Heroes for Health: A Comprehensive Plan for Combating Childhood Obesity Proposed for Texas Health Resource

Bio-Music Facilitators

Amanda Buhrkuhl

Shelby McCraw

Daniel Moore

Kevin Nguyen

Jimmy Njoroge

If we, Texas Health Resources (THR), as a responsible and caring business could make a difference for improving health, extending life, increasing productivity, and lowering costs shouldn't we eagerly pursue it? What problem could be so pervasive that it affects us in such an overarching way? Obesity is the problem. Its a disease that affects a significant percentage of people in the United States. Figure A shows the obesity rates in 2011, with Texas being one of the states with the highest percentages.

Figure A (Retrieved November 14, 2013, from http://calorielab.com/news/categories/fattest-states/.)

Though obesity is a problem for Americans at any age, childhood obesity is particularly concerning. Children who have habits causing obesity are more likely to remain obese in adulthood (Centers for Disease Control and Prevention, 2013). Figure B shows the trend in rates of obesity in children since 1974:

Figure B Percentage of U.S. Children Who Are Obese. Adapted from Michelle Obama kicks off anti-obesity drive with White House events, L. Sweet, February 2, 2010, Politics Daily,( Retrieved November 10, 2013, from http://www.politicsdaily.com/2010/02/09/michelleobama-kicks-off-anti-obesity-drive-in-oval-office-event/ ) Obesity among children is also a concern here in Dallas. In 2012, Texas ranked 7th among states with the most obese children and Dallas was listed as one of the 10 most overweight cities in the nation (Fancher, 2012). At Texas Health Resources (THR), we want to continue the ongoing fight against childhood obesity. We intend to use our resources to improve the community by combating this serious disease. Is childhood obesity a problem that can be addressed? Are there actions a business can take that would make a difference? Abigail Arons (2011), in her work for the Childrens Hospital Association of Texas, declared innovative policies can reach children while they are still young, reversing their unhealthy weight trends, and preventing weight gain in the first place. One of the benefits of these policies would be prevention. Education is clearly one of the most powerful tools in prevention. THR can most certainly be involved in educating children, and their families about the dangers of obesity and the benefits of maintaining a healthy lifestyle. Although no singular action by a company can eliminate childhood obesity, the cumulative efforts of businesses, schools, communities and government can combine to have a positive impact on youth. It is important to understand that this proposal will complement efforts that have already been started in the public sector; however, the ideas we will recommend create a model for how a business could address the issue in the community. Our proposal shows how

Texas Health Resources can engage the community to be visibly involved in combating childhood obesity. The most prominent example is the efforts of First Lady Michelle Obama, who has been at the forefront of the Obama administrations Task Force on Childhood Obesity (Sweet, 2010). Through our community action plan, Heroes for Health, we will provide a vehicle for educating children and their families about the implications of lifestyle decisions. We will focus on diet and exercise habits, with the intention of reversing trends in obesity. In this report, we will discuss: 1. 2. 3. 4. The nature of childhood obesity including its causes and effects. The structure of our proposed community action plan for Heroes for Health. The human resources necessary to make Heroes for Health a reality. The financial resources required to mobilize Heroes for Health.

Childhood Obesity: Description, Causes, and Effects Obesity is a problem that affects millions around the world, with Texas ranking 12th in the nation in the number of obese people in 2011 (CBS Local CBS DFW, 2011). Our main focus for Heroes for Health is children from age six to twelve. Studies have shown that out of the young people in the nation, approximately one-third of them are obese. Child obesity rates have more than doubled and adolescent rates have more than tripled over the past 20 years (Odum, 2013, Pg. 3). Obesity is a complex and multifactorial chronic disease that usually becomes manifest in childhood and adolescence (Serra, 2013, Pg. 2). The United States Centers for Disease Control and Prevention (CDC) determines the degree of obesity in children based on where they fall on the BMI Charts. BMI, or Body Mass Index, is calculated by [weight in pounds] divided by [Height in inchest^2] multiplied by 703 (Centers for Disease Control and Prevention, 2013). Children who are calculated to be in the 85th to 95th percentiles are viewed as being overweight. Those children who surpass the 95th percentile are considered obese. Children in the 99th percentile are considered severely obese (Hellmich, 2013). One of the causes of obesity is a sedentary lifestyle. Studies show that behavior and environment greatly affect childhood obesity. Children that practice sedentary behavior, rarely engaging in physical activity, are at a greater risk of becoming obese. In a National Institutes of Health(NIH)study, elementary school personnel reported that technology played a major role in the inactivity among elementary school children, namely televisions, computers, and gaming systems (Odum, 2013, pg. 2). Either at school or at home, children prefer playing on their game systems or other electronic devices rather than participating in physical activities. This study also

highlights the profound amount of parents who are in denial about the weight status of their child and the lack of education about the health concerns of being overweight. Furthermore, our research reveals that too many environmental influences deter families and kids from making the correct decisions to produce an active lifestyle. Those influences include video games, TV, and computers as far as electronics. Children 818 years of age spend an average of 7.5 hours a day using entertainment media, including TV, computers, video games, cell phones, and movies (Centers for Disease Control and Prevention, 2013). These influences promote a sedentary lifestyle. Another contributing cause is a lack of access to safe play areas for children. A lack of safe play areas can contribute to childhood obesity if children are unable to find an appropriate place to participate in physical activity. For many children this is a concern (Centers for Disease Control and Prevention, 2013). Unhealthy diets also contribute to childhood obesity. In a study conducted by the National Institutes of Health (NIH), elementary teachers were interviewed and agreed that parents and the home environment had the largest impact on childhood obesity (Odum, 2013, pg.2). The reasoning for this view stems from the parents lack of education about health most likely caused by time constraints because of work or other obligations. Also, parents are unable to spend enough time and effort into providing a healthy life for their children. Specifically, this time constraint reduces the time needed to prepare home-cooked healthy meals. Instead, most parents resort to processed, canned, or fast foods. In addition, dollar menus and combo meals encourage overindulgence of less healthy food options. Commercialization of dollar-menus incentivizes poor food choices. Furthermore, obtaining access to healthy food can be difficult for families of certain socioeconomic backgrounds. In disadvantage areas, large chains, such as Wal-Mart or McDonalds are easily accessed than healthier options, like Central Market or Whole Foods.(Centers for Disease Control and Prevention, 2013). Socioeconomic forces also encourage poor food choices. A study conducted in 11 OECD countries, including several European countries, Australia, Canada, Korea and the USA showed that obesity is more prevalent in areas that are socioeconomically disadvantaged (Serra, 2013, pg. 25). In the US, it is not surprising that families with a low income have a greater reliance on processed food and fast food than on healthful food. Though diet and exercise are the most frequently observable causes of obesity, there are other contributing causes. First, it is important to note that our goal is not to merely encourage weight loss, but to promote a healthy lifestyle. Our culture often oversimplifies the issue of obesity, merely encouraging being thin instead of being healthy. Instead of society promoting thin as the goal and obesity as the devil, we could promote eating healthy as a first priority (Taylor, 2013). Children often face discrimination because of their size and a preconceived notion that the perfect body is skinny like the Hollywood-model figure. There is not enough awareness about the importance of living a lifestyle that leads to a healthy body. An imbalance

of physical activity and food consumption, along with cultural changes have had profound effects on the obesity epidemic. Also, family and genetic factors play an important role in the development of obesity (Odum, 2013, pg. 1). Studies have shown that the lifestyle a mother lives during the prenatal period of her pregnancy could have a profound effect on whether her child develops obesity. Excessive or low nutrient intakes during the prenatal and perinatal period play a role in the appearance of obesity in other life stages (Serra, 2013, pg. 2). Although it may be assumed that pregnant mothers who overeat would give their child a greater chance of developing obesity, actually, mothers who had significantly low intake in the first 3-6 months caused an increase in the potential for childhood obesity. The effects of obesity include a number of health disorders, such as heart disease, diabetes, asthma, high blood pressure, and sleep apnea (Centers for Disease Control and Prevention, 2013). However, health disorders are not the only concern; many obese children are affected by social discrimination. Obesity can be a contributor to low self-esteem, unpleasant social interactions, and poor body image. Struggling with self esteem can consequently hinder academic and social functioning, and persist into adulthood (Lets Move, 2013). Heroes for Health: A Community Action Plan Now we examine the purpose, structure, and benefits of our proposal. Childhood obesity is a topic that has already moved many people to action. However, the primary portion of the work that has been done has occurred in the public school system. Across the nation, there have been initiatives to feed children healthy lunches and promote exercise in the schools. In a report specifically addressing the issue of childhood obesity in Texas, Abigail Arons (2011) clearly showed what has worked and what could work in the future. Specifically, Texas has already addressed or is addressing: 1. Implementation of healthy school menus in public schools and a reduction in the availability of unhealthy alternatives like processed snacks and soft drinks. 2. Requirement of physical education in public schools and an effort to improve these programs across all age levels. 3. Initiation of comprehensive plans to address childhood obesity supported through the schools. (Arons, 2011, pg.7) It is this third point - the comprehensive plan - that shows the most potential for a business to address. A comprehensive plan is a plan that addresses the issue of obesity by promoting a healthy diet and encouraging exercise. Comprehensive plans have the greatest impact because both primary causes of obesity are addressed sedentary lifestyle and unhealthy diet (Arons, 2011, pg. 5). Though schools have begun to implement comprehensive plans, it would be unwise for our business to become directly entangled in the programs promoted by the public schools. There would be greater restriction working through the schools and a reduced sense of presence for THR. Part of our goal is to show how THR cares about the community and

how we want to be active in making a positive difference in the lives of community members. Therefore, our proposal is a comprehensive one that is supported without the school structure. The purpose of the proposal is to address the issue of childhood obesity by educating families on the importance of a healthy diet and active lifestyle. Though understanding how obesity is caused can be relatively simple; however, it is not always easy for individuals within families to understand the impact of their habits. Education can show how small choices in diet can benefit or harm them and their families. Additionally, educated parents will know how choices in preferred family activities can transform a childs lifestyle. If sedentary activities, such as television and video games, are the prevalent activities, children will be less likely to get enough exercise. Our proposal will address these issues. Heroes for Health is comprised of two parts. First, there will be a three-month participation program for children to log, with their parents help, their physical activity and food eaten on a daily basis. We will supply a child-friendly booklet for participants that suggests different family activities and healthy meal options. Included in the booklet would be simple facts, such as calories burned by different activities or calories contained in foods. We will use an excel spreadsheet that requires children to record their dinner meals and exercises completed that day. The children will not be required to record their caloric intake, but rather just write down what they ate. Second, after the three-month participation program, there will be a community celebration at White Rock Lake Park. We will hold a carnival style event with healthy food, fun activities, entertainment, and special prizes for the children. One of the highlights of our event is our collaboration with nutrition expert, Amy Goodson, who will speak to children and their parents about the importance of a healthy diet. She is a local nutritionist for the Dallas Cowboys, Texas Rangers and many athletes in the Dallas-Fort Worth area. Goodson also teaches nutrition courses at Texas Womens University. In an interview conducted by e-mail, she was able to make several recommendations for children. The following are the recommendations Amy Goodson will present: 1. Develop Healthy Eating Habits Start your day with a powerful breakfast. Include a powerful protein, nutrientrich whole grains, and a fresh fruit and/or vegetable. One meal example is whole wheat English muffin with Canadian bacon, a scrambled egg, fresh spinach, and a low-fat cheese slice. Choose beverages wisely. Eliminate soda and energy drinks, replace high concentrated fruit drinks with fresh fruit, choose low-fat milk instead of whole milk, and prioritize water over other sugar-filled drink choices. Fuel throughout the day. Provide a healthy lunch and snacks for children such as a peanut butter sandwich on whole-grain bread with reduced sugar jelly or sliced bananas or multi-grain wheat thins with a mozzarella string cheese. Eating healthy snacks will discourage eating junk food between meals. 2. Participate in physical activity everyday Regular physical activity is just as important to a healthful lifestyle as healthy eating. Children and teenagers should be physically active for 60 minutes

every day or most days. Set aside time each day to engage in active play such as tossing a ball, playing tag, going for a walk, or participating in a sport. 3. Get kids involved in nutrition If children are involved in the planning, purchasing, and preparation of healthy items, they are more likely to try the food. Involve children in the planning of the weekly menu, picking out the ingredients from the grocery stores, and preparation in the kitchen. The whole family will feel better and benefit from eating delicious, nutritious meals together. (A. Goodson, personal communication, October 18, 2013) Immediately, one can consider the potential problems for abuse. Perhaps participants in the three-month program would not accurately log their behavior. Maybe parents would only bring children to the Heroes for Health event without concern for the message of adopting a healthy lifestyle. However, this proposal is a huge benefit because, regardless of the degree of participation, Heroes for Health promotes awareness and shows how children can change their habits to improve their health. Heroes for Health targets all children in order to promote a healthy lifestyle, which will lead to a reduction in the number of obese children. Even if only a few children and families are affected, our promotion of a healthy lifestyle moves in the direction of reducing childhood obesity. Furthermore, it allows THR the opportunity to show that we care about the well-being of the community, regardless of the degree of success. We do not have to push strongly for accountability. This makes it a low-risk, easy to implement, and highly successful plan. Heroes for Health: People as the Driving Force In preparation for approximately 1000 participants for the Heroes for Health communitywide event, we are planning for about 300 volunteers to help run the event. We plan on using volunteers from our 25 metroplex hospitals, which consist of more than 21,000 employees (Texas Health Resources, 2013). These volunteers will help by being involved with variety of activities on the day of the event. All volunteers will be coordinated by a paid event manager. We plan on offering a day of paid vacation as an incentive for employees to volunteer for the event. We want to promote the program throughout our hospitals, so each hospital will compete with each other to recruit volunteers for Heroes for Health. Hospitals with the most volunteers will get additional funding for their Christmas party. Furthermore, families of volunteers will have their kids automatically entered into our company-only raffle drawing. We will also be hiring a staff for the event, which will be located at White Rock Lake Park. A private security firm will be employed so that no employee of THR will be responsible for any security issues. We will have an event staff to handle parking, set-up and clean-up. Additionally, we have the flexibility to add sponsors for our event who can bring in more volunteers and provide additional funding for the event. However, we will not rely on the extra sponsorship. With our number of volunteers, we are confident that we have enough people to run a safe and wonderful event.

Heroes for Health: How much would it cost? The budget for Heroes for Health consists of six categories: site costs, decorations, prizes, refreshments, program expenses, and miscellaneous cost. The total expenses for this event are about $86,600. Figure C identifies details of the expenses by item, and Figure D shows the division of expenses by category. These expenses are based on an estimated attendance of 1,000 people.

Figure C. Expenses.

Figure D. Expenses by Category. Conclusion In summary, Heroes for Health will create a community event that will educate children and their families about the impact of obesity and the methods to combat it. Healthy diet and an active lifestyle are critical ideas the children will receive first-hand. This proposed model will show Texas Health Resources commitment to the community and its concern for reducing childhood obesity. We have explained the two-part plan of Heroes for Health a three-month participation program followed by a community event at White Rock Lake Park. Our proposal is a flexible model that can be easily adjusted to accommodate other venues and can become an annual event. Furthermore it can be regarded as a success simply by having a large presence of participants at the event. However, the more people we can engage in the community, the greater impact we can have in promoting a healthy lifestyle for children and in reducing childhood obesity. Finally, our proposal presents an opportunity for a strong partnership between Heroes for Health and the Dallas community, and provides a solid foundation for the Chamber of Commerce funding our program. Combating childhood obesity is a worthy cause and Heroes for Health offers a wonderful method for businesses to make an impact in the lives of children and the community as a whole.

References Arons, Abigail. (January, 2011). Childhood obesity in Texas report. Childrens Hospital Association of Texas. Retrieved from http://www.childhealthtx.org/issues-and-advocacy/ CBS Local CBS DFW. (July 7, 2011). Texas ranked as 12th most obese state. CBSLocal. Retrieved from http://dfw.cbslocal.com/2011/07/07/texas-ranked-as-12th-most-obesestate/ Centers for Disease Control and Prevention. (October, 2013). Basics about childhood obesity. Childhood Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/ childhood/basics.html Fancher, Julie. (October 30, 2012). Coalition unveils plan to eliminate childhood obesity in Dallas by 2020. The Dallas Morning News. Retrieved from http://www.dallasnews.com/news/community-news/dallas/headlines/20121030-coalitionunveils-plan-to-eliminate-childhood-obesity-in-dallas-by-2020.ece?nclick_check=1 Hellmich, Nanci. (September 9, 2013). Heavy kids face health problems, have few options. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2013/09/09/severelyobese-medical-risks/2781343/ Lets Move. (2013). Health problems and childhood obesity. Lets Move: About Lets Move. Retrieved from http://www.letsmove.gov/health-problems-and-childhood-obesity Odum, M., McKyer, E., Tisone, C., & Outley, C. (January 24, 2013). Elementary school personnel's perceptions on childhood obesity: Pervasiveness and facilitating factors. The Journal of School Health, 83(3), 206-212. doi:10.1111/josh.12016 Serra-Majem, L., & Bautista-Castao, I. (September, 2013). Etiology of obesity: Two "key issues" and other emerging factors. Nutricion Hospitalaria, 2832-43. doi:10.3305/nh.2013.28.sup5.6869 Sweet, Lynn. (February 2, 2010). Michelle Obama kicks off anti-obesity drive with White House events. Politics Daily. Retrieved from http://www.politicsdaily.com/2010/02/09/ michelle-obama-kicks-off-anti-obesity-drive-in-oval-office-event/ Taylor, Sydney. (September 11, 2013). Tackle child obesity with diet, exercise: Your say. USA Today. Retrieved from http://www.usatoday.com/story/opinion/2013/09/11/childhoodobesity-treatment-your-say/2802257/ Texas Health Resources. (2013). About us. Texas Health Resources. Retrieved from

http://www.texashealth.org/about