FULL POTENTIAL 2009: Actions on Obesity

An update to: FACTS ABOUT GROWING UP HEALTHY IN FRANKLIN COUNTY: 2008 Collaborative Children’s Health Report Table of Contents

Reaching Their Full Potential ...... 1 OSU College of Education, Department of Moving Forward ...... 2 Human Nutrition, OSU Extension ...... 15 The Launch of Full Potential ...... 3 YMCA of Central Ohio ...... 16 Actions on Obesity: Community Update ...... 4 Stambaugh Family Continues Weight Loss Children’s Hunger Alliance ...... 5 Success ...... 18 Columbus City Schools ...... 7 Nationwide Children’s Hospital ...... 20 Danny Gwirtz Finds Self-confi dence at Critical Funders ...... 26 Healthier Weight ...... 10 Ohio Business Roundtable: Advocating for Columbus Public Health...... 12 Children’s Health ...... 27 Ohio Action for Healthy Kids ...... 14 Recommendations for Addressing Pediatric Obesity ...... 28 Reaching Their Full Potential CONTINUING THE CONVERSATION ON PEDIATRIC OBESITY

n 2008, Nationwide Children’s Hospital was honored to collaborate with 20 community partners to create Full IPotential: Facts About Growing Up Healthy in Franklin County, 2008 Collaborative Children’s Health Report. This inaugural report identifi ed 10 critical indicators for our children’s health. Each issue was explored with insights from local experts and brought to life by the stories of children and families affected. Pediatric obesity rose to the forefront in the report as the most signifi cant obstacle impeding the current and future ability of our children to reach their full potential. The initial report clearly defi ned the need for interventions and the opportunity to partner. For 2009, we have again collaborated with local resources to deliver this update report highlighting strategies within our community to reduce the incidence of childhood obesity. Nationwide Children’s has actively joined this effort and we are excited to report on several new initiatives. Most notable for us is the launch of our Healthy Neighborhoods, Healthy Families (HNHF) program. Modeled after successful urban revitalization programs from across the country, HNHF presents a multi-pronged approach to addressing barriers to health and well-being for the thousands of families surrounding our downtown campus. Combating childhood obesity is a foundational element of our HNHF health platform, creating new partnerships with area neighborhood associations, Columbus City Schools, Columbus Health Department and many others. We are fortunate to have many community partners included in this report representing health care, education, social services, government, business and foundations. All are reaching outside their own systems to work with other organizations to address the obesity issue. Collaboration is key, because, while obesity is a nationwide epidemic, its remedies will be discovered locally by organizations working together to develop and test many new ideas. This is precisely what is happening in Franklin County now, as refl ected on these pages. During 2008, the organizations represented in this report were involved in a signifi cant number of programs that brought opportunities for making healthy changes to children and families in central Ohio. In addition to the benefi ts these programs are creating in our community, they hold the potential to extend beyond the borders of the state. A concerted effort is being made to report information and best practices nationwide, and what we do in Franklin County may one day inform a national model for the prevention and treatment of childhood obesity. Nationwide Children’s thanks our partners for their commitment and actions on obesity. Ours is a “can do” community, supported by a wealth of institutional knowledge and expertise, as well as the capacity and desire to tap wide-ranging points of view. Together, we can craft a better future for our children. Please read on to learn how Nationwide Children’s and our community partners are working to combat childhood obesity.

Steve Allen, MD Chief Executive Offi cer Nationwide Children’s Hospital Columbus, Ohio

Page 1 Moving Forward TO ADDRESS CHILDHOOD OBESITY

olumbus remains committed to creating safe and healthy environments for our residents, especially children, and so Cwe are proud to be part of Full Potential 2009: Actions on Obesity.

While central Ohio has among the nation’s highest levels of childhood obesity, diabetes and heart disease, we also understand the benefi ts of early childhood prevention and wellness initiatives as critical components in helping our children fi ght these diseases. Several promising initiatives have been launched or further developed since the 2008 Full Potential report, each depending on the involvement and support of community partners. Healthy Neighborhoods, Healthy Families is an exciting partnership between the City of Columbus and Nationwide Children’s Hospital to focus on neighborhood revitalization in Columbus’ South Side. In addition, my offi ce created the Institute for Active Living with Columbus Public Health. The Institute shares a common vision with Nationwide Children’s and we will work together, sharing data, expertise and people, to move forward. Columbus Public Health initiatives, including Healthy Children, Healthy Weights and Healthy Places, demonstrate results-oriented work to reduce childhood obesity. We can also be proud that Columbus City Schools now has all-water vending in its middle and high schools. I want to thank all our community partners for continuing to focus on broad-based measures to address the obesity epidemic.

Michael B. Coleman Mayor Columbus, Ohio

Page 2 The Launch of Full Potential

Nationwide Children’s Hospital’s Full Potential pediatric obesity initiative was launched at a community breakfast at the Columbus Convention Center on May 1, 2008. That morning, we also released the report Full Potential: Facts About Growing Up Healthy in Franklin County, 2008 Collaborative Children’s Health Report. The report can be downloaded at www.NationwideChildrens.org/FullPotential. Hard copies may be requested online as well. 1 The report, developed in partnership with Columbus Public Health and more than 20 other community agencies, highlighted 10 indicators presenting critical preventable health threats for Franklin County children. A number of vital issues affecting our community’s children were worthy of focus. The following 10 threats, however, were called out in the 2008 report as particularly pressing:

- Infant Mortality 2 - Immunization - Asthma - Teen Smoking - Teen Pregnancy - Unintentional Injuries - Adolescent Suicide - Adolescent Homicide - Access to Health Care - Obesity

1 | Full Potential: Facts About Growing Up Healthy in Franklin County, 2008 Collaborative Children’s Health Report 2 | Find out the facts about childhood obesity. 3 | Learn what leaders representing health care, business and government have to say about the obesity issue’s implications 3 and solutions.

Page 3 Actions on Obesity: Community Update

Overview of Key Programs In the 2008 Full Potential report, we concluded the discussion of pediatric obesity with a series of During the past year, an exciting number and recommendations* for families, schools, health variety of signifi cant programs and initiatives and social service organizations, communities and focused on pediatric obesity prevention or society to effectively “tip the scales” in the management have been taking place in opposite direction on pediatric obesity. Franklin County. While the organizations included in this report Overwhelmingly, our community recognizes did not set out specifi cally to meet these the magnitude of the obesity epidemic – it recommendations, they have addressed many challenges our children’s ability to reach their of them through programs offered during the current and future potential, and it threatens past year. For each organization covered in to overcome our health and human service this report, we have called out the organizations, employers and other institutions. recommendations addressed by their Together, we can prevent this from happening. programs, resources or advocacy**. The community response, as represented in this For the full list of recommendations from the report, demonstrates an encouraging resolve to 2008 Full Potential report, see page 28. create effective evidence-based treatment and prevention programs supported by committed funding sources in an environment of continual * These recommendations were developed by physicians in the Nationwide Children’s Hospital Center for Healthy Weight and Nutrition and incorporate several advocacy on behalf of children. recommendations from Healthy & Fit: A Community Action Plan for Franklin County Children & Families, a publication of the Osteopathic Heritage Foundations and Children’s Hunger Alliance.

**Effort has been made to include many signifi cant organizations and programs in this report; however, it is not an exhaustive list of all the organizations and programs addressing the issue of childhood obesity in Franklin County.

Surveying the bounty of food at the Columbus Public Health farmer’s market. Photo courtesy of Columbus Public Health.

Page 4 • In 2008, 78 sites actively participated in the USDA Children’s Hunger Alliance food program resulting in 1,993 children receiving The mission of the Children’s Hunger nutritious food each month. CHA served 221,494 meals and snacks in 2008, bringing in an additional Alliance (CHA) is to break the cycle of $455,000 in USDA dollars to central Ohio. childhood hunger through education, leadership, advocacy and service. As part Adult Nutrition Education In 2008, CHA reached 358 low-income adults in Franklin of their vision that all children will be well County with Nutrition Education Classes. These classes nourished, healthy and thrive, CHA provides use USDA curriculum to teach how to eat healthfully on a and supports a variety of programs to help budget, how to utilize available food resources and how to combat obesity. feed your family. School Breakfast Program Early Care and Nutrition The CARES (Children Are Ready for Education and Eating a nutritious school breakfast gives children the energy Success) program is a literacy, school readiness, nutrition needed to do well in school. Studies show that kids who eat and physical activity initiative for Ohio children. This breakfast are less likely to eat junk food. CHA works closely program reaches almost 2,000 family child care providers with the Ohio Department of Education to help schools in Ohio through the USDA’s Child and Adult Care access and implement School Breakfast Programs. The Food Food Program. The effectiveness of the program was Research and Action Center – School Breakfast Report Card demonstrated in a 2007 random survey of providers that indicates the following for central Ohio: found 86 percent plan learning activities from a CARES kit • Columbus City Schools increased daily breakfast at least once a month; 56 percent at least once per week. participation by 3,038. Providers receive four CARES kits each year. • Reynoldsburg City Schools increased daily breakfast Afterschool Programs participation by 1,730. CHA provides free, direct service nutrition education (Food Folks curriculum) and physical activity (CATCH) curriculum • South-Western City Schools increased breakfast programs to afterschool programs that serve low-income participation by 668. children, ages 5 through 18. CHA also sponsors the USDA • Hamilton Local School District increased breakfast After School Meal Program to more than 70 afterschool participation by 1,028. programs in Franklin County to ensure low-income children are receiving a hot meal during the afterschool hours.

• Of 2,009 children who participated in Food Folks, 81 percent completing the pre- and post-test improved their nutrition knowledge.

• Of 1,844 children who participated in CATCH, 85 percent completing the pre- and post-test increased their cardiovascular endurance.

The beginnings of an award-winning community garden. Photo courtesy of Children’s Hunger Alliance.

Page 5 Childhood Obesity South Side Healthy Food Access and Nutrition Interventions: Education Program CHA has helped to facilitate and lead community partnership programs to Recommendations improve access to healthy food in various Columbus neighborhoods, including Addressed the South Side Healthy Food Access and Nutrition Education Program. This program is a community-wide, multi-faceted initiative designed to increase √ Healthy lifestyle food access and promote healthy lifestyles and nutrition education among behaviors start early. South Side residents. √ Increase opportunities Utilizing multiple strategies, CHA, serving as the fi scal agent, partners for physical activity. with key community organizations to achieve three goals: (1) provide comprehensive nutrition education targeting for food stamp eligible adults; √ Ensure all food and (2) increase access to high-quality nutritious food to low-income residents and drink choices are their families; and (3) enhance leadership and increase community awareness of healthy lifestyles and resources within the South Side Community. healthy. Impact from this collaborative resulted in: √ Advocate and provide • Quality nutrition education for South Side adults and seniors. learning opportunities. • Establishment of a weekly farmers market that was one of the fi rst in √ Neighborhood Columbus to accept EBT food stamps and which served roughly 100 families per week in its fi rst year. groups are credible advocates. • Full conversion of four traditional food pantries to a choice model. • Planting a school-based community garden recognized by Franklin Park Conservatory with an Education Garden of the Year award.

This project also made tremendous strides in creating partnerships and alliances on the South Side committed to addressing food access issues that can be factors in the prevalence of overweight/obesity. To learn more: www.childrenshungeralliance.org 614-341-7700

Page 6 Columbus City Schools Highlights of the committee work include: BMI Assessments Recognizing that students spend 25 to 30 As part of their routine annual student screenings, percent of their day and get 35 to 50 percent district school nurses conduct Body Mass Index (BMI) of their daily calories while at school, and screenings on every kindergarten, third-, fi fth-, seventh- and ninth-grade student. Each child’s individual results are sent to that students perform better when they are the parents explaining BMI and the hidden dangers of healthy, through generous funding from the being overweight or obese. All children identifi ed with a Osteopathic Heritage Foundation, Columbus BMI in the 85th percentile or above are referred to their City Schools (CCS) has developed and primary care provider and additional community resources in efforts to prevent, monitor and treat obesity related implemented an effective and sustainable complications and encourage the adoption of healthier habits. wellness initiative based on the Coordinated School Health Model to create the healthiest BMI Assessment Results 2007 - 2008 School Year school environment possible. Kindergarten • Total number of students screened = 4,254

Components of the wellness initiative include the • A total of 32% of kindergarten students screened following: had a BMI > 85% (BMI 95% (+) =16% and BMI • A district-level School Health Advisory Council to 85-94% = 16%) guide the work of the wellness initiative. • A total of 1,396 kindergarten students were referred • School Health Services Committee that serves to to their primary care for assessment and treatment promote and enhance a healthy and safe school related to increased BMI learning environment. Third Grade • Physical Activity and Physical Education Committee • Total number of students screened = 4,287 that serves to educate and encourage CCS students to develop lifelong healthy physical activity • A total of 42% of third-grade students screened behaviors. had a BMI > 85% (BMI 95% (+) = 25% and BMI 85-94% = 17%) • Nutrition Committee that serves to increase the nutritional value of foods and beverages available to • A total of 1,775 third-grade students were referred students during the school day and educate students to their primary care for assessment and treatment on how to make healthy food choices. related to increased BMI

• Staff Wellness Committee that serves to create a Fifth Grade culture that values and supports the development • Total number of students screened = 4,027 of lifelong health and fi tness habits among CCS • A total of 44% of fi fth-grade students screened personnel. had a BMI > 85% (BMI 95% (+) = 26% and BMI • Communications Committee that serves to create 85-94% = 18%) a district-wide wellness movement through increased • A total of 1,754 fi fth-grade students were referred to awareness and participation in the Wellness Initiative. their primary care for assessment and treatment related to increased BMI

Page 7 Acanthosis Nigricans Screenings Acanthosis Nigricans is a skin marker for high levels of insulin in the blood that can help identify early metabolic changes associated with increased weight. CCS and the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital collaborate to conduct this screening. Assessments were conducted during the 2007-2008 school year at three Columbus City School sites in grades 3, 5 and 7, and follow-up services for identifi ed students were offered by Nationwide Children’s.

Rates of Acanthosis Nigricans among 3rd, 5th and 7th Grade Students in Target Zip Codes

100% 90% 85.7% 80% 80%

70% 63.6% 65.2% 60%

50% 42.4% 40% 31.8% 30% 3rd Grade 20% 5th Grade 10% 7th Grade 0% Percentage of students Percentage of students identifi ed as AN+ that have identifi ed as AN+ that have a BMI > 85th percentile a BMI > 95th percentile (70 of 177) (55 of 72)

Additional components of the Wellness Initiative implemented during 2008 (and continuing through the 2008-2009 school year) include: • Water only vending in all student accessible vending machines.

• Improved nutritional standards in the Food Service Department: beverages, other than water, are served in restricted serving sizes and include low fat milk and 100 percent juice only.

• Fresh fruit/vegetable bars at all secondary schools.

• Development of an enhanced health education curriculum.

• Building-level School Health Committees.

Page 8 Other obesity related community-based programs in which CCS was a Childhood Obesity partner include: Interventions: Happy Healthy Preschoolers (HHP) Recommendations CCS district school nurses conducted pre-kindergarten (ages 3-5 years) BMI Addressed screenings and referred parents of identifi ed children to the HHP program. Among the 275 pre-kindergarten students in target zip codes who received √ Measure and intervene. a BMI assessment, 65, or 23.6 percent had a BMI in the 85th percentile or above. See page 23 for a program description. √ Increase opportunities Healthy Children, Healthy Weights for physical activity. CCS implemented this program at eight Columbus City School Ensure all food and pre-kindergarten sites, in collaboration with Columbus Public Health. √ See page 12 for a program description. drink choices are healthy. Fitness And Nutrition Club (F.A.N. Club) Nationwide Children’s Hospital created this 90 minute physical activity and √ Advocate and provide nutrition education afterschool program, targeting third through fi fth grade learning opportunities. students. It was launched at one elementary school site. See page 20 for program description and results. √ Healthy lifestyle Children’s Hunger Alliance Partnership behaviors start early. CCS also worked with Children’s Hunger Alliance to install and maintain a large community garden at one elementary site and provide adult nutrition classes at four Columbus City School sites. See page 5 for descriptions of these programs.

Managing and Preventing of Diabetes and Weight Gain Project CCS received funding for the Managing and Preventing Diabetes and Weight Gain Project (MAP) administered by the National Association of School Nurses, with funding by the Centers for Disease Control and National Diabetes Education Program. This program provides a CCS school nurse part-time to serve as the district’s MAP resource nurse to coordinate care for over 180 diabetic students and provide education, training and resources for school nurses, students and families. To learn more: www.columbus.k12.oh.us 614-365-8995

New food service equipment supports fresh fruit and vegetable bars. Photo courtesy of United Way of Central Ohio.

Page 9 Danny Gwirtz Finds Self-confi dence at Healthier Weight

anny Gwirtz was one of the young people whose story was featured in the inaugural Full Potential report. He shared how he began gaining weightD in second grade after his parents’ divorce changed family eating habits, and explained how this problem was compounded by unhealthy school meals. Even the family physician failed to help by perpetuating the myth that children grow out of their “baby fat.”

Eventually Danny’s embarrassment from being taunted and teased by classmates motivated him to lose weight. His mom helped him enroll in a weight program for children that taught him about healthy eating and exercise.

Danny, now 15, has made signifi cant progress in his battle by eating healthier foods and exercising frequently. “Better choices are the key. It’s the simple things, like drinking more water, that continue to make a difference,” he says.

Page 10 “Mentally, I feel good about myself. No one makes fun of me anymore.” – Danny Gwirtz

Improved opportunities at school are helping While Danny believes his school has made Danny make better choices. His school now positive changes to help students deal with offers more healthy food selections, such as obesity, he thinks more progress can be made bottled water, more fruits and baked versus fried by providing even more healthy food options, foods. Danny also has joined Bigger, Faster, nutrition classes and physical education activities. Stronger, an afterschool exercise program for He also stresses that eating well and staying students. "I love the program because it keeps active don’t end with the school day. At home, me active and you have your friends for support Danny’s family encourages his fi t lifestyle by and encouragement." preparing healthy dinners and supporting his Danny says he is always looking for new things efforts to stay active. to keep him informed and fi t. He is thinking It takes constant work, but Danny has succeeded about taking a new nutrition and exercise class in making health and fi tness part of his daily being offered at his school. He also stays active routine. And, his self-esteem has improved now in school sports, playing football in the fall and that he is maintaining a healthier weight. soccer in the spring. “Mentally, I feel good about myself. No one makes fun of me anymore.”

Page 11 Columbus Public Health on centers in Columbus-area zip codes with the highest prevalence of overweight/obesity. The program combines Columbus Public Health (CPH) is a leader training of adult caregivers in early learning centers (child in improving the health and safety of care centers and preschools), technical assistance to the Columbus by monitoring community health centers to improve nutrition and physical activity practices at the center through menu development, status, identifying and addressing public physical activity equipment and other resources, and health threats, enforcing laws that protect social marketing to infl uence parents’ behaviors at home. the public’s health, and providing services to In 2008, HCHW served 46 child care centers and prevent and control disease. In keeping with preschools, training 500 adults and impacting over 2,800 this mission, CPH has created or supports a children. Results demonstrate increased knowledge and variety of obesity-related initiatives, including self-effi cacy on the part of center staff to make changes those listed below. that impact the food and physical activity environment in which young children spend signifi cant time. Through Heart Health Network technical assistance visits, documented changes include: The Heart Health Network (HHN) takes a population- • Reduced frequency of serving juice and sugar based approach to addressing the six main risk factors sweetened beverages, of heart disease in the settings of community, schools, worksites and health care. HHN is funded by the Centers • More nutritious snack offerings, and for Disease Control and Prevention and is administered by the Ohio Department of Health. • Increase structured, teacher- or peer-led, physical activity throughout the day. In 2008: • HHN worked with community partners to pilot a Happy Healthy Preschoolers Veggie Mobile Market at four recreation centers, one CPH provided expert advice, materials and support to the in each quadrant of the city, providing food stamp development of this program. See page 23 for program access to fresh local produce. description.

• The Heart Health Worksite Wellness Network Healthy Places (HHWWN) hosted three networking luncheons Healthy Places is a key component of the City’s focus on and a full day conference. They provided local community design with active living in mind. Columbus businesses with resources and information on Public Health’s Safe Places Program has created walking employee wellness, including the “how-tos” of maps for 18 Columbus neighborhoods, eight of them in starting a worksite wellness team. HHWWN 2008. The City of Columbus passed legislation on currently serves 80 local businesses. Complete Streets, a partnership between the Mayor Coleman Administration (Public Service, Development, Healthy Children, Healthy Weights Utilities, and Technology) and the bicycle community. Healthy Children, Healthy Weights (HCHW) is an The legislation supports the City’s plan to expand its evidence-based obesity prevention program that focuses current network of 87 miles of bike trails, bike routes and on improving the food and physical activity environments bike lanes by adding 31 miles of off-street trails and 58 of children ages 0 to 5 years in early learning centers and miles of on-street bike lanes and bike routes. at home. Over the last year, the program focused efforts

Page 12 Farmer’s Markets Childhood Obesity Three farmer’s markets, held at CPH at 240 Parsons Avenue, drew more Interventions: than 11,000 residents who were able to purchase reasonably priced, fresh Recommendations local produce. The markets have the capability to accept Women, Infants and Children (WIC) Farmer’s Market Vouchers, Senior Farmers Market Addressed Vouchers, and, new in 2008, customers could use their food stamp dollars to purchase fresh fruits and vegetables. √ Increase opportunities for physical activity. The Institute for Active Living Mayor Coleman created The Institute for Active Living (IAL) within CPH √ Ensure all food and drink in July 2008 to help Columbus residents build an active and healthier choices are healthy. community. IAL works to lower the incidence of childhood obesity and diabetes by developing strategies and initiatives and assisting community √ Advocate and provide partners with their implementation. IAL was launched with Mayor learning opportunities. Coleman’s annual bicycle event, which raised awareness about the importance of children maintaining a healthy weight and taking steps to √ Healthy lifestyle behaviors prevent diabetes. A new initiative, City Green Bikes, was also launched to start early. enhance workplace wellness for city employees and to serve as an example for other workplaces. Bicycles donated by the Police Impound Lot and tuned √ Implement a comprehensive up by the Fleet Division, have been located at various city offi ces to allow community plan. employees to bike from place to place around the city. In addition, IAL created a City Department Advisory Committee that meets monthly to look √ Support the recommendations at ways in which all departments can operate using an “active living” lens. of the Ohio Activity Plan. To learn more: √ Employers must get in on www.publichealth.columbus.gov the action. 614-645-7417

1 2 3 1| Choosing healthy nutrition for mother and child. Photo courtesy of Columbus Public Health. 2| Cooking up a nutritious dish. Photo courtesy of United Way of Central Ohio. 3| Purchasing fresh fruits and vegetables with WIC vouchers. Photo courtesy of Columbus Public Health. Page 13 Ohio Action for Healthy Kids Ohio Action for Healthy Kids (AFHK) represents a consortium of education and health professionals dedicated to improving Childhood Obesity the health and educational performance of Ohio’s children by Interventions: promoting healthy school environments that offer sound Recommendations nutrition and adequate opportunities for physical activity. Addressed In central Ohio in 2008, the Zone 8-Ohio AFHK regional team √ Increase opportunities provided conferences, workshops, mini grants, monthly newsletters for physical activity. and technical assistance to advance school wellness policies. √ Ensure all food and drink 2008 Healthy Schools, Healthy Kids Conference choices are healthy. The Zone 8-Ohio AFHK annual conference reached more than 180 participants. The conference is designed to help local schools strengthen wellness policies Advocate and provide √ and program activities that support nutrition and physical activity. learning opportunities. Mini-Grants to Local Schools The Zone 8-Ohio AFHK team allocated funding to help local schools implement nutrition and physical activity programs. Four schools initiated wellness activities that included breakfast initiatives, nutrition education and increasing physical activity opportunities.

Game-On Funding Recipients Game-On is a National AFHK program that challenges youth and their families to incorporate healthy nutrition and physical activity into their daily lives. Several central Ohio schools were selected this year as Game-On recipients.

Snackwise® Nutrition Rating System On the recommendation of AFHK, several local schools have implemented Nationwide Children’s Hospital’s Snackwise® online rating program to provide healthier, nutrient rich snacks in vending and a la carte areas. To learn more: http://www.ohioactionforhealthykids.org/ zone_teams/zone8.htm Setting up for the Fruit and Veggie Challenge. Photo courtesy of Ohio Action for Healthy Kids. 614-341-7700 x216

Page 14 OSU College of Education, Department Childhood Obesity of Human Nutrition, OSU Extension Interventions: Recommendations The mission of the OSU College of Education, Department of Addressed Human Nutrition, OSU Extension at The Ohio State University is to generate, disseminate, and apply knowledge in the areas of √ Measure and intervene. human nutrition and dietetics to improve the quality of life for √ Increase opportunities individuals, families and associated organizational systems. Faculty for physical activity. and students are at the fore of research that will lead to evidence- based solutions to pediatric obesity. √ Ensure all food and drink choices are Food Fit healthy. Food Fit is a 14-week behavior change program that is designed to teach children the skills needed to execute food behaviors associated with prevention of childhood obesity (AMA Expert Committee Guidelines. Pediatrics. 2008; 120: S164-S192). Two Food Fit studies were conducted in 2008, in a total of seven low-income sites with a total of 179 participants.

In the fi rst study, 12 dietetic interns from the Department of Human Nutrition delivered and evaluated Food Fit in six YMCA-sponsored afterschool programs for children in grades 3 through 5. Statistically signifi cant changes in children’s nutrition skills and dietary behaviors were found. Results regarding changes in BMI and changes in numbers of servings within major food groups and macro and micronutrient intake were being evaluated when this report went to print.

In the second study, Food Fit is being delivered and evaluated with two new age groups: grades kindergarden through 2 and 5 through 7. In addition to examining skills attained and impact on self effi cacy, the study is evaluating anthropometrics and dietary behaviors that will include a review of the differences in dietary intake noted during weekdays as compared to days during the weekend.

YMCA-OSU Snack Program Under the direction of a faculty member and Director of the Dietetic Internship in the Department of Human Nutrition, a dietetic intern developed an afterschool, four-week cycle snack menu that: 1) complied with federally funded Child and Adult Care Food Program (CACFP) regulations, 2) improved nutrient density and nutrition quality of the snack program, and 3) did NOT Access to fresh produce is vital to proper nutrition. Photo courtesy of Columbus Public Health. increase costs for the program. To learn more: http://ehe.osu.edu/hn/ 614-292-4485 Page 15 Childhood Obesity YMCA of Central Ohio Interventions: The YMCA of Central Ohio has a long tradition of Recommendations providing innovative and family focused fi tness programming Addressed at all branches and program sites. Youth of all ages choose √ Increase opportunities from a wide variety of programs to challenge skill levels, for physical activity. build confi dence and have fun.

√ Ensure all food and Youth Sports and Physical Activity Programs drink choices are healthy. The YMCA offers a series of youth sports and physical activity programs targeting children and youth ages 6 through 16. The programs provide opportunities for √ Advocate and provide children of all abilities to participate, to learn and to have fun while being learning opportunities. physically active. The programs include activities such as basketball, soccer, martial arts, gymnastics, dance, swim lessons, swim teams, teen conditioning and more. √ Healthy lifestyle From programs that required tracking, 87 percent of participants achieved 60 behaviors start early. minutes of physical activity at least fi ve days per week. Y Kids Are Fit The Y Kids Are Fit curriculum has been implemented in more than 40 before and afterschool child care sites in Franklin County. The program is designed to increase youths’ strength, fl exibility and endurance. The curriculum includes health and nutrition lessons, as well as fi tness activities that on-site Y-Club staff can implement with youth. • 733 youth participated for more than eight months during the school year. • 96 percent of participants improved in at least one of the fi tness test areas. • 82 percent of participants improved in at least two of the fi tness test areas. • 44 percent of participants improved in all three of the fi tness test areas. Fitness tests included a shuttle run (endurance), curl ups (strength), and sit and reach (fl exibility). Summer Day and Resident Camp The YMCA of Central Ohio offered youth from all over central Ohio the opportunity for camp fun and activity. More than 3,800 youths participated in active camp programs such as youth sports, horseback riding, dance and more. Nutritious Meals The YMCA of Central Ohio served more than 62,000 free nutritious meals in their child care, camp and early education programs.

Page 16 Partnerships The YMCA of Central Ohio and The Ohio State University’s College of Human Nutrition partnered to provide fi tness and nutrition programming in seven of the YMCA’s afterschool programs. The YMCA afterschool staff provide the Y Kids Are Fit curriculum and activities, and OSU graduate students provide a 14-week Food Fit nutrition program to enhance the Y Kids are Fit program. The YMCA of Central Ohio collaborated with Nationwide Children’s Hospital’s Center for Healthy Weight and Nutrition’s New U and New U Jr. programs to offer free 6-month memberships to their graduates. The Ohio State University’s Department of Human Nutrition recreated the daily afterschool snack menu. See page 15 for additional information. To learn more: www.ymcacolumbus.org 614-224-1142

Fitness is fun! Photo courtesy of YMCA of Central Ohio.

Page 17 Stambaugh Family Continues Weight Loss Success

mall steps have added up to big progress for the Stambaugh family in their efforts to lose weight. Since they came forward to tell their story during the Full Potential Sbreakfast in 2008, they’ve continued exercising the winning strategy that has helped them shed a combined weight of nearly 300 pounds over the past two years.

“I believe the small, gradual changes are what it’s

The Stambaugh family celebrates their success with Eddie about,” says mom, Dianna Stambaugh. “Big, fast George, former OSU Buckeye and NFL running back, during the 2008 Full Potential breakfast event. changes are scary and make it more likely you will fail.”

Being successful is terribly important to Dianna, who once weighed 317 pounds and has lost nearly 125 of them. Before she started losing weight, Dianna was afraid that obesity related health problems would prevent her from seeing her children grow up. She feared for her family’s health as well. Now, she, husband Lawrence, and their children Nicole and David all are feeling healthier and happier.

Page 18 “It’s been great to share my story with others and hopefully inspire them to stay focused on their weight-loss goals.” – Dianna Stambaugh

Their strategy of making small changes has consistently, so the family goes to the gym at least involved taking a variety of steps to ensure they three times a week. eat healthy foods and stay active. Another key to losing weight is staying focused. The family limits the amount of fast food they eat Family members post before-and-after pictures of in favor of healthy meals. “It’s not that we can’t themselves throughout their home. “Seeing the have it, but we have learned not to overindulge. progress we’re making really keeps us motivated,” Don’t get out of control.” They also have learned says Dianna. “Plus, it helps that we feel better.” that eating in moderation, reducing sugar intake, Dianna also has noticed that her complexion is reading labels, measuring food portions and clearer and she looks much younger. counting calories gives them control over what Dianna is inspiring others with her story. Each they eat, which helps the family achieve their week, Dianna mentors women dealing with weight-loss goals. weight issues through a program offered at her In addition to the dietary measures they’ve taken, local fi tness center. “It’s been great to share my the Stambaughs have incorporated regular story with others and hopefully inspire them to exercise into their routines. According to stay focused on their weight-loss goals.” Lawrence, what works best for them is to exercise

Page 19 Nationwide Children’s Hospital Primary Care Nationwide Children’s offers community-based physician Nationwide Children’s Hospital currently services to help keep children healthy with regular physical addresses childhood obesity through medical exams, vision, hearing and general development checks, services, community programs, policy initiatives and immunizations against childhood diseases. There are 10 Primary Care Centers in Franklin County, including one on and employee wellness programs. These include: the hospital’s main campus. There were more than 137,000 Center for Healthy Weight and Nutrition Initiatives patient visits to the Primary Care Network in 2008. The Center for Healthy Weight and Nutrition (CHWN) In 2008, an electronic health record system was rolled out to at Nationwide Children’s Hospital offers families a all of the Primary Care Centers. The system calculates and comprehensive approach to weight management, graphs the Body Mass Index (BMI) for all patients, 2 years providing programs for both the prevention and and older, seen during well child/adolescent visits. Our treatment of overweight children. Primary Care Network providers can now more easily In 2008, an Expert Committee of physicians within the identify children with unhealthy weights, monitor their American Medical Association provided specifi c, stepwise care and make appropriate referrals to the Center for guidance for healthcare providers on treating obesity. Healthy Weight and Nutrition or other community resources. Prevention, early identifi cation through use of Body Mass Fitness and Nutrition Club (F.A.N. Club) Index (BMI) and education and counseling in practice are The F.A.N. Club curriculum is based on a social cognition the cornerstones. The CHWN continues to develop new model, combining fi tness training and nutrition programs, resources to help make such interventions as effective as for high risk and obese youth administered over 30 weeks possible here in central Ohio. Since the last Full Potential in an afterschool format. In June 2008, the program was report, the CHWN has added: launched at Livingston Elementary School, near the • The New U Jr. program, a weight management hospital campus. program for kids ages 6 to 11 years and their families

• The Healthy Happy Preschoolers program, in By the beginning of the winter semester 2008, 11 collaboration with the community and funded by participants completed the most recent post United Way of Central Ohio and the Central assessment and had, as a group: Benefi ts Foundation (see page 23) • Increased their aerobic endurance by 42 percent. • Website materials at www.NationwideChildrens.org/ • Increased their strength. HealthyWeight: – Average number of push-ups increased 139 – A video on bariatric surgery percent (an increase of an average of 6 push-ups per student). – Resources for physicians to implement the new Expert Committee recommendations in their practices – Average number of sit-ups increased 115 percent (an increase of an average of 11 – Parent information on how to work with the sit-ups per student). nine core evidence-based obesity prevention and treatment messages • Increased their overall fl exibility and maintained their BMI. These activities complement the full-service medical and surgical programs for pediatric obesity patients and their families.

Page 20 By February 2009, the F.A.N. Club included 54 children Hospital, Snackwise® is a research-based online snack at Livingston Elementary School and Lincoln Park rating system that calculates nutrient density in snack foods. Elementary School. In March 2009, 20 participants Snackwise® is designed for use by any organization or completed at least one post assessment and had, as a group, individual interested in making healthier snack choices. improved their overall fi tness and decreased their BMI. This online tool uses a scientifi c formula based on the March 2009 F.A.N. Club Results current Dietary Guidelines for Americans, considering 11 weighted nutrition parameters, to measure the nutrient Body Mass Index richness of snack foods straight out of the kitchen pantry or off of grocery shelves. Then, using an easy-to-understand, 100% color-coded system, the calculator assigns the snack food 71% 68% one of three colors, indicating the nutritional quality of the 80% snack. Visit www.Snackwise.org for more information. 60% Education Collaboration with YMCA

40% The Education Institute and the Department of Clinical Nutrition Services at Nationwide Children’s Hospital 20% conduct the Healthy Lifestyles Weight Management program in collaboration with the YMCA. This four- 0 week program, held at rotating YMCA sites, is a primer BMI Percentile in healthy eating and activity, and sessions are held for Fitness both parents/caregivers and children. Participants receive six months of follow-up newsletters and a three month YMCA membership after program completion. 20 17 18 16 14.61 Healthy Neighborhoods, Healthy Families 14 12 This initiative was announced in 2008 as a community 10.28 12 9 collaboration dedicated to taking action in Columbus’ 10 South Side to help create/improve affordable housing, 8 6 health and wellness services, educational opportunities, 6 safe and accessible neighborhoods, and workforce and 4 economic development. 2 0 While additional partners are expected to join this Push-ups Sit-ups Aerobic Endurance (total number) (total number) (pacer laps) collaborative effort, current partners include:

Pre Assessment Post Assessment • City of Columbus

• Community Development For All People

The F.A.N. Club now has 30 participants at Livingston • Columbus Public Health Elementary School and an additional 37 at Lincoln Park • Columbus City Schools Elementary School. • Home Again Snackwise® Developed by doctors and nutritionists in the Center for • Nationwide Children’s Hospital Healthy Weight and Nutrition at Nationwide Children’s Page 21 Childhood Obesity Nationwide Children’s Hospital will provide support for Healthy Neighborhoods, Interventions: Healthy Families. The health and wellness services and safe and accessible neighborhoods components in particular will provide focused programs to Recommendations address obesity. Addressed

√ Measure and intervene. √ Healthy lifestyle behaviors start early.

√ Increase opportunities for physical activity. Executive Leadership in the Ohio Business Roundtable Child Obesity Prevention Collaborative √ Ensure all food and drink The Ohio Business Roundtable is a leadership group of the chief executive choices are healthy. offi cers of the state’s largest corporations. The Roundtable has adopted the prevention of childhood obesity as one of its main goals related to the health √ Advocate and provide of Ohio workers and their families. Dr. Steve Allen, CEO of Nationwide learning opportunities. Children’s Hospital, provides the executive leadership for the Collaborative convened by the Roundtable to advocate for more effective statewide policies √ Employers must get in on fi tness and nutrition for children and adolescents. on the action. Employee Wellness Each year, insured spouses and employees of Nationwide Children’s Hospital complete an annual Health Risk Assessment. Recent trends indicate a 9 percent increase in the number of low-risk employees/spouses, and a 7 percent decrease in the number of moderate-risk employees/spouses.

In 2008, employees participating in the Weight Watchers® at Work program surpassed the goal of losing 2,008 pounds by losing 2,011.6 pounds. As a wellness incentive, the hospital supplements a portion of the Weight Watchers® program fee.

In 2008, Nationwide Children’s hosted two farmer’s markets to encourage employees to eat more fruits and vegetables and make produce shopping more convenient. The markets were also open to the community. Additionally, at no cost, employees are able to meet one-on-one with a licensed dietitian or attend monthly nutrition education workshops.

Keeping active after school as part of All employees have the opportunity to join the on-site, 24/7-access fi tness the F.A.N. Club. Photo courtesy of Nationwide center and attend free group fi tness classes including yoga, toning, aerobics Children’s Hospital. and boot camp. At no cost, employees can meet with a certifi ed exercise specialist to receive individual fi tness assessments and exercise plans.

Page 22 Happy Healthy Preschoolers A Partnership in Early Intervention

Happy Healthy Preschoolers • Central Benefi ts Health Care Foundation is an intensive six-week, community based Lead funder for the program. program whose aim is to remodel the • United Way of Central Ohio family’s daily habits toward ones that Fiscal agent for the project. promote health and fi tness. It provides an initial intervention offered to families • Nationwide Children’s Hospital – at the fi rst signs of overweight in their Center for Healthy Weight and Nutrition child or for children deemed high-risk. Program development, implementation, supervision and management. The long-term goal is to offer the program throughout central Franklin County in easily • The Ohio State University College of accessible sites: child care facilities, faith Public Health (OSU-CPH) centers, health care facilities and recreation Evaluation support, design and centers. The program’s curriculum and implementation assistance. materials were developed using the • YMCA of Central Ohio American Medical Association’s Expert Assists in securing program sites and Committee on Obesity core evidence-based supporting implementation of the program. messages. Piloted in 2008, the program will collect and evaluate data to improve • Columbus Public Health (CPH) program delivery and effectiveness. Assists in securing program sites and supporting the implementation. Happy Healthy Preschoolers brings together Contributes expert advice and materials. a broad coalition to provide this unique community based model of intervention. • Columbus City Schools (CCS) Supports implementation of the program through data collection and participant referral and recruitment.

Page 23 New Initiatives: 2009 and Beyond

Supporting Our Community Partners Data Analysis, Reporting and Training Program It’s clear that pediatric obesity is a complex (DART) epidemic disease that affects all segments of To support Columbus City Schools’ collection and reporting of child height, weight and body mass society. However, it is especially prevalent and index, we will conduct training in the use of automated destructive in low-income, urban communities, entry programs that enable secure and encrypted data such as those in which Nationwide Children’s storage, management and reporting. In addition, we Hospital’s main campus and primary care will conduct school, census tract and zip code trend analysis of the data collected. centers are located. Fitness and Nutrition Club (F.A.N. Club) Columbus City Schools Over the next three years, Nationwide Children’s Because we have a unique passion and responsibility to hopes to expand community collaborations and grow improve quality of life for these neighbors, in 2009 we the F.A.N. Club to serve a total of 500 children or will continue to partner with Columbus City Schools and more per year in 20 Columbus City Schools locations. other local leadership organizations to develop a scalable, effi cient and accountable program to increase fi tness, McConnell Heart Health Center improve nutrition, identify children at risk, coordinate We look forward to a new partnership with the referrals and communication, and measure outcomes for McConnell Heart Health Center, which has requested elementary-aged children in high-risk schools. that the Center for Healthy Weight and Nutrition collaborate with them for the 2009 Wolfe Symposium Nationwide Children’s is fortunate to have a consistent “Creating Health Through the Prevention and Treatment source of BMI data through the Columbus City Schools, of Obesity Within Our Community.” This will be a one of the few school systems in the nation to measure service program targeting 9 to 13 year-olds in the Boys BMI regularly. The challenge is how to analyze and use and Girls Club of Columbus, Milo-Grogan location. this data, to evaluate which interventions are working, and to refer at-risk children into them. Nationwide Children’s Hospital as an Employer: Leading By Example In 2009, Nationwide Children’s will introduce three Additional Coverage for Employee Dependent programs designed to make childhood obesity Children interventions more effective: Nationwide Children’s Hospital is one of the fi rst Ohio School Nurse Advocacy Program (SNAP) employers to participate in the Alliance For A Healthier We will provide an annual training and continuing Generation’s childhood obesity health care initiative, a education program, an ongoing learning collaborative collaborative effort with national medical associations, and facilitated referral program for school nurses leading insurers and employers to offer comprehensive managing obese or morbidly obese children in the health benefi ts to children for the prevention, assessment Columbus City Schools. Training will cover new and treatment of childhood obesity. Nationwide information on prevention and management of Children’s will provide eligible children ages 3 to 18 pediatric obesity, measurement and database with access to at least four follow-up visits with their education, communication strategies and motivational primary care provider and four visits with a registered interviewing for interaction with parents, and referral dietitian per year. The new health benefi ts will be mechanisms. offered to those children at or above the 85th

Page 24 percentile for Body Mass Index (BMI). As a member • Also in 2009, healthy options from Mark Pi’s will be of the Alliance, Nationwide Children’s will also participate added in the food court. in a fi rst-time evaluation of this new benefi t program. Employee Health and Wellness The goal is for more than 6.2 million children nationally Nationwide Children’s will also implement a variety of to have access to this health care benefi t within the next programs and policies to improve the health and fi tness three years. The benefi ts are in line with the American of our employees, including: Medical Association’s Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child • Expanding our comprehensive employee wellness and Adolescent Overweight and Obesity. For more program. information, visit www.HealthierGeneration.org. • The hospital’s gift shop has coordinated with the Healthy Food Choices Center for Healthy Weight and Nutrition to reduce Nationwide Children’s is working to meet our responsibility portion sizes on all snack foods and introduce several to provide the same healthy choices for employees, new nutrient-dense options. patients and their families that we advocate for the greater community. In 2008, we instituted several nutritional • Expand farmer’s markets to increase frequency. practices as a foundation for additional changes in 2009: • Build upon the Diabetic Counseling program to • Lite mayonnaise is used in all recipes that call for include an exercise program and support group. mayonnaise. To learn more: • Neither butter nor margarine is added to any vegetables in the cafeteria. www.NationwideChildrens.org 614-722-2000 • Salmon patties, veggie burgers and turkey burgers are available in the food court and cafeteria.

• A yogurt and fruit bar was added during breakfast in the cafeteria, using lite yogurt.

• Nutritional information for items in the cafeteria is posted daily.

• Subway® was added as a food vendor in the food court, offering healthy choices and limiting the drink sizes available.

• All hospital vending machines follow the Snackwise® system, and the color-coded designation is posted for each snack.

• In 2009, fried foods will be eliminated in the Making nutritious food choices after school cafeterias and replaced with healthier, baked versions. as part of the F.A.N. Club. Photo courtesy of Nationwide Children’s Hospital.

Page 25 Critical Funders

Central Ohio is fortunate to have several United Way of Central Ohio philanthropic organizations that provide Current investment in nutrition and fi tness-related programming in central Ohio exceeds $2 million, fi nancial support for community-based supporting nearly 20 programs per year that engage programs promoting physical activity and people in healthy nutrition and physical activity. This good nutrition. Several of these vital resources investment also aims to improve the nutrition and are listed below along with the obesity related physical activity environment to help people more easily programs they helped support during 2008. eat healthy food and be more physically active. Following are several programs currently supported by the organization. Columbus Medical Association Foundation South Side Healthy Food Access and Nutrition Education St. Stephen’s House SNS All Stars – Health, nutrition Program – See page 6 for program description. and physical activity project. Healthy Children, Healthy Weights – See page 12 for Union County Health Department – Healthfl ix video program description. contest supporting the Physical Activity category entry for PSA’s to be developed. Healthy & Fit Partnership – Initiative designed to change the cafeteria environment in three Westside schools: Children’s Hunger Alliance – Health promotion on the Westmoor Middle, West High School, and Hilltonia South Side. This program aims to train four adult health Middle. Supported by a funding partnership including advocates who will then be deployed throughout the the Abbott Fund and United Way of Central Ohio, the community to provide nutrition and physical activity program resulted in: education to other community members. There is also a youth component that is being developed that will engage • Fruit and vegetable expenditures 24 percent higher in the youth at Southside Settlement House to educate their target schools. peers on healthy food choices and physical activity. • Between 27 percent and 41 percent of students Osteopathic Heritage Foundations selecting healthy food options, surpassing the Columbus City Schools – To advance the district-wide expected benchmark of 19 percent. wellness initiative, including nutrition improvements and infrastructure support. See page 7 for program description. Happy Healthy Preschoolers – Funding partnership including the Central Benefi ts Health Care Foundation, The Columbus Foundation United Way of Central Ohio, and Nationwide Children’s Ohio State University Research Foundation – Hospital. See page 23 for program description. Supported the Food Fit program serving children at risk of obesity. See page 15 for program description.

United Way of Central Ohio, Inc. – Two grants to support the Health Funder’s Collaborative to improve the health of Franklin County residents by reducing the incidence of overweight and obesity.

Page 26 To learn more: Ohio Business Columbus Medical Association Roundtable: Advocating Foundation for Children’s Health www.goodhealthcolumbus.org 614-240-7410 Last year, the Ohio Business Roundtable launched a major initiative that seeks to identify and implement Osteopathic Heritage Foundations short- and long-term strategies to address Ohio’s www.osteopathicheritage.org growing childhood obesity epidemic. The initiative 614-737-4370 is led by Dr. Steve Allen, CEO of Nationwide The Columbus Foundation Children’s Hospital (on behalf of all children’s www.columbusfoundation.org hospitals across the state) and Toby Cosgrove, 614-251-4000 CEO of the Cleveland Clinic.

United Way of Central Ohio Key partners include Ohio Action for Healthy Kids, www.liveunitedcentralohio.org American Heart Association, Cardinal Health 614-228-8700 Foundation, Children’s Hunger Alliance, Nationwide Better Health, Ohio Department of Health, Ohio Children’s Hospital Association and Ohio Hospital Association.

The initial focus of the initiative will be major state legislation addressing school nutrition, physical education and BMI/fi tnessgram screening assessment standards that the Ohio Business Roundtable is preparing and expects to release during the fi rst half of 2009. The initiative will also consider actions employers can take to address childhood obesity among their employees and their dependents. Learning to make healthy snack choices. Photo courtesy of United Way of Central Ohio.

Page 27 2008 FULL POTENTIAL REPORT EXCERPT Recommendations for Addressing Pediatric Obesity

For the Family Eat a quality diet. Follow the U.S. Dietary Guidelines. Incorporate fi ve servings of fruits and vegetables per day, try to use whole grains when possible. Include low-fat (skim, 1%, or 2%) dairy products, and concentrate on low-fat protein sources (lean meats, fi sh, beans and nuts). Limit consumption of juice, soft drinks, fast food, and fried foods. Being aware of correct portion size is also helpful. Portion sizes vary with age; for adolescents and adults, one-half cup generally represents one serving of pasta or rice and 4 ounces (the size of the palm of your hand) represents a serving of meat or protein. Remember that the amount of calories—especially in sugars and fats—that can safely be consumed each day depends on the person’s activity level. Be better consumers. Learn to read a food label and look for products with less than 30 percent of calories coming from fats, and seek out food with high percentages of vitamins and minerals. Reading the nutrition information panel will help identify empty calories—those with high calories but no vitamins or minerals. Eliminating empty calories helps ensure that every food and drink contributes to a quality daily diet.

Processed foods tend to be less healthful and should be avoided. You can identify processed foods as those containing multiple ingredients that are diffi cult to pronounce and possibly unfamiliar to you. Healthful foods tend to contain ingredients that are known to you. Shopping more around the outside edges of the grocery store (fruits, vegetables, meat, freezer, dairy sections) and less in the inside aisles (packaged foods) will promote a more nutritionally balanced diet.

Two helpful web sites: www.nutrition.gov and www.snackwise.org

Page 28 Eat together as a family. Restart the tradition of a family dinner together without the TV. Cut sweet drinks. Substitute sweet drinks and juices with water or other drinks with no calories. Know your child’s Body Mass Index (BMI). The American Academy of Pediatrics recommends using BMI to screen for overweight children beginning at age 2 and through age 19. Discuss your child’s BMI with your family doctor. Stay away from fast food. Eat fast food rarely. When you do, pick the restaurant and your food carefully. Look up the nutrition information (available at the counter) to know how many calories you’re eating. Stick to non-supersized portions. Downsize your selections using the junior menu. Add fruit or a baked potato rather than fries. Add vegetables and fruits at every opportunity. Avoid non-diet sodas and desserts. For Schools Measure and intervene. Increase school based BMI screening connected with the medical practices to form a seamless system of early identifi cation and intervention. Increase opportunities for physical activity. Ensure daily recess in all elementary and middle schools. Implement Take 10! This program encourages taking two 10-minute breaks in the school day for moderate to vigorous activity in the classroom.

Page 29 Ensure all food and drink choices are healthy. School nutrition standards should be established for all non-USDA food in schools, including vended, a la carte, school store and fundraisers. Advocate and provide learning opportunities. Schools should incorporate healthy eating and physical activity behaviors into their lessons. Afterschool programs will provide nutritious food choices and a safe environment for learning and physical activity. Parents, school agencies and schools should advocate, support and implement programs which provide a healthier environment. For Other Organizations Healthy lifestyle behaviors start early. Meals and snacks at child care centers should comply with the USDA guidelines. Child care providers need to be trained on best practices in nutrition and physical activity for the young child. Faith-based organizations can reach out to families. Faith-based organizations are a trusted source of support for families. They offer an excellent venue for screening, educational and health promotion programs. Health care providers need to screen all children for obesity. Along with screening children using body mass index, they should counsel families on strategies to prevent childhood obesity. Health care providers should receive training on evidenced-based obesity management guidelines. In addition, they must be involved in basic, translational and clinical research programs that advance our knowledge on causes, prevention and treatment of childhood obesity.

Page 30 For Communities Neighborhood groups are credible advocates. Along with working toward safe sidewalks, parks, and neighborhood physical activity programs, neighborhood groups can work in collaboration with stores and local farmers to increase availability of fresh fruits and vegetables. Food industry can help improve food choices. The food industry should offer a variety of healthy food options and provide information on nutrient quality, e.g., require restaurants to list calorie content of food items. Employers must get in on the action. Businesses should support employee activity through corporate steps challenges, Eco-bucks programs, walking and cycling clubs during lunch hour, and other programs that get people moving. For Society Engage the media to increase awareness about obesity and co-morbid conditions. Assist with health promotion messages on healthy lifestyle behaviors. Implement a comprehensive community plan. Community leaders, business leaders, hospitals, government and other stakeholders need a coalition to develop and implement a Columbus community plan to promote optimal nutrition and daily activities.

Page 31 Support the recommendations of the Ohio Activity Plan. This recently enacted program of the Ohio Parks and Recreation Department will include communities working on creating a built environment that entices its citizens outside using parks, walkways, bike and roller-blade paths, and skateboard parks. Building downtown grottos that showcase sculpture, fountains and parkland to draw workers and visitors out onto the streets is also advocated. Advocate for local, state and federal government polices. Enact policies that create and improve resources for physical activity in schools, workplaces and neighborhoods. Advocate for legislation that supports reimbursement for obesity-related offi ce visits; improve access to nutritious food choices for children who are affected by food insecurity; and promote diversifi cation of healthy and culturally appropriate food options in the Women, Infant and Child (WIC) program.

Support legislation to improve the built environment in communities, such as safe sidewalks. There must be uniform access to green spaces, parks and recreation centers in all communities. Note: Recommendations were developed by physicians at the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital and incorporate several recommendations from a report “Healthy & Fit: A Community Action Plan for Franklin County Children & Families by the Osteopathic Heritage Foundations and Children’s Hunger Alliance.”

Page 32 Page 33 700 Children’s Drive Columbus, Ohio 43205 www.NationwideChildrens.org/FullPotential