Changing the Landscape to Prevent Childhood Obesity

Kansas City’s Childhood Obesity Collaborative-Weighing In

KC Capacity Inventory

Trends and Healthy People Targets

NHANES I NHANES II NHANES III NHANES 2003-06

02468

101214161820

2-5 6-11 12-19

HP 2010 to 5%

HP 2020-10%

Past Year Activities and Accomplishments

• Published 11 Weighing In updates • Hosted and expanded quarterly meeting attendance

by 62% • Increased number on e-mail list by 42%• Launched WI Website - (www.kcweighingin.org)• Conducted Member Survey • Updated Strategic Plan • Aligning Working Group and compiling action plans• Adopted Operations Guide for Weighing In -

November 2010.

Past Year Activities and Accomplishments, cont.

• Conducted review of capacity to address childhood obesity

• Compiled inventory of assets and resources • Compiled report for recommendations for population

groups—pregnancy, breastfeeding, early childhood and school-age and infrastructure supports

• Secured funding for core operations through 2013• Competed in pool of 200 applications to become

designated as one of 10 Healthy Weight Collaborative Teams—representing Region VII

Childhood Obesity Prevention Capacity

• Conducted inventory of current capacity• Population based

– Prenatal– Early Childhood– School-age

• Identified current and sustainable capacity, information needs and priorities

KC Collaboratives Addressing Childhood Obesity

Greater KC Food Policy Coalition

Building a Healthier Heartland

Mother and Child Health Coalition

KC Childhood Obesity Collaborative-Weighing

In

Agencies by Population Group

Prenatal Mother and Child Health Coalition

0-5 yearsKC Childhood Obesity Collaborative-Weighing InMid America Regional Council (MARC)-Head StartMother and Child Health Coalition

K-12Alliance for a Healthier GenerationEnergy Balance for KidsJunior League of Kansas City, MOKansas Coordinated School HealthKC Childhood Obesity Collaborative-

Weighing InPE4LifeScore 1 for Health

  

GeneralBlue Cross/Blue ShieldChildren’s Mercy Family Health PartnersGreater Kansas City Food Policy Coalition

Health Care Foundation of Greater KCIndependence City Health Department

Jackson County Health Department

Kansas City Health DepartmentKC Healthy KidsMenorah Legacy FoundationMid America Coalition on Health CareMid America Regional Council (MARC)

Public Health Department-Unified Government of WyandotteRegional Office-US Department of Health and Human University of KansasUniversity of Missouri-Extension YMCA of Greater Kansas City

InformationWhat you want:1. What is effective2. Obesity prevalence data3. Programs and efforts in my area

Distribution opportunities• Half have constituent newsletters• All had websites• One-third used social media• All willing to distribute information on

childhood obesity

Number of Programs by StrategiesCommunity Strategies to Prevent Obesity

Programs by Strategy

%

CDC Recommended Community Strategy Categories Promote the availability of affordable healthy food & beverages 9Encourage communities to organize for change 7Create safe communities that support physical activity 6Encourage physical activity or limit sedentary activity among children and youth 3Support healthy food and beverage choices 1Encourage breastfeeding 0

Total Programs within CDC Recommended Strategies 26 36%Other Strategies

Schools-based programs 14Research based efforts 8Screening and treatment 9Education programs and other activities 6Early childhood and infant focused programs 6Funding support 4

Total Programs within Other Strategies 47 64%Total Programs 73

Agencies with whichInterviewees (N=25) Collaborated

Number of times reported

Percent

School(s)/School Districts 11 44%

KC Healthy Kids 10 40%

Building a Better Heartland 7 28%

Food Policy Coalition 6 24%

Weighing In 6 24%

Children’s Mercy Hospital and Clinics 6 24%

Mother and Child Health Coalition 6 24%

Local Public Health Agency 5 20%

University of Kansas 4 16%

Mo Council on Activity and Nutrition (MoCAN) 4 16%

MU Extension 3 13%

Beans and Greens Program 3 13%

PrioritiesSetting

FocusSchool Neighborhood Community-Region Other

General

Provide technical assistance and resource supportsSupport after school programsLaunch and maintain school-based programs, Secure school district supportConduct youth empowerment programChange school environments and policiesConduct school-based screenings and refer at risk for weight management treatmentProvide counseling for overweight/ obese children and their families

Support neighborhood based initiativesIncrease community mobilization on HE/AL Conduct adult and youth HE/AL programs

Increase community gardening

Create sustainable corridorsSupport linkage between schools and worksites/ corporate supportWork to align activities Increase and strengthen community health planning Collaborate with others on HE/AL activitiesProvide technical assistance and resource supportsEstablish enforceable policy

Support Head Start and child care initiativesEducate employers on health plan designCollect and analyze dataIncrease public awareness of problem and solutionMarket services and provide rationale for useSeek and maintain funding to support activitiesSurvive tight timesEducate and provide resources to healthcare professionalsProvide health coachingAdvocate for insurance coverage for weight management services

Healthy Eating (HE)

Conduct nutrition educationEstablish school gardensProvide nutrition counseling

Increase access to local, affordable healthy food

Improve access to local foodsPromote purchase of local foods in institutionsExpand Beans and Greens programEstablish Food Policy Coalition

Change mindset on use of fresh fruits and vegetables

Active Living (AL)

Document impact of physical activity levels on academic successIncrease physical activity opportunitiesAdd walking trails

Advocate for livable streets and improved parksPromote use of walking trails

Support Metro Green Trail System

Anticipated Changes

Align and increase col-lective efforts (8)

Become more effective (6)

Keep childhood obesity prevention as ongoing priority (4)

Shift from program to policy & environment focus (2)

Adapt based on health care reform (3)

Not sure (2)

Build on our current capacity and assets

Population Recommendations • Healthy weight pregnancies• Infants and Early Childhood• School-age

General Recommendations• Information Needs• Capacity to Track Childhood

Obesity Indicators• Consistent messaging• Systems Approach• Governance Framework• Treatment

School-age RecommendationsHighlights• 44 % collaborate with schools • 10 interviewees had school-

specific programs• 15 of all 75 programs/initiatives

for schoolsWhat’s happening on a broader

scale• New insights regarding what is

effective to support healthy school environment

Healthy Hunger Free Kids Act, 2010• USDA will set nutrition standards for all foods

regularly sold during school day• Funding to meet updated nutritional standards• Supports local farm to school networks, school

gardens, local foods• Expands access to drinking water• Standards for local wellness policies• Increase number eligible—direct certification• Universal meal access in high poverty

communities

School Recommendations Compile list of agencies

serving schools-build on current rich capacity

Bi-state policy inventory Collaborate on 1-2 priorities

regionally for action plan to support implementation of Healthy Hunger Free Kids Act, 2010

Link with broader community efforts

Position paper Consistent Messages

Breastfeeding-Everyone Supports

Breastfeeding rate at 6 months (CDC Report Card-2010)

US: 44.3% KS: 41.0MO: 35.1

Strive to have Kansas City Hospital(s) on the Baby Friendly Designation Map:

http://www.babyfriendlyusa.org/eng/03.html

• White House Task Force on Childhood Obesity

• Healthy People 2020 Goals

• Surgeon General-Call to Action

• Healthy Hunger Free Kids Act, 2010

• Health Care Reform• Centers for Disease

Control and Prevention

Much more ….

Pregnant women

Mothers’ pre-conception weight and weight gain during pregnancy are two of the most important prenatal determinants of childhood obesity.

Early childhood

Development is more rapid during these early years than at any other time after birth, and young children’s early experiences are “built into their bodies,” affecting neural, metabolic, and behavioral systems in ways that can influence the risk for obesity, health, and well-being through the life span.

…and still more.• Information Needs

– Track Childhood Obesity Indicators

– Communication-impressive untapped capacity for coordinated communication

• Systems Approach– Childhood obesity is a

large complex, multi-sector issue

• Treatment

Greater Kansas City Obesity Collaborative

HWC Phase One Teams

Region 1: MassachusettsRegion 2: New YorkRegion 3: VirginiaRegion 4: FloridaRegion 5: OhioRegion 6: ArkansasRegion 7: Missouri-Greater Kansas City Obesity CollaborativeRegion 8: MontanaRegion 9: CaliforniaRegion 10: Washington

Kansas City is one of ten teams nationally selected to participate in the Healthy Weight Collaborative-created by the Affordable Care Act and supported through the Prevention and Public Health Fund

Who We AreCommunity Organizations• Deborah Markenson, MS, RD,

LD Team LeaderKC Childhood Obesity Collaborative-Weighing In

816-234-9223 dmarkenson@cmh.edu

Children’s Mercy Family Health Partners:

» Greg Hanley, FACHE, MBA» Beth McElwain, RD, LD, MPHYMCA:» Gail VesselsKC Healthy Kids:» Gretchen Kunkel, MBA, MHA» Erika Devore, MS, RD, LD

Primary Care Weight Management Services, Children’s Mercy Hospital– Sarah Hampl, MD– Kerri Wade, PNP-BC– Shelly Summar, MSEd, RD,

LD

Public HealthKC (MO) Health Department– Clyde Bolton, BGS, MSA– Christine Riederer, PhD

HWC Model for Improvement

AIM: What are we trying to accomplish?

MEASURES: How will we know if a change is an improvement?

CHANGE: What changes can we make that will result in improvement?Plan

DoStudy

Act

Healthier Children and Families in Kansas City

Community

Primary Care

Public Health

Kansas City HWC Target Population

• Children 2-5 years of age• Targeted lower income zip code areas of

Kansas City• Preliminary targeted area:

N – Missouri RiverW – Kansas State LineE – 435 (N-S)S – 435 (E-W)

Overweight + Obesity RatesAdult = 63.1%

(2007-Jackson Co BRFSS)

Young Children = 30.7%(2009-Jackson Co PedNSS)

CMH primary care clinic = 27.7%(2010, 2-5 year olds)

CMH Primary Care Clinic-32.6% (2010, 2-12 year olds)

Baseline Data on Target Population

Children Mercy Hospital Primary Care Clinic 2-5 year old Well Child Clinic (2010, n=4838)

Percentage for 2-5 yr olds with

BMI≥85th %ile

2-5 year olds with BMI≥85th

percentile27.7

-African Americans 40.4 -Hispanic 25.9 -Caucasian 20.7 -Medicaid recipients 85.7 -Commercial insurance 5.6 -Uninsured 8.0

PUBLIC HEALTH: Review, strengthen, and reinforce nutrition and physical activity standards in inspected child care facilities

State Collaboration

Metropolitan Official Health

Agencies of the KC Area

COMMUNITY: Increase the number of settings that reinforce consistent message on feeding practices for children 2-5

CMFHP

Child Care Settings

Head Start

YMCA

Community Centers

WIC Clinics

Safety Streets

PRIMARY CARE: Increase proportion of primary care providers assessing, counseling and scheduling follow-up with families with children with BMI ≥85.

Assess and Diagnose Counsel Follow-up

Preliminary Targeted Changes for KC

STAY TUNED….…we’ll keep you posted on what works and doesn’t work.

WE WELCOME YOUR COMMENTS AND SUGGESTIONS….

…we present at a national meeting 9/13-15/11 and would love your thoughts and questions.