Executive Summary 1

Overview of Obesity Prevalence, Causes & Consequences 3

Field Assessment Purpose and Methods 5

Field Assessment Findings I: The Obesity ProblemWhy are Children Overweight? 6What do Children Consume? 6How do Schools Contribute to the Problem? 7What Happens in Afterschool Programs? 9How does Culture Affect Diets? 11Are Foods Accessible and Available? 12Is Recreation Available for Children? 13What is the Impact of the Home Environment? 14

Field Assessment Findings II: How to Prevent ObesitySchool-Based Interventions 15Afterschool Interventions 17Parent Education 18Community-Based Interventions 19

Summary of Key Findings 20

Toward a Strategy for Obesity Prevention for Children in Rural America 22

References 24

Appendices 27

Contents

NHANES: National Health and Nutrition Examination Survey

BMI: Body Mass IndexAFDC: Aid to Families with

Dependent Children

WIC: Woman, Infants and Children

PE: Physical EducationAZ: ArizonaCA: CaliforniaGA: Georgia

KY: KentuckyMS: Mississippi

NM: New MexicoSC: South CarolinaTN: TennesseeWV: West Virginia

This report was funded with generous support from Mott’s, Inc.

Abbreviations

ExecutiveSummary

Executive SummaryThe prevalence of obesity is dramatically rising among children in theUnited States, particularly among minority populations. There aremultiple causes of childhood obesity, most of which are associated withpoor nutritional habits and inactivity. Obesity and overweight havebeen found to be difficult and expensive to treat and cure, thereforepreventing this condition in children will be the key to addressing thisnational epidemic. So far, however, there are few examples of effectiveobesity prevention programs especially among high risk isolated, ruralpopulations. This first, national assessment of the obesity problem andpotential opportunities for obesity-related interventions for children inrural, isolated America documents important findings.

The factors that contributed to obesity highlighted through thisqualitative research were:

• Rural children consumed large quantities of “junk food,” fast food,and fried food.

• Access to healthy food choices was limited in isolatedcommunities.

• Reliance on food stamps can create cycles of household foodinsufficiency which may prompt children to overeat during timesof plenty.

• Children had access to unhealthy food and drink choices atschool.

• Limited nutrition education was taught in school and childrenhad few opportunities to learn about nutrition in afterschoolsettings.

• Little or no physical education was provided in rural schools.• Rural communities had limited parks, recreational facilities, and

fitness centers.• Access to school facilities and recreational areas was a barrier to

providing physical activity for afterschool programs.• Most afterschool programs had indoor and/or outdoor areas for

physical activity, although few programs provided structuredactivities.

• Sedentary lifestyles, including excessive television viewing, playingvideo games, and using the computer were major reasons forinactivity.

• Limited parental involvement in how children spend free timeand a lack of role models for physical activity reduced activitylevels of children.

1

ExecutiveSummary

The potential areas for intervention mentioned by participants were to:• Improve availability and quality of physical education (PE) in

schools.• Modify the focus of PE from sports to lifelong fitness habits.• Develop nutrition education programs for children in school,

afterschool, as well as for parents and the community.• Improve infrastructure for physical activity such as playgrounds

and sports fields.• Increase access to school and community recreational facilities

for afterschool programs.• Develop community-based obesity prevention programs

delivering messages to children in schools, in afterschoolprograms, as well as among parents and in the community.

The information from this assessment, combined with State-levelefforts to address obesity and evidence-based approaches to obesityprevention, will set the stage for developing and implementing aprevention strategy for rural America.

2

Overview of ObesityPrevalence, Causes & Consequences

PrevalenceThe prevalence of obesity is rising dramatically among adults andchildren in all racial and ethnic groups in the United States. Accordingto the National Health and Nutrition Examination Survey (NHANES),31% of U.S. adults aged 20-74 years are obese (BMI) >30)1. Amongpreschool children in the United States, the prevalence of overweighthas doubled over the last two decades and is estimated to be over10%2. The prevalence has also doubled among youth aged 12 to 19years (from 6.1% to 15.5%). The most striking increase has beenamong children 6 to 11 years, where the rates of obesity have morethan tripled (5% to 15.3%).

Certain sub-groups, namely, Hispanic, non-Hispanic black and NativeAmerican populations are experiencing disproportionately higher ratesof obesity. Recent data revealed that 24% of Mexican-American andnon-Hispanic black children are overweight, compared toapproximately 15% of non-Hispanic white2. Among American Indianschool-age children, the prevalence of obesity is estimated to be over30%3, higher than any other group in the United States.4-6

Socio-economic status is also associated with obesity prevalence.Several studies have associated low socio-economic status with higherrates of obesity among children.7-10

Furthermore, children living in rural areas are disproportionatelyaffected by these higher rates of obesity (see Table 1 below). Over35% of middle school boys and girls from a Save the Children partnersite in Whitley County, Kentucky were obese.

3

State Population PrevalenceKentucky Children in grades 3 to 5 (n=54) One-third of rural children

were overweight11

West Virginia Fifth grade children in three 40% were overweight12

rural counties

West Virginia 5th grade children in 27% overweight13

14 rural counties (n=1338)

North Carolina Rural and urban The odds of being obese 3rd and 4th grade children were 50% higher for rural

children14

South Carolina 6th graders (n=352) in two rural 49% of the students were counties compared to national obese compared to national average; 75% African American students average of 21%15

Mississippi Children from middle school (n=205) 32% overweight16

Central New Mexico Rural American-Indian One third of the students fifth graders (n~2000) were overweight17

TTaabbllee 11:: Prevalence of Overweight among Rural Children in Save the Children regions.

Overview of ObesityPrevalence, Causes

& ConsequencesCausesThe causes of obesity in children are numerous and can mostly beattributed to environmental determinants including:

• Sedentary behaviors, television viewing, computer usage andsimilar behaviors that require limited movement.

• Poor nutritional choices and unhealthy eating habits includingover-consumption of high-calorie foods, eating when not hungry,eating while involved in other activities like watching TV or doinghomework.

• Familial factors, socio-economic status, food access, eating habitsand behaviors.

• Over-exposure to television and print advertisements of high-fat,high calorie foods.

• Lack of recreational facilities and/or opportunities for physicalactivity.

In addition, other environmental and cultural challenges to maintaininga healthy weight exist for children living in rural areas. For example,several studies have found that rural school-age children have a higherfat intake than their urban peers, especially among African-Americangirls.11,18,19 Also, limited resources and lack of access to places forexercise in rural communities make it more difficult for children to bephysically active.

ConsequencesPhysical, emotional, and social consequences are associated withchildhood obesity. Although some of the repercussions do not surfacefor several decades, even young children can suffer from serious healthproblems.20 The physical health effects are numerous, some of whichinclude hypertension, hypercholesterolimia, type 2 diabetes, andcardiovascular disease.20 Other health consequences includegallstones, hepatitis, and sleep apnea.20

Children and adolescents are also increasingly being diagnosed withtype 2 diabetes.21 A disproportionately higher rate of type 2 diabeteshas been found among American Indian,African-American and Hispanicyouth.22,23 The increasing prevalence of type 2 diabetes in children canmainly be attributed to the increase in childhood obesity. Thereforemany of the factors associated with developing type 2 diabetes arepotentially modifiable and preventable by controlling childhood obesity.22

Obese children often suffer emotional problems that range from lowself-esteem and negative body image to depression. Many overweightchildren also experience discrimination as they are often marginalizedfrom their peers, negatively stereotyped and teased. These social andemotional health issues can impact children over the short- and long-term.24

4

Field AssessmentPurpose and Methods

The overall purpose of the Nutrition and Physical Activity FieldAssessment was to gather and document information on: the extent ofthe obesity epidemic among children in our partner communities; thecurrent status of nutrition and physical activity activities including workdone by other organizations; and the potential opportunities forintervening in the area of nutrition and physical activity.

This assessment consisted of a series of in-depth interviews and focusgroups with over 45 participants in Appalachia (Kentucky and WestVirginia), the Southeastern area (South Carolina, Georgia, Mississippi,and Tennessee), and the Western area (Arizona, New Mexico, andCalifornia). The list of specific field sites included in this assessment isprovided in Appendix A. Data were collected from individuals affiliatedwith schools, community groups and healthcare facilities. Schoolpersonnel included in this assessment were Principals, Food servicemanagers, Physical Education (PE) teachers and classroom teachers.Assessment participants were Save the Children partners in bothschool and community-based afterschool programs including programdirectors, literacy specialists, physical activity coordinators, andvolunteers. Additional interviews were conducted with local andregional experts in the area of physical activity and nutrition includingnutritionists, epidemiologists, and medical doctors from variousregions. Extensive field notes were taken during the interviews as wellas tape recorded, when permissible, for accuracy in data collection.

All notes and tapes were transcribed into Word documents anddownloaded into a qualitative research program, NUD*IST, for dataanalyses. Textual data from the interviews were coded and analyzedbased on underlying themes in the data (e.g. physical activity barriers,dietary preferences).

5

Field AssessmentFindings I:

The Obesity ProblemWhy are Children Overweight?Childhood obesity is multi-faceted, including individual, household, andcommunity factors. The overall consensus among participants wasthat children were becoming overweight because of “bad habits,”heredity, and environmental factors, such as poverty and lack ofaccess to facilities. One informant, who shared the same sentiment asmost of the participants, indicated that, “Kids are eating junk food andstaying at home watching TV or playing with an X-Box which are the majorreasons for obesity.” The poor eating and exercise habits of parentswere mentioned as a contributing factor to the ‘bad habits’ observedin children, even at an early age.

Other informants attributed the high rates of obesity in children tolack of physical activity. One teacher in California noted, “Since thehigh school removed PE (physical education) 2 years ago, I have seen anincrease in obesity among older kids.” Most of the informants werequick to say that childhood obesity, as well as adult obesity and healthfactors associated with obesity (e.g. diabetes, heart disease), weremajor problems in their communities. Few informants had estimatesof the extent of the obesity epidemic, but many have seen the effectsof it over recent years. The issues mentioned with respect to the risein childhood obesity, primarily included factors related to diet andactivity levels of children.

What do Children Consume?Barriers to eating healthy were multi-dimensional and numerousacross all of the regions. One of the major issues cited for the rise inchildhood obesity was the excessive consumption of “junk food”including chips, candy, cookies, and other high-fat and high-sugar foods.The most frequently cited food consumed by children across all of theregions was “Hot” Cheetos®, a spicy snack item that contains nearly 65%of its calories from fat. Children were also reported to consumeexcessive amounts of soda in all age groups across all regions. Anutritionist in Kentucky reported that children as young as 4 monthsof age are consuming “pop-in-a-bottle.” According to one informant,“Kids are ‘Popaholics’ and are drinking ‘Big gulps’ all day. They are drinking itin the morning for breakfast, then for lunch and dinner.” (AZ)

“Our moms are feeding

whole milk before kids are 1

year old. They are feeding

them pop in a bottle at 4

months old… That is why we

are seeing obesity rates

starting so early. I have seen

babies that are well above

the 90th percentile weight for

height. Babies and children

are taught to ignore their

body functions as far as being

full or hungry. We are

teaching our children to

ignore that and obesity rates

are starting even younger

than our school age kids and

it is very disheartening.” (KY)

6

Field AssessmentFindings I:The Obesity Problem

How do Schools Contribute to the Problem?Vending Machines. Vending machines in primary and middle schoolsprovided children with easy access to high-fat and high-sugar foods anddrinks. Some school personnel discussed attempts to reduce oreliminate children’s access to junk food during certain times of theschool day, such as during lunch; however, the majority of the schoolsin this assessment had vending machines available to children duringschool and afterschool hours. One of the major reasons mentionedfor maintaining vending machines was the revenue generated for theschool from the sale of items. In one school district, children had anestablished 10-minute “snack break” at 10 a.m. that consisted ofpurchasing “junk food” and soda from the vending machines.

Nearly all of the schools had vending machines with the exception ofone of the elementary schools visited in the Western region. ThePrincipal at this school did not want to have vending machines availablefor children because he “didn’t see the need for it in school”. Theabsence of vending machines eliminates the opportunity to purchasefood; however, many children bring chips, candy and soda to school.

School Lunches. Menus were collected from many of the schooldistricts and samples are in Appendix B. Food Service managersmentioned some of the challenges of following USDA guidelines whilealso finding ways to make the food appetizing to children. Theguidelines require schools to serve at least one serving of fruit andone of vegetable per day, which is less than the recommended intakeof fruits and vegetables recently published in the Dietary Guidelinesfor Americans, 2005.25 Most of the informants indicated that childrenalmost never consumed vegetables and infrequently consumed fruit.Children’s food preferences included: pizza, french fries, chickennuggets, hamburgers, corn dogs, and hot dogs. For breakfast, many ofthe kids preferred pancakes, donuts, or cinnamon rolls over otherhealthier choices like cereal, oatmeal or fruit. In addition, childrenbought food from vending machines or snack bars in lieu of the schoollunch provided.

Some schools were attempting to improve the selection of foods aswell as reduce food waste. One food service manager surveyedchildren about their food preferences. Based on her results sheeliminated certain items from the menu and added other foods thatwere more culturally acceptable in the region, such as Mexican andFilipino food. In addition, she replaced some of the typically high-fatitems with lower fat alternatives. “We serve the kids low-fat foods andthey don't even know it… like low-fat cheese, hot dogs made from turkey,corndogs made from turkey.” (CA)

“Kids get a 10-minute break

and they rush to the vending

machines to get snacks and

soda. Some of the kids get

fruit drinks but there is more

sugar in the fruit drinks than

the soda. Most kids eat candy

or chips during the break.

They cannot go outside

because by the time they

stand in line for their snack

they have no time to go

outside.” (KY)

7

Field AssessmentFindings I:

The Obesity ProblemAccording to many informants, the pressure to increase academicscores has forced some school districts to reduce time allocated forrecess and lunch.

“Some kids only have 1/2 hour for lunch because they cut thelunch hour to make more time for academics. They don't havetime to eat because they have to wait in line for their food. Theyhave to ‘slam down’ food quickly. We see kids eating their food inthe lunch line or as they are walking up to dump their tray.” (CA)

Nutrition Education. Lack of nutrition education was cited as amajor reason for the inadequate knowledge of healthy eating amongchildren and families. Many of the schools had incorporated limitedhealth and nutrition education into their health or science curriculum.Most of the interviews with school staff revealed that they felt that thenutrition and health information taught in school was inadequate.Where nutrition education was available, most of the informants saidthat children learned about the food pyramid and food groups. Manyinformants stated that “No Child Left Behind” has forced schools whopreviously taught nutrition and health, to remove it from thecurriculum because it is not a required “knowledge set” for theacademic standardized exams.

Physical Activity. The majority of the regions had limited PEprograms at the elementary and middle school levels. Informantsattributed this to the “No Child Left Behind” legislation that mandatedschools to improve their academic standards. As a result, many of theinformants said that this legislation was the direct reason why theyhave eliminated PE in their school. Without adequate resources,including both financial and time, schools indicated that they were notable to continue with PE when “they are now focused on academicprogram improvement in school and PE gets short changed because thereare not enough minutes in a day.” (CA)

“Physical activity has not been a priority because of the ‘No Child Left Behind’ mandate that the schools are strugglingjust to meet what they were required to meet before that camedown.” (MS)

Several school districts had PE as part of their curriculum, however,they did not have a PE instructor. Providing physical education forschool children became the responsibility of the classroom teacher,when time permitted.

“A Typical meal at school wouldbe chicken nuggets and frenchfries that are all fried, or pizza.They are trying to improve thelunches, but they have to makeit palatable for the kids. Kidswill eat the chicken nuggets andthe pizza and the burgers andthe hot dogs. I have literallyseen children take their lunchesand dump it in the garbage andtake their snack ticket and go tothe snack bar. A lot of theschools have a snack bar so thatafter the kids have lunch theycan get cakes, cookies, candies,and ice cream… all stuff that ishigh in fat. Some schools thatdo provide it are trying tochange it or they tell their kidsto eat their lunch first and thekids just dump their traybecause nobody is monitoring it.And they take their snacktickets and get snacks and thatwould be their lunch.” (KY)

8

Field AssessmentFindings I:The Obesity Problem

Other informants indicated that there were a lot of political reasonsassociated with reduction in physical activity for children.

“Let’s face it… when some of the new school buildings weredesigned and built the economic requirements and the politicalcomments that went into those funding of those school buildingswasn’t always conducive to physical activity for the children sothere is some barriers that… move down to the state level andthat funnels down into the local level which affects all theagencies that are trying to provide physical activity andnutrition.” (KY)

In schools that have PE programs, on average, one to two classes of PEwere offered per week. The typical PE activities were sports such asbasketball, volleyball, football, and t-ball. Other lifetime physicalactivities, such as walking, were not highlighted in most PE programs.One highly motivated teacher in Appalachia taught step aerobics to thechildren for PE and for children in the afterschool program. Anotherprogram in the Western Area used the SPARKa curriculum and “projectadventure” program to teach team building and problem solving skills.The physical education coordinator indicated that these curricula de-emphasize competitive sports and, instead focus on healthy lifestylesby incorporating hiking, running, and other fun games and activities into the program.

In addition to cuts in PE, many of the schools throughout the regionshave eliminated or reduced the time children have for recess.Reduction of recess time was cited as a necessary component toschools attempting to achieve higher academic standards. There is “norecess for kids. They have quiet time instead, but no scheduled recess unlessteacher decides to let them go outside.” (GA)

What Happens in Afterschool Programs?Snacks. Most of the afterschool program staff indicated that childrenreceived healthy snacks as part of the program. A few informantsmentioned that they were not able to give the children the most“healthy options” due to resource constraints and reliance on outsidedonations for food.

“There is no structuredphysical activity and theschool does not see theimportance of physicalactivity, even though the kidsare not getting it. Theteachers are committed toraising test scores and we aredoing it. It requires everyounce of energy for theteachers and we don’t havetime to do PE with the kidsbecause the kids only have a10-minute break… there is norecess except for one hour aweek which is considered PEtime. The school board isaware of the issues with thekids having no PE, but theyhave limited funds to raisetest scores so that is why PE,music, and art weredropped.” (KY)

9aSPARK (Sports Play and Active Recreation for Kids) is a nationally recognized program withdocumented research showing improved quality and quantity of physical activity in children.

Field AssessmentFindings I:

The Obesity Problem

“We provide meals that are available based on what is donatedor funded through USDA. Some of the food is healthy and someis not… we get a lot of cookies from Nabisco that are donated…many agencies are desperate for food ...” (CA)

Snacks provided in afterschool programs included: Rice Krispies®,Oreos®, sugar cookies, graham crackers, granola bars, crackers, wheatthins, chips, light popcorn, peanut butter and jelly sandwiches, crackersand cheese, flavored rice cakes, yogurt, celery, fruit, such as apples,flavored applesauce, apple juice, Gatorade®, Crystal Light®, Capri Sun®,and milk.

Nutrition Education. Several of the afterschool program staffindicated that they had incorporated nutrition lessons into theirliteracy program. One program in Appalachia utilized a child-friendlywebsite that allowed children to learn and explore various nutritiontopics. This provided children with nutrition information while alsoserving as an opportunity to use reading skills. Other programdirectors mentioned that they invite speakers, such as nutritionistsfrom local Extension offices, to teach children about the food pyramidand preparation of healthy snacks. Many of the afterschool programstaff indicated that they “do nutrition” every day, which involvesproviding a snack for the children, with limited or no nutritioneducation. Where there was more explicit nutrition education in theafterschool program it appeared to be limited to learning the basicfood groups and conducting cooking sessions with the children.

Physical Activity. Many of the afterschool partners had access toplaces for children to exercise. Several of the partners had indoorand/or outdoor areas where they can organize physical activities forchildren. However this varied considerably by site. In somecommunities, the afterschool center was the only place where childrenhad an outlet to be active.

“Kids need to be in organized things like sports or afterschoolprograms. If they are not in these programs they don’t get anyphysical activity because there is no gym or YMCA to stop by. Wedon’t have the resources or the transportation or the number ofthings it takes to make a group of kids want to come. We don’thave the draw we use to.” (WV)

“The schools provide us with

the afterschool snacks for our

program. It is always a

nutritious thing. Yesterday it

was a fruit roll-up and they

get a carton of low fat milk

or a thing of apple juice. The

day before it was a little

snack pack of pretzels,

popcorn, peanuts and

M&Ms… and some kind of a

cereal in there, like Chex

Mix. We asked the chief cook

to make them nutritious.”

(WV)

10

Field AssessmentFindings I:The Obesity Problem

Several afterschool programs throughout the regions had relativelyunstructured and organized physical activity. A partner in a remotelocation in the Western region had inadequate outdoor space forchildren to play. In contrast, a program visited in Whitley County,Kentucky, had structured, organized, and wide-ranging activities forchildren in the afterschool program. These included:Tae Kwon Doe,basketball, volleyball, aerobics, walking, and running (outdoor track).Each activity had a coach that guided and encouraged children throughthe various physical activities. This program was held at the middleschool, which allowed the children access to both indoor and outdoorrecreational facilities.

Although programs varied in the number, frequency, and intensity ofactivities, most of the partners provided some opportunity for childrento engage in outdoor play (weather permitting). This often involvedplaying on jungle gyms or basketball courts (where available), orengaging in group games such as Simon Says, Follow-the-Leader,Duck-Duck-Goose, etc. Several partners discussed their desire toincorporate team sports into their afterschool programs, but notedthat they had difficulty gaining access to facilities such as schools orrecreational facilities. “We were doing teams like basketball, softball, andsoccer, but it is hard to find a facility to do that, to practice. Even our CivicCenter, it’s like pulling teeth to get in there and use the space.” (KY)

How does Culture Affect Diets?Children’s food preferences for sweets, snacks, and soda were similaracross regions. Cultural and regional differences in food types,preferences, and availability of food did exist. Examples of typical mealsby region as reported by the informants are presented in Table 2.

11

Region Typical FoodsKentucky/West Virginia soup beans, corn bread, fried pork chops, fried chicken, and baloney

Western Native fry bread, tortillas, and fried potatoes American reservations

California – Rice and Beans, burritos, tacos, tamales, Mexican, or Filipino foods.Hispanic population

Southwest Region greens, yams, fried chicken, meatloaf, cornbread, mashed potatoes,and peas

TTaabbllee 22:: Typical foods consumed by region

Field AssessmentFindings I:

The Obesity Problem

Fried foods were common across all of the regions, especially the useof lard, ham hocks, and fat back for many local dishes. This wasreported on Native American reservations in the Western area as wellas among informants in the Appalachia and Southeast regions. Some ofthe informants indicated that it was culture and tradition that guidedpeople in their dietary patterns. “One of the biggest issues in our area isthe culture… the way they were taught to fry potatoes and eat friedchicken.” (SC)

Cultural factors were also mentioned as influential in families choosingto take their kids to fast food restaurants. “It is the immigrant culture ofacculturating by going to McDonald's, Burger King, eating junk food, cookies,and candy. When they go to McDonald's they buy cheap food and say weare Americans now.” (CA) Consumption of fast food by children wascommonly reported by informants in all regions of the United States.Most communities have fast food restaurants nearby or within 30minutes of their town. A large proportion of the families, throughoutall of the regions, frequented fast food restaurants, as reported byinformants.

Informants indicated that even when families in their community did nothave enough to eat; they would share whatever they had with others.

Are Foods Accessible and Available?Access to and availability of food, especially healthy food, in these rural,isolated communities affected family food choices. Many of the familiespurchased food in bulk, which often involved traveling long distances of30 minutes to 2 hours to a “decent” grocery store where they could“make their dollar stretch.” Informants indicated that the majority offamilies relied on some type of government assistance including foodstamps,AFDC,WIC, and commodity foods. In some cases, familiesused food pantries or other emergency food distribution programs intheir communities when their food supply ran out.

“When you go to someone’s

house, that’s how they welcome

you. It’s because they welcome

you with food because that’s all

they have to give you. But I

know and it still goes on today

that if you do home visits there

may not be anything else in that

house for the rest of the people

to eat, but if they offer you

something, you better take it

because they’re probably giving

you the last piece of bread or

whatever it is they have in their

house and the last cup of coffee

or tea. They’re giving it to you

because they respect and honor

you as a person who has come

to your house… and that still is

very prevalent in some areas of

the counties now, even today.

It’s just part of the culture.”

(KY) 12

Field AssessmentFindings I:The Obesity Problem

Food stamps, in particular, were mentioned as a factor in a monthlypattern of food availability and food scarcity that existed in many ruralhouseholds. Behavioral factors such as binge eating among childrenwere reported to occur at the beginning of the month (after thereceipt of food stamps) when there was a lot of food available in thehousehold. In addition, many families used other means to provide fortheir family when their food supply diminished toward the end of themonth. Some of these strategies included relying on family or friendsfor food, utilizing a food pantry, or using staples (e.g. flour to make frybread or tortillas, and potatoes) to make a meal for their family. Oneinformant stated that in her county there are “a lot of overweight peoplethat are undernourished… and they don't feel right.” (KY)

Lack of basic education was suggested as a reason why many familiesrun out of food stamps.

“They don’t know how to purchase healthy foods wisely and usetheir money dollar. A lot of our families are not able to budgetbuying foods, education-wise that is a big problem. The averagereading level in this area is about 5th grade so families have ahard time with that. Families have a hard time trying tounderstand how to make that dollar work for them.” (WV)

Is Recreation Available for Children?There were regional differences in terms of availability and accessibilityof places for children to be active. While some locations had parks,fitness centers, or recreational facilities, other communities had limitedplaces for physical activity. Although most of the schools hadplaygrounds or gyms, they were often inaccessible to children afterhours. One principal indicated that, “There is nothing available for thekids to do beyond the school playground and fields, but it gets locked atnight and on the weekends. Kids still find a way to squeeze through thegates so they can play.” (CA) Other barriers to physical activity in thecommunity were cost and transportation associated with participatingin recreational activities.

In several communities spaces for recreation and physical activity hadbecome dilapidated due to damage and neglect. “Many communityrecreation areas have been destroyed from vandalism, although most of

“Before the first of the

month the cupboards are

bare and families are eating

commodity foods.They use

all of the food stamps at the

beginning of the month

because they just ‘Shoot em’

… A lot of people buy food

in bulk, and packaged food,

or they use food stamps for

other things and do not have

food for the rest of the

month. When food is

purchased at the beginning

of the month, children would

‘Eat, eat, eat’.” (NM)

13

Field AssessmentFindings I:

The Obesity Problemthem still have a basketball court.” (AZ) In one very remote area in theWestern region, a community was able to raise revenue to build arecreation center. “We have a new recreation facility being built near theafterschool center that will have a weight room, a pool, a basketball court.This is being built with donations from the community.” (AZ) These newfacilities offer opportunities for community members, especiallychildren, to engage in physical activity in a safe environment.

What is the Impact of the Home Environment?Most of the children reportedly do not engage in physical activity whilethey are at home. According to nearly all of the informants, a sedentarylifestyle that included excessive time spent watching television, usingcomputers, and playing video games was the main reason children werenot active. An informant from the Southeastern area said, “Video games,like Nintendo and Play Station are a barrier to physical activity. Kids justwant to play games. Even the poorest of children have video games. Parentsuse television and video games as a ‘babysitter’.” (SC)

Lack of parental involvement was identified as a reason why childrenwere not very active while at home. Many of the communities had alarge proportion of single parent families and/or two parent homeswhere both parents work. Informants said that many of the childrenwere “latch-key” kids and did not have a parent who was at homewhen they arrived to encourage them to eat well or be physicallyactive. In addition, some parents did not feel it was safe for theirchildren to leave the house. “There are a lot of ‘latch key kids’ who stayhome alone. Parents don’t want their kids to go outside because they mightget hurt, so they just stay inside and watch TV.” (AZ) Physical activity athome may not be a priority or encouraged among some parents.

Several informants mentioned a lack of adult role models as a factor inthe inactivity of children. “Some of our educational role models are notthe role models they should be… yes meaning the teachers and the parents,the Principals.” (WV) In addition, “There are no role models for physicalfitness because adults are not active and obesity is the norm in thecommunity.” (AZ) Not seeing physical activity as a priority was alsocited as a factor in sedentary lifestyles. “Kids and families do not havegood habits, like exercising before school. We don’t make time for exerciseeven though we make time for everything else.” (KY)

“They assume their kids are

getting physical activity at

school, they’re getting

physical activity afterschool

and that’s good enough…

A lot of our parents work…

It’s easier from them to let

their kid go in, sit down at

the T.V. or the computer and

play games than it is to

actually deal with them.”

(KY)

14

Field AssessmentFindings II: How toPrevent Obesity

Overall, the majority of informants indicated that preventing obesitywould require collaboration of many different groups in all sectors ofthe community. One informant in West Virginia summed it up bystating that this effort “needs to involve schools, health professionals,private and public collaboration process for the survival and health ofchildren.” In addition, most of the informants indicated that it shouldbe a “comprehensive program that includes both physical activity andnutrition.”

The participants agreed that in order for a nutrition and physicalactivity program for children to be effective and sustainable, it must beappealing to children. A teacher in California said, “We need to changepeople's attitudes about health and make it fun and interesting.” Anotherinformant in Mississippi said, “If a program is fun kids will go.”

Schools-Based InterventionsPhysical Activity. Many of respondents felt that it was important tohave some type of physical activity at school. Several teachersindicated that children were more attentive after they had anopportunity to play outside. Several principals and school staffindicated that they would like to have more time for PE and/or initiatea structured PE program in their school. A few informants indicatedthat for a program to be successful, “You need a volunteer physical trainerthat likes working with kids and can be a role model for the kids.” (CA)Some informants suggested incorporating different activities that teachlifelong fitness habits, such as walking, dancing, yoga, martial arts,aerobics, weightlifting and using exercise machines. “We need to havean organized physical activity program which would include team orindividual sports, like Yoga, Karate,Tai kwon do, Judo… and a dance machineto get kids moving.” (MS)

Several schools had limited access to indoor and outdoor facilities forchildren to be active; therefore, many of the suggestions includedimproving the outdoor play areas. School officials indicated that theywould like to make structural improvements at their schools toimprove access to activities by children. Some of the suggestionsincluded improving the outdoor recreational areas, such as addingplayground equipment, building a walking track or trail, adding baseballand basketball courts. One informant suggested the followingenhancements to her school:

“We need a comprehensiveapproach that includes the schools,the health care professionals – bothprivate and public.We need acollaboration process where we canbring all the entities to the tablewhere they have common ground.And that common ground is survivaland the health of the children inthe population they are workingwith. And if there could be 3 or 4health care goals – physicalactivity, nutrition, dental – whateverit might be… if they could identifythose areas and do acomprehensive plan. And it has tobe community based… it has to bethe bringing together of the entitiesthat are the key players and do theprogram for the community thatyou are working with.And youtarget them… and you cover everybase… you have to make sure it’sgoing to be reinforced in everything – whether it’s in school,whether it’s in afterschool, whetherit’s in church, whether it’s in thedoctor’s office.” (WV)

15

Field AssessmentFindings II: How to

Prevent Obesity“We would like to improve the playground equipment and addthings like climbing equipment, parallel bars, forts, obstacle coursesfor kids, more swings, cement walls to play hard/hand ball. It wouldalso be great if we could add a weight lifting room that would alsohave exercise equipment machines made for kids.” (CA)

Nutrition. Few informants suggested improving school meals bychanging the breakfast and lunch options offered to children. Althoughthis may be a likely place to intervene, informants described theimportance of adhering to the USDA guidelines when developingmenus for children. Although many community members interviewedsuggested that schools remove vending machines and snack bars fromschools (or at least modify what is offered), a limited number of schoolpersonnel offered this as an option for supporting healthy eatingamong children. One informant in New Mexico thought that theyshould “change snack machines in schools to not allow soda and providemore juices and diet drinks.”

Many of the informants attributed the low rate of vegetable and fruitconsumption by children to a lack of knowledge of nutrition andsuggested developing nutrition education programs for their school. Itwas suggested by several informants that programs needed to becreative and led by a person who is knowledgeable about nutrition,such as a nutritionist. In one county in Kentucky, a nutritionist from thehealth department taught children about nutrition at various schoolsusing a “hands-on” approach.

The majority of the programs that were visited as part of thisassessment did not have ready access to a nutritionist within theircommunities. Some of the participants suggested that school districts,

“Hire a nutritionist for the schools to teach and train little kidsabout what parts of the body are geared towards food that theyeat. Like food for your heart, lungs and brain. Have thenutritionist go into the classrooms to teach because so many ofthe teachers are loaded down and there is no curriculum to teacha few things about nutrition.” (MS)

Another suggestion for school-based nutrition education programs,which would also be applicable in an afterschool setting, was the use ofpeers.

“I get the kids involvedbecause I find if they arebored, they are not going todo anything… When you dothat exercise stuff with them,they love that. I try to bringin every aspect of teaching,visual, because most peopledon’t remember what theyhear. What they see andwhat they do, they willremember better. So I try toget them seeing and doingthings, using the food modelsand things. I show them aserving size of pizza and theylook at you because they areamazed. You know it is oneslice, and they say they wouldeat 10 of those.” (KY)

16

Field AssessmentFindings II: How toPrevent Obesity

“Tutor kids and have kids teach the lesson so that they learnbetter. When they have to teach a lesson they ask morequestions and talk to kids in terms of what the studentsunderstand.” (CA)

Although there were few nutrition education programs available atmost of the schools, one middle school in Kentucky started a“nutrition fitness challenge” to help reduce overweight among children.

A food service manager in California offered her thoughts on nutritioneducation, “It is hard to stop kids from eating junk food but maybe you canteach them to eat “Hot” Cheetos® with a salad or with chicken to balanceout the bad with the good.”

Afterschool InterventionsPhysical Activity. Several afterschool program staff suggested havingexercise programs for kids that would include using exercise tapes(aerobics and Tae Bo), walking, hiking, martial arts, sports teams andusing the outdoor recreational areas. Many of the informantssuggested a more structured program where they would have staffavailable to teach the children various activities. One informant fromGeorgia said,

“We should have more staff to do activities… staff to work withkids in the afterschool program to provide safe activities forkids… They would be responsible for setting up the grounds foractivities, supervising the children, and scheduling different agegroups and different sports.” (GA)

Several program directors indicated that in order to increase physicalactivity among children, playgrounds and sports fields needed to beimproved or built. Informants indicated that improved access tofacilities in their community needs to be a priority. Suggestions weremade to collaborate with schools and community groups in order tohave access to gyms (that are not in use) as well as recreational areasthat are often off-limits at various times of the day or year. In addition,transportation was mentioned as a major barrier to childrenparticipating in afterschool programs and recreational activities.Suggestions were made by many of the informants to work with theschool districts to use or lease buses or have a ‘late bus’ service. Thiswould allow children an opportunity to participate in afterschoolactivities, even when they live in remote areas.

“We are going to start out

with nutrition classes then

physical activity on a daily

basis… work that into their

days… do 3-a-day and 5 a-

day (vegetable and fruit)

challenges.The kids that

actually complete the

program are going to get

incentives that are physical

activity and nutrition related

(bikes and stuff) or school

related.They (the school)

wants to do this because they

have such a problem with

high levels of overweight.”

(KY)

17

Field AssessmentFindings II: How to

Prevent ObesityNutrition. The major suggestion with respect to the nutritioninterventions was to incorporate more nutrition education into theafterschool program. One informant stated that they should, “Get booksand software on nutrition and food groups to combine with the literacyactivities.” (AZ) This was suggested by other informants as they felt thatthey had limited time to incorporate literacy activities and nutritioneducation into the time available afterschool. Several of the informantsthought that it would be important to “bring someone in”, such as anutritionist, to teach children about nutrition through activities such asby cooking with them or helping them to grow a garden.

Parent EducationMost of the partners highlighted the importance of including parents inthe effort to teach children about nutrition. Many ideas for programsincluded, but were not limited to, involving parents in the effort topromote healthy habits in their children. Some of the partners werepresently working with parents to educate them on nutrition relatedissues. Among the partners who had parenting programs, most of thesessions centered on preparing healthy meals.

Many informants shared the challenge of budget constraints and lack ofaccess to healthy foods in providing good nutrition for families andsuggested the need to teach parents how to “stretch their food dollar”and how to prepare healthy foods on a budget. “There should benutrition classes for parents to teach them how to have balanced diets. Theywould be pleased about the foods because we could show them that theycan stay within their budgets.” (NM)

Cultural aspects were also an important factor mentioned by severalinformants with respect to nutrition education for parents.Suggestions were made to have programs taught in one’s nativelanguage, such as Spanish or Navajo. In addition, some informantssuggested that nutrition messages be sensitive to cultural differences.One informant said, “Provide nutrition education for people about differentfoods because they may not culturally be used to eating foods like brusselsprouts.” (NM) In order for some families to participate, “They needpeople in the community who talk to them in their language and get themto buy into programs for kids. If families understand importance ofprograms… that will make a change.” (CA)

“We try to teach parents

about cooking, such as

making greens with smoked

turkey instead of ham hocks.

We teach families about

moderation… you can't eat

pizza, candy, and potato

chips every day. We try to

get parents to expose their

children to more vegetables

and fruits.” (GA)

18

Field AssessmentFindings II: How toPrevent Obesity

Many of the participants indicated that parenting classes should alsoemphasize the importance of motivating their children to be active.Some of the informants suggested finding ways to “Help parents putaway TV and video during the day light and have kids playing outside.” And“teach them how to play games and do things with kids to keep them awayfrom the TV.” (NM) Other informants felt that parents needed to bemotivated to spend more time doing things with their childrenbecause, “If you get parents motivated then kids will be motivated.” (KY)Several suggestions were made, such as a walking club for parents andchildren, group exercise (aerobics, dance) activities at communitycenters and special events at schools and in afterschool programs thatencouraged families to be active together.

Community-Based InterventionsThe major suggestion for a nutrition and physical activity program wasto make it a comprehensive community-based effort where messagesare delivered in schools, afterschool, among parents and in thecommunity. An informant in Appalachia mentioned a recent grant thatwas submitted to address child obesity as described in her own words,

“We want to train teens to be nutrition outreach workers, wherewe train them in nutrition, fitness, and child health. Each of theteens were going to identify kids in public housing that had aweight problem and teens were going to be a big brother, bigsister or a “fitness buddy” or “health buddy.” They were going towork one-on-one with the kids with a health workbook. We weregoing to have a nutrition class, with the nutritionist, orsomeone… to have a class once a week afterschool. Also, once amonth have a dinner where we would have the kids… workingwith someone from the Extension office… to plan a low costnutritious meal that the kids prepare and serve it to the parents.And that way we would give out recipes… and draw parents inbecause really it is the parents that have a lot to do with the kidsbehaviors.” (KY)

This program idea included several segments of the community, fromteen leaders, to local nutritionist, and to parents. Another program inCalifornia incorporated cultural aspects into health information byusing “telenovelas” (Spanish language soap operas). In addition, thisprogram brought the information directly to community members sotransportation would not be a barrier to participation.

“We did ‘nutrition on the go’which was a mobile truck thatwe sent to rural areas to do 2-3hour stations of nutritioneducation.This had 1 to 2 quicktips on nutrition-related topicslike the food pyramid, portionsizes, and health relatedinformation… We did diabetesinformation in the form of‘novellas’, child seat program,and taste tests. At the end ofthe stations were freeinformation… and families gotto take bags of fresh fruit andvegetables home with them. Alot of families were coming tothe program for theinformation, not just the food...They really wanted to eathealthy. All of this was donewith volunteers that weretrained within the localcommunities… they knewnutrition-related knowledge andpassed it on to friends andneighbors.” (CA)

19

Summary of Key Findings

This qualitative research yielded several important findings related tothe development of a programmatic strategy for obesity prevention inthese communities. The problem of obesity was evident in theassessment communities and key informants were well aware thatchildren were overweight as a result of factors related to bothnutrition and physical activity. The key informants had a wide range ofsuggestions for how to begin to tackle the obesity problem.

The Impact of Nutrition/Food Choices and Food Availability

• Consumption of “junk food” and fast food was the norm. It isstriking that across all four areas the most commonly reportedfood consumed by children was “Hot” Cheetos®.

• Children’s preference for other less healthy foods includedfrench fries, hot dogs, and donuts was a key barrier to alteringfood choices.

• Fried foods were common across all of the regions, despitecultural and regional differences.

• High-fat and high-sugar foods and drinks were available tochildren at schools through vending machines.

• Although required to follow USDA guidelines, school meals oftendid not provide adequate healthy alternatives for children.

• Afterschool programs did not consistently provide healthy snacksto children because of a lack of resources, lack of nutritionknowledge and the unavailability of healthy options.

• Access and availability of food, especially healthy food, was asignificant factor in these rural isolated communities.

• Poverty and dependence on food stamps can create a cycle offood plenty to food scarcity in these households; during times ofplenty children may overeat.

The Impact of Physical Activity Opportunities and Practices

• The majority of the schools had limited or no PE programs inschool; this was attributed to cuts made as a result of the “NoChild Left Behind” legislation.

• Many schools did not have PE instructors; classroom teacherswere often responsible for providing physical education.

• Typical PE activities were focused around sports such asbasketball, volleyball, football, and t-ball, whereas other lifetimefitness activities, such as walking, were not part of most PEprograms.

20

Summary of Key Findings

• Regional differences existed in the availability and accessibility ofplaces for children to be active; some locations had parks, fitnesscenters, or recreational facilities while other communities hadnone.

• Most afterschool programs provided low to moderate physicalactivity; few centers had structured, vigorous, regular physicalactivity for children.

• Access to school facilities and recreational centers were majorbarriers to providing physical activity in the afterschool setting.

• Rural children were inactive because the norm in these settingsis sedentary lifestyles including excessive time spent watchingtelevision, using computers and playing video games at home.

• A lack of physically active adult role models and little parentalinvolvement during children’s free time affected the inactivity ofchildren.

Potential Areas for Intervention• Making high-quality physical education available in schools was

seen as a key area for intervention.• Shifting the focus from sports to teaching lifelong fitness habits,

such as walking, dancing, yoga, martial arts, aerobics, weightliftingand using exercise machines was recommended.

• Nutrition education programs in school, afterschool, for parentsand in the community was a felt need expressed by mostinformants.

• Infrastructure for physical activity – sports fields and playgrounds– need improvement and expansion.

• Afterschool programs need access to facilities for recreation andphysical activity in the school and community.

• In general, key informants felt the need for a comprehensivecommunity-based effort at obesity prevention with consistentmessages delivered in schools, in afterschool programs, amongparents and in the community.

21

Toward a Strategyfor Childhood

Obesity Preventionin Rural America

Obesity and overweight have been found to be difficult and expensiveto treat and cure, therefore preventing this condition in children willbe the key to addressing this national epidemic. So far, however, thereare few examples of effective obesity prevention programs especiallyamong high risk isolated, rural populations. This first, nationalassessment of the obesity problem and potential opportunities forobesity-related interventions for children in rural, isolated Americadocuments important findings. This information, combined with State-level efforts to address obesity and evidence-based approaches toobesity prevention will set the stage for developing and implementing aprevention strategy for rural America.

State Legislation and InitiativesOver the last several years various states (including some of thoseincluded in this assessment) have passed legislation to combat thegrowing rates of childhood obesity. California, for example, is a leaderin terms of legislation passed to prohibit the sale of foods and drinksof low-nutritional value from vending machines in schools.27 Inaddition, California has implemented standards for nutrition educationand physical education in schools.27 Arkansas has mandated onehour/week of physical education with no less then 20 minutes ofphysical activity for grades Kindergarten through nine. See Appendix Cfor other obesity-related legislation passed by the states included inthis assessment.

Many states also have developed state-wide and local initiatives toprevent obesity and chronic diseases. For example, Coloradodeveloped a resource kit that encourages schools to implementprograms and policies that promote a healthy school environment.This kit provides action steps on how to create a positive environmentfrom the cafeteria to the classroom to impact a child’s eating andphysical activity behaviors.28 In West Virginia, an after-school program,Choosy Kids Club, provides elementary school children with anopportunity to learn healthy nutrition and physical activity decision-making skills.29 Appendix D lists other programs and initiatives by statethat focus on obesity prevention.

Evidence-Based Approaches to Obesity Prevention Researchers have attempted to identify the multi-dimensional causes ofobesity as well as effective solutions to combat the problem. A recentsystematic review examined nutrition and physical activity programsaimed at children to identify evidence-based approaches toprevention.30 Some of the key conclusions from this review and fromother research will contribute to the foundation of a strategy for

22

Toward a Strategyfor ChildhoodObesity Prevention inRural America

childhood obesity prevention in rural America. What we know so faris as follows:

• Programs to address physical activity should focus on aerobicactivity, rather than sports or skill development that is typicallytaught in physical education classes.

• PE teachers ensure more moderate to vigorous activity thanclassroom teachers.

• If classroom teachers are to play a role in physical education theywill need training and mentoring skills to learn how to maximizethe level of physical activity offered to children.

• Schools that provide concentrated physical activity programshave seen improvements in academic performance, despite havingreduced class time for academics to implement the physicalactivity program.31-34 A study conducted with children whoreceived a health related physical activity program (SPARK)26,found improvements in reading scores after 2 years of doublingtime for physical education.35

• Schools that successfully promote less video game and televisionuse appear to be highly effective in reducing physical inactivityand reducing obesity.36

• Research shows that successful nutrition interventions had atleast 10 sessions and were multi-faceted involving healthycafeteria choices, mass media campaigns, and parent involvement.

• Increasing knowledge in nutrition is insufficient; educationalmessages need to focus on changing actual behaviors rather thanimproving knowledge and/or attitudes.

• Interventions that target students, school cafeterias, after-schoolprograms, parents, and the community are more effective thanany intervention alone.

• Multi-faceted obesity prevention programs for primary schooland high school students that included components such asschool curricula, mass media, parent mailings, and healthycafeteria changes over at least 8 to 10 weeks show the mostpromise for altering food intake.

Conclusion Save the Children has worked for more than 70 years in partnershipwith schools and community-based organizations in these rural areashardest hit by the obesity crisis. This strong, long-term connectionputs Save the Children in an ideal position to help develop and adapteffective approaches to obesity prevention for these children. Bygaining perspective directly from the communities in which Save theChildren works, this Nutrition and Physical Activity Field Assessmenthas helped to further strengthen partnerships and collaborationsneeded to develop and implement a successful obesity preventionstrategy for children in rural America.23

1. Flegal KM, Carroll MD, Ogden CL, Johnson CL Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002; 288(14):1723-7.

2. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002; 288(14):1728-32.

3. Caballero B, Clay T, Davis SM et al. Pathways: a school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003; 78(5):1030-38.

4. Story M, Evans M, Fabsitz RR, Clay TE, Holy Rock B, Broussard B. The epidemic of obesity in American Indian communities and the need for childhood obesity-prevention programs.Am J Clin Nutr. 1999; 69(4):747S-754S.

5. Eisenmann JC, Katzmarzyk PT,Arnall DA, Kanuho V, Interpreter C, Malina RM. Growth and overweight of Navajo youth: secular changes from 1955 to 1997. Int J Obes Relat Metab Disord.2000; 24(2):211-8.

6. Sugarman JR,White LL, Gilbert TJ. Evidence for a secular change in obesity, height, and weight among Navajo Indian schoolchildren. Am J Clin Nutr. 1990; 52(6):960-6.

7. Strauss RS, Knight J. Influence of the home environment on the development of obesity in children. Pediatrics. 1999; 103(6):e85.

8. Strauss RS, Pollack HA. Epidemic increase in childhood overweight, 1986-1998.JAMA 2001;122;86(22):2845-8.

9. Goodman E.The role of socioeconomic status gradients in explaining differences in US adolescents' health. Am J Public Health. 1999; 89(10):1522-8.

10. Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs.Am J Clin Nutr. 2004;79(1):6-16.

11. Crooks DL. Food consumption, activity, and overweight among elementary school children in an Appalachian Kentucky community.Am J Phys Anthropol. 2000; 112(2):159-70.

12. Neal WA, Demerath E, Gonzales E, Spangler E, Minor VE, Stollings R, Islam S. Coronary Artery Risk Detection in Appalachian Communities (CARDIAC): preliminary findings.W V Med J. 2001; 97(2):102-5.

13. Demerath E, Muratova V, Spangler E, Li J, Minor VE, Neal WA. School-based obesity screening in rural Appalachia. Prev Med. 2003; 37(6):553-60.

14. McMurray RG, Harrell JS, Bangdiwala SI, Deng S. Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999; 15(4):365-74.

15. Felton GM, Pate RR, Parsons MA,Ward DS, Saunders RP,Trost S, Dowda M. Health risk behaviors of rural sixth graders. Res Nurs Health. 1998; 21(6):475-85.

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17. Davis SM, Lambert LC. Body image and weight concerns among Southwestern American Indian preadolescent schoolchildren. Ethn Dis. 2000;10(2):184-94.

18. McMurray RG, Harrell JS, Bangdiwala SI, Deng S. Cardiovascular disease risk factors and obesity of rural and urban elementary school children. J Rural Health. 1999;15(4):365-74.

19. Kumanyika SK, Ewart CK. Theoretical and baseline considerations for diet and weight control of diabetes among blacks. Diabetes Care. 1990; 13(11):1154-62.

20. Must A, Strauss RS.Risks and consequences of childhood and adolescent obesity.Int J Obes Relat Metab Disord. 1999; 23 Suppl 2:S2-11.

21. Fagot-Campana A, Pettit DJ, Engelgau MM, Rios Burrows N, Geiss LS,Valdez R, et al.Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pedatr 2000;136:664-72.

22. Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ. Increasing prevalence of Type II diabetes in American Indian children. Diabetologia. 1998; 41(8):904-10.

23. Goran MI, Ball GD, Cruz ML. Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents. J Clin Endocrinol Metab. 2003; 88(4):1417-27.

24. Koplan JP, Liverman CT, Kraak VI. Preventing Childhood Obesity: Health in the Balance. Institute of Medicine. The National Academie Press. Washington, DC 2005.

25. Dietary Guidelines for Americans 2005. U.S. Department of Health and Human Services. U.S.Department of Agriculture (online) http://www.health.gov/dietaryguidelines/ (Accessed January 15, 2005).

26. SPARK. www.sparkpe.org/index.jsp. (Accessed February 25, 2005).

27. Wellever,A, Reichard A,Velasco,A. Obesity and Public Policy: Legislation Passed by States, 1999 to 2003. Kansas Health Institute,April 2004 (online).http://www.khi.org/Obesity/ObesityReport_Part1.pdf (accessed January 4, 2005).

28. Action for Healthy Kids (online) http://www.actionforhealthykids.org (Accessed January 27, 2005).

29. Choosy Kids Club.West Virginia Motor Development Center. West Virginia University (online) http://www.wvu.edu/~physed/mdc/about_choosy.htm (accessed January 27, 2005).

30. Thomas H, Cilisk D, Micucci,Wilson-Abra, Dobbins M. Effectiveness of Physical Activity Enhancement and Obesity Programs in Children and Youth. Public Health Research, Education & Development Program, 2004 (online) http://www.city.hamilton.on.ca/PHCS/EPHPP/Research/Summary/2004/HealthyWeightsFull2004.pdf (Accessed January 11, 1004).

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31. Symons, CW. Bridging Student Health Risks and Academic Achievement through Comprehensive School Health Programs. Journal of School Health 1997; 224.

32. President’s Council on Physical Fitness and Sports. Physical activity promotion and school physical education. Physical Activity and Fitness Research Digest, 1999.

33. National Association of Sports and Physical Education (NASPE), Executive Summary,Shape of the Nation, 2001.

34. Shephard RJ. Curricular physical activity and academic performance. Pediatric Exercise Science 1997; 9:113-126.

35. Sallis JF, McKenzie TL, Kolody B, Lewis M, Marshall S, Rosengard P. Effects of health-related physical education on academic achievement: project SPARK Res Q Exerc Sport.1999; 70(2):127-34.

36. Campbell K,Waters E, O’Meara S, Kelly S, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 2002; CD001871.

27

Appendix AField Assessment

State City Site NameAZ Sells Pisinemo Learning CenterAZ San Carlos St. Charles Mission SchoolAZ San Carlos San Carlos Health Education DepartmentCA Visalia FoodLink Food PantryCA Earlimart Alila Elementary SchoolCA Terra Bella Terra Bella ElementaryGA Forsythe Community Improvement Coalition of Monroe CountyGA Hogansville West End CenterKY Hazard UK Center for Rural HealthKY Whitesburg Cowan Community CenterKY Pippa Passes Caney Creek Family Resource/Youth Services CenterKY Hindman Hindman Family Resource/Youth Services CenterKY Williamsburg Housing Authority of WilliamsburgKY Stearns Whitley City Middle SchoolKY Berea Berea CollegeMS Mound Bayou National Council of Negro WomenMS Mound Bayou Delta Health CenterMS Mound Bayou I.T. Montgomery Elementary SchoolNM Kirtland Kirtland Youth AssociationNM Crownpoint Crownpoint Department of YouthNM Crownpoint Crownpoint Community Wellness CenterNM Shiprock Indian Health ServicesNM Tierra Amarilla Chama Valley Independent School District #19SC Spartanburg Crescent Hill ApartmentsSC Spartanburg Community S.L.A.S.H. CenterSC Spartanburg Park Hill ElementaryTN Covington Children and Family ServicesWV Kermit ABLE Families

28

Appendix BCalifornia

29

Appendix BKentucky

30

Appendix BNew Mexico

31

Appendix BTennessee

32

Appendix CO

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ates

the

Obe

sity

Stu

dy a

nd P

reve

ntio

n A

ct –

Dir

ects

Dep

artm

ent

of H

ealth

to

anal

yze

the

effe

ctiv

enes

s of

th

e Pu

b.A

cts

exis

ting

met

hods

of t

reat

men

ts a

nd p

reve

ntio

n of

obe

sity

and

to

expl

ore

alte

rnat

ive

met

hods

.of

200

2M

S20

01C

hapt

er 4

32C

reat

es t

he M

issi

ssip

pi C

ounc

il on

Obe

sity

Pre

vent

ion

and

Man

agem

ent

Stud

y;re

quir

es a

rep

ort

to le

gisl

atur

e.D

irec

ts t

he c

ounc

il to

stu

dy t

he fe

asib

ility

of t

ax in

cent

ives

for

wor

ksite

s th

at p

rom

ote

activ

ities

to

redu

ce

obes

ity in

wor

k fo

rce.

MS

2003

Cha

pter

484

Exte

nds

the

char

ter

for

the

Mis

siss

ippi

Cou

ncil

on O

besi

ty,P

reve

ntio

n an

d M

anag

emen

t to

July

1,2

006.

NM

20

03SJ

M 9

5C

reat

es a

tas

k fo

rce

to a

ddre

ss t

he g

row

ing

heal

th p

robl

ems

of y

oung

peo

ple,

incl

udin

g ob

esity

and

dia

bete

s an

d to

dev

elop

pro

pose

d le

gisl

atio

n.

Scho

ol F

ood

Pro

gram

s an

d P

olic

ies

AR

2003

Act

122

0C

reat

es t

he C

hild

Hea

lth A

dvis

ory

Com

mitt

ee t

o de

velo

p nu

triti

onal

and

phy

sica

l act

ivity

sta

ndar

ds,a

nd t

o m

ake

reco

mm

enda

tions

on

com

petit

ive

food

s so

ld t

hrou

gh v

endi

ng m

achi

nes.

Bans

ven

ding

mac

hine

s in

ele

men

tary

sch

ool

star

ting

in 2

003-

2004

sch

ool y

ear;

requ

ires

bod

y m

ass

inde

x sc

reen

ing

in s

choo

ls.

CA

2001

SB19

Proh

ibits

the

sal

e of

car

bona

ted

beve

rage

s in

ele

men

tary

and

mid

dle

scho

ols

and

plac

es n

utri

tion

stan

dard

s on

fo

ods

sold

to

stud

ents

at

brea

ks a

nd t

hrou

gh v

endi

ng m

achi

nes.

CA

2003

Cha

pter

458

Proh

ibits

sch

ool b

oard

s fr

om e

nter

ing

into

exc

lusi

ve o

r no

n-ex

clus

ive

cont

ract

s fo

r ad

vert

isin

g or

the

sal

e of

ca

rbon

ated

bev

erag

es u

nles

s a

polic

y is

ado

pted

aft

er a

pub

lic h

eari

ng.

CA

2003

Cha

pter

62

Dir

ects

sta

te a

genc

ies

and

the

Cal

iforn

ia s

choo

l foo

d se

rvic

e as

soci

atio

n to

dev

elop

sch

ool l

unch

men

u pl

ans

that

pr

ovid

e op

tiona

l veg

etar

ian

scho

ol lu

nche

s.C

A20

03C

hapt

er 4

15Se

ts n

utri

tiona

l sta

ndar

ds fo

r fo

od s

old

in a

nd p

rodu

ced

by p

ublic

sch

ools

.Pro

hibi

ts t

he s

ale

of c

arbo

nate

d be

v era

ges

in e

very

ele

men

tary

sch

ool c

ampu

s be

ginn

ing

2004

.Sal

es w

ould

cea

se in

mid

dle

scho

ols

2005

and

in

hig

h sc

hool

200

7.C

A20

03C

hapt

er 8

79En

cour

ages

sch

ools

and

chi

ld d

evel

opm

ent

prog

ram

s to

pro

vide

fres

h fr

uits

and

veg

etab

les

to s

tude

nts

on a

dai

ly b

asis

.

33

Appendix C

Res

olu

tio

n N

um

ber

Year

or

Sta

tute

S

tate

Pas

sed

Lo

cati

on

Des

crip

tio

n

Nut

riti

on E

duca

tion

CA

2002

CA

.Edu

catio

nR

equi

res

the

Dep

artm

ent

of E

duca

tion

to in

corp

orat

e nu

triti

on e

duca

tion

into

hea

lth c

urri

culu

m.

Cod

e 89

90

CA

2002

CA

.Edu

catio

n A

utho

rize

s nu

triti

on e

duca

tion

to b

e pr

ovid

ed a

s pa

rt o

f the

edu

catio

nal e

nric

hmen

t co

mpo

nent

of

Cod

e 84

82.3

an a

fter

sch

ool p

rogr

ams.

CA

20

03C

hapt

er 5

505

Spec

ifies

tha

t as

par

t of

a c

ompr

ehen

sive

hea

lth e

duca

tion

prog

ram

pup

ils m

ay r

ecei

ve in

stru

ctio

n on

pre

vent

ive

heal

th c

are

on t

opic

s su

ch a

s ob

esity

and

dia

bete

s.

Phy

sica

l Edu

cati

on a

nd P

hysi

cal A

ctiv

ity

of C

hild

ren

AZ

2001

Cha

pter

320

of

App

ropr

iate

s $1

50,0

00 o

ver

the

next

tw

o ye

ars

(FY

2001

-200

3) t

o fu

nd D

epar

tmen

t of

Hea

lth S

ervi

ces

the

Publ

ic A

cts

for

scho

ol-b

ased

pro

gram

s fo

r ch

ildre

n’s

phys

ical

fitn

ess

activ

ities

.of

200

1A

R

2001

AR

Sta

t Ann

M

anda

tes

K-9

pub

lic s

choo

ls t

o re

quir

e no

less

tha

n 1

hour

/wee

k of

PE

trai

ning

and

inst

ruct

ion

whi

ch in

clud

es n

o 6-

4-1

less

tha

n 20

min

utes

of p

hysi

cal a

ctiv

ity 3

tim

es a

wee

k.A

R20

01A

R S

tate

Ann

C

reat

es t

he “

Gre

at S

trid

es”

prog

ram

,whi

ch a

lloca

tes

fund

ing

for

rura

l com

mun

ities

to

esta

blis

h m

ile t

o w

alki

ng p

arks

.20

-8-3

02C

A20

01C

hapt

er 1

11Es

tabl

ishe

s C

A T

ask

Forc

e on

You

th a

nd W

orkp

lace

Wel

lnes

s to

pro

mot

e fit

ness

and

hea

lth in

sch

ools

and

wor

kpla

ces.

CA

2002

CA

.Edu

catio

n D

irec

ts t

he S

tate

Boa

rd o

f Edu

catio

n to

ado

pt m

odel

con

tent

sta

ndar

ds fo

r ph

ysic

al e

duca

tion

by 2

004.

Cod

e 60

605.

2C

A20

02C

A E

duca

tion

Req

uire

s th

e D

epar

tmen

t of

Edu

catio

n to

doc

umen

t th

e ac

tual

num

ber

of m

inut

es o

f ins

truc

tion

in p

hysi

cal

Cod

e 33

352

educ

atio

n pr

ovid

ed b

y ea

ch s

choo

l dis

tric

t to

det

erm

ine

com

plia

nce

with

the

law

.C

A

2003

Cha

p 93

Rec

ogni

zes

that

sch

ools

hav

e an

obl

igat

ion

to p

rovi

de p

hysi

cal e

duca

tion

to s

tude

nts

and

urge

s sc

hool

s to

co

mpl

y w

ith t

hose

obl

igat

ions

.C

A

2003

Cha

pter

459

Req

uire

s th

at t

rain

ing

of a

fter

sch

ool p

rogr

am s

taff

incl

udes

phy

sica

l fitn

ess

stan

dard

s.M

S20

02M

S C

ode

Ann

.R

ecom

men

ds g

uide

lines

to

scho

ol d

istr

icts

for

phys

ical

edu

catio

n an

d fit

ness

cla

sses

.Req

uire

s st

udy

of

37-1

3-13

4re

latio

nshi

p be

twee

n ph

ysic

al a

ctiv

ity a

nd c

lass

room

per

form

ance

.N

M19

99N

M S

tat.

Ann

A

llow

s m

oney

from

the

tob

acco

set

tlem

ent

fund

to

be a

ppro

pria

ted

for

publ

ic s

choo

l pro

gram

s in

clud

ing

6-4-

10ex

trac

urri

cula

r an

d af

ter-

scho

ol p

rogr

ams

desi

gned

to

invo

lve

stud

ents

in a

thle

tic a

ctiv

ities

.N

M20

02SJ

M 1

7R

eque

sts

that

the

Sta

te D

epar

tmen

t of

Pub

lic E

duca

tion

wor

k w

ith t

he D

epar

tmen

t of

Hea

lth a

nd o

ther

s to

de

velo

p st

rate

gies

to

help

tea

cher

s im

plem

ent

qual

ity p

hysi

cal e

duca

tion

curr

icul

a.N

M20

03C

hapt

er 1

48C

reat

es t

he “

Safe

Rou

tes

to S

choo

l:” p

rogr

am t

o in

crea

se a

nd m

ake

safe

r a

stud

ent’s

abi

lity

to w

alk

or r

ide

a bi

cycl

e to

sch

ool.

Oth

er O

besi

ty L

egis

lati

on

CA

2002

CA

Edu

catio

n R

equi

res

the

Dep

artm

ent

of E

duca

tion

to m

ake

com

petit

ion

gran

ts a

vaila

ble

for

scho

ol d

istr

icts

to

star

t or

C

ode

9000

expa

nd in

stru

ctio

nal s

choo

l gar

dens

and

sch

ool g

arde

n sa

lad

bars

with

a c

ompo

st p

rogr

am.

NM

1999

HB7

62

App

ropr

iate

s $1

00,0

00 fo

r SF

Y 2

000

for

publ

ic a

nd p

rofe

ssio

nal e

duca

tion

on t

he d

ange

rs o

f and

tre

atm

ents

(a

ppro

pria

tion)

for

obes

ity a

nd $

50,0

00 fo

r an

ti-ob

esity

dru

gs n

ot e

ligib

le fo

r re

imbu

rsem

ent

unde

r th

e M

edic

aid

prog

ram

for

low

-inco

me

pers

ons

in n

eed

of t

reat

men

t fo

r cr

itica

l or

chro

nic

obes

ity.

Sta

teIn

itia

tive

Des

crip

tio

nS

ou

rce

AR

Act

175

0:T

he G

reat

La

w r

equi

ring

tob

acco

set

tlem

ent

mon

ies

to b

e us

ed t

o pr

ovid

e gr

ants

N

atio

nal C

ente

r fo

r C

hron

icSt

ride

s G

rant

to r

ural

com

mun

ities

who

are

inte

rest

ed in

bui

ldin

g sa

fe,w

ell-l

it D

isea

se P

reve

ntio

n an

d H

ealth

yw

alki

ng p

arks

for

thei

r ci

tizen

s.Pr

omot

ion,

Ark

ansa

s C

ente

r fo

r H

ealth

Impr

ovem

ent

AR

Gov

erno

r's

Cou

ncil

A d

atab

ase

of p

rofe

ssio

nal p

erso

ns fr

om fi

tnes

s re

late

d oc

cupa

tions

suc

h as

N

atio

nal C

ente

r fo

r C

hron

icPr

ofes

sion

al D

atab

ase

coac

hes,

form

er a

thle

tes,

mot

ivat

iona

l spe

aker

s,an

d co

ache

s.D

isea

se P

reve

ntio

n an

d H

ealth

y Pr

omot

ion

AR

"Be

Act

ive

& C

are"

Aft

er-s

choo

l pro

gram

tha

t ta

rget

s 45

0 K

-5 s

tude

nts

at t

en d

iffer

ent

scho

ols

Act

ion

for

Hea

lthy

Kid

sth

roug

hout

the

Litt

le R

ock

Scho

ol D

istr

ict.

AR

The

Gre

at A

rkan

sas W

orko

utA

n an

nual

eve

nt in

volv

ing

over

600

3rd

an

d 4

th g

rade

rs r

epre

sent

ing

Nat

iona

l Cen

ter

for

Chr

onic

elem

enta

ry s

choo

ls a

cros

s th

e st

ate

with

phy

sica

l edu

catio

n pr

ogra

ms.

Dis

ease

Pre

vent

ion

and

Hea

lthy

Prom

otio

n

AR

Food

Mar

ketin

g an

d En

cour

ages

sta

te g

over

nmen

t an

d sc

hool

dis

tric

ts t

o de

sign

ate

scho

ols

Adv

ertis

ing

Dir

ecte

d at

as a

dver

tisin

g-fr

ee z

ones

;enc

oura

ges

colla

bora

tion

of t

he d

evel

opm

ent

of

Act

ion

for

Hea

lthy

Kid

sC

hild

ren

and

Ado

lesc

ents

:sc

hool

pol

icie

s th

at p

rom

ote

a he

alth

y ea

ting

envi

ronm

ent

and

guid

elin

es fo

r Im

plic

atio

ns fo

r O

verw

eigh

tre

spon

sibl

e ad

vert

isin

g.

AR

Act

122

0:BM

I Ini

tiativ

eM

ulti-

pron

ged

initi

ativ

e to

impr

ove

heal

th o

f Ark

ansa

s ch

ildre

nA

rkan

sas

Cen

ter

for

Hea

lth Im

prov

emen

t

AZ

Ari

zona

Hea

lthy

Scho

ol

Serv

es a

s a

guid

e to

est

ablis

hing

sta

ndar

ds fo

r a

heal

thy

scho

ol e

nvir

onm

ent

Envi

ronm

ent

Mod

el P

olic

ysu

ch a

s th

e fo

llow

ing:

30 m

inut

es o

f phy

sica

l edu

catio

n an

d re

cess

bef

ore

lunc

h in

ele

men

tary

sch

ools

;45

min

utes

of p

hysi

cal e

duca

tion

per

day

in m

iddl

e an

d

Act

ion

for

Hea

lthy

Kid

shi

ghsc

hool

s;en

cour

ages

sch

ools

to

offe

r br

eakf

ast

and

lunc

h op

tions

con

sist

ent

with

USD

A D

ieta

ry g

uide

lines

;and

,ade

quat

e sp

ace

and

time

for

scho

ol m

eals

.

CO

AFH

K H

ealth

y Sc

hool

s Su

mm

itT

he S

umm

it ou

tline

d th

e im

port

ance

of i

mpr

ovin

g nu

triti

on a

nd p

hysi

cal a

ctiv

ity

Act

ion

for

Hea

lthy

Kid

sin

Col

orad

o sc

hool

s.

CO

The

Col

orad

o Ph

ysic

al A

ctiv

ity

The

Kit

incl

udes

mat

eria

ls t

hat

enco

urag

e sc

hool

s to

impl

emen

t pr

ogra

ms

and

Act

ion

for

Hea

lthy

Kid

san

d N

utri

tion

Prog

ram

Sch

ool

polic

ies

that

pro

mot

e a

heal

thy

scho

ol e

nvir

onm

ent.

Site

Res

ourc

e K

it

GA

Geo

rgia

Coa

litio

n fo

r Ph

ysic

alA

col

labo

ratio

n of

pub

lic,p

riva

te,a

nd n

on-p

rofit

bus

ines

s or

gani

zatio

ns,a

nd

Geo

rgia

Coa

litio

n fo

r Ph

ysic

alA

ctiv

ity a

nd N

utri

tion

busi

ness

es w

hose

mis

sion

is t

o im

prov

e th

e he

alth

of G

eorg

ians

by

prom

otin

g A

ctiv

ity a

nd N

utri

tion

heal

thy

eatin

g an

d ph

ysic

al a

ctiv

ity.

GA

Geo

rgia

Obe

sity

Act

ion

A g

roup

of h

ealth

care

pro

fess

iona

ls t

hat

are

invo

lved

in e

duca

tion,

rese

arch

,G

eorg

ia D

epar

tmen

t of

Net

wor

k (O

AN

)an

d pr

ogra

m in

itiat

ives

in G

eorg

ia r

elat

ive

to c

hild

and

ado

lesc

ent

phys

ical

H

uman

Res

ourc

esac

tivity

,nut

ritio

n,an

d ov

erw

eigh

t.

34

Appendix D

Sta

teIn

itia

tive

Des

crip

tio

nS

ou

rce

KY

Phys

ical

Act

ivity

pilo

t pr

ogra

mT

he K

entu

cky

Stat

e Te

am is

col

labo

ratin

g w

ith t

he D

epar

tmen

t of

Edu

catio

n to

impl

emen

t a

pilo

t pr

ogra

m in

4 e

lem

enta

ry s

choo

ls t

hat

inco

rpor

ate

phys

ical

A

ctio

n fo

r H

ealth

y K

ids

activ

ity in

the

cla

ssro

om.

KY

Gro

win

g H

ealth

y K

ids

An

annu

al c

onfe

renc

e de

sign

ed t

o he

lp K

entu

cky

yout

h ac

hiev

e a

heal

thy

wei

ght.

Act

ion

for

Hea

lthy

Kid

s

KY

Blue

prin

t fo

r H

ealth

y K

ids

Ken

tuck

y C

hild

Now

and

the

Ken

tuck

y Sc

hool

-Bas

ed H

ealth

Cen

ter

Coa

litio

n K

entu

cky

Chi

ld N

ow!

have

form

ed a

par

tner

ship

to

impr

ove

the

heal

th o

f Ken

tuck

y ch

ildre

n.

KY

Twee

nsA

soc

ial m

arke

ting

inte

rven

tion

targ

etin

g ch

ange

s in

beh

avio

rs r

elat

ed t

o C

ente

r fo

r D

isea

se C

ontr

olnu

triti

on a

nd p

hysi

cal a

ctiv

ity a

mon

g ch

ildre

n be

twee

n th

e ag

es o

f 9 a

nd 1

3.

KY

The

Par

tner

ship

for

T

his

5 ye

ar C

DC

Obe

sity

gra

nts'

mis

sion

is a

coo

rdin

ated

effo

rt t

o re

duce

a

Fit

Ken

tuck

yan

d pr

even

t ob

esity

and

chr

onic

dis

ease

in K

entu

cky.

The

pla

n w

ill t

arge

t C

ente

r fo

r D

isea

se C

ontr

olbu

sine

sses

,com

mun

ities

,the

env

iron

men

t,he

alth

car

e an

d sc

hool

s.

MS

CD

C g

rant

Mis

siss

ippi

rec

eive

d gr

ants

to

fund

obe

sity

pre

vent

ion

prog

ram

s in

25

The

Ass

ocia

ted

Pres

s,A

pril

26,2

004

elem

enta

ry a

nd s

econ

dary

sch

ools

.

MS

Offi

ce o

f Hea

lthy

Scho

ols

The

Mis

siss

ippi

Dep

artm

ent

of E

duca

tion

is c

reat

ing

an

Offi

ce o

f Hea

lthy

Scho

ols

to a

ddre

ss h

ealth

and

edu

catio

n in

a

Mis

siss

ippi

Dep

artm

ent

of E

duca

tion

coor

dina

ted

appr

oach

.

MS

Del

ta N

utri

tion

Inte

rven

tion

Thi

s in

itiat

ive

is fo

cuse

d on

the

des

ign,

impl

emen

tatio

n,an

d ev

alua

tion

of

Mis

siss

ippi

Dep

artm

ent

of E

duca

tion:

Res

earc

h In

itiat

ive

nutr

ition

inte

rven

tion

rese

arch

str

ateg

ies

in 3

rur

al c

omm

uniti

es in

the

Low

er

Offi

ce o

f Chi

ld N

utri

tion

Mis

siss

ippi

Del

ta u

sing

a c

omm

unity

-bas

ed p

artic

ipat

ory

proc

ess.

MS

Del

ta H

ope

(Hea

lth O

ptio

ns

The

Coo

pera

tive

Exte

nsio

n Se

rvic

es a

t th

e LS

U A

gCen

ter,

the

Uni

vers

ity o

f fo

r Pe

ople

Thr

ough

Ext

ensi

on)

Ark

ansa

s an

d M

issi

ssip

pi S

tate

Uni

vers

ity a

re c

ondu

ctin

g an

edu

atio

nal i

nitia

tive

LSU

AgC

ente

rde

sign

ed t

o fig

ht c

hild

hood

obe

sity

in t

he r

egio

n.

Nat

iona

l C

arol

M.W

hite

Phy

sica

l G

rant

s ra

ngin

g fr

om $

50,0

00 t

o $7

20,0

00 a

re g

iven

to

purc

hase

equ

ipm

ent

Am

eric

an C

ounc

il fo

r Fi

tnes

s Ed

ucat

ion

Prog

ram

(PE

P)an

d tr

ain

teac

hers

.an

d N

utri

tion

NM

Hea

d to

Toe

Con

fere

nce

A n

etw

orki

ng e

vent

bro

ught

tog

ethe

r he

alth

pro

fess

iona

ls fr

om a

cros

s N

etw

orki

ng E

vent

New

Mex

ico

to s

hare

suc

cess

es,s

trat

egie

s,an

d ba

rrie

rs r

egar

ding

obe

sity

A

ctio

n fo

r H

ealth

y K

ids

prev

entio

n/re

duct

ion

prog

ram

s.

NM

Nav

igat

ing

Gui

de fo

r Te

ache

rs:

A g

uide

cre

ated

for

New

Mex

ico

scho

ol p

erso

nnel

pro

vide

s in

form

atio

n R

esou

rces

for

Scho

ol H

ealth

rela

ted

to s

tude

nt p

hysi

cal h

ealth

,men

tal,

and

emot

iona

l hea

lth,a

saf

e sc

hool

A

ctio

n fo

r H

ealth

y K

ids

envi

ronm

ent,

nutr

ition

,phy

sica

l act

ivity

,sta

ff w

elln

ess,

heal

th e

duca

tion,

and

pare

nt a

nd c

omm

unity

invo

lvem

ent.

NM

Coo

rdin

ated

App

roac

h to

T

his

NM

Dep

t of

Edu

catio

n fu

nded

pro

gram

incl

udes

nut

ritio

n cu

rric

ulum

,C

ente

r fo

r D

isea

se C

ontr

olC

hild

Hea

lth (

CAT

CH

)en

hanc

ed p

hysi

cal a

ctiv

ity,f

amily

invo

lvem

ent,

and

impr

oved

sch

ool n

utri

tion.

cont

.

35

Appendix D

36

Appendix DS

tate

Init

iati

veD

escr

ipti

on

So

urc

e

NM

Hea

lthie

r Sc

hool

s N

ew M

exic

oT

his

prog

ram

,fun

ded

by t

he N

ew M

exic

o D

epar

tmen

t of

Hea

lth a

dvoc

ates

fo

r th

e in

clus

ion

of t

he 8

com

pone

nts

of c

ompr

ehen

sive

sch

ool h

ealth

.T

his

Cen

ter

for

Dis

ease

Con

trol

grou

p pr

omot

es t

he u

se o

f the

Em

ergi

ng M

odel

of P

hysi

cal E

duca

tion,

emph

asiz

ing

life-

long

phy

sica

l act

ivity

,ind

ivid

ual p

ract

ice

and

skill

opp

ortu

nitie

s.

NV

Rec

ess

befo

re lu

nch

and

the

Thi

s pr

ogra

m fo

cuse

s on

impr

ovin

g ph

ysic

al a

ctiv

ity o

ppor

tuni

ties

and

A

ctio

n fo

r H

ealth

y K

ids

Brea

kfas

t Be

fore

Sch

ool P

rogr

amem

phas

izin

g th

e im

port

ance

of a

dequ

ate

time

and

sche

dule

for

scho

ol m

eals

.

SCSC

Par

tner

ship

for

Obe

sity

Fu

ture

effo

rts

incl

ude

part

neri

ng w

ith S

.C.H

ealth

y Sc

hool

s us

ing

Scho

ol

Cen

ter

for

Dis

ease

Con

trol

Prev

entio

n (S

CPO

P)H

ealth

inde

x an

d th

e im

plem

enta

tion

of a

nut

ritio

n ed

ucat

ion

curr

icul

um.

SCSC

PEA

P:T

he S

C P

hysi

cal

A p

rogr

am a

sses

smen

t to

hel

p im

prov

e th

e qu

ality

of P

.E.c

lass

es in

SC

.So

uth

Car

olin

a N

utri

tion

Educ

atio

n A

sses

smen

t Pr

ojec

tR

esea

rch

Con

sort

ium

SCR

eces

s Po

sitio

n St

atem

ent

The

invo

lvem

ent

of c

hild

ren

in d

aily,

unst

ruct

ured

phy

sica

l act

ivity

dur

ing

Sout

h C

arol

ina

Coa

litio

n fo

rsc

hool

hou

rs is

cri

tical

for

thei

r cu

rren

t an

d fu

ture

hea

lth.

Prom

otin

g Ph

ysic

al A

ctiv

ity

(htt

p://w

ww

.scc

ppa.

org/

advo

cacy

/r

eces

s.ht

ml)

SCD

.U.C

.K.-

Wal

king

- D

isco

ver

Prog

ram

tha

t en

cour

ages

tea

cher

s fr

om e

lem

enta

ry s

choo

ls t

o in

corp

orat

e So

uth

Car

olin

a N

utri

tion

and

Und

erst

and

Sout

h ph

ysic

al a

ctiv

ity in

to t

he s

choo

l wee

k.R

esea

rch

Con

sort

ium

Car

olin

a N

utri

tion

Res

earc

h

TN

Tenn

esse

e H

ealth

y W

eigh

t Lo

cal c

oalit

ions

to

impl

emen

t st

rate

gies

and

obj

ectiv

es a

imed

at

impr

ovin

g A

ctio

n fo

r H

ealth

y K

ids

Net

wor

k fo

r C

hild

ren

and

Yout

hhe

alth

of c

hild

ren

and

yout

h

TN

Coo

rdin

ated

Sch

ool

Prog

ram

is in

tend

ed t

o re

duce

tob

acco

use

and

add

ictio

n,im

prov

e ea

ting

Act

ion

for

Hea

lthy

Kid

spa

tter

ns,i

ncre

ase

phys

ical

act

ivity

,and

red

uce

obes

ity a

mon

g yo

uth.

Tenn

esse

e D

epar

tmen

t of

Edu

catio

n

TN

Tenn

esse

e N

utri

tion

and

Thi

s nu

triti

on e

duca

tion

prog

ram

is fo

r Te

nnes

see

fam

ilies

who

rec

eive

or

The

Uni

vers

ity o

fC

onsu

mer

Edu

catio

n ar

e el

igib

le fo

r Fo

od S

tam

ps.

The

goa

l is

to t

each

fam

ilies

how

to

choo

se a

nd

Tenn

esse

e Ex

tens

ion

Prog

ram

(T

NC

EP)

prep

are

nutr

ition

ally

ade

quat

e di

ets.

WV

Cho

osy

Kid

s C

lub

An

afte

rsch

ool p

rogr

am fo

r el

emen

tary

sch

ool c

hild

ren

from

a t

ri-c

ount

y ar

ea.

Thi

s pr

ogra

m fo

cuse

s on

Act

ive

lifes

tyle

s ba

sed

on h

ealth

y de

cisi

ons.

http

://w

ww

.bec

hoos

y.or

g

WV

“Suc

cess

Sha

red”

pro

ject

Thi

s st

ate

team

is w

orki

ng o

n a

pro

ject

tha

t ai

ms

to r

ecog

nize

and

rew

ard

the

acco

mpl

ishm

ents

of s

choo

ls m

akin

g po

sitiv

e su

stai

nabl

e ch

ange

s in

nut

ritio

n A

ctio

n fo

r H

ealth

y K

ids

and

phys

ical

act

ivity

.

WV

Rec

ipe

for

Succ

ess

Thi

s st

ate

team

dev

elop

ed R

ecip

e fo

r Su

cces

s,a

CD

-Rom

too

lkit

that

ass

ists

pr

inci

pals

in t

rain

ing

thei

r pe

ers

and

iden

tifyi

ng k

ey a

reas

of c

hang

e th

at m

odel

A

ctio

n fo

r H

ealth

y K

ids

heal

thfu

l eat

ing

and

prom

ote

phys

ical

act

ivity

in s

choo

ls.

cont

.

37

Photo Credits

Michael Bisceglie: Pages 1, 6, 7, 8, 9, 11, 12, 13, 16, 18, 21Susan Warner: Cover, pages 2, 3, 4, 5, 10, 14, 15, 17, 19, 20, 22, 23

54 Wilton Road • Wesport, Connecticut 06880www.savethechildren.org