Community interventions help tackle childhood obesity

May 11 2007

A community-based environmental change intervention to prevent obesity in culturally diverse, early elementary school children reduced weight gain over one school year.

The multi-faceted program was designed and implemented by researchers from the Friedman School of Nutrition Science and Policy at Tufts University and the Tufts University School of Medicine in close collaboration with the community. The first year results reflect efforts of children, parents, teachers, school food service providers, health care providers and policy makers, as well as city departments, before-and-after school programs, restaurants, and local media outlets to provide and promote healthy eating options and physical activity among elementary school-aged children in Somerville, Massachusetts.

Corresponding author Christina Economos, PhD, assistant professor and New Balance Chair in Childhood Nutrition at the Friedman School, and colleagues used a measure called BMI-z score (or BMI-for-age percentile) to report a reduction in weight gain among children who participated in the Shape Up Somerville (SUS) intervention, as compared to children in two socio-demographically similar communities in Massachusetts who did not receive the intervention.

"On average, SUS reduced approximately one pound of weight gain over eight months for an eight-year-old child. This may seem small for an individual, but on a population level this reduction in weight gain, observed through a decrease in BMI z-score, would translate into large numbers of children moving out of the overweight category. Such a reduction is important given today's obesigenic environment where the shifts continue to be observed in the opposite direction," says Economos.

A key element of the intervention was the work done in collaboration with Somerville schools. Economos and her team planned and implemented a range of initiatives designed to provide and promote healthy eating options and physical activity. These included:

• Work with the school food service director to offer healthier foods, develop more healthful recipes, and promote consumption of new foods through interactive education programs in the cafeteria
• An after-school curriculum that included creative cooking, cooperative games, yoga, soccer, and field trips, including a farm visit to learn how food is grown
• An in-class curriculum with all first through third grade teachers that included daily "cool moves" sessions, weekly nutrition and physical activity lessons, and fun and healthy giveaways
• Evaluation and expansion of school wellness policies, such as those that impact school health and physical education environments, and pedestrian safety

The intervention went well beyond the Somerville schools. Parents and community members were encouraged to participate through school, after- school, and community events. There were parent forums to engage members of the four major language communities in Somerville: English, Spanish, Portuguese, and Haitian-Creole, newsletters with health tips, walking contests, traffic calming campaigns, and coupons for healthy foods. The SUS team also worked with school and community officials to establish a city employee fitness and wellness benefit. School nurses, pediatricians, and family physicians were trained to address issues of overweight and obesity among children. SUS also collaborated with 21 local restaurants to develop the SUS stamp of approval, which indicates that the restaurant offers healthy menu options.

"If this seems like a very large number of activities, it is" says Dr. Economos, "but we believe that it is the sum of these efforts that will guide children to form habits that prevent excess weight gain as they move into their teenage and adult years. Many programs offer nutrition and physical activity education, but SUS also worked with individuals and community organizations that shape a child's environment, improving the chances that the healthful changes they make will last."

Community interventions such as SUS are not without challenges, says Economos. "SUS researchers spent several years building relationships within the Somerville community before the intervention could be implemented." The researchers were only able to measure and follow BMI z-scores for approximately 60 percent (385/631) of students assigned to the intervention community mainly because children moved out of the area. Economos concludes, however, that "Creating programs like SUS for communities is essential as the US obesity rates have more than tripled in children in the last three decades. Furthermore, given the intractable nature of the condition once established, proactive strategies that begin during childhood are needed to prevent overweight."