It’s been in the news and at the forefront of public health policy debates—childhood obesity has tripled in the past 30 years and now represents one of the leading public health threats for our nation. (1) According to the National Center for Health Statistics, more than one-third of children and adolescents are overweight or obese. (2) These numbers are alarming because obesity is associated with a number of significant health consequences, including heart disease, type 2 diabetes and some cancers, as well as psychosocial and emotional consequences. Until recently, many of these chronic conditions were seen primarily in adults; however, an increasing number of overweight and obese children are beginning to show signs of these conditions. (3)(4)

The need to decrease the prevalence of childhood obesity has garnered the attention of state and federal public health agencies, policymakers and health practitioners. First Lady Michelle Obama has made the issue one of her top priorities, establishing the national Let’s Move! campaign to encourage healthy eating and physical activity within homes, schools and communities. A number of programs and initiatives have emerged that target the behaviors of children, families and child care professionals and aim to improve eating habits and increase physical activity as a means of preventing childhood obesity.

The need to change the behaviors of individuals and families is a critical component of the effort to reduce childhood obesity; however, it is not the only one. Interventions that target communities and the environments in which children spend their days are becoming increasingly important. Individually focused interventions may have limited effectiveness if they are conducted in communities with poor access to healthy foods, unsafe roadways, no sidewalks and a lack of public parks and other recreation areas.

Interventions designed to improve community environments to make them more conducive to healthy living have received long-standing funding and support from the Centers for Disease Control and Prevention. The most recent iteration of these grants is the community transformation grant program, which is designed to support community-level efforts to reduce chronic diseases such as heart disease, cancer, stroke and diabetes. The CTG program is supported by the Affordable Care Act’s Prevention and Public Health Fund and is projected to run for five years, reaching 1 in 3 U.S. citizens. So far, $103 million has been awarded to 61 state and local government agencies, tribes and territories and nonprofit organizations to improve their community’s health and wellness using strategies that focus on tobacco-free living, active lifestyles, healthy eating and the prevention of high blood pressure and high cholesterol.

The promise of the CTG program as it relates to childhood obesity is in the development of a greater number of communities that encourage healthy eating, physical activity and the establishment of safe and healthy environments for children. Examples of specific community interventions being implemented through the CTG program include establishing and supporting local farmers markets and small grocery stores; improving roadways, paths and sidewalks to encourage people to walk and ride bicycles; and instituting standards for physical education and for food offered in schools. The pursuit of health equity among communities also presents an opportunity to create sustainable improvements in communities that face a disproportionate prevalence of chronic diseases and their associated risk factors.

In addition to the state and community implementation grants, seven CTG awards were made to national networks to engage community partners and help disseminate CTG work across the country, particularly in rural and other underserved areas. Altarum Institute’s Center for Healthy Child and Youth Development and Policy, Planning and Evaluation Practice Area are currently working with one of these grantees, the YMCA of the USA, to develop a plan for evaluating their CTG project. Y-USA has been funded to implement strategies related to active living and healthy eating, clinical and other preventive services, social and emotional wellness and healthy and safe physical environments, with a focus on serving African-American and Hispanic/Latino populations nationwide.

Y-USA’s two core strategies include enhancing local efforts to achieve jurisdiction-wide health impact through improved healthy eating and physical activity standards in early childhood and afterschool settings and coordinating prevention efforts and systems between clinical settings, health care providers and community-based organizations. The latter strategy will build on the Y’s diabetes prevention program. This program was translated from the National Institutes of Health’s Diabetes Prevention Program, which has been replicated in a number of communities nationwide since a 2002 study showed that it decreased the development of type 2 diabetes by 58 percent over a 3-year period.(5) Using the diabetes prevention program and past history of community-based chronic disease prevention efforts as criteria for site selection, Y-USA will fund local YMCAs to develop and implement community strategies for addressing childhood obesity and related community health issues. Specific activities will include conducting comprehensive community assessments, recruiting and sustaining community member leadership teams and developing and implementing community action plans.

The CTG program has great potential to create healthy communities and improve health equity, but it will not be easy. Each grantee, including Y-USA, must define its own vision for community transformation and which strategies will be most effective in achieving this vision. In addition, the focus on health equity will require grantees to define this concept for their communities, select measures or markers for health equity success and ensure that program activities are conducted in accordance with health equity goals.

For Y-USA, implementing early childhood and afterschool standards and the diabetes prevention program in underserved areas and developing partnerships to accomplish this is only the beginning of community-level intervention. Health equity-related objectives also include training minority diabetes prevention program graduates to be program coaches, providing diabetes prevention program participants with opportunities for community leadership and building new partnerships with minority-led organizations to help empower community members and improve community environments.

Other challenges will include maintaining momentum in previously funded local Y communities while new cohorts of YMCAs are added to the program each year, as well as sustaining CTG improvements after the funding period has ended. An important lesson from previous CDC community health promotion grants is that key improvements in health outcomes, community education and especially job creation can be difficult to sustain once grant funding has ended. CTG grantees such as Y-USA are aiming to create sustainable change that will be owned by the community and continue beyond the life of the grant program.

In the coming months, Altarum will be working alongside Y-USA in its efforts to develop and implement community-level strategies to increase healthy eating and physical activity among children and to empower underserved communities and their members to improve their environments. Our journey as Y-USA’s CTG evaluation partner, including achievements as well as challenges and how we address them, will be chronicled in future Health Policy Forum postings.

References

1. Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007–2008. Journal of the American Medical Association, 303(3), 242–249.
2. National Center for Health Statistics. (2011). Health, United States, 2010: With special features on death and dying. Hyattsville, MD: U.S. Department of Health and Human Services.
3. Freedman, D. S., Zuguo, M., Srinivasan, S. R., Berenson, G. S., & Dietz, W. H. (2007). Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics, 150(1), 12–17.
4. L,i C., Ford, E. S., Zhao, G., & Mokdad, A. (2009). H. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among US adolescents: NHANES 2005–2006. Diabetes Care, 32, 342–347.
5. Knowler, W.C., Barrett-Conner,  E., Fowler, S. E., Hamman, R. F, Lachin, J. M, Walker,  E. A., & Nathan, D, M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. T

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All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.