiting rooms and exam rooms are ideal places for brochure racks that house brochures about local nutrition and exercise programs, written in the languages of the patient population. Pediatric providers could use something like the AAP’s Healthy Active Living Prescription to give families information about community health resources—during a checkup, a pediatrician could write the phone number of the local YMCA on a prescription and give it to a parent. Some practices may already have staff or volunteers onsite whose express role is to help patients access community resources (e.g. Health Leads, Community Health Workers, etc.).

Second, when existing policies are hindering or even preventing efforts to address the causes of childhood obesity, healthcare professionals can use their unique and powerful position to advocate for sustainable changes in their communities. For example, a school nurse could go to the local school board to propose changes to the district’s nutrition policies and provide examples of patient stories that support such changes. NICHQ’s Be Our Voice project trains healthcare professionals in advocacy by providing a curriculum, toolkit, and technical assistance resources for those who wish to become advocates for policy changes that positively impact childhood obesity outside the clinic walls.

Third, if there are insufficient community resources to which families can be referred, healthcare providers can form partnerships or join coalitions to create community programs and services for their patients. This kind of work is happening in NICHQ’s Collaborate for Healthy Weight initiative, in which teams of primary care providers, public health professionals, and community organizations address obesity at the community level. Part of the project is coming up with long-term ways to promote nutrition and exercise plans in communities, which may involve developing new partnerships and new resources. Another example of creating resources is the program Walk With a Doc, in which healthcare providers lead community walks for patients and families to offer healthy exercise options. 

Fourth, healthcare professionals can practice both clinical and community advocacy by joining with external organizations to offer resources onsite. In some places, to meet the needs of those at highest risk, such “one-stop shops” offer medical care and more. For example, the Hennepin County Medical Center Pediatric Clinic in Minnesota has instituted a hospital-based food pantry where food is given to needy patients and families when they come for office visits. This strategy both helps to prevent hunger and, since the food meets clinical nutrition standards, helps address some of the possible causes of obesity.⁵ On a national level, Kaiser Permanente’s prevention efforts include teaming with local organizations near their medical centers to offer Farmers’ Markets onsite, which increases access to fresh produce for patients, families, and staff.⁶

Medical homes offer the opportunity for children and families to receive comprehensive, coordinated medical care—and, as part of this, to be connected to community resources that can help them lead healthier, more productive lives. Making these connections is a vital part of addressing and preventing childhood obesity, and it benefits patients, families, and healthcare professionals alike.      

References

1. National Center for Medical Home Implementation. “History of Medical Home at the AAP.” http://www.medicalhomeinfo.org/about/#history                       
2. National Initiative for Children’s Healthcare Quality. “Area of Focus: Medical Home.” http://www.nichq.org/areas_of_focus/medical_home_topic.html
3. National Center for Medical Home Implementation. “Family-Centered Medical Home Overview.” http://www.medicalhomeinfo.org/about/medical_home/
4. Palfrey, Judith. Child Health in America: Making a Difference Through Advocacy. Baltimore: The Johns Hopkins University Press, 2006. Page 107.
5. Barr, Sarah. “Where 'Hospital Food' Takes On A New Meaning.” Kaiser Health News. November 22, 2011. http://www.kaiserhealthnews.org/stories/2011/november/22/hospital-pantry.aspx
6. Kaiser Permanente. “Medical Center and…Grocery Store?” https://members.kaiserpermanente.org/redirects/farmersmarkets/   

Purchasing healthy foods on a budget can be a challenge. And fresh fruits and vegetables may not be available in all neighborhoods. When food competes with covering other basic household expenses like rent or mortgage, medical bills, or transportation to work, families have to make tough choices. And that sometimes means sacrificing quality and nutrition for what is convenient and least expensive.  

Feeding America, the nation’s leading domestic hunger-relief charity, reports that hunger is increasing: their organization is now annually providing food to 37 million Americans, including 14 million children. And although it may seem contradictory at first glance, hunger and obesity can both occur in the same child, family, or community.

A recent Huffington Post article, “Hunger Obesity and Innovation in the Emergency Food System” points out that “following a 30-40 percent rise in people visiting food pantries since the recession, food banks have become a strategic point of opportunity to improve the health of poor families.” But it can be difficult for food banks, which rely almost entirely on food donations, to provide healthy options like fresh produce and whole grains. So how do we overcome the economic and logistical barriers to getting healthier foods into food banks?

One answer is collaboration. The Huffington Post author highlights the California partnership between MAZON and Kaiser Permanente called Healthy Options, Healthy Meals. In this partnership, collaboration is key. MAZON brings healthy eating and nutritional education specific to the state’s emergency food programs to Kaiser Permanente’s eight patient regions; Kaiser then utilizes its network of healthcare professionals to support food bank program and policy changes.

Another example of this kind of successful partnership can be found in the Let’s Move! Detroit community‘s Green Ribbon Collaborative. Featured on the Let’s Move! Blog, the Green Ribbon Collaborative coordinates efforts among the Gleaners Community Food Bank, the Green of Detroit’s Urban Agriculture program, the Detroit Economic Growth Corporation (DEGC) and the Fair Food Network. The agricultural partners provide 20 pounds of fresh produce to residents at a minimal price, and, in turn, Gleaners Community Food Bank arranges for distribution to Detroit’s east side.

Collaborative, community-based solutions like these are critical in addressing both the rising hunger and obesity rates across the county. Emergency food systems and food banks demonstrate a critical point of opportunity for healthcare professionals to improve child and family nutrition. By partnering with local businesses and existing organizations, healthcare professionals can have a lasting impact on the health of their communities.

• Feeding America
  http://feedingamerica.org/default.aspx
• Huffington Post Article: “Hunger Obesity and Innovation in the Emergency Food System” 
  http://www.huffingtonpost.com/nicole-skibola/hunger-obesity-and-innova_b_830447.html
• Healthy Options, Healthy Meals
  http://mazon.org/about/about-our-grantmaking/hohm/
• Let's Move! Blog: "Inspiration Found in Let's Move! Detroit"
  http://www.letsmove.gov/blog/2011/03/17/inspiration-found-in-let%E2%80%99s-move-detroit/
• Sesame Street’s Food For Thought: Eating Well On A Budget—Resources for Providers
  http://www.sesamestreet.org/parents/food/providers

It’s no secret that Americans struggle to get their two or more fruit servings and three or more vegetables servings per day. In fact, the latest CDC statistics from the Behavioral Risk Factor Surveillance System show that only 32.5% of adults are eating the recommended daily servings of fruit and only 26.3% are eating the daily recommended servings of vegetables. But what are concerned individuals to do? In the end, unhealthy snacks are just more readily available and cheaper for adults and kids than are healthy snacks.

Some private companies are out to change that imbalance. The Wall Street Journal Health Blog reported last Halloween that A Bunch of Carrot Farmers™ (led by Bolthouse Farms) launched an ambitious campaign to rebrand baby carrots. The “Eat 'Em Like Junk Food” campaign was taken nationwide with the release of Scarrots, “a new kind of Halloween treat.” Carrots came in mini-packages and included glow-in-the-dark tattoos. But did kids go for it? "We've been blown away by the response to this campaign," said Jeff Dunn, chief executive officer, Bolthouse Farms. The company is following up the success of Scarrots with Super Bowl-themed packaging. More pictures and information can be found on their website, BabyCarrots.com. And if this packaging is not available in your area, the website offers a place where you can write Bolthouse Farms and “tell [them] why [they] should bring ‘em to your city.”

But carrots aren’t the only thing getting a makeover in the snack world. As the Wall Street Journal reported last October, “Fresh Del Monte Produce and a vending-machine maker, the Wittern Group, collaborated on a machine specially engineered to dispense fresh-cut fruits and veggies — even easily bruised bananas.” The machine—which went on the market in 2010—has two temperature zones. The top is loaded with bananas kept at about 57 degrees. The bottom zone—kept at about 34 degrees—holds packages of fresh-cut fruit and vegetables. The vending machine is already in some schools and sells for more than $5,000 compared to about $3,000 for a typical machine.

And even though adults seem more reluctant to pick fruits and veggies over chips and soda, recent research shows that children may be more likely to choose healthy snacks as long as the packaging features familiar cartoon characters. Using characters to market healthy foods was perhaps more prevalent in the pop culture of years past (remember Popeye and his spinach?), but it’s seeing a comeback today in characters like those from Veggie Tales. Of course, the implications of character marketing to kids make some parents and experts uncomfortable, which is why fun packaging like the kind used for these baby carrots—that doesn’t feature popular cartoon characters—is being met with such applause.

In the end, every child may not be getting the recommended daily servings of fruit and veggies yet, but innovations like these may help combat the stereotype that snacks have to be unhealthy to be fun and tasty.

Pushing Fruits and Veggies With Junk Food Tactics
http://blogs.wsj.com/health/2010/10/21/pushing-fruits-and-veggies-with-junk-food-tactics/?blog_id=10&post_id=42555

The Great Banana Challenge—How to Dispense Healthy Snacks From A Vending Machine
http://online.wsj.com/article/SB10001424052702303550904575562480804057778.html

State-Specific Trends in Fruit and Vegetable Consumption Among Adults --- United States, 2000-2009
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5935a1.htm?s_cid=mm5935a1_w

Influence of Licensed Characters on Children's Taste and Snack Preferences
http://www.yaleruddcenter.org/resources/upload/docs/what/advertising/LicensedCharacters_Pediatrics_7.10.pdf

According to the New York Times, on Thursday, January 20, Wal-Mart announced a five year plan to drop prices on fruits and vegetables and to make thousands of its packaged foods lower in unhealthy salts, fats and sugars. The move represents a big step forward in addressing the affordability of healthy food in America.

While other national companies—like ConAgra—have promised similar reductions in unhealthy ingredients, Wal-Mart has much more influence over the market as a whole since it is the largest retailer in the United States. Wal-Mart “sells more groceries than any other company in the country” and is one of the largest purchasers of foods produced by national suppliers. Michael Jacobson, Executive Director of Center for Science in the Public Interest, describes Wal-Mart as being “in a position almost like the Food and Drug Administration” in terms of influence on the American food industry. The company’s five year plan is not only a great starting point for testing pricing strategies, it’s also a move that will likely push the major food suppliers it does business with—like Kraft—to follow a similar approach.

However, Wal-Mart’s plan is not without its caveats. According to Mr. Jacobson, “The company’s proposed sugar reductions are ‘much less aggressive’ than they could be” and “[Wal-Mart] is not proposing to tackle the problem of added sugars in soft drinks, which experts regard as a major contributor to childhood obesity.” The five year timeline is also much less aggressive than most experts would like.

There is also the question of accountability and holding hold Wal-Mart to its promises. According to the New York Times, The Partnership for a Healthier America  “will monitor the company’s progress” as it implements its plan. Still, the changes will not go into effect immediately and, while Wal-Mart has been specific about its goals for reducing unhealthy ingredients by 2015, it has been vague about a timeline for rolling out the pricing reductions on fruits and vegetables.

The company is receiving attention for its plan from high places—First Lady Michelle Obama has publicly thrown her support behind their initiative. Mrs. Obama’s support of Wal-Mart is seen as “a prominent effort by the administration to spur further moves toward healthier food.”

The Robert Wood Johnson Foundation has made using pricing strategies to promote healthy food one of its 6 policy priorities for reversing childhood obesity by 2015. And although Wal-Mart’s five year plan is in imperfect in its details, it has already successfully accomplished one goal of childhood obesity advocates: help push the national discussion about pricing disparities and strategies to the forefront of public attention.   

We’re eager to hear from healthcare professional advocates about how they think this might affect the children and families in their community. If you’d like to share, please leave a comment!

Read More:

Wal-Mart Shifts Strategy to Promote Healthy Foods
http://www.nytimes.com/2011/01/20/business/20walmart.html?pagewanted=1&_r=1&emc=eta1

On December 13^th, 2010, President Obama signed into law the Healthy, Hunger-Free Kids Act, also known as the Child Nutrition Reauthorization (CNR). NICHQ joins with our friends and partners at the RWJF Center to Prevent Childhood Obesity in celebrating the passage of this landmark legislation.

Dr. Dwayne Proctor, Director of the Childhood Obesity Program Management Team at RWJF   summarized the magnitude of this legislation: “This is a huge victory for the 31 million students who participate in federal school meal programs and for all kids in schools.  This law is a game-changer in our efforts to reverse childhood obesity - it improves school nutrition, increases program access, and puts an additional $4.5B towards child nutrition programs over 10 years – that’s the largest increase to the authorization since it was started.” 

What exactly does the Healthy, Hunger-Free Kids Act do?

Improves School Nutrition¹

• The law allows the U.S. Department of Agriculture to update school nutrition standards for all food in schools, including offerings through vending machines, stores and à la carte lines. It provides the largest increase in school lunch reimbursements in 30 years (6 cents per lunch, which would be tied to schools meeting stronger school lunch standards).
• School meal quality also would be enhanced through stronger technical assistance to schools, improved meal financing and increased accountability regarding the foods schools serve and sell, and how they operate their programs.
• TheThe law strengthens local school wellness policies by updating existing requirements, increasing transparency, providing opportunities for community involvement and creating compliance measurements.

Increases Program Access¹

• It makes it easier for children receiving Medicaid benefits to participate in school meal programs by using Medicaid data to directly certify eligible children, instead of requiring individual applications. About 115,000 more low-income children will receive free school meals each year as a result of the bill.
• An additional 21 million after-school suppers will be served to at-risk children by 2015, and after-school sites would receive roughly $14,000 in additional revenue per site, on average, per fiscal year. The law also establishes nutrition requirements for these after-school programs.
• Schools will receive $40 million for farm-to -school and school-garden programs to bring more healthy foods into schools and support local agriculture.

Payment¹

• The legislation will spend $4.5 billion on child nutrition programs over 10 years. That is 10 times as large as the last reauthorization.
• The law is partially paid for by eliminating a $2.2 billion temporary increase to Supplemental Nutrition Assistance Program (SNAP) benefits that was part of the stimulus package. This offset was the source of some opposition by House Democrats.
• The reduction in SNAP benefits would not go into effect until 2013. The White House has committed to working with Congress to restore the SNAP funding.

We at NICHQ would like to thank everyone who’s worked so hard to get this vital legislation through Congress. What a victory for child health!

¹ Summary points authored by Dr. Dwayne C. Proctor.

Last week, the Rudd Center for Food Policy & Obesity at Yale University released a new report entitled Fast Food F.A.C.T.S. (Food Advertising to Children and Teens Score). The Center found that children as young as 2 are seeing more fast-food ads than ever before, and that restaurants provide largely unhealthy side dishes and drinks as the default options that come with kids’ meals. The new report is the most comprehensive study of fast food nutrition and marketing ever undertaken.

Researchers examined the marketing efforts of 12 of the nation’s largest fast-food chains. Additional data included the calories, fat, sugar and sodium in more than 3,000 kids’ meal combinations and 2,781 menu items. Perhaps the most disturbing finding, indicative of the disheartening nature of the overall report, is that “out of 3,039 possible kids’ meal combinations, only 12 meet the researchers’ nutrition criteria for preschoolers” and “only 15 meet nutrition criteria for older children.” That breaks down to only 0.39% and 0.49% of kids’ meal combinations for each respective age group. 

Any healthcare professional could tell that the fast food climate being pushed in today’s market was unhealthy for our children. But the Rudd Center’s report shows just how detrimental fast food and marketing is—and it’s far beyond anything people expected.

However, hope is not lost. In the words of RWJ President and CEO Risa Lavizzo-Mourey, “Parents should demand the healthy items in kids’ meals—like apple slices and low-fat milk—and they should let fast-food companies know they don’t want them using games, toys and popular characters to lure their children toward unhealthy habits. In the words of one fast-food slogan, let the fast food companies know that you want to ‘have it your way.’”  The report authors also offer practical recommendations for transforming the restaurant and marketing landscapes. The Rudd Center’s findings may be alarming, but hopefully this report will serve as a call to action for both the healthcare and fast food industries alike.

Fast Food FACTS (full report): http://www.rwjf.org/files/research/20101108fffactsreport.pdf

Fast Food FACTS (summary): http://www.rwjf.org/files/research/20101108fastfoodfactsbrochure.pdf

A Statement by Risa Lavizzo-Mourey on Fast Food FACTS: http://www.rwjf.org/pr/product.jsp?id=71424&topicid=1024

This past March the U.S. House of Representatives passed a resolution designating September 2010 as the first ever National Childhood Obesity Awareness Month. Then, on September 1^st, President Obama released a memo officially proclaiming  the designation (read the presidential proclamation here). To commemorate this event, Be Our Voice is creating new resources to give healthcare professionals, as well as the general population, more information about the causes of childhood obesity and the efforts being made to address them.

BOV is in a unique position to celebrate National Childhood Obesity Awareness Month. Be Our Voice aims to get healthcare professionals out of their offices and into their communities as voices and implementers of change. Because the project does not focus on one clinical or policy recommendation, BOV is highly compatible with many existing initiatives and individual passions. Clinicians and other HCPs who are engaged in childhood obesity prevention and reduction programs can make sustainable, community-based level changes.  We are very proud of the over two hundred BOV advocates currently out there and ask you to join with them for change. 

The official website for National Childhood Obesity Awareness Month, Healthier Kids, Brighter Futures, has a list of events happening around the country during the month of September. I encourage you to find and participate in the events happening in your area.

And, of course, spend some time on the Be Our Voice website to learn how you, as a healthcare professional, can raise your voice for kids this September.

Congratulations to NICHQ Obesity National Advisory Council members Lisa Simpson, William Dietz, Jon Klein, David Ludwig, and Debbie Chang on their contributions to the March 2010 edition of Health Affairs. The publication examines the root causes of child obesity as well as potential prescriptions for improving the health of American’s children. Topics covered in the journal, and discussed at a press briefing in Washington, D.C. March 2, include differences in obesity rates among diverse groups, agriculture policies and possible impacts, snacking habits of children, statewide initiatives in child care centers, and the impact of junk foods in schools. (http://content.healthaffairs.org/content/vol29/issue3/)

US Department of Agriculture Secretary Tom Vilsack held a conference call to outline the Administration’s priorities for the upcoming Child Nutrition Reauthorization. The President has proposed an additional $1 billion per year in new funding in his 2011 Budget to focus on efforts such as: expanding use of direct certification to help more children participate; increasing participation in school breakfast programs; improving the nutritional quality of meals and snacks; and supporting local farmers and ranchers by promoting farm to school programs.

Last month I attended a meeting of Robert Wood Johnson Foundation grantees working to reduce childhood obesity across the country.  Over 400 dedicated, motivated and passionate people gathered in Atlanta, GA to catalyze the “movement.”  This got me thinking of the word movement?  Is there a movement?  Am I part of the movement?  What is the movement?

My mind first goes to my internal organs – I guess too many years of being around the practice of healthcare.  Then, quickly realizing we are not talking about my innards,  I switch gears.   My first reaction is a very excited “yes!” (not to look a gift horse in the mouth, this is a RWJF grantee meeting, and I am a grantee).  But then, I remember the reality that obesity among children has reached epidemic proportions and everywhere I look I see a fast food outlet or soft drink advertisement.

I am stumped.  How can I make a difference in this environment? 

What’s to be done?  As I often do, I go straight from denial to anger to action.  I quickly realize I can no longer  sit back and watch the ads with a soda in my hand.  It is time to take a stand. 

Just as I was sitting back, noshing on pre-Thanksgiving dinner appetizers, I was struck by the voice of our President.  President Obama was suddenly on the screen talking about  choosing healthy foods and getting active.
 
I was immediately inspired to share President Obama's commercial with my colleagues at NICHQ. I wanted to help push the momentum of this movement within my team at the office. Movement is all about energy and as the team and I worked in the final weeks to launch this advocacy Web site, I hope to encourage all of those I work with that they can be advocates, too.

So, this is it.  Advocates of all kinds, from the White House to the NFL to my family sitting at the Thanksgiving table, and to my colleagues educating others on the benefits of helping kids, and ourselves, get active. I see our White House growing vegetables and fruits, a First Lady talking about the issues and the White House Chef eating with kids at their school meals.  YMCA’s, Boys and Girls Clubs, schools, and workplaces such as SAS and Google are making strides to offer healthy choices for their employees.  Research and articles are published on a daily basis.

How do all these great pieces translate into a movement?  Federal action, state action, local action and of course, those 400 + individuals. 

As President Obama says, I would like to give a “Shout out” to those colleagues and to say, yes, I am proud to be part of the movement. 

What inspires you to be part of the movement?

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