Reducing Childhood Obesity: OMG’s Contribution to Advancing Effective Practice

We started out by following children to the garden they and their parents and teachers built to collect the vegetable of the month, carrots. Once back in their classroom holding bunches of carrots covered in dirt, the young gardeners sat on the floor around their teacher and proceeded to learn all there is to know about the vegetable: where it originated in the world, what part of the plant it comes from, what nutrients it contains, how these nutrients help the body, and what are some good ways to eat it. When the lesson concluded, the school’s chef worked with the children to make a sweet dessert using grated carrots. The joy of learning by doing was evident from the smiling faces, sticky hands, and loud exclamations of approval when the dish was finished and tasted. When we were done, there was no doubt even in our skeptical evaluators’ minds of the impact of this simple but powerful intervention.

Background
As part of its commitment to halt the epidemic of childhood obesity, the Robert Wood Johnson Foundation has been supporting interventions that

• Improve children’s environments to increase physical activity
• Improve access to and appeal of less-calorie dense foods

Projects envisioned for this grant-making strategy were safe parks and walkable neighborhoods, daily physical education in schools, farmers markets to provide fresh fruits and vegetables to families in low income neighborhoods, and revised school lunch and breakfast menus offering more fresh, locally-grown foods.

In early 2006, OMG was contracted by the Foundation to widen the evidence base for these types of environmental interventions, which in its early stages of development is very limited. We conducted assessments of eight 18-month small project grants to organizations in Greenville, NC, Cincinnati, OH, New York City, Hartford, CT, Little Rock, AR, Portland, OR, Seattle, WA, and Chicago, IL. These grantees had extensive experience in building safer communities for children through behavioral, environmental, and policy interventions, and were using a combination of these approaches to tackle the problem of childhood obesity in their communities.

The main goal of the assessment was to gather preliminary data that would inform the Foundation of promising approaches that would warrant more formal summative evaluation at more advanced stages of development. OMG was also asked to assess the grantees’ capacity to support these more rigorous summative evaluations if their practices looked promising.

What we learned
OMG’s assessment identified six promising program strategies across the eight grantees. The criteria we used to make these determinations are:

1) potential for impact, based on logic of the design
2) potential for impact, based on program intensity and duration
3) innovativeness of approach(es)
4) ability to reach the target population
5) acceptability to stakeholders
6) feasibility of implementation
7) potential for replication and
8) sustainability

While none of the eight programs in its entirety could be considered a promising model for replication at the time of our assessment, we found the following program elements worthy of attention and further exploration for their obesity prevention potential.

Peer mentoring
The project in Cincinnati used a peer mentoring program to educate young children in an after-school program about healthy eating, nutrition, and physical activity. The peer mentors were from a magnet high school focused on health careers. This strategy showed a high potential for replication in other school settings because older students are always available and can easily connect with younger children. Additionally, the mentors themselves learn from the curriculum they are teaching to the children and report seeing the personal benefits of a healthier lifestyle.

Childcare menu changes and parent cooking classes
The Chicago grantee hired a registered dietician to train Head Start center cooking staff on better nutrition and healthier cooking methods. Parent engagement was further facilitated by evening cooking classes offered at the center. The training of the cooking staff in conjunction with the parent nutrition education and cooking classes could be a model to be replicated nationally in Head Start centers and childcare centers. Because the program targets a very young audience and reaches their parents, this intervention has high potential to change behavior in the long run.

“Plant of the week/harvest of the month” program
In Portland, the Garden of Wonders program engages the children in healthy eating through gardening on the school’s premises, incorporating the food that is grown into the school breakfast and lunch and a classroom curriculum designed to increase knowledge of seasonal fruits and vegetables. The program is promising as a best practice because it is well received by students, teachers, and parents. Although not all schools can have a garden on their premises, the idea of teaching children about locally grown seasonal foods, along with an opportunity to taste them, makes this a perfect combination of didactic and experiential approaches, strengthening its potential impact on behavior.

Walking programs
A walking program, either to school or in school, is a primary focus in at least three sites (Little Rock, Seattle, and Portland) and some element of walking is included in others. Some grantees have integrated walking programs into other curricular courses, such as math and geography by having students count the number of steps it would take to go from their neighborhood to the nearest farmer’s market and plotting the route on a map, for instance. These types of programs show promise in part because they are well received and people at all levels of fitness can participate: often they are activities children and their parents can do together. With adults as role models, walking programs show great potential for significant impact on children’s and adults’ long-term behavior.

Increasing physical activity in classrooms
The New York and Little Rock grantees developed exercise breaks in the classroom to incorporate more physical activity into the school day in the face of time and space limitations. In New York, “transition exercises,” vary in intensity, from stretching and yoga to jumping/shaking. The Little Rock program staff developed materials to provide teachers with ready ideas for short, fun activities that get children moving. The practice shows promise because it does not require setting aside dedicated periods to engage in physical activity since it is included in the class time. Also, teachers report benefits in terms of students’ attention and concentration during class after the brief period of physical activity.

Farmers’ markets
A few sites are operating or are considering the development of farmers’ markets. This strategy has gained increased attention an approach that provides easy access to healthier foods while benefiting local farmers. Farmers’ markets hold promise for several reasons. It increases access to fresh fruits and vegetables at affordable prices in low income urban settings, For rural areas, the produce is easily available from local providers that operate close to small communities. By eliminating middlemen, the cost of fruits and vegetables is lowered and both families and growers benefit. Markets also offer choices for families, especially if the items available cater to their cultural food preferences. Because of their visibility on school grounds, well-run farmers’ markets become a community resource. Finally, the opportunity to impact the entire family’s food consumption is a very attractive feature of this promising practice.

In terms of the second goal of the assessment, to inform the Foundation about the capacity of grantees to support more rigorous evaluation of their promising practices, OMG found that although all grantees had a solid foundation based on their academic research experience, their ability to transfer these research approaches to evaluate the impact of a program operating under the constraints of the “real world” was tested by the pilot grants. Most grantees faced challenges related to instrument development and data collection from an often unreliable pool of child informants. Unclear expectations from the funder about the pilots’ evaluations and a long list of unrealistic outcomes, combined with limited funding and limited time to produce measurable results further compromised the grantees’ capacity to develop solid designs and methodologies.

The Robert Wood Johnson Foundation recently announced its plans to allocate $500 million dollars over five years to help children increase physical activity and to eat healthier foods. In the fertile learning environment that will accompany this investment, pilots such as these will provide vital information to help identify promising practices worth funding and to strengthen provider capacity to demonstrate clear links between their programs and the reduction of childhood obesity.