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Childhood Obesity Prevention in Texas: Workshop Summary 9 Major Themes A number of major themes emerged during the workshop’s public forum, which also included reports from individual meetings with speakers from the community, the state, and the legislature and from field trips made by several committee members to CATCH schools. This section uses information provided by the workshop speakers and does not report consensus findings or conclusions. GARNERING SUPPORT FOR CHILDHOOD OBESITY INITIATIVES Obesity prevention initiatives are destined to fail without support from the public at large and from legislators. Achieving traction for health-promoting initiatives requires buy-in on both fronts. Obtaining Buy-in from the Public Many individuals fail to understand the threat childhood obesity poses to society. Therefore, it was suggested that organizations targeting childhood obesity should consider including a public education component in their strategic plan. Also essential is to engage members of the community in obesity prevention initiatives. The Paso del Norte Health Foundation has been highly successful in implementing several programs in El Paso because it engages and draws support from community members by having business leaders, parents, and educators participate on its committees.
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Childhood Obesity Prevention in Texas: Workshop Summary Obtaining Buy-in from Legislators As some legislators in Texas have learned, presenting unassailable data on childhood obesity and the need to change state law may not hold sway without buy-in from colleagues. Legislators often balk at the cost of health initiatives and physical fitness programs for schools and communities, even though the cost of these programs is insignificant compared with the costs that will be incurred if the trend of childhood obesity is not reversed. Childhood obesity does not resonate as a cause with some policymakers, perhaps because they find the idea of addressing the problem unattractive or the consequences too distant. Linking the problem to broader, more familiar issues, such as education and economic development, appears to be an effective approach. For example, Comptroller Combs’s efforts to quantify the cost of obesity to Texas businesses have been highly influential in bringing about policy change. Focusing on short-term versus long-term outcomes also appears to be more persuasive among legislators given the nature of political cycles and the desire to influence constituents. Policy makers who spoke with the committee stressed the importance of placing childhood obesity prevention within the framework of education. Whereas a number of policy makers view health as an expenditure, they view education as an investment. Indeed, many legislators strongly believe in the need to invest in education, so forging a link between education and obesity prevention could help in securing funding for the anti-obesity cause. Such a link also facilitates a systematic approach to change by involving all public schools, which in turn allows for sustainability. MODELING HEALTHY BEHAVIORS THROUGHOUT THE COMMUNITY To extend anti-obesity efforts beyond its schools, Texas is offering incentives to businesses to institute workplace wellness centers. Such programs already established in a handful of Texas businesses have realized benefits in the form of fewer inpatient hospital admissions, reduced absenteeism, annual insurance savings, and reductions in health care costs, thus yielding a positive return on the workplace wellness investment. These employers have recognized that having a healthy workforce that is ready and able to work improves the fiscal bottom line. Texas has also implemented programs to encourage healthy behaviors among its state employees. These programs include time off for physical activity, physical education programs that occur during business hours, and delivery of farm-fresh food on site. In addition, state employees can obtain discounts for walking and running shoes at certain stores, and all city facilities offer showers and bike racks. Leaders within the state legisla-
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Childhood Obesity Prevention in Texas: Workshop Summary ture are visible with respect to their own physical fitness routines, leading runs and walks around the city and exemplifying healthy behaviors to their employees and constituents. LEVERAGING THE POWER OF PARTNERSHIPS Collaborative efforts often generate more momentum, resources, and influence than individual efforts. Representatives of nearly all organizations commented that community-based solutions to childhood obesity require a diverse array of partners, including elected officials; state agencies, such as the Department of State Health Services; worksites and schools; institutions of higher education; the food industry; community groups; providers and hospitals; urban planners, developers, and architects; and many other partners, such as city councils, county commissioners, the police, and non-profit organizations. One of the most important partners is parents, since they serve as models for their children. Large collaboratives, such as CAN DO Houston and Live Smart Texas, appear to be particularly effective at the city and state levels. Several key strategies enable such collaboratives to function effectively in bringing many partners together. One such strategy is to identify the mission of the partnering organizations and to maintain unwavering focus on that mission. Partnership for a Healthy Texas clearly defined its mission as focusing solely on policy change, rather than the implementation of that change, so as to concentrate its efforts for optimal impact. Since its inception in 2006, the Partnership has succeeded in filing more than 20 bills with the state, emphasizing coordinated school health. Another important strategy for achieving an effective partnership is to ensure open communication and transparency so that all groups feel equally informed and invested in advancing the partnership’s strategic goals. The workshop speakers also stressed the importance of inclusiveness in building partnerships at the local level. Having a diversity of stakeholders represented in a partnership can lead to innovative solutions to strategic problems. This point is exemplified by the LEAN Coalition in Henderson, which was able to obtain additional park lands through a land swap with a town resident and an unused historic building that it plans to convert into a senior citizen center. IMPLEMENTING COMPREHENSIVE APPROACHES Previous public health campaigns have demonstrated the need for a comprehensive approach. The Texas Tobacco Prevention Initiative, conducted in Austin/Travis County, taught leaders in the Health and Human Services Department that multicomponent interventions involving schools
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Childhood Obesity Prevention in Texas: Workshop Summary and communities, the media, smoking cessation programs, and law enforcement are more effective than single-component interventions in reducing tobacco use. One multicomponent intervention that has been successful in Texas is the CATCH initiative. CATCH is an evidence-based, coordinated school health program that promotes physical activity and healthy food choices. More than 2,500 schools in Texas offer the CATCH program, potentially affecting more than 800,000 schoolchildren. CATCH’s many programmatic components are well organized and integrated within the school system. A visit to two schools with CATCH programs revealed nutrition messaging during school announcements, enthusiastic children participating in physical education classes, healthy foods offered in the cafeteria (fruits, vegetables, reduced-sugar cereals, and reduced-fat pizza), a math lesson using nutrition labels to teach children how to calculate fractions, and wellness programs for teachers. A study conducted in CATCH schools in El Paso found that 11 percent fewer girls and 9 percent fewer boys were overweight after 3 years of the program. USING SOCIAL MARKETING Speakers emphasized that organizations need to think and act like marketers when trying to promote the anti-obesity cause. Several groups well versed in social marketing stated that promoting healthy lifestyles, as opposed to the prevention of childhood obesity, is more powerful in influencing people to change their habits. According to these groups, the future of social marketing with respect to childhood obesity prevention lies in lifestyle marketing: the issue is not about losing weight, but about gaining access to a better world. The goal of such groups is to help change people’s mindsets, empower individuals to make changes on their own, and create a tipping point for sustainable change. Moreover, ingraining healthy behaviors early in childhood increases the likelihood that these behaviors will be maintained into adulthood. IDENTIFYING A CHAMPION During the workshop, it became clear that those programs that developed organically at the local level and were successful had individual champions advocating a specific cause, such as a better park system for the town or a walking marathon geared specifically to children. These champions, who can also be found at the state level, tend to be energizing individuals who lead by action and who spread their enthusiasm by communicating continually with others in the community. Their efforts unite people toward a common goal and leverage resources.
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Childhood Obesity Prevention in Texas: Workshop Summary RECOGNIZING THE POWER OF COMMUNITY DATA In culturally diverse states such as Texas, it is important to collect community data to measure the outcomes of interventions. Efforts that are effective in north Texas may not be influential in border communities in south Texas. The size and cultural diversity of Texas often necessitate customized interventions. Equally important is collecting state-level data that allow a state to compare its performance with that of others. This is one way to mobilize a call to action, particularly among policy makers. IMPLEMENTING FEDERAL POLICY CHANGE Representatives of some organizations, particularly those at the state level, advocated policy change at the federal level as a strategy for creating change at the community and state levels. This approach, it was argued, ensures that no communities or schools fall through the cracks with regard to nutrition and physical fitness standards. Moreover, instituting some basic changes at the federal level provides a foundation upon which states and communities can build. SECURING FUNDING Funding is an obvious need of all organizations targeting childhood obesity. Funders are sometimes risk averse, meaning that innovative initiatives can be overlooked for funding. One speaker requested that innovation be placed at the top of funding priorities and that success be redefined. He suggested that funders should also consider financing only projects that are scalable, adaptable, and sustainable so that successful programs can be translated to other locales. Marathon Kids and CATCH are two examples of programs that are adaptable and have been implemented in other cities around the country. Funding is needed not only to launch programs but also to sustain them, particularly at the local level. Many small organizations are focused so intently on getting their initiatives off the ground that they can lose sight of the resources needed to sustain their efforts. CLOSING THOUGHTS Childhood obesity remains a major challenge facing the nation—one that threatens the immediate health of our children; the future stability of our health care system; and ultimately the long-term vitality of local, state, and national economies. A number of workshop speakers emphasized that the changes needed to reverse the obesity trend must be robust enough to
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Childhood Obesity Prevention in Texas: Workshop Summary counteract the factors that led to obesity in the first place. Collaborative involvement of multiple sectors and stakeholders at all societal levels is important to alter collective cultural norms that have contributed to the childhood obesity epidemic. The efforts undertaken in Texas serve as a case study of various streams of influence at the state and local levels that are merging to effect the prevention and reversal of childhood obesity across the state.