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Read Success Stories About Advocating Against Childhood Obesity

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Scott Gee, MD
Oakland, California

Scott Gee, MD, developed a network of physician champions to find practical solutions to community health challenges.

Dr. Gee’s passion for advocacy reflects his commitment to the children he sees in his pediatric practice. After witnessing the power of individuals joining as communities to advocate for bike helmet legislation in the early 1990s, Dr. Gee knew that he could not battle obesity alone. He believed that while most physicians understood the need for advocacy, they would need to be convinced that their efforts were worth the time away from their busy professional and personal lives.

He decided to lead by example. Dr. Gee is involved in strategic planning for the Kaiser Permanente Healthy Eating Active Living (HEAL) community grants program, which funds initiatives to expand local capacity to reduce obesity. He provides evaluation, consultation and technical assistance for HEAL programs, and his advocacy has helped secure $24 million to implement the “Safe Routes to School Initiative,” which supports improvements in walking and biking conditions on school routes while enabling and encouraging children to use them.

Much of Dr. Gee’s time outside of his practice is spent training his peers to become effective communicators who can impact policies that create environmental changes to measurably improve the health of communities. Dr. Gee has trained more than 200 health professionals as part of the CMA Foundation’s “Physicians for Healthy Communities” project, where he provides practical tools to address childhood obesity through advocacy with lawmakers, partners and funders.

Building a physician champion corps isn’t always easy. Time constraints, funding and seemingly insurmountable health disparities facing communities often feel overwhelming. However, when Dr. Gee talks with his colleagues about the dramatic impact that bike helmet legislation has had on childhood head trauma, and likens the battle against obesity to anti-tobacco campaigns that have changed attitudes around smoking from “cool” to disdainful, his audience begins to see a glimmer of hope that individual advocacy can make a difference.

Dr. Gee believes that the obesity epidemic must be addressed through community partnerships and advocacy, with physicians leading the charge toward a “tipping point” where our culture shifts and healthy eating and physical activity become the social norm that encourages families and children to lead healthier lives.

This story has been adapted from the CMA Foundation Obesity Prevention Project.

Eric Ramos, MD
Patterson, California

Eric Ramos, MD, inspired student specialists to lead a movement and change the way families view their health.

When Eric Ramos, MD, learned that 40% of Patterson’s school age children were overweight, he realized that there would be one of two outcomes: these students could continue with their current lifestyles and increase their risk of serious health problems; or they could be given skills and incentives to change their habits for a better chance at health and longevity.

As a family practice physician and Medical Director of the Del Puerto Health Center in Patterson, Dr. Ramos knew that any intervention must include entire families, and be multifaceted. He partnered with Health Net, Patterson High School and the City of Patterson Department of Parks and Recreation to create Project FITNESS – Fostering Individual Improvement Through Nutrition Exercise Student Specialists. The comprehensive program teaches students and their families how to live healthier lives through 20 weeks of instruction that develops students into nutrition and exercise “specialists.” This program provides the skills and inspiration necessary for them to create and implement an exercise and nutrition program to fit their families’ lifestyles.

Dr. Ramos does not put Project FITNESS participants on a diet. Rather, teens and their families attend project meetings which include cooking  emonstrations, nutrition education and self image classes. They set personal goals and progress is monitored. The program has proven to be dynamic because it changes the way entire families view their health, from simply treating illness to taking measures to prevent it.

Dr. Ramos launched the program with a school assembly for freshmen featuring retired Sacramento Monarchs basketball player Cardte Hicks, who motivated students by talking about the importance of health and fitness as an athlete. At the time, nearly 20% of students had a Body Mass Index (BMI) of 30 or higher, with the highest at 50%. Each student participating in Project FITNESS reduced his or her BMI during the first 20-week course, which culminated in a graduation ceremony for students and their families. Graduates received healthy foods, iPods and gift certificates in recognition of their achievements.

With Project FITNESS, Dr. Ramos and his community partners created a program for health that empowers teens to become leaders among their peers and with their families. Participants are successful because they are invested in the program and the results. Ultimately, their efforts will have far-reaching implications, from improved fitness and academic performance to healthier families and reduced costs to the community’s health care system.

This story has been adapted from the CMA Foundation Obesity Prevention Project.

Bonnie Hamilton, MD
Fairfield, California

Tilling the soil, teaching our children – What we eat enriches what we learn!

Children’s relationship with food and physical activity is a far cry from what it was 100 years ago. Instead of sharing in the labor to grow your own fruits and vegetables, most children now feed on processed food while they play video games and watch TV. This shift in American society has led to an obesity epidemic with children developing obesity related health complications that are typically seen in adults. As a pediatrician at Kaiser Permanente in Fairfield, California concerned with the physical, emotional, and social health of children, Dr. Hamilton has taken an active role in doing her part to prevent childhood obesity. As a way to stay dedicated to fighting childhood obesity, she is now involved with the California Instructional School Garden Program.

The School Garden Program is an outdoor classroom where children gain knowledge of how to plant, grow, and harvest fruits and vegetables, at the same time learning about the nutrients they provide. This classroom setting generates more enthusiasm from students and fosters a preference for healthier foods.

As a parent and a pediatrician, Dr. Hamilton knows full well the correlation between nutrition and academic success. She pointed out that healthy children have better attendance, are more motivated to learn, and perform better in school. Dr. Hamilton shared that by offering a program that allows for interactive learning, children are eager to participate, and in this instance they are learning valuable practices in healthy eating. By learning to make healthier food choices they are increasing their chances of excelling in school.

Schools have an exceptional opportunity to instill healthy habits in students at an influential age that will help shape their lifestyles as adults. Teachers will tell you, and the research shows, that students eat what they grow. Children who plant and harvest their own fruits and vegetables are more likely to eat them. Although the fundamental mission of schools is to promote academic success, there is also a responsibility to provide children with a healthy nutrition environment.

In 2006, Assembly Bill (AB) 1535 was signed into law giving State Superintendent of Public Instruction, Jack O’Connell, the authority to establish the School Gardens Advisory Group. As one of the 26 members of the Advisory Group, Dr. Hamilton supported the program’s efforts by providing technical assistance, resources, in-kind support, school site visits, and other efforts to promote instructional school gardens in California Public Schools. AB 1535 also provided over $11 million in grants and “seed money” to schools to develop school gardens or expand their existing garden. The Advisory Group is responsible for helping to establish the criteria for providing schools with grants to develop or sustain school gardens.

With the endless efforts and dedication of the Advisory Group, the mission of the garden program has grown to include additional healthy environment concepts such as linking local agricultural areas with school cafeterias, cooking in the classroom, and school recycling.

To continue this great work, Dr. Hamilton applied for, and received, a $5,000 grant from Lowes to build a garden at her young daughter’s school. Working with the PTA president, a plot was selected on school grounds for the garden. A faculty member was designated to champion the project. Dr. Hamilton stated that it is her hope that with the same amount of dedication and hard work her daughter’s school will achieve success. Her work and commitment have resulted in greater opportunities for healthy food choices and hands-on experience in learning how to grow the foods we eat for her daughter and school children throughout California.

This story has been adapted from the CMA Foundation Obesity Prevention Project.

Clifford Walters, MD, EMBA
San Bernardino County, California

Medical Societies can be catalysts for change. The Healthy Lifestyle Program is great example of community partnership that has strengthened schools and improved student health.

Healthy Lifestyles Award (HLA) Program is celebrating its 14th anniversary. This successful community program, developed by the San Bernardino County Medical Society, its Alliance, and Inland Wellness Information Network (IWIN), encourages school children in grades K-6, to learn about and develop healthy lifestyles involving good nutrition, regular exercise, proper hygiene and awareness of the dangers of smoking, alcohol and drugs.

Each year they invite between 150-175 elementary schools in San Bernardino County to participate, creating an opportunity for all schools, including those in underserved, diverse communities, to become involved. Invitations are extended to principals and teachers through email, fax, and first-class mail. Personal phone calls to each principal and/or vice principal describing the program further encourage a school’s participation.

“Working with the kids in grade school has been a real joy. To see their enthusiasm not just to win an award for their class, but to see them take seriously healthful eating and living, makes the efforts of the Medical Society certainly gratifying and worth all the effort. Change in behavior is never easy, especially as adults. To learn better habits for our health especially during the times of impression on our youth is a great start to a quality life. When you believe in something and it comes from your heart, you become passionate about it. Change then happens.” During his term as SBCMS president, Dr. Walters, along with representatives from the Alliance and IWIN, participated in judging the creative entries. Each is judged for content, appropriateness for grade, creativity, uniqueness, and effort in making an enduring impact on the health of the young participants. For the 2008/2009 school year, 10 schools, 142 students were presented with certificates and cash awards.

Using the HLA criteria, teachers and their students develop an entry that demonstrates the importance of increasing daily consumption of fruits and vegetables and physical activity. Cash prizes of $300 are given by SBCMS, IWIN, and the SBCMS Alliance to winning classes along with personalized certificates of recognition to each student in the winning classes.

HLA is supported by donations/grants from individuals, foundations, organizations and the SBCMS Alliance. Annually the SBCMS Alliance presents a check to the SBCMS and IWIN for the HLA program. Dr. Walters thoroughly enjoyed making presentations, with the assistance of Alliance advisor Linda Letson, RN, and IWIN President, Nabil Razzouk, PhD, at school assemblies. He was able to personally shake the hands of students from the winning classes and present them with a personalized certificate. In addition to recognizing the classes who participated and received cash prizes, the assemblies allowed him the opportunity to promote HLA and educate the entire student body on the importance of healthy eating, nutrition, and exercise.

Examples of some winning projects:
* Food Pyramid Fun Facts, a book with illustrations, pictures and photos that exemplifies healthy lifestyle messages or individual stories
* Healthy Lifestyles, a 5-minute video skit of students illustrating appropriate exercises. Students worked together writing the script, designing the set, and producing the video.
* Healthy Choices – May I Have…, a trivia game that illustrates healthy eating and exercising
* Healthy Recipes, Weekly Menu Books, Food Pyramids
* Health Awareness Pledges and Exercise Guidelines
* Shopping Guide designed by students to take with their parents to the supermarket to make healthy food choices

With the increase of obesity among children, there are a number of health problems that can arise, including pediatric hypertension, risk of coronary heart disease, stress on the weight-bearing joints, lower self-esteem, and relationship problems with peers. Early and appropriate intervention is valuable, because childhood eating and exercise habits are more easily modified than adult habits. HLA is significant because of its impact on children’s lives to assist in preventing obesity and other health problems.

This story has been adapted from the CMA Foundation Obesity Prevention Project.

Ron Reece, MD
Redding, California

Ron Reece, MD, is a dermatologist in Redding, California who is actively involved in efforts to make sure that Shasta County is taking steps to stem the tide of the obesity epidemic. He is working diligently to ensure that when decisions are made by municipal government and schools, they consider the health consequences of their decisions, focusing on what is needed to create a healthier community for all Shasta County residents.

As a dermatologist, Dr. Reece is perhaps an unexpected advocate to address the issue of obesity prevention in his community. When asked what was the motivation behind his energy and passion, Dr. Reece is quick to answer. His training as a physician is from Loma Linda University Medical School where there is a strong emphasis on caring for one’s community. His father was a physician as well, who taught Dr. Reece that as a physician, it is essential to give back. These two factors influenced his values and elevated the importance of community service.

It was Richard Jackson, MD, MPH, California’s former State Health Officer, who provided the focus. Dr. Jackson was the featured speaker at a conference in 2005 in Redding that Dr. Reece attended. Dr. Jackson told his audience that healthy people do not live in unhealthy communities, that planning decisions made by cities and counties are health decisions and doctors should be involved to make this point. Dr. Reece took that advice and hasn’t looked back since!

Let’s put Dr. Reece’s work in its proper context: Shasta County had a higher poverty rate (14.5%) than California (13.0%) in the 2005-2007 U.S. Census estimates. This was even more evident among children under 18 years of age, where 21% were below the Federal Poverty Level compared to 18% statewide. Low-income individuals are significantly more likely to be overweight or obese than those who are financially secure. And, Shasta County’s poverty rate estimates from 2005-2007 show minority groups were almost twice as likely as Whites to be living in poverty.

Since 2006, Dr. Reece has been involved in a number of efforts to help Redding and Shasta County become healthier communities. There were no farmer’s markets in Redding in 2006. Dr. Reece worked with a group of advocates who partnered with local farmers to ensure that there was a place for their produce close to where it was grown. Today, there is one farmer’s market four days a week in Redding.

A “spoke in the wheel” is how Dr. Reece characterizes himself. In 2007, he became involved in the HOPE Project to create a school for troubled children. Again, he worked with the agricultural community to maximize the healthy food choices on the school’s menus and worked with school staff and students to create gardens where students could grow their own food, helping the students better understand where food comes from, and strengthen the school’s Eat Fit curriculum.

Dr. Reece has also been instrumental in ShastaForward, a regional planning tool, focusing on how Shasta County would grow into its future, looking at parks and open space, and transportation that includes bikeways. He was involved in seeing through to completion the Redding Healthy Communities Resolution which made the link between how cities are planned and an individual’s access to healthy food choices and physical activity resources.

Each time he is involved in his community engagement, Dr. Reece considers what will make his patients and community healthier. His experience has taught him that this perspective in the public square, as he calls it, often provides the persuasive argument for decision makers to make the healthy choice. And no one can do this more persuasively than a physician.

This story has been adapted from the CMA Foundation Obesity Prevention Project.

Sherril Rieux, MD
Los Angeles, California

Dr. Rieux made the link between what happens in her community and how it impacts her patients and took action to make change.

Dr. Rieux is an internist who is in solo practice in the Los Angeles area. She cares for patients who care for others, playing an important role in California’s safety-net. She began to see a growing trend among her patients – an increase in those who were overweight or obese. Dr. Rieux took action. With support from the National Committee for Quality Assurance [NCQA], she developed a project in her small practice that she called the WAIST Project. WAIST, or Whittling Abdominal Inches by Sequential Transformation, focused on increasing the communication and education she provided to her patients on ways to prevent overweight and obesity, incorporating healthy eating and physical activity messages and resources for her patients and her staff. WAIST is designed to provide African Americans with a high body mass index and waist circumferences with culturally appropriate education and counseling in order for the patients to develop healthier lifestyles and to reduce the prevalence of co-morbidities.

She knew that implementing this new project into her solo practice would not be easy and she knew she would have to do it one step at a time. Implementing the project taught Dr. Rieux and her small staff how to work with her patients in ways that will improve their care and lives. Dr. Rieux began the implementation process by first getting “buy-in” from her staff. She knew that implementing a new project in her office would add several new steps and changes to their daily routine.

Dr. Rieux was able to slowly implement the project step by step in an organized way which helped her staff to not only accept the changes, but also stay organized while providing patients with the same quality of care they are known for. Her electronic health record has enabled Dr. Rieux and her staff to track the success of the WAIST Project among her patients, giving her feedback to fine tune and target the project.

Dr. Rieux didn’t stop there. Her awareness of the obesity epidemic caused her to step out of her office and into her community. She didn’t just want to wait until her patients came to her in need of help, she wanted to work in her community to prevent the spread of overweight and obesity. As a leader in the Association of Black Women Physicians, Dr. Rieux regularly attends the annual Leadership Summit sponsored by the CMA Foundation and the Network of Ethnic Physician Organizations. A Champions for Change training was offered at the Summit in 2007 and Dr. Rieux was there. In the training, Dr. Rieux learned how to channel her energy and passion to prevent overweight and obesity in her community. She is volunteering in her sister’s 6th grade classroom, educating the students and their families about ways to prevent overweight and obesity. Dr. Rieux is also a member of The Links, Incorporated, a volunteer service organization with 12,000 professional women of color who donate thousands of hours of community service annually. Her chapter has adopted an elementary school where members participate in an education program for the 4th graders and their parents. Dr. Rieux’s local group received a national award from The Links, Incorporated for this community service project.

Dr. Rieux is a busy physician who has found the time to be part of her community to see firsthand the role a physician can play to bring about change in the lifestyles of young children, their families and her patients.

This story has been adapted from the CMA Foundation Obesity Prevention Project.