Community Project: Healthy Kids, Capstone Project Example

Introduction

Preventing and solving the problem of childhood obesity is an important national  that has reached to the White House.  Michelle Obama has made childhood obesity the cause of her term as First Lady (Let’s Move, 2011). The issue is of such importance that it impacts the long-term health and well-being of a whole generation of children.

In Hamilton and Butler Counties in Ohio (the Cincinnati region), an annual community program called Run for Shelter is designed to raise money for protecting and rescuing young girls trapped in the sex slave trade (Run for Shelter, 2011). While the main purpose of the fund-raising activity is for this very worthwhile cause, many other community service programs participate in a type of mutual self-help program designed to maximize awareness across a number of community projects.

Healthy Kids is a community service project designed to educate parents and children about obesity, healthy eating, and physical activity.  Implemented in conjunction with the April 2011 Run for Shelter, the goal was to reach out to the community and provide education and awareness of the issue of childhood obesity.

The main event for Run for Shelter is a 5K run. In addition, however, the event includes a festival with activities, information booths and other projects designed to be both fun and enlightening.

This paper presents the details and rationale of the Healthy Kids community service project and the results of the April, 2011 event.

Review of Literature

Childhood obesity is a major health concern in the United States.Obese children are subject to a substantial number of diseases and health problems, including developing risk factors for heart disease, type 2 diabetes, reduced health-related quality of life, low self-esteem due to the social stigma of being obese, depression, binge-eating disorders, asthma, and other problems (White House, 2011).

In the 2007-2008  National Health and Nutrition Examination Survey (NHANES), the prevalence of obesity among children aged 2 to 19 was 16.9%, more than triple the prevalence of obesity in the 1971-1974 NHANES survey (Ogden & Carroll, 2010).  Obesity shows a steady upward trend since initiation of NHANES in the mid-1960s.  Figure 1 (data from Ogden & Carroll, 2010) illustrates the trend in childhood obesity over the years from the 1971-1974 NHANES to the most recent 2007-2008 NHANES.

The NHANES study uses the Body Mass Index (BMI) as a measure of obesity in children, where the BMI is based on age-appropriate weight levels for boys and girls. This is, however, not a perfect measure of obesity given that it is not a direct measure of the actual adiposity of an individual (Ogden, Carroll, Curtin, Lamb, Flegal, 2010).  Furthermore, it is a better measure for adults than for children, even using the age-appropriate BMI growth charts developed by the CDC.  In part, this is because level of adiposity varies by ethnicity even for the same BMI (Ogden, et al., 2010).

Of particular concern is the prevalence of obesity in children in both the 6-11 age group and the 12-19 age group.  These children are at risk of developing long term health issues including cardiovascular problems, diabetes, hypertension, and many other effects of obesity. While obesity in the pre-school (2 to 5 years) age group has improved since the highest rate in the 2003-2004 NHANES, obesity in the two older age groups is as high or higher as it was in 200 (Ogden & Carroll, 2010).

While the exact causes of this epidemic are not fully understood, a consensus of conclusions about childhood obesity include: (a) that children with a genetic propensity to obesity need help in primary prevention, individual attention, and strong support systems; (b) obesity  is caused by a complex mixture of genetics, easy availability of high calories, and reduction in physical activity; (c) while a child may have a genetic propensity toward obesity, this does not necessarily mandate an obese future (Wright, 2010).

Some risk factors for obesity can start in the womb. Children whose mothers smoked during pregnancy or who themselves have diabetes can generate an increased risk of obesity in their children (White House, 2011).  There is also some evidence that babies who grow very rapidly during infancy are prone to obesity (White House, 2011).  These prenatal and early infancy factors may at least partially explain racial and ethnic differences in obesity factors (White House, 2011).  There are also possible genetic influences, as shown by twin studies and correlations between obese parents and obese children (White House, 2011).  Still, although genetic factors may exist, they do not exclusively determine the development of obesity because environmental factors also are important (White House, 2011). Such factors include the reduction in physical activity, increase in time spent in front of “screens” (i.e., televisions, video games, computers, etc.), consumption of more fast-food and high-sugar foods and beverages, fewer family meals at home, and increased consumption of packaged and processed foods (White House, 2011).

The literature supports a somewhat counterintuitve link between low birth weight and excessive gain of weight in adulthood and particularly with the development of type 2 diabetes. Thus, moving from a malnourished (or simply undernourished) period during fetal development combined with later access to high calorie foods, provides an opportunity for obesity and related conditions to develop (Caballero, 2007).  Possibly one of the greatest roadblocks to treating obesity is that political leaders do not see the problem as a socioeconomic one as much as one of individual behavioral choices (Caballero, 2007).

The Centers for Disease Control and Prevention (CDC) have laid down guidelines for children’s activity levels.  These guidelines include 60 minutes of physical activity every day, most of that in aerobic activity, with vigorous aerobics at least three times a week, muscle strengthening at least 60 minutes a week, and bone-strengthening activities (i.e., jumping rope, running) at least three times a week (CDC, 30 March 2011).  Appropriate activities can include games such as soccer, playing catch, tag, and hopscotch or sports such as gymnastics. Playing on a jungle gym, climbing trees, and similar games are also appropriate activities (CDC, 30 March 2011).

A number of community based projects to increase activity levels in children and decrease obesity have shown promise at decreasing the amount of time children spend in passive activities (television and video game playing, for example) and increasing the amount of time children spend in physical activity (Ogden, et al., 2010). Still, in spite of the effectiveness of these programs and the increased emphasis in implementing them over the past decade, the prevalence of BMIs above normal weight levels has not declined and has remained relatively stable for ten years (Ogden et al., 2010).  Moreover, there is some indication that boys in the heaviest group are actually getting heavier rather than losing weight; thus the complex mixture of  biological, environmental, social, and behavioral factors that contribute to increasing BMI need further research to understand the relationships among these factors (Ogden et al., 2010).

With the entrance of a new regime in the White House in 2008, the new First Lady, Michelle Obama, has made reducing childhood obesity a critical cause of the Obama presidency. The establishment of the White House Task Force on Childhood Obesity and the development of its action plan is intended to solve the problems of childhood obesity within this generation. This task force established a four-point plan to accomplish this goal: (1) give parents and caregivers power to deal with the problem; (2) ensure that school meals are healthy; (3) make healthy foods affordable and accessible;  and (4) ensure that physical activity in children is increased (White House, 2011).  The ultimate goal of this program is to return to a childhood obesity rate of just 5% by the year 2030. Figure 2, taken from the White House report, presents the hoped-for progress in this goal.

Methodology and Procedures

Healthy Kids was designed as a program to be implemented in conjunction with the 2011 Run for Shelter program in the greater Cincinnati, Ohio area.  The event included a 5K run and a carnival including booths, activities, a silent auction, and opportunities for fun for those of all ages. More than forty local companies, organizations, commissions, and individuals sponsored the day. The main events were organized by a group of volunteers.

The organizational process operated around a series of meetings across several months to plan this event.  In addition to organizing the Healthy Kids activities at the carnival section of the day, additional participation involved finding sponsors for the Run for Shelter day.

Of critical importance to the success of this project was the necessity of working with a wide variety of organizations and individuals both in a leadership role, but also as a “sales” person to convince sponsors to contribute to the cause, and also to work successfully with many other people.  This was a project that required the contribution of dozens of volunteers, and the  success of the day was due to the mutual goodwill of all those involved in the project.

My role in the project began long before the event itself.  As part of the organizing committee I took on several roles in setting up the event. These roles are outlined in the following sections.

Sponsor Procurement

I acted in a key role to procure sponsors for the event.  In this role, I solicited help by letter (attached as an appendix), and in person, following up with the sponsors to ensure the funds were submitted to the event.  The sponsors I personally was responsible for bringing in include:

• Shelley Tagtmeyer
• Russel Custom Embroider
• Sharon & Pat MacDonald
• Chris Parks
• Jennifer Withrow
• Heather Cramer
• Hudepohl Jewelers
• City Barbeque
• Remke Markets
• Biggs
• Perfection Gymnastics
• Cincinnati Gymnastics

Organizing and Running the Kids Games Area of the Event

In addition to procuring sponsors and participating in the decision-making as part of the organizing committee, I also was responsible for setting  up and running the Kids Games area of the event to ensure that children were kept busy and entertained during the day.  This included arranging for the donation of all games materials and all prizes handed out during the day.  The sponsors noted above are included in the list of donors to the Kids Games area.

Day of Event Participation

On the actual day of the event, in addition to overseeing the Kids Game area, I interacted with parents and children, discussing with them the amount and types of exercise children should participate in.  I also had a set of suggestions for healthy, low-fat, low-sugar snacks ideas for them.  These recommendations included items such as (PCRM, no date):

• Fresh fruit: bananas, apples, oranges, strawberries
• Low-fat fresh or frozen yogurt
• Air-popped popcorn
• Celery stalks
• Low-fat cheese
• Unsalted pretzels
• Low-fat cookies
• Frozen juice bars
• Cucumber slices
• Bran muffins
• Cheerios

In addition to meeting with and talking with parents and children, I put together a flyer that outlined the need in Hamilton County for obesity prevention and treatment in children. Specifically, the Hamilton County Public Health department reports that more than 22% of all third-graders are already obese, with that percentage being significantly higher percentage of African-American children in Hamilton County (HCPH, 2011).  The information provided in the printed handouts included information from the Alliance for a Healthier Generation (AHG), which notes that medical experts now believe that obesity is an epidemic in the U.S. with nearly one child and teen in three being either overweight or obese (AHG, 2011).  The AHG also notes that obese and overweight children are at high risk for serious health outcomes including diabetes, high cholesterol, asthma, hypertension, heart disease and other serious health problems (AHG, 2011). Other statistics included in the flyer were that more than one-quarter of all adults in Hamilton County are obese, and nearly one-quarter (24%) of all residents reported no physical activity over the previous month (HCPH, 2011).

Results

The results of this day of fun were highly successful.  More than 350 people attended the carnival in conjunction with the 5K race, and 226 adults and children successfully completed the 5K run.  Organizers agreed that the day was a big success.

In terms of the Healthy Kids program, the booth we prepared included educational materials, fun games and activities, and healthy snacks.  In the course of the day, nearly 75 children visited the booth and took away materials to teach them how to stay healthy through their lives.  The parents were extremely receptive to the information I provided in printed hand-outs and I received phone numbers and contact information from several of them because they wanted to get involved in future similar events.

As noted earlier, I was deeply involved in the organization of the event. I identified and convinced local companies, organizations, and individuals to sponsor the Run for Shelter program. This generated more than $3000 for the Run for Shelter charity.  I also convinced several local companies to donate materials for the Healthy Kids booth, including reproduction of educational materials, decorations, and healthy snacks for the children and their parents.  I took responsibility for organizing the Kids Games portion of the event.

My participation during the event encompassed several aspects of the day, primarily in regard to the carnival section of the day. The morning of the race, I was present first thing in the morning to run the runner registration table.  I was also in charge of getting volunteers to work on the runner registration with me, and to help in checking in all the racers and their teams.  On the day of the event, I was involved in setting up the booth, manning it throughout the day, and helping tear it down at the end of the day.  In addition, I took a leadership role in recruiting and training the volunteers for the Kids Games program, so they could explain the games to the children and their parents and supervise the games safely.  I  also was responsible for recruiting other physician assistants to help me man the Healthy Kids table and for arranging all the snacks and refreshments for the children. A thank-you letter from the event organizer is available as an Appendix to this report.

Overall, the vast majority of parents and children  visiting the Healthy Kids booth not only had a great time with the snacks and activities implemented in the booth, but also walked away knowing just a little more about how to prevent childhood obesity.

Discussion and Conclusions

One of the key lessons in a project like this is the importance of people with disparate goals to work together in harmony to achieve a greater good.  While each of the other organizations participating in the carnival had individual goals that may have differed from the main Run for Shelter event’s goals, all were able to work together to put on an event that promoted all the programs presented there.  While Run for Shelter received the cash contributions from sponsors, etc., the other programs participating received important access to the public in a positive setting.

The project provided important experience in persuasion and “salesmanship” in that it involved convincing local businesses and organizations to contribute money and become a sponsor.  Other key attributes included the need to organize the booth properly, and to  arrange for donations of snacks and other materials to be given away.  It was also important to coordinate a small band of volunteers in setting up the booth at the beginning of the day, and cleaning up and tearing it down at the end of the day.  Overall, this experience provided useful practice in event planning and execution.Another important skill this event helped me develop was the skill of being a leader.  I was required to recruit staff (volunteers), train them, schedule them, and supervise them throughout the organization effort and especially during the event itself.  While I was not responsible for all volunteers, my area of responsibility included staffing the runner registration table at the beginning of the day, as well as the volunteers working on the Kids Games area and the Healthy Kids table.  This experience of leadership and volunteer management was an eye-opening one for me, and I feel I learned a tremendous amount about how to work with others in a supervisory role.

Even more importantly, the event offered opportunities to talk directly with parents and children about obesity and discover their attitudes and needs.  It seemed particularly important to listen to their questions and concerns and use that as a guide to issues that patients will have when they attend the clinic.

Implications and Recommendations

Participation in events such as the Run for Shelter day offer amazing opportunities to become an active community member. By participating in events such as this, healthcare workers can become involved and aware of the needs and aspirations of their community.  Actively listening to the questions and comments made by those coming to the Healthy Kids booth provided insight into their concerns.

In addition, working on such events offers an opportunity to extend personal skills in ways that are not often encountered in day to day work environments. These skills include general leadership skills, coordination with others, including other organizations, salesmanship skills to convince sponsors to donate to the event, and the opportunity to meet with the general public in a much more informal construct.

Because of the success of this event, it is recommended that ongoing participation in this event be considered.  While time-consuming, the overall rewards coming from reaching out to the community are too great to miss. 

References

Alliance for a Healthier Generation (AHG). (2011). Childhood Obesity: An American Epidemic. Web. Retrieved from: http://www.healthiergeneration.org/about.aspx?id=3439

Caballero, B. (2007). The global epidemic of obesity. Epidemiologic Reviews.29, 2007, 1-5. Web. Retrieved from: http://epirev.oxfordjournals.org/content/29/1/1.full.pdf+html

Centers for Disease Control and Prevention (CDC). (3 March 2011). U.S. obesity Trends. Website. http://www.cdc.gov/obesity/data/trends.html

Centers for Disease Control and Prevention(CDC). (30 March 2011). How much physical activity to children need? Web. Retrieved from: http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html

Hamilton County Public Health (HCPH). (2011). We THRIVE! Web. Retrieved from: http://www.hamiltoncountyhealth.org/en/programs_and_services/community_health_services/physical_activity_and_healthy_eating/wethrive.html

Healthy People 2020. (2011). Nutrition and Weight Status. Web. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29

Let’s Move. (2011). Website. Available at: http://www.letsmove.gov/

Ogden, C.L., Carroll, M. D., Curtin, L. R., Lamb, M. M., Fiegal, K M. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. The Journal of the American Medical Association, 303 (3), 242-249.

Ogden, C. & Carroll, M.  (2010). Prevalence of Obesity among children and adolescents: United States, trends 1963-1965 through 2007-2008. Centers for Disease Control and Prevention. Web. Retreived from: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm

Physicians Committee for Responsible Medicine (PCRM). (no date). Healthy Snacks for Kids Fact Sheet. Web. Retrieved from: http://www.pcrm.org/health/veginfo/snacks.html

Run for Shelter. (2011). Website. Available at: http://runforsheltercincy.org/

White House. (2011). White House task force on childhood obesity report to the President-One-year progress report.  Web. Retrieved from: http://www.letsmove.gov/sites/letsmove.gov/files/Obesity_update_report.pdf

World Health Organization. (2000). Obesity: Preventing and managing the global epidemic. WHO Technical Report Series 894.Geneva: WHO. Available from: http://apps.who.int/bookorders/WHP/detart1.jsp?sesslan=1&codlan=1&codcol=10&codcch=894

Wright, C. (2010). A U.S. epidemic: Childhood obesity. Journal of Physician Assistant Education, 21 (2), 39-41.