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We're Better Together



The Inside Track profiled Leader Karla Lester and her organization, Teach a Kid to Fish, in April. At the time, Lester was in the midst of developing an integrated model between health care providers and schools to figure out the best way to help prevent and reduce childhood obesity, a project funded by the American Academy of Pediatrics.

In the special guest article below, Lester shares her motivation for the project and what she’s learned so far — and even offers up a few tips for those looking to do the same in their own community.

Back in 2007, a group of medical experts unveiled their recommendations for preventing and treating childhood obesity. I was working as a pediatrician, and the report served as a call to action.  

The “Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity” were unveiled at a time when I found myself diagnosing more of my patients with things such as type 2 diabetes, high cholesterol, hypertension, depression and a whole host of serious conditions. Meanwhile, there was an obvious gap in community programs and services in my hometown community of Lincoln, Neb., to address childhood obesity.

I knew I had to do something about it. I mobilized to start Teach a Kid to Fish, a nonprofit organization with a mission to prevent and reduce obesity by empowering children and families to eat healthy and be active. We envision creating community solutions for children’s health.

After starting Teach a Kid to Fish, I received calls from school nurses, parents, grandparents and healthcare providers asking where they could take their obese and overweight children for help. One child in particular has always stuck with me, an obese first grader who was not able to walk down four steps without turning blue.  

From that experience, I knew there was a gap in intervention programs and services for overweight and obese children. We often focus on prevention when addressing childhood obesity, but rarely do we work to help the children of our community who are already suffering from the epidemic. 

Flash forward to January 2011, when I was awarded a “Community Approach to Child Health” planning grant from the American Academy of Pediatrics. (The acronym is “CATCH” —  pretty ideal for an organization called Teach a Kid to Fish, eh?)

The grant tasked me and my research team with developing an integrated intervention model to tackle childhood obesity in our community. Our goal was to bring schools, healthcare providers, parents, organizations and the community together to develop a model to help overweight and obese children. 

We focused our research in Lincoln Public Schools, where overall obesity and overweight rates for kindergarten to eighth grade is about 31.5 percent. We gathered information through a number of key areas, including focus groups with families from our community’s cultural centers, low-income schools and school nurses. We also gathered data through surveys from parents, physicians and school nurses.

We asked parents about the barriers they encounter when trying to provide healthy meals and physical activity for their children; whether their child’s physician was talking to them about things such as body mass index percentage and healthy behaviors; whether doctors offered community resources; and who in the community they would be willing to discuss their child’s weight status with, including at their child’s school.

What we found is that a number of barriers exist for parents. The biggest perhaps is cost, as many told us it can be expensive to buy healthy food. 

But there are other obstacles. Many people in our community are new to the country and encounter language barriers. Others find some physicians don’t accept Medicaid. Parents also said physicians weren’t discussing BMI or healthy behaviors with them.

The good news is parents want to discuss their child’s weight with their doctor. They also are OK with information coming from schools as long as it is from the school nurse, is done in a confidential manner and comes with resources and referral information.  

After we gathered our findings, we held community meetings with key stakeholders and  mapped out nutrition, physical activity, and medical access in the community, so we knew what we had to work with. Working with potential funding partners and others, we developed goals designed to help those children in the community suffering from obesity. 

Goals included BMI screenings for all students; blood pressure and diabetes screenings for at-risk students; development of a health report card for schools to give to parents; training parents to be health liaisons in the community; creating a community directory of health resources; developing curriculum programs specifically for obese children and their families; and instituting training programs for physicians.

Of course, developing goals is only one part of the process. Actually implementing them in the community is a whole other ballgame. We learned a few lessons along the way that might help others looking to tackle obesity in their own community:
  • Planning is crucial; we took about six months. Taking time to mobilize partner groups, write grant proposals and crafting some sort of actual roadmap for implementing the project is key. Always keep your eyes on the project’s implementation and be action-oriented. 
  • Developing partnerships is critical for implementation and sustainability of the project. Local health departments, schools and potential funders are all potential partners. Be a good listener. When you are mobilizing a community around an issue like childhood obesity, it’s crucial to listen to what others have to say.
  • After the planning process, small pilot projects help with the implementation. Right now, we are starting with one school to implement and serve as a model in our community. 
  • Developing outcomes is imperative for sustainability and funding.  Finding the evidence-based model for what works in your community and for your project should be one of your primary goals.  
  • Creating infrastructure means you don’t have to go it alone and that your work will continue even if you are not involved. Again, be sure to work you’re your partner groups, especially with those who do the actual legwork.
Community models aren’t always easy to implement; it takes more than one program and one organization to get the work done. But it’s crucial to success. It will take the entire community to find a solution to the epidemic of childhood obesity.