EB Community Childhood Obesity Interventions

Capstone Paper Project

Samuel Turner, BSPH
University of South Florida

EB Community Childhood Obesity Interventions

Introduction
According to the Healthy Kids Healthy Future website, one in five children is overweight
or obese by age 6. The Institutes of Medicine says the rate of childhood obesity has more than
tripled in the 6-11 year old age group over the last thirty years. Childhood obesity is a national
as well as a local public health problem. The evidence based community interventions discussed
in this paper will be concentrated in Hillsborough County located in the state of Florida. Current
interventions as well as other evidence based interventions that could work in the county will be
reviewed. All levels (primary, secondary, and tertiary) of public health interventions will be
discussed.
Hillsborough County is primarily an urban setting. It is 1,136 square miles with a
population of 1,229,226 as of the 2010 Census. Some of the major employers according to
Suncoast Employers are Hillsborough County School District and County Government, MacDill
Air Force Base, Tampa International Airport, University of South Florida, Publix Supermarkets,
Tampa General Hospital, JP Morgan Chase & Co., Busch Gardens, St. Josephs Hospital, and H.
Lee Moffit Cancer Center. As shown by the major employers listed, some of the main health
care systems in Hillsborough County are also some of the largest employers such as Tampa
General Hospital, Baycare Healthcare Systems (St. Josephs Hospital). The other major health
care system is Florida Hospital Systems.
In Hillsborough County there are 180,266 or 15% of the population that is living in
poverty. Compared to the State of Florida, Hillsborough County has approximately the same

EB Community Childhood Obesity Interventions

percentage. The percentage of people who graduated high school is higher at 86.8% than the
state, which is at 85.3%. According to the US Census the percentage of people who does not
speak English either at all or not well is 26% in the state of Florida. According to the community
atlas in Hillsborough County the percentage who does not speak English either at all or not well
is only 4%.
Strengths and Needs
Hillsborough County has several strengths. One strength is there is a program in place
called Steps to a Healthier Hillsborough County, which is a CDC (Centers for Disease Control)
program that helped the school district establish goals for improving physical activity programs
and provide healthy food options. A diverse population gives is a strength by bringing many
different ideas, thoughts, opinions, and resources to the table. Hillsborough County also has a
good education system with access to multiple higher education institutions. There are also a
good number of hospitals in the area to ensure timely healthcare delivery. There are also many
needs in Hillsborough County. There is 15% of the population living in poverty. There are a
great number of migrant farm workers who are at greater risk for poverty, under-education, and
healthcare issues. There is also a significant issue with childhood obesity which turns into adult
obesity, lower productivity, higher medical costs, and a high incidence of disability.
Childhood obesity is a priority health issue in Hillsborough County. It is such an
important issue because it leads to increased costs and a decreased quality of life. According to
the Healthy Kids Healthy Future website, childhood obesity can cause emotional and
psychological problems which will lower self-esteem and general acceptance. Childhood obesity
can also lead to nutrition deficiencies which can hinder brain development, thought processes

EB Community Childhood Obesity Interventions

and learning. Learning difficulties can put a drain on our education system with IEPs
(individual education plans) where special teachers have to come in to teach these children or
they may need more time to understand lessons and may end up repeating grade levels.
Childhood obesity also leads to adult obesity and with that comes an on slot of health
complications and diseases such as heart disease, high cholesterol, strokes, diabetes type II,
hypertension, respiratory problems, and more. Health problems cost a lot as well as lower
productivity levels or even lead to disability. Many problems arise from childhood obesity and
thus it is the best time in a persons life to address it while they are a child.

Community Health Models

The Determinants of Health Model is used to combine many factors that may affect the
health of populations and individuals. It will help you understand population health and the
multitude of factors that set its status. These factors that determine whether the level of health of
the population is made up of (but not limited to) the social, economic, and physical environment
and the individuals (or individuals that make up the population) characteristics, behaviors and
lifestyle choices. (WHO, 2015).
The model helps the public health nurse develop interventions that can improve a health
issue for a population. The nurse will be able to systematically analyze statistics about the
community as well as contributing factors. Any biases will be recognized during the reflection
process and overcome. The interventions developed using the model can be trusted to ensure the
most effective results because evidence based best practices were used.
In Hillsborough County there are many contributing factors to childhood obesity. Human
biology is the first I will address, which is actually not a controllable factor. Many people

EB Community Childhood Obesity Interventions

believe that genetics plays a large role in obesity. While genetics can increase your risk, it is not
written in stone. Lifestyle changes can and does play a larger role. The CDC says that over the
past few decades, genetic factors have not changed however childhood obesity has more than
doubled. In the physical environment there are several. Physical environment factors consist of
lack of safety for children to go outside and play (this is area specific), amount of fast food
restaurants which is clearly seen during a windshield survey and lack of biking and walking
friendly streets. Fast food or convenience foods (i.e., microwavable meals) are an affordable and
fast option for a busy family; unfortunately these foods are loaded in fat and sodium and are low
in vitamins and minerals. A study shows that when a fast food restaurant is within a tenth of a
mile from where they go to school it increases the chance of obesity by 5.2% (Currie, Et.al.
2009). The study shows that convenience is a large factor. Sociocultural and behavior factors
consist of the lack of or small amount of physical and health education in the school systems
(Mrs. Lutz says students in Hillsborough County School System can opt-out of their HOPE
(Health Opportunities through Physical Education) class and therefore may receive no health or
physical education), and amount of families living in poverty which is 15% of the population in
Hillsborough County. Many of these lead to other factors such as without a safe environment to
play, children may stay in the house watching television or playing video games. In a national
study conducted by Danner in 2008, he showed that the more children watched television, the
more weight they gained.
A population diagnosis would be children in Hillsborough County are at increased risk
for childhood obesity when they are living in a poverty situation, go to a school close to a fast
food restaurant, do not get enough physical activity, watch too much television or play too much

EB Community Childhood Obesity Interventions

video games, do not receive health and physical education, and/or eat too much fast food or
convenience foods as evidenced by above mentioned references.
Evidence Based Interventions
The primary level of prevention of childhood obesity will prevent new cases or at the
very least reduce the number of new cases. The level of the recipient will be system wide. It
would be implemented in the school system. Many children spend more awake time at school
than at home during the week day. A multifaceted approach would be needed. It would be
attacked by providing health education for every grade, providing at least 30 minutes of rigorous
exercise every day and providing only healthy menu options. Also, educational brochures and
parental meetings would also be held to get parental help on the home front. These interventions
will cover both health promotion and risk factor modification. Many experts advocated for
school based interventions siting it as a prime location for healthy behavior promotion (Zenzen
& Kridli, 2009). The stakeholders to whom the interventions are geared are the students, parents,
and members of the school district, as well as the primary providers seeing the students who are
referred. The school board and possibly legislators would also be stakeholders due to having to
change standards/requirements and additional costs which would need to be built into the school
districts funding. The community health nurse could take many roles in developing and carrying
out these interventions. The community health nurse could advocate for the changes and even
help coauthor legislation to get them implemented. The nurse could also teach the health course
or at the very least help design some of the content as the subject matter expert as well as be a
school nurse to monitor trends and provide referrals.

EB Community Childhood Obesity Interventions

The secondary level of prevention of childhood obesity will happen after a student has
been identified as having a risk factor or has progressed toward childhood obesity. The level of
recipient would be individual. The school would assign a personal success coach for students
who have risk factors or who start to progress toward obesity. The students would be identified
though screening by the school nurse. The success coach would help the student put together an
action plan with a personalized diet that would take the familys financial status as well as
personal tastes into consideration, an exercise schedule which would offer additional exercise
during the school day as well as set a prescribed schedule while at home and on weekends and
take into account the familys living situation, environmental factors, and time availability, and
during the school exercise the personal coach will also function as a personal trainer to motivate
the student. The parent may also be trained by the success coach if they are willing in order to
help them understand the diet and exercise routine. The stakeholders to whom the interventions
are geared are the students, parents, and members of the school district. The school board and
possibly legislators would also be stakeholders due to having to change standards/requirements
and additional costs which would need to be built into the school districts funding. The
community health nurse could take on the role of success coach or help in implementing or
running the program.
The tertiary level of prevention of childhood obesity will happen after a student has been
diagnosed with childhood obesity (this could also be called treatment). The level of recipient
would be individual. The student who presents with obesity will have the same success coach as
the secondary level of prevention but they would modify the diet and exercise routine to a more
aggressive stance and spend a bit more time with them. The student would also be referred out
for any clinical consultations needed to places who the school district has an agreement with to

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see these students regardless of financial ability. The consultations would include both medical
and psychological that way if there is an underlying cause, it could be found. Monitoring would
be done during the health education class that is mandatory for all grades. The monitoring would
also be able to tract how treatments are helping the student become healthier. The success coach
will be able to prevent further negative impact on the health of the student. The stakeholders to
whom the interventions are geared are the students, parents, and members of the school district.
The school board and possibly legislators would also be stakeholders due to having to change
standards/requirements and additional costs which would need to be built into the school districts
funding. The community health nurse who maintains and runs the program will be charged with
tracking the results and may be able to write an evidence based practice papers to be published
on the successful progress of the program and thus secure additional grant funding.
Health Policy Proposal
A health policy proposal to combat childhood obesity would be to implement the above
mentioned secondary prevention program. Student success coaches would be assigned to
students who are at risk and/or who are progressing toward obesity. The student would feel like
there is someone there for them who cares and takes a vested interest in their health. It would
encourage the student to stay with the diet and exercise program even on the weekends when
they are not in school. The overall health impact would be amazing.
The policy proposal would state that students would have their BMI (body mass index)
measured monthly as part of a health screening by either health class instructor or school nurse
(or even one of the success coaches could fulfill this function). Any student who is moving in to
the overweight to obesity area of the BMI index or has a risk factor for obesity would be

EB Community Childhood Obesity Interventions

matched to a student success coach. Each success coach could take on several students. The
success coach would be responsible to help the student put together an action plan with a
personalized diet that would take the familys financial status as well as personal tastes into
consideration, an exercise schedule which would offer additional exercise during the school day
as well as set a prescribed schedule while at home and on weekends and take into account the
familys living situation, environmental factors, and time availability, and during the school
exercise the personal coach will also function as a personal trainer to motivate the student.
The goal of the policy would be to reduce the incidence of those students reaching
obesity on the BMI index and getting them to and maintaining them in the normal range. This
would create life-long health habits so they have the needed skills and knowledge (including
knowing it is attainable) so they will not progress into adulthood obesity and all the negative
health consequences that go with those.
. The stakeholders to whom the interventions are geared are the students, parents, and
members of the school district. The school board and possibly legislators would also be
stakeholders due to having to change standards/requirements and additional costs which would
need to be built into the school districts funding.
Supporters of the policy would be students and parents (who can influence others
decisions to support this such as school board members and legislatures by attending their
meetings, writing letters, and voting for those who support it). Other supporters would be certain
school board members (who has the influence to implement it), certain legislators (who have the
power to fund and pass a law requiring it), health care providers who care (they can offer their

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expert opinions to help influence others), and certain foundations who may be able to provide
some source of funding in the way of grants.
Opposing forces may be parents (who dont either care or dont want someone telling
them what to do), students (who may not want to participate due to various reasons), school
board members (who may not want to have the extra work or are afraid it would take resources
away from other areas), legislators (who may not want to add more legislation due to party
lines or other factors).
The game plan to get the policy into action would be to meet with school board officials
first in order to go over the pros and cons, to see what would need to be overcome, and they may
also have someone who would be willing to help author it. A competent legislator would be
needed to help author it and present it as a bill in congress.
The health policy proposed will greatly reduce the amount of childhood obesity in
Hillsborough County. The strain on healthcare will come down in time. Population health in
general will improve due to the amount of chronic disease as the generation of students age
increase will be lower. Productivity will increase. The underserved population of people living
in poverty who are at greater risk of obesity will have lower health care costs and lower
incidence of disease along with an improved quality of life.
Conclusion
Childhood obesity has had an increase in prevalence during the past few decades.
Hillsborough County, Florida has a problem with childhood obesity for numerous reasons.
However there are things that can be done. There are safeguards that can be put into place to
lower this rate and reverse the prevalence of it. If the above mentioned primary, secondary, and

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tertiary interventions are adopted and implemented, there will reduction of incidence of
childhood obesity. The population as a whole will benefit.

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References

Centers for Disease Control (2015). The Steps to a Healthier Hillsborough County. Retrieved
from
http://www.cdc.gov/steps/steps_communities/cities_communities/hillsborough_county_fl
.htm on April 10, 2015.
Currie, J. , Vigna, D. , Moretti , E., Pathania, V., (2010). The Effect of Fast Food Restaurants on
Obesity and Weight Gain. American Economic Journal: Economic Policy, American
Economic Association, vol. 2(3), pages 32-63.
Danner, FW. (2008). A national longitudinal study of the association between hours of TV
viewing and the trajectory of BMI growth among US children. Journal of Pediatric
Psychology, 33, 1100-7.
Dansinger, M.L., Tatsioni, A., Wong, J.B., Chung, M., Balk, E.M. (2007). Meta-analysis: the
effect of dietary counseling for weight loss. Annual of Internal Medicine. 147 (1), 41-50.
Florida Department of Health (2012). Chronic disease. Retrieved from
http://www.floridacharts.com/charts/ChronicDiseases/ on March 23, 2015.
Healthy Kids Healthy Future (2015). 5 Healthy Goals. Retrieved from
https://healthykidshealthyfuture.org/5-healthy-goals/ on April 10, 2015.
Hillsborough Community Atlas. (2011). USF. Retrieved from
http://www.hillsborough.communityatlas.usf.edu/demographics/default.asp?ID=12057 on
April 10, 2015.

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Institute of Medicine (2004). Childhood Obesity in the United States: Facts and Figures.
Retrieved from http://www.iom.edu/~/media/Files/Report%20Files/2004/PreventingChildhood-Obesity-Health-in-the-Balance/FINALfactsandfigures2.pdf on April 10, 2015.
Koplan, J.P., Liverman, C.T., Kraak, V.A. (2005). Preventing childhood obesity: health in the
balance. National Academies Press. Retrieved from
http://www.iom.edu/Reports/2004/Preventing-Childhood-Obesity-Health-in-theBalance.aspx on April 10, 2015.
Medical Home Portal (2015). Screening and Prevention of Childhood Obesity in the Medical
Home. Retrieved from http://www.medicalhomeportal.org/clinical-practice/screeningand-prevention/childhood-obesity on April 10, 2015.
Zenzen, W., & Kridli, S. (2009). Integrative review of school-based childhood obesity prevention
programs. Journal of Pediatric Healthcare, 23(4), 242-258.