EAT WELL, PLAY HARD, LIVE LONG

Final Program Plan: Eat Well, Play Hard, Live Long Stephanie Mulac Liberty University Online: HLTH 634 8/18/13

EAT WELL, PLAY HARD, LIVE LONG Obesity has become a major health concern in recent years and is beginning to

threaten the lives of many Americans. The Centers for Disease Control (CDC) estimates that 17% of children and adolescents aged 2-19 years of age are obese.1 Additionally, since 1980 the obesity prevalence among children and adolescents has nearly tripled.1 There are a variety of reasons that may explain this worsening trend such as lack of regular exercise and poor dietary habits. Many Americans have adopted a more sedentary lifestyle not only leading to an increased prevalence of obesity, but also an increased prevalence of many other chronic conditions as well. The development of obesity at a young age sets a child up for a future of health problems, which is why it is extremely important to develop an intervention geared toward the identification and prevention of obesity at an early age. The purpose of the "Eat Well, Play Hard, Live Long" program is to educate young children and adolescents with the hopes that they will gain the knowledge and information needed to live a healthy, well-rounded life. The goal of this intervention is to work in cooperation with the Healthy Eating and Active Living program established by the Virginia Department of Health to establish a set curriculum in which teachers and other school staff members can actively implement. The Healthy Eating and Active Living program attempts to promote healthy eating and active living, fosters evidence based strategies, systems and environmental changes which support health, compiles and disseminates evidence based interventions which support health, and develops partnerships and community lead initiatives throughout Virginia.2 Within the established curriculum, students will gain valuable information related to diet and exercise habits similar to the Healthy Eating and Active Living program; however, this particular

EAT WELL, PLAY HARD, LIVE LONG intervention will focus on a younger population. These guidelines will be drawn from recommendations set by the United States Department of Agriculture and the American College of Sports Medicine. The intended intervention will specifically benefit all school-aged children in the state of Virginia ranging from 2-19 years of age. This intervention will establish a

comprehensive curriculum in which teachers and other school staff members can actively implement. School staff members will not only lecture about proper health habits, but they will also distribute informational flyers for the children and their parents. The shortterm goal of this intervention program is to provide young children and adolescents with the tools and education needed to make healthy decisions to support the long-term goal of obesity prevention and the prevention of other obesity related conditions. To accomplish the short-term goal, children will demonstrate the ability to acknowledge and verbally identify the main food groups along with the amount of regular exercise that is recommended by the American College of Sports Medicine. As a result of the program approximately 80% of children will possess a BMI percentile that lies between the 5th and 85th percentile for his or her age. Furthermore, the prevalence of childhood and adolescent obesity will decrease from 16.1% to 14.5% by the year 2020 nationwide as a result of nationwide efforts. In order to assess progress, data will be compared to the Body Mass Index scale of measurement primarily because this scale is the most common scale used to assess overall body mass based on height and weight ratios. Lack of parental support may significantly hinder the implementation process. Specifically, parental involvement plays a huge role in the effectiveness and the overall success of the intervention and poor parental support may halt progress that has been made in the school

EAT WELL, PLAY HARD, LIVE LONG environment. Upon the completion of the intervention, children will develop a greater understanding of the proper diet and exercise habits and the benefits of developing good lifestyle habits; therefore, leading a longer and healthier life. The primary target audience of this proposed intervention is all school-aged individuals aged 2-19 years living in inner cities within the state of Virginia. These

individuals may vary based on gender or ethnicity, but the main goal is to reach all young school aged individuals living in inner cities and address proper diet and physical activity habits within the school setting. A child does not have the ability to choose his or her family, which is why a school intervention may be helpful in establishing healthy habits that may not be addressed in the home setting. The main goal of the intended program is to provide young students with the proper education and tools so that they can ultimately make healthier diet choices and become more physically active. The program will focus on diet and exercise education and teaching students how engaging in good health habits will keep them healthy later in life. It is important to emphasize how decisions made now will affect each one of them later in life. Activities will include mandatory monthly assemblies along with an individual dietary analysis. Each child will be required to complete a weeklong food log/diary and then a dietician will analyze and discuss the diet log with each individual child. In order to help children become healthier, the program will focus on health education through the implementation of educational seminars and classroom activities. The Eat Well, Play Hard, Live Long program will be primarily promoted in the school setting. This will be done by conducting regular monthly assemblies, by addressing a random health fact of the day on the morning announcements, by handing out informational flyers for children to take home to their

EAT WELL, PLAY HARD, LIVE LONG parents, by enforcing mandatory recess time each day, and by posting informational flyers around the school The intended secondary audience includes all parents or primary caregivers of young school-aged children. Parents play an extremely important role in the effectiveness of the program and the ability to develop a healthy home environment for

young children. Children will be provided with informational brochures that can be taken home and given to parents, which would not only educate parents, but also give parents the ability to become involved in this health movement. Additionally, parents will be given the opportunity to volunteer at and attend the monthly assemblies so that they can further enhance their own health knowledge. The basis of this proposed intervention will focus primarily on the PRECEDEPROCEDE Model. This model would be beneficial to the program because it begins by assessing the need for change and then works backward to identify the source of the issue. Once a need for change is identified, the process then implements an intervention geared toward treating or preventing the issue of concern, and then proceeds to carry out the intervention ultimately evaluating the effectiveness of the intervention program. It is safe to say that based on existing data, there is a clear need for an obesity intervention in order to not only prevent the trend from worsening, but to also help children make healthier decisions. This model would be a good basis for this program because it would allow healthcare professionals to recognize the barriers to success early on and modify the program to overcome these barriers and achieve the ultimate goal of obesity prevention.

EAT WELL, PLAY HARD, LIVE LONG

It is projected that the intervention program will last approximately two years and will consist of two phases. Each child will gain the ability to meet one on one with a healthcare professional and dietician to review specific dietary habits. Additionally, each child will have access to a school counselor or psychologist if they feel that they need additional support for any reason. The success of the program requires the cooperation of students, teachers and other school staff members, public health professionals, dieticians, parents, government officials, and the rest of the community. It is important that a sense of cohesiveness is developed among these different entities because consistency is the best way to modify the mindset and behavior of young children and adolescents. Teachers and other school staff members will be in charge of carrying out the implementation process, public health professionals will be in charge of assessing, developing, implementing, and evaluating the program, parents will be in charge of carrying out and implementing good health choices in the home environment, and government officials will be in charge of analyzing and funding the promotional program. The total cost of the program will be roughly five million dollars and the total duration of the program will last two years. It is projected that the program will utilize roughly three million during the first year and two million the following year. The first year is considered to be phase one of the program and will account for the implementation cost, whereas the second phase of the program will focus on maintaining the current program. The majority of the budget will focus on marketing and advertising, followed by the cost of training. Getting the message out to the public is the most important part of the program because it exposes the target population to valuable health

EAT WELL, PLAY HARD, LIVE LONG information. The hope is that exposure will motivate individuals to make necessary life

changes. Training also plays an extremely important role in the success of the program. It is important to provide students with access to qualified healthcare professionals so that they can gain a better understanding of good health and risk factors related to obesity prevention. Additionally, it is important to make sure all information dispersed is consistent and that all teachers and staff members are provided with the same training. Specifically, advertising and marketing costs will account for roughly thirty percent of the total budget or 1.5 million dollars. The cost of supplies and research will both likely account for ten percent of the total budget each or 500,000 dollars. Supplies needed for this intervention may include items such as computers, paper, printers, scales, tape measuring tools, calculators, notebooks, and much more. Salary compensation for participating healthcare professionals will account for fifteen percent of the total budget or 750,000 dollars, along with the cost of space. The benefits of the program clearly outweigh the cost of the program long-term. By adopting a healthier lifestyle it is likely that people will spend less money on healthcare expenses long-term. When evaluating the effectiveness of the program, initial BMI measurements will be taken, followed by a five year follow up. As with any program, there are some limitations that may hinder the effectiveness of the overall program. To ensure program effectiveness it is important to have sufficient funds and staff necessary to carry out the program. The program will ultimately be ineffective if school staff members do not enforce good diet and exercise. Another thing that may hinder progress from being made is if parents do not enforce good health habits at home. Those children who pack their lunches are subjected to whatever their parents pack for them, meaning that little to no

EAT WELL, PLAY HARD, LIVE LONG progress may be made in some cases; however, the goal is that the majority of children and adolescents will become knowledgeable enough to know the difference between healthy and unhealthy lifestyle choices and are able to take full responsibility for their choices. Another limitation may be that some school staff members make poor decisions; therefore, they may lack passion to educate young students on the benefits of good health habits. Health communication program evaluation is an extremely important part of the health program intervention. An outcome evaluation is important because it shows how

well the program was able to meet its intended objective.3 If the objective is not met, one should go back through the process and identify which aspect of the process was responsible for this discrepancy and fix it. Learning whether or not the program has met its communication objectives is necessary for justifying the program to management, providing evidence of success or the need for more resources, increasing organizational understanding and support for health communication, and encouraging ongoing ventures with other organizations.3 The data collected will consists of Body Mass Index (BMI) scores of each school aged individual, which will be collected by taking each individuals height in meters and weight in kilograms. The data will be collected during P.E. class by a designated healthcare professional using both a scale and tape measure. Once the data is collected, BMI will be calculated for each individual by dividing the persons weight by his or her height in meters squared. The results will be placed in the computer and the computer will then generate a graph based on the individuals BMI, the national average, the healthy level for BMI, and the BMI of the particular school itself. The school data will then be relayed to officials at the state level and will be evaluated based on national

EAT WELL, PLAY HARD, LIVE LONG standards. Once the initial data has been acquired, teachers and other school staff

members will implement mandatory educational assemblies designed to educate students on proper diet and exercise habits. Additionally, school cafeterias will refrain from serving foods high in sugar and fat, with the hopes of providing a healthier environment for students. When evaluating the effectiveness of the program, initial BMI measurements will be taken, followed by a two year follow up. At the two-year mark, approximately 80% of children will possess a BMI percentile that lies between the 5th and 85th percentile for his or her age. A formative evaluation of the program will be done to ensure that the implementation of the program is optimized for success. This will be done by comparing implementation strategies to other similar programs and will also include an evaluation of whether or not the implementation process was able to accomplish the overall goal within the specific timeframe and budget. A process evaluation of the program will be done to determine whether or not the intended program successfully received the attention of all school-aged children and their parents, as well as whether or not the children were able to gain and retain valuable health knowledge about obesity prevention. This proposed program has been developed with the high hopes of changing the future for the better. Statistics have proven that the obesity trends show no signs of slowing down in the near future and it is evident that change is necessary to prevent the inevitable. Children are indeed our future and in order to break this cycle, children must be targeted. Targeting children will not only better the health of children, but will also hopefully decrease the money spent on nationwide healthcare costs. A change such as this will take a lot of time, but it is certainly attainable. A nationwide effort needs to be

EAT WELL, PLAY HARD, LIVE LONG made by all supporting parties in order to ensure the success of similar health related programs.

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EAT WELL, PLAY HARD, LIVE LONG Resources

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1. Centers for Disease Control and Prevention. Overweight and Obesity. Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/data/childhood.html. Accessed August 12, 2013. 2. Virginia Department of Health. Healthy Eating and Active Living Program. Virginia Department of Health. http://www.vdh.state.va.us/ofhs/Prevention/heal/about.htm. Accessed August 12, 2013. 3. National Institutes of Health. Pink Book- Making Health Communication Programs Work. National Cancer Institute. http://www.cancer.gov/cancertopics/cancerlibrary/pinkbook/page8. Accessed August 13, 2013.