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2009: Actions on Obesity

An update to: FACTS ABOUT GROWING UP HEALTHY IN FRANKLIN COUNTY: 2008 Collaborative Children’s Health Report
Table of Contents
Reaching Their Full Potential ................................1 OSU College of Education, Department of
Moving Forward ..................................................2 Human Nutrition, OSU Extension .....................15
The Launch of Full Potential .................................3 YMCA of Central Ohio .........................................16
Actions on Obesity: Community Update ..............4 Stambaugh Family Continues Weight Loss
Children’s Hunger Alliance ...................................5 Success .............................................................18
Columbus City Schools ........................................7 Nationwide Children’s Hospital ............................20
Danny Gwirtz Finds Self-confidence at Critical Funders ....................................................26
Healthier Weight ...............................................10 Ohio Business Roundtable: Advocating for
Columbus Public Health.......................................12 Children’s Health ..............................................27
Ohio Action for Healthy Kids ................................14 Recommendations for Addressing Pediatric
Obesity .............................................................28
Reaching Their Full Potential

n 2008, Nationwide Children’s Hospital was honored to
collaborate with 20 community partners to create Full
Potential: Facts About Growing Up Healthy in Franklin County, 2008
Collaborative Children’s Health Report. This inaugural report identified
10 critical indicators for our children’s health. Each issue was explored with insights from local experts and brought to life by
the stories of children and families affected. Pediatric obesity rose to the forefront in the report as the most significant obstacle
impeding the current and future ability of our children to reach their full potential.
The initial report clearly defined the need for interventions and the opportunity to partner. For 2009, we have again
collaborated with local resources to deliver this update report highlighting strategies within our community to reduce the
incidence of childhood obesity. Nationwide Children’s has actively joined this effort and we are excited to report on several
new initiatives. Most notable for us is the launch of our Healthy Neighborhoods, Healthy Families (HNHF) program.
Modeled after successful urban revitalization programs from across the country, HNHF presents a multi-pronged approach
to addressing barriers to health and well-being for the thousands of families surrounding our downtown campus. Combating
childhood obesity is a foundational element of our HNHF health platform, creating new partnerships with area neighborhood
associations, Columbus City Schools, Columbus Health Department and many others.
We are fortunate to have many community partners included in this report representing health care, education, social services,
government, business and foundations. All are reaching outside their own systems to work with other organizations to address
the obesity issue.
Collaboration is key, because, while obesity is a nationwide epidemic, its remedies will be discovered locally by organizations
working together to develop and test many new ideas. This is precisely what is happening in Franklin County now, as reflected
on these pages. During 2008, the organizations represented in this report were involved in a significant number of programs
that brought opportunities for making healthy changes to children and families in central Ohio.
In addition to the benefits these programs are creating in our community, they hold the potential to extend beyond the borders
of the state. A concerted effort is being made to report information and best practices nationwide, and what we do in Franklin
County may one day inform a national model for the prevention and treatment of childhood obesity.
Nationwide Children’s thanks our partners for their commitment and actions on obesity. Ours is a “can do” community,
supported by a wealth of institutional knowledge and expertise, as well as the capacity and desire to tap wide-ranging points
of view. Together, we can craft a better future for our children. Please read on to learn how Nationwide Children’s and our
community partners are working to combat childhood obesity.

Steve Allen, MD
Chief Executive Officer
Nationwide Children’s Hospital
Columbus, Ohio

Page 1
Moving Forward

olumbus remains committed to creating safe and healthy
environments for our residents, especially children, and so
we are proud to be part of Full Potential 2009: Actions on Obesity.

While central Ohio has among the nation’s highest levels of childhood
obesity, diabetes and heart disease, we also understand the benefits of
early childhood prevention and wellness initiatives as critical components in helping our children fight these diseases.
Several promising initiatives have been launched or further developed since the 2008 Full Potential report, each
depending on the involvement and support of community partners. Healthy Neighborhoods, Healthy Families is
an exciting partnership between the City of Columbus and Nationwide Children’s Hospital to focus on neighborhood
revitalization in Columbus’ South Side.
In addition, my office created the Institute for Active Living with Columbus Public Health. The Institute shares a common
vision with Nationwide Children’s and we will work together, sharing data, expertise and people, to move forward.
Columbus Public Health initiatives, including Healthy Children, Healthy Weights and Healthy Places, demonstrate
results-oriented work to reduce childhood obesity. We can also be proud that Columbus City Schools now has all-water
vending in its middle and high schools.
I want to thank all our community partners for continuing to focus on broad-based measures to address the obesity epidemic.

Michael B. Coleman
Columbus, Ohio

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The Launch of Full Potential
Nationwide Children’s Hospital’s Full Potential
pediatric obesity initiative was launched at a
community breakfast at the Columbus Convention
Center on May 1, 2008.
That morning, we also released the report Full
Potential: Facts About Growing Up Healthy in Franklin
County, 2008 Collaborative Children’s Health Report.
The report can be downloaded at
Hard copies may be requested online as well.
The report, developed in partnership with
Columbus Public Health and more than 20 other
community agencies, highlighted 10 indicators
presenting critical preventable health threats for
Franklin County children. A number of vital issues
affecting our community’s children were worthy
of focus. The following 10 threats, however, were
called out in the 2008 report as particularly pressing:
- Infant Mortality 2
- Immunization
- Asthma
- Teen Smoking
- Teen Pregnancy
- Unintentional Injuries
- Adolescent Suicide
- Adolescent Homicide
- Access to Health Care
- Obesity

1 | Full Potential: Facts About Growing Up Healthy in Franklin County,

2008 Collaborative Children’s Health Report
2 | Find out the facts about childhood obesity.
3 | Learn what leaders representing health care, business and
government have to say about the obesity issue’s implications 3
and solutions.

Page 3
Actions on Obesity: Community Update
Overview of Key Programs In the 2008 Full Potential report, we concluded the
discussion of pediatric obesity with a series of
During the past year, an exciting number and
recommendations* for families, schools, health
variety of significant programs and initiatives
and social service organizations, communities and
focused on pediatric obesity prevention or
society to effectively “tip the scales” in the
management have been taking place in
opposite direction on pediatric obesity.
Franklin County.
While the organizations included in this report
Overwhelmingly, our community recognizes
did not set out specifically to meet these
the magnitude of the obesity epidemic – it
recommendations, they have addressed many
challenges our children’s ability to reach their
of them through programs offered during the
current and future potential, and it threatens
past year. For each organization covered in
to overcome our health and human service
this report, we have called out the
organizations, employers and other institutions.
recommendations addressed by their
Together, we can prevent this from happening.
programs, resources or advocacy**.
The community response, as represented in this
For the full list of recommendations from the
report, demonstrates an encouraging resolve to
2008 Full Potential report, see page 28.
create effective evidence-based treatment and
prevention programs supported by committed
funding sources in an environment of continual * These recommendations were developed by physicians in the Nationwide Children’s
Hospital Center for Healthy Weight and Nutrition and incorporate several
advocacy on behalf of children. recommendations from Healthy & Fit: A Community Action Plan for Franklin
County Children & Families, a publication of the Osteopathic Heritage Foundations
and Children’s Hunger Alliance.

**Effort has been made to include many significant organizations and programs in
this report; however, it is not an exhaustive list of all the organizations and programs
addressing the issue of childhood obesity in Franklin County.

Surveying the
bounty of food at
the Columbus Public
Health farmer’s market.
Photo courtesy of Columbus
Public Health.

Page 4
• In 2008, 78 sites actively participated in the USDA
Children’s Hunger Alliance food program resulting in 1,993 children receiving
The mission of the Children’s Hunger nutritious food each month. CHA served 221,494
meals and snacks in 2008, bringing in an additional
Alliance (CHA) is to break the cycle of $455,000 in USDA dollars to central Ohio.
childhood hunger through education,
Adult Nutrition Education
leadership, advocacy and service. As part
In 2008, CHA reached 358 low-income adults in Franklin
of their vision that all children will be well County with Nutrition Education Classes. These classes
nourished, healthy and thrive, CHA provides use USDA curriculum to teach how to eat healthfully on a
and supports a variety of programs to help budget, how to utilize available food resources and how to
combat obesity. feed your family.

Early Care and Nutrition School Breakfast Program

The CARES (Children Are Ready for Education and Eating a nutritious school breakfast gives children the energy
Success) program is a literacy, school readiness, nutrition needed to do well in school. Studies show that kids who eat
and physical activity initiative for Ohio children. This breakfast are less likely to eat junk food. CHA works closely
program reaches almost 2,000 family child care providers with the Ohio Department of Education to help schools
in Ohio through the USDA’s Child and Adult Care access and implement School Breakfast Programs. The Food
Food Program. The effectiveness of the program was Research and Action Center – School Breakfast Report Card
demonstrated in a 2007 random survey of providers that indicates the following for central Ohio:
found 86 percent plan learning activities from a CARES kit • Columbus City Schools increased daily breakfast
at least once a month; 56 percent at least once per week. participation by 3,038.
Providers receive four CARES kits each year.
• Reynoldsburg City Schools increased daily breakfast
Afterschool Programs participation by 1,730.
CHA provides free, direct service nutrition education (Food
Folks curriculum) and physical activity (CATCH) curriculum • South-Western City Schools increased breakfast
programs to afterschool programs that serve low-income participation by 668.
children, ages 5 through 18. CHA also sponsors the USDA
• Hamilton Local School District increased breakfast
After School Meal Program to more than 70 afterschool
participation by 1,028.
programs in Franklin County to ensure low-income children
are receiving a hot meal during the afterschool hours.

• Of 2,009 children who participated in Food Folks, 81

percent completing the pre- and post-test improved
their nutrition knowledge.

• Of 1,844 children who participated in CATCH, 85

percent completing the pre- and post-test increased
their cardiovascular endurance.

The beginnings of an award-winning community garden.

Photo courtesy of Children’s Hunger Alliance.

Page 5
Childhood Obesity South Side Healthy Food Access and Nutrition
Interventions: Education Program
CHA has helped to facilitate and lead community partnership programs to
Recommendations improve access to healthy food in various Columbus neighborhoods, including
Addressed the South Side Healthy Food Access and Nutrition Education Program. This
program is a community-wide, multi-faceted initiative designed to increase
! Healthy lifestyle food access and promote healthy lifestyles and nutrition education among
behaviors start early. South Side residents.

! Increase opportunities Utilizing multiple strategies, CHA, serving as the fiscal agent, partners
for physical activity. with key community organizations to achieve three goals: (1) provide
comprehensive nutrition education targeting for food stamp eligible adults;
! Ensure all food and (2) increase access to high-quality nutritious food to low-income residents and
their families; and (3) enhance leadership and increase community awareness
drink choices are
of healthy lifestyles and resources within the South Side Community.
Impact from this collaborative resulted in:
! Advocate and provide • Quality nutrition education for South Side adults and seniors.
learning opportunities.
• Establishment of a weekly farmers market that was one of the first in
! Neighborhood Columbus to accept EBT food stamps and which served roughly 100
families per week in its first year.
groups are credible
advocates. • Full conversion of four traditional food pantries to a choice model.

• Planting a school-based community garden recognized by Franklin Park

Conservatory with an Education Garden of the Year award.

This project also made tremendous strides in creating partnerships and

alliances on the South Side committed to addressing food access issues that
can be factors in the prevalence of overweight/obesity.

To learn more:

Page 6
Columbus City Schools Highlights of the committee work include:
BMI Assessments
Recognizing that students spend 25 to 30 As part of their routine annual student screenings,
percent of their day and get 35 to 50 percent district school nurses conduct Body Mass Index (BMI)
screenings on every kindergarten, third-, fifth-, seventh- and
of their daily calories while at school, and
ninth-grade student. Each child’s individual results are sent to
that students perform better when they are the parents explaining BMI and the hidden dangers of
healthy, through generous funding from the being overweight or obese. All children identified with a
Osteopathic Heritage Foundation, Columbus BMI in the 85th percentile or above are referred to their
primary care provider and additional community resources
City Schools (CCS) has developed and
in efforts to prevent, monitor and treat obesity related
implemented an effective and sustainable complications and encourage the adoption of healthier habits.
wellness initiative based on the Coordinated
School Health Model to create the healthiest BMI Assessment Results 2007 - 2008 School Year
school environment possible. Kindergarten
• Total number of students screened = 4,254
Components of the wellness initiative include the • A total of 32% of kindergarten students screened
following: had a BMI > 85% (BMI 95% (+) =16% and BMI
• A district-level School Health Advisory Council to 85-94% = 16%)
guide the work of the wellness initiative.
• A total of 1,396 kindergarten students were referred
• School Health Services Committee that serves to to their primary care for assessment and treatment
promote and enhance a healthy and safe school related to increased BMI
learning environment.
Third Grade
• Physical Activity and Physical Education Committee • Total number of students screened = 4,287
that serves to educate and encourage CCS students
to develop lifelong healthy physical activity • A total of 42% of third-grade students screened
behaviors. had a BMI > 85% (BMI 95% (+) = 25% and BMI
85-94% = 17%)
• Nutrition Committee that serves to increase the
nutritional value of foods and beverages available to • A total of 1,775 third-grade students were referred
students during the school day and educate students to their primary care for assessment and treatment
on how to make healthy food choices. related to increased BMI

• Staff Wellness Committee that serves to create a Fifth Grade

culture that values and supports the development • Total number of students screened = 4,027
of lifelong health and fitness habits among CCS
• A total of 44% of fifth-grade students screened
had a BMI > 85% (BMI 95% (+) = 26% and BMI
• Communications Committee that serves to create 85-94% = 18%)
a district-wide wellness movement through increased
• A total of 1,754 fifth-grade students were referred to
awareness and participation in the Wellness Initiative.
their primary care for assessment and treatment
related to increased BMI

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Acanthosis Nigricans Screenings
Acanthosis Nigricans is a skin marker for high levels of insulin in the blood that can help identify early
metabolic changes associated with increased weight. CCS and the Center for Healthy Weight and
Nutrition at Nationwide Children’s Hospital collaborate to conduct this screening. Assessments were
conducted during the 2007-2008 school year at three Columbus City School sites in grades 3, 5 and 7,
and follow-up services for identified students were offered by Nationwide Children’s.

Rates of Acanthosis Nigricans among 3rd, 5th and 7th Grade

Students in Target Zip Codes

90% 85.7%
70% 63.6% 65.2%

50% 42.4%
40% 31.8%
30% 3rd Grade
20% 5th Grade
7th Grade
Percentage of students Percentage of students
identified as AN+ that have identified as AN+ that have
a BMI > 85th percentile a BMI > 95th percentile
(70 of 177) (55 of 72)

Additional components of the Wellness Initiative implemented during 2008

(and continuing through the 2008-2009 school year) include:
• Water only vending in all student accessible vending machines.

• Improved nutritional standards in the Food Service Department: beverages, other than water,
are served in restricted serving sizes and include low fat milk and 100 percent juice only.

• Fresh fruit/vegetable bars at all secondary schools.

• Development of an enhanced health education curriculum.

• Building-level School Health Committees.

Page 8
Other obesity related community-based programs in which CCS was a Childhood Obesity
partner include: Interventions:
Happy Healthy Preschoolers (HHP) Recommendations
CCS district school nurses conducted pre-kindergarten (ages 3-5 years) BMI Addressed
screenings and referred parents of identified children to the HHP program.
Among the 275 pre-kindergarten students in target zip codes who received ! Measure and intervene.
a BMI assessment, 65, or 23.6 percent had a BMI in the 85th percentile or
above. See page 23 for a program description. ! Increase opportunities
Healthy Children, Healthy Weights for physical activity.
CCS implemented this program at eight Columbus City School
! Ensure all food and
pre-kindergarten sites, in collaboration with Columbus Public Health.
See page 12 for a program description. drink choices are
Fitness And Nutrition Club (F.A.N. Club)
Nationwide Children’s Hospital created this 90 minute physical activity and ! Advocate and provide
nutrition education afterschool program, targeting third through fifth grade
learning opportunities.
students. It was launched at one elementary school site. See page 20 for
program description and results. ! Healthy lifestyle
Children’s Hunger Alliance Partnership behaviors start early.
CCS also worked with Children’s Hunger Alliance to install and maintain a
large community garden at one elementary site and provide adult nutrition
classes at four Columbus City School sites. See page 5 for descriptions of
these programs.

Managing and Preventing of Diabetes and Weight Gain Project

CCS received funding for the Managing and Preventing Diabetes and Weight
Gain Project (MAP) administered by the National Association of School
Nurses, with funding by the Centers for Disease Control and National
Diabetes Education Program. This program provides a CCS school nurse
part-time to serve as the district’s MAP resource nurse to coordinate care for
over 180 diabetic students and provide education, training and resources for
school nurses, students and families.

To learn more:

New food service equipment supports fresh

fruit and vegetable bars. Photo courtesy of United
Way of Central Ohio.

Page 9
Danny Gwirtz Finds
Self-confidence at
Healthier Weight

anny Gwirtz was one of the
young people whose story
was featured in the inaugural
Full Potential report. He
shared how he began gaining
weight in second grade after his parents’ divorce
changed family eating habits, and explained how
this problem was compounded by unhealthy
school meals. Even the family physician failed
to help by perpetuating the myth that children
grow out of their “baby fat.”

Eventually Danny’s embarrassment from being

taunted and teased by classmates motivated him
to lose weight. His mom helped him enroll in
a weight program for children that taught him
about healthy eating and exercise.

Danny, now 15, has made significant progress in

his battle by eating healthier foods and exercising
frequently. “Better choices are the key. It’s the
simple things, like drinking more water, that
continue to make a difference,” he says.

Page 10
“Mentally, I feel good about myself.
No one makes fun of me anymore.”
– Danny Gwirtz

Improved opportunities at school are helping While Danny believes his school has made
Danny make better choices. His school now positive changes to help students deal with
offers more healthy food selections, such as obesity, he thinks more progress can be made
bottled water, more fruits and baked versus fried by providing even more healthy food options,
foods. Danny also has joined Bigger, Faster, nutrition classes and physical education activities.
Stronger, an afterschool exercise program for
He also stresses that eating well and staying
students. "I love the program because it keeps
active don’t end with the school day. At home,
me active and you have your friends for support
Danny’s family encourages his fit lifestyle by
and encouragement."
preparing healthy dinners and supporting his
Danny says he is always looking for new things efforts to stay active.
to keep him informed and fit. He is thinking
It takes constant work, but Danny has succeeded
about taking a new nutrition and exercise class
in making health and fitness part of his daily
being offered at his school. He also stays active
routine. And, his self-esteem has improved now
in school sports, playing football in the fall and
that he is maintaining a healthier weight.
soccer in the spring.
“Mentally, I feel good about myself. No one
makes fun of me anymore.”

Page 11
Columbus Public Health on centers in Columbus-area zip codes with the highest
prevalence of overweight/obesity. The program combines
Columbus Public Health (CPH) is a leader training of adult caregivers in early learning centers (child
in improving the health and safety of care centers and preschools), technical assistance to the
centers to improve nutrition and physical activity
Columbus by monitoring community health
practices at the center through menu development,
status, identifying and addressing public physical activity equipment and other resources, and
health threats, enforcing laws that protect social marketing to influence parents’ behaviors at home.
the public’s health, and providing services to In 2008, HCHW served 46 child care centers and
prevent and control disease. In keeping with preschools, training 500 adults and impacting over 2,800
this mission, CPH has created or supports a children. Results demonstrate increased knowledge and
variety of obesity-related initiatives, including self-efficacy on the part of center staff to make changes
that impact the food and physical activity environment
those listed below.
in which young children spend significant time. Through
Heart Health Network technical assistance visits, documented changes include:
The Heart Health Network (HHN) takes a population-
• Reduced frequency of serving juice and sugar
based approach to addressing the six main risk factors
sweetened beverages,
of heart disease in the settings of community, schools,
worksites and health care. HHN is funded by the Centers • More nutritious snack offerings, and
for Disease Control and Prevention and is administered
by the Ohio Department of Health. • Increase structured, teacher- or peer-led, physical
activity throughout the day.
In 2008:
• HHN worked with community partners to pilot a Happy Healthy Preschoolers
Veggie Mobile Market at four recreation centers, one CPH provided expert advice, materials and support to the
in each quadrant of the city, providing food stamp development of this program. See page 23 for program
access to fresh local produce. description.

• The Heart Health Worksite Wellness Network Healthy Places

(HHWWN) hosted three networking luncheons Healthy Places is a key component of the City’s focus on
and a full day conference. They provided local community design with active living in mind. Columbus
businesses with resources and information on Public Health’s Safe Places Program has created walking
employee wellness, including the “how-tos” of maps for 18 Columbus neighborhoods, eight of them in
starting a worksite wellness team. HHWWN 2008. The City of Columbus passed legislation on
currently serves 80 local businesses. Complete Streets, a partnership between the Mayor
Coleman Administration (Public Service, Development,
Healthy Children, Healthy Weights Utilities, and Technology) and the bicycle community.
Healthy Children, Healthy Weights (HCHW) is an The legislation supports the City’s plan to expand its
evidence-based obesity prevention program that focuses current network of 87 miles of bike trails, bike routes and
on improving the food and physical activity environments bike lanes by adding 31 miles of off-street trails and 58
of children ages 0 to 5 years in early learning centers and miles of on-street bike lanes and bike routes.
at home. Over the last year, the program focused efforts

Page 12
Farmer’s Markets Childhood Obesity
Three farmer’s markets, held at CPH at 240 Parsons Avenue, drew more Interventions:
than 11,000 residents who were able to purchase reasonably priced, fresh
local produce. The markets have the capability to accept Women, Infants
and Children (WIC) Farmer’s Market Vouchers, Senior Farmers Market Addressed
Vouchers, and, new in 2008, customers could use their food stamp dollars
to purchase fresh fruits and vegetables. ! Increase opportunities for
physical activity.
The Institute for Active Living
Mayor Coleman created The Institute for Active Living (IAL) within CPH ! Ensure all food and drink
in July 2008 to help Columbus residents build an active and healthier choices are healthy.
community. IAL works to lower the incidence of childhood obesity and
diabetes by developing strategies and initiatives and assisting community ! Advocate and provide
partners with their implementation. IAL was launched with Mayor
learning opportunities.
Coleman’s annual bicycle event, which raised awareness about the
importance of children maintaining a healthy weight and taking steps to ! Healthy lifestyle behaviors
prevent diabetes. A new initiative, City Green Bikes, was also launched to
start early.
enhance workplace wellness for city employees and to serve as an example
for other workplaces. Bicycles donated by the Police Impound Lot and tuned ! Implement a comprehensive
up by the Fleet Division, have been located at various city offices to allow
employees to bike from place to place around the city. In addition, IAL
community plan.
created a City Department Advisory Committee that meets monthly to look
! Support the recommendations
at ways in which all departments can operate using an “active living” lens.
of the Ohio Activity Plan.
To learn more: ! Employers must get in on the action.

1 2 3
1| Choosing healthy nutrition for mother and child. Photo courtesy of Columbus Public Health.
2| Cooking up a nutritious dish. Photo courtesy of United Way of Central Ohio.
3| Purchasing fresh fruits and vegetables with WIC vouchers. Photo courtesy of Columbus Public Health.
Page 13
Ohio Action for Healthy Kids
Ohio Action for Healthy Kids (AFHK) represents a consortium
of education and health professionals dedicated to improving
Childhood Obesity
the health and educational performance of Ohio’s children by
promoting healthy school environments that offer sound
nutrition and adequate opportunities for physical activity.
In central Ohio in 2008, the Zone 8-Ohio AFHK regional team
! Increase opportunities
provided conferences, workshops, mini grants, monthly newsletters
for physical activity.
and technical assistance to advance school wellness policies.
! Ensure all food and drink
2008 Healthy Schools, Healthy Kids Conference
choices are healthy. The Zone 8-Ohio AFHK annual conference reached more than 180 participants.
The conference is designed to help local schools strengthen wellness policies
! Advocate and provide and program activities that support nutrition and physical activity.
learning opportunities.
Mini-Grants to Local Schools
The Zone 8-Ohio AFHK team allocated funding to help local schools
implement nutrition and physical activity programs. Four schools initiated
wellness activities that included breakfast initiatives, nutrition education and
increasing physical activity opportunities.

Game-On Funding Recipients

Game-On is a National AFHK program that challenges youth and their
families to incorporate healthy nutrition and physical activity into their
daily lives. Several central Ohio schools were selected this year as
Game-On recipients.

Snackwise® Nutrition Rating System

On the recommendation of AFHK, several local schools have implemented
Nationwide Children’s Hospital’s Snackwise® online rating program to
provide healthier, nutrient rich snacks in vending and a la carte areas.

To learn more:
Setting up for the Fruit and Veggie Challenge.
Photo courtesy of Ohio Action for Healthy Kids. 614-341-7700 x216

Page 14
OSU College of Education, Department Childhood Obesity
of Human Nutrition, OSU Extension Recommendations
The mission of the OSU College of Education, Department of Addressed
Human Nutrition, OSU Extension at The Ohio State University
is to generate, disseminate, and apply knowledge in the areas of ! Measure and intervene.
human nutrition and dietetics to improve the quality of life for ! Increase opportunities
individuals, families and associated organizational systems. Faculty for physical activity.
and students are at the fore of research that will lead to evidence-
based solutions to pediatric obesity. ! Ensure all food and
drink choices are
Food Fit
Food Fit is a 14-week behavior change program that is designed to teach
children the skills needed to execute food behaviors associated with
prevention of childhood obesity (AMA Expert Committee Guidelines.
Pediatrics. 2008; 120: S164-S192). Two Food Fit studies were conducted in
2008, in a total of seven low-income sites with a total of 179 participants.

In the first study, 12 dietetic interns from the Department of Human Nutrition
delivered and evaluated Food Fit in six YMCA-sponsored afterschool
programs for children in grades 3 through 5. Statistically significant changes
in children’s nutrition skills and dietary behaviors were found. Results
regarding changes in BMI and changes in numbers of servings within major
food groups and macro and micronutrient intake were being evaluated when
this report went to print.

In the second study, Food Fit is being delivered and evaluated with two new age
groups: grades kindergarden through 2 and 5 through 7. In addition to examining
skills attained and impact on self efficacy, the study is evaluating anthropometrics
and dietary behaviors that will include a review of the differences in dietary intake
noted during weekdays as compared to days during the weekend.

YMCA-OSU Snack Program

Under the direction of a faculty member and Director of the Dietetic
Internship in the Department of Human Nutrition, a dietetic intern developed
an afterschool, four-week cycle snack menu that: 1) complied with federally
funded Child and Adult Care Food Program (CACFP) regulations, 2) improved
Access to fresh produce is vital to proper
nutrient density and nutrition quality of the snack program, and 3) did NOT
nutrition. Photo courtesy of Columbus Public Health.
increase costs for the program.

To learn more:
Page 15
Childhood Obesity YMCA of Central Ohio
The YMCA of Central Ohio has a long tradition of
providing innovative and family focused fitness programming
at all branches and program sites. Youth of all ages choose
! Increase opportunities from a wide variety of programs to challenge skill levels,
for physical activity. build confidence and have fun.
! Ensure all food and Youth Sports and Physical Activity Programs
drink choices are healthy. The YMCA offers a series of youth sports and physical activity programs targeting
children and youth ages 6 through 16. The programs provide opportunities for
! Advocate and provide children of all abilities to participate, to learn and to have fun while being
physically active. The programs include activities such as basketball, soccer, martial
learning opportunities.
arts, gymnastics, dance, swim lessons, swim teams, teen conditioning and more.
! Healthy lifestyle From programs that required tracking, 87 percent of participants achieved 60
behaviors start early. minutes of physical activity at least five days per week.
Y Kids Are Fit
The Y Kids Are Fit curriculum has been implemented in more than 40 before
and afterschool child care sites in Franklin County. The program is designed
to increase youths’ strength, flexibility and endurance. The curriculum includes
health and nutrition lessons, as well as fitness activities that on-site Y-Club staff
can implement with youth.
• 733 youth participated for more than eight months during the school year.
• 96 percent of participants improved in at least one of the fitness test areas.
• 82 percent of participants improved in at least two of the fitness test areas.
• 44 percent of participants improved in all three of the fitness test areas.
Fitness tests included a shuttle run (endurance), curl ups (strength), and sit and
reach (flexibility).
Summer Day and Resident Camp
The YMCA of Central Ohio offered youth from all over central Ohio the
opportunity for camp fun and activity. More than 3,800 youths participated in
active camp programs such as youth sports, horseback riding, dance and more.
Nutritious Meals
The YMCA of Central Ohio served more than 62,000 free nutritious meals in
their child care, camp and early education programs.

Page 16
The YMCA of Central Ohio and The Ohio State University’s College of Human Nutrition
partnered to provide fitness and nutrition programming in seven of the YMCA’s afterschool
programs. The YMCA afterschool staff provide the Y Kids Are Fit curriculum and activities, and
OSU graduate students provide a 14-week Food Fit nutrition program to enhance the Y Kids are
Fit program.
The YMCA of Central Ohio collaborated with Nationwide Children’s Hospital’s Center for
Healthy Weight and Nutrition’s New U and New U Jr. programs to offer free 6-month
memberships to their graduates.
The Ohio State University’s Department of Human Nutrition recreated the daily afterschool
snack menu. See page 15 for additional information.

To learn more:

Fitness is fun! Photo courtesy of YMCA of Central Ohio.

Page 17
Stambaugh Family Continues
Weight Loss Success

mall steps have added up to big
progress for the Stambaugh
family in their efforts to lose weight.
Since they came forward to tell
their story during the Full Potential
breakfast in 2008, they’ve continued exercising
the winning strategy that has helped them shed a
combined weight of nearly 300 pounds over the
past two years.

“I believe the small, gradual changes are what it’s

The Stambaugh family celebrates their success with Eddie about,” says mom, Dianna Stambaugh. “Big, fast
George, former OSU Buckeye and NFL running back,
during the 2008 Full Potential breakfast event. changes are scary and make it more likely you
will fail.”

Being successful is terribly important to Dianna,

who once weighed 317 pounds and has lost nearly
125 of them. Before she started losing weight,
Dianna was afraid that obesity related health
problems would prevent her from seeing her
children grow up. She feared for her family’s
health as well. Now, she, husband Lawrence, and
their children Nicole and David all are feeling
healthier and happier.

Page 18
“It’s been great to share my story with others
and hopefully inspire them to stay focused on
their weight-loss goals.” – Dianna Stambaugh

Their strategy of making small changes has consistently, so the family goes to the gym at least
involved taking a variety of steps to ensure they three times a week.
eat healthy foods and stay active.
Another key to losing weight is staying focused.
The family limits the amount of fast food they eat Family members post before-and-after pictures of
in favor of healthy meals. “It’s not that we can’t themselves throughout their home. “Seeing the
have it, but we have learned not to overindulge. progress we’re making really keeps us motivated,”
Don’t get out of control.” They also have learned says Dianna. “Plus, it helps that we feel better.”
that eating in moderation, reducing sugar intake, Dianna also has noticed that her complexion is
reading labels, measuring food portions and clearer and she looks much younger.
counting calories gives them control over what
Dianna is inspiring others with her story. Each
they eat, which helps the family achieve their
week, Dianna mentors women dealing with
weight-loss goals.
weight issues through a program offered at her
In addition to the dietary measures they’ve taken, local fitness center. “It’s been great to share my
the Stambaughs have incorporated regular story with others and hopefully inspire them to
exercise into their routines. According to stay focused on their weight-loss goals.”
Lawrence, what works best for them is to exercise

Page 19
Nationwide Children’s Hospital Primary Care
Nationwide Children’s offers community-based physician
Nationwide Children’s Hospital currently services to help keep children healthy with regular physical
addresses childhood obesity through medical exams, vision, hearing and general development checks,
and immunizations against childhood diseases. There are 10
services, community programs, policy initiatives
Primary Care Centers in Franklin County, including one on
and employee wellness programs. These include: the hospital’s main campus. There were more than 137,000
Center for Healthy Weight and Nutrition Initiatives patient visits to the Primary Care Network in 2008.
The Center for Healthy Weight and Nutrition (CHWN) In 2008, an electronic health record system was rolled out to
at Nationwide Children’s Hospital offers families a all of the Primary Care Centers. The system calculates and
comprehensive approach to weight management, graphs the Body Mass Index (BMI) for all patients, 2 years
providing programs for both the prevention and and older, seen during well child/adolescent visits. Our
treatment of overweight children. Primary Care Network providers can now more easily
In 2008, an Expert Committee of physicians within the identify children with unhealthy weights, monitor their
American Medical Association provided specific, stepwise care and make appropriate referrals to the Center for
guidance for healthcare providers on treating obesity. Healthy Weight and Nutrition or other community resources.
Prevention, early identification through use of Body Mass Fitness and Nutrition Club (F.A.N. Club)
Index (BMI) and education and counseling in practice are The F.A.N. Club curriculum is based on a social cognition
the cornerstones. The CHWN continues to develop new model, combining fitness training and nutrition programs,
resources to help make such interventions as effective as for high risk and obese youth administered over 30 weeks
possible here in central Ohio. Since the last Full Potential in an afterschool format. In June 2008, the program was
report, the CHWN has added: launched at Livingston Elementary School, near the
• The New U Jr. program, a weight management hospital campus.
program for kids ages 6 to 11 years and their families

• The Healthy Happy Preschoolers program, in By the beginning of the winter semester 2008, 11
collaboration with the community and funded by participants completed the most recent post
United Way of Central Ohio and the Central assessment and had, as a group:
Benefits Foundation (see page 23)
• Increased their aerobic endurance by 42 percent.
• Website materials at • Increased their strength.
– Average number of push-ups increased 139
– A video on bariatric surgery percent (an increase of an average of 6
push-ups per student).
– Resources for physicians to implement the new Expert
Committee recommendations in their practices – Average number of sit-ups increased 115
percent (an increase of an average of 11
– Parent information on how to work with the sit-ups per student).
nine core evidence-based obesity prevention and
treatment messages • Increased their overall flexibility and maintained
their BMI.
These activities complement the full-service medical and surgical
programs for pediatric obesity patients and their families.

Page 20
By February 2009, the F.A.N. Club included 54 children Hospital, Snackwise® is a research-based online snack
at Livingston Elementary School and Lincoln Park rating system that calculates nutrient density in snack foods.
Elementary School. In March 2009, 20 participants Snackwise® is designed for use by any organization or
completed at least one post assessment and had, as a group, individual interested in making healthier snack choices.
improved their overall fitness and decreased their BMI.
This online tool uses a scientific formula based on the
March 2009 F.A.N. Club Results current Dietary Guidelines for Americans, considering 11
weighted nutrition parameters, to measure the nutrient
Body Mass Index richness of snack foods straight out of the kitchen pantry or
off of grocery shelves. Then, using an easy-to-understand,
color-coded system, the calculator assigns the snack food
71% 68% one of three colors, indicating the nutritional quality of the
snack. Visit for more information.
Education Collaboration with YMCA
The Education Institute and the Department of Clinical
Nutrition Services at Nationwide Children’s Hospital
20% conduct the Healthy Lifestyles Weight Management
program in collaboration with the YMCA. This four-
0 week program, held at rotating YMCA sites, is a primer
BMI Percentile
in healthy eating and activity, and sessions are held for
both parents/caregivers and children. Participants receive
six months of follow-up newsletters and a three month
20 17
YMCA membership after program completion.
16 14.61 Healthy Neighborhoods, Healthy Families
14 12 This initiative was announced in 2008 as a community
12 9
10.28 collaboration dedicated to taking action in Columbus’
10 South Side to help create/improve affordable housing,
8 6 health and wellness services, educational opportunities,
6 safe and accessible neighborhoods, and workforce and
economic development.
0 While additional partners are expected to join this
Push-ups Sit-ups Aerobic Endurance
(total number) (total number) (pacer laps) collaborative effort, current partners include:
Pre Assessment Post Assessment • City of Columbus

• Community Development For All People

The F.A.N. Club now has 30 participants at Livingston • Columbus Public Health
Elementary School and an additional 37 at Lincoln Park
• Columbus City Schools
Elementary School.
• Home Again
Developed by doctors and nutritionists in the Center for • Nationwide Children’s Hospital
Healthy Weight and Nutrition at Nationwide Children’s
Page 21
Childhood Obesity Nationwide Children’s Hospital will provide support for Healthy Neighborhoods,
Interventions: Healthy Families. The health and wellness services and safe and accessible
neighborhoods components in particular will provide focused programs to
Recommendations address obesity.
! Measure and intervene.
! Healthy lifestyle behaviors
start early.
! Increase opportunities for
physical activity. Executive Leadership in the Ohio Business Roundtable Child Obesity
Prevention Collaborative
! Ensure all food and drink The Ohio Business Roundtable is a leadership group of the chief executive
choices are healthy. officers of the state’s largest corporations. The Roundtable has adopted the
prevention of childhood obesity as one of its main goals related to the health
! Advocate and provide of Ohio workers and their families. Dr. Steve Allen, CEO of Nationwide
learning opportunities. Children’s Hospital, provides the executive leadership for the Collaborative
convened by the Roundtable to advocate for more effective statewide policies
! Employers must get in on fitness and nutrition for children and adolescents.
on the action. Employee Wellness
Each year, insured spouses and employees of Nationwide Children’s Hospital
complete an annual Health Risk Assessment. Recent trends indicate a 9 percent
increase in the number of low-risk employees/spouses, and a 7 percent decrease in
the number of moderate-risk employees/spouses.

In 2008, employees participating in the Weight Watchers® at Work program

surpassed the goal of losing 2,008 pounds by losing 2,011.6 pounds. As a
wellness incentive, the hospital supplements a portion of the Weight Watchers®
program fee.

In 2008, Nationwide Children’s hosted two farmer’s markets to encourage

employees to eat more fruits and vegetables and make produce shopping more
convenient. The markets were also open to the community. Additionally, at
no cost, employees are able to meet one-on-one with a licensed dietitian or
attend monthly nutrition education workshops.
Keeping active after school as part of All employees have the opportunity to join the on-site, 24/7-access fitness
the F.A.N. Club. Photo courtesy of Nationwide center and attend free group fitness classes including yoga, toning, aerobics
Children’s Hospital.
and boot camp. At no cost, employees can meet with a certified exercise
specialist to receive individual fitness assessments and exercise plans.

Page 22
Happy Healthy Preschoolers
A Partnership in Early Intervention
Happy Healthy Preschoolers • Central Benefits Health Care Foundation
is an intensive six-week, community based Lead funder for the program.
program whose aim is to remodel the
• United Way of Central Ohio
family’s daily habits toward ones that
Fiscal agent for the project.
promote health and fitness. It provides
an initial intervention offered to families • Nationwide Children’s Hospital –
at the first signs of overweight in their Center for Healthy Weight and Nutrition
child or for children deemed high-risk. Program development, implementation,
supervision and management.
The long-term goal is to offer the program
throughout central Franklin County in easily • The Ohio State University College of
accessible sites: child care facilities, faith Public Health (OSU-CPH)
centers, health care facilities and recreation Evaluation support, design and
centers. The program’s curriculum and implementation assistance.
materials were developed using the • YMCA of Central Ohio
American Medical Association’s Expert Assists in securing program sites and
Committee on Obesity core evidence-based supporting implementation of the program.
messages. Piloted in 2008, the program will
collect and evaluate data to improve • Columbus Public Health (CPH)
program delivery and effectiveness. Assists in securing program sites and
supporting the implementation.
Happy Healthy Preschoolers brings together Contributes expert advice and materials.
a broad coalition to provide this unique
community based model of intervention. • Columbus City Schools (CCS)
Supports implementation of the program
through data collection and participant
referral and recruitment.

Page 23
New Initiatives: 2009 and Beyond
Supporting Our Community Partners Data Analysis, Reporting and Training Program
It’s clear that pediatric obesity is a complex (DART)
To support Columbus City Schools’ collection and
epidemic disease that affects all segments of
reporting of child height, weight and body mass
society. However, it is especially prevalent and index, we will conduct training in the use of automated
destructive in low-income, urban communities, entry programs that enable secure and encrypted data
such as those in which Nationwide Children’s storage, management and reporting. In addition, we
Hospital’s main campus and primary care will conduct school, census tract and zip code trend
analysis of the data collected.
centers are located.
Fitness and Nutrition Club (F.A.N. Club)
Columbus City Schools
Over the next three years, Nationwide Children’s
Because we have a unique passion and responsibility to
hopes to expand community collaborations and grow
improve quality of life for these neighbors, in 2009 we
the F.A.N. Club to serve a total of 500 children or
will continue to partner with Columbus City Schools and
more per year in 20 Columbus City Schools locations.
other local leadership organizations to develop a scalable,
efficient and accountable program to increase fitness, McConnell Heart Health Center
improve nutrition, identify children at risk, coordinate We look forward to a new partnership with the
referrals and communication, and measure outcomes for McConnell Heart Health Center, which has requested
elementary-aged children in high-risk schools. that the Center for Healthy Weight and Nutrition
collaborate with them for the 2009 Wolfe Symposium
Nationwide Children’s is fortunate to have a consistent
“Creating Health Through the Prevention and Treatment
source of BMI data through the Columbus City Schools,
of Obesity Within Our Community.” This will be a
one of the few school systems in the nation to measure
service program targeting 9 to 13 year-olds in the Boys
BMI regularly. The challenge is how to analyze and use
and Girls Club of Columbus, Milo-Grogan location.
this data, to evaluate which interventions are working,
and to refer at-risk children into them. Nationwide Children’s Hospital as an Employer:
Leading By Example
In 2009, Nationwide Children’s will introduce three
Additional Coverage for Employee Dependent
programs designed to make childhood obesity
interventions more effective:
Nationwide Children’s Hospital is one of the first Ohio
School Nurse Advocacy Program (SNAP) employers to participate in the Alliance For A Healthier
We will provide an annual training and continuing Generation’s childhood obesity health care initiative, a
education program, an ongoing learning collaborative collaborative effort with national medical associations,
and facilitated referral program for school nurses leading insurers and employers to offer comprehensive
managing obese or morbidly obese children in the health benefits to children for the prevention, assessment
Columbus City Schools. Training will cover new and treatment of childhood obesity. Nationwide
information on prevention and management of Children’s will provide eligible children ages 3 to 18
pediatric obesity, measurement and database with access to at least four follow-up visits with their
education, communication strategies and motivational primary care provider and four visits with a registered
interviewing for interaction with parents, and referral dietitian per year. The new health benefits will be
mechanisms. offered to those children at or above the 85th

Page 24
percentile for Body Mass Index (BMI). As a member • Also in 2009, healthy options from Mark Pi’s will be
of the Alliance, Nationwide Children’s will also participate added in the food court.
in a first-time evaluation of this new benefit program.
Employee Health and Wellness
The goal is for more than 6.2 million children nationally
Nationwide Children’s will also implement a variety of
to have access to this health care benefit within the next
programs and policies to improve the health and fitness
three years. The benefits are in line with the American
of our employees, including:
Medical Association’s Expert Committee Recommendations
on the Assessment, Prevention and Treatment of Child • Expanding our comprehensive employee wellness
and Adolescent Overweight and Obesity. For more program.
information, visit
• The hospital’s gift shop has coordinated with the
Healthy Food Choices Center for Healthy Weight and Nutrition to reduce
Nationwide Children’s is working to meet our responsibility portion sizes on all snack foods and introduce several
to provide the same healthy choices for employees, new nutrient-dense options.
patients and their families that we advocate for the greater
community. In 2008, we instituted several nutritional • Expand farmer’s markets to increase frequency.
practices as a foundation for additional changes in 2009:
• Build upon the Diabetic Counseling program to
• Lite mayonnaise is used in all recipes that call for include an exercise program and support group.
To learn more:
• Neither butter nor margarine is added to any
vegetables in the cafeteria.
• Salmon patties, veggie burgers and turkey burgers are
available in the food court and cafeteria.

• A yogurt and fruit bar was added during breakfast in

the cafeteria, using lite yogurt.

• Nutritional information for items in the cafeteria is

posted daily.

• Subway® was added as a food vendor in the food

court, offering healthy choices and limiting the
drink sizes available.

• All hospital vending machines follow the Snackwise®

system, and the color-coded designation is posted for
each snack.

• In 2009, fried foods will be eliminated in the Making nutritious food choices after school
cafeterias and replaced with healthier, baked versions. as part of the F.A.N. Club. Photo courtesy of
Nationwide Children’s Hospital.

Page 25
Critical Funders
Central Ohio is fortunate to have several United Way of Central Ohio
philanthropic organizations that provide Current investment in nutrition and fitness-related
programming in central Ohio exceeds $2 million,
financial support for community-based supporting nearly 20 programs per year that engage
programs promoting physical activity and people in healthy nutrition and physical activity. This
good nutrition. Several of these vital resources investment also aims to improve the nutrition and
are listed below along with the obesity related physical activity environment to help people more easily
eat healthy food and be more physically active. Following are
programs they helped support during 2008.
several programs currently supported by the organization.
Columbus Medical Association Foundation
South Side Healthy Food Access and Nutrition Education
St. Stephen’s House SNS All Stars – Health, nutrition
Program – See page 6 for program description.
and physical activity project.
Healthy Children, Healthy Weights – See page 12 for
Union County Health Department – Healthflix video
program description.
contest supporting the Physical Activity category entry
for PSA’s to be developed. Healthy & Fit Partnership – Initiative designed to change
the cafeteria environment in three Westside schools:
Children’s Hunger Alliance – Health promotion on the
Westmoor Middle, West High School, and Hilltonia
South Side. This program aims to train four adult health
Middle. Supported by a funding partnership including
advocates who will then be deployed throughout the
the Abbott Fund and United Way of Central Ohio, the
community to provide nutrition and physical activity
program resulted in:
education to other community members. There is also a
youth component that is being developed that will engage • Fruit and vegetable expenditures 24 percent higher in
the youth at Southside Settlement House to educate their target schools.
peers on healthy food choices and physical activity.
• Between 27 percent and 41 percent of students
Osteopathic Heritage Foundations selecting healthy food options, surpassing the
Columbus City Schools – To advance the district-wide expected benchmark of 19 percent.
wellness initiative, including nutrition improvements and
infrastructure support. See page 7 for program description. Happy Healthy Preschoolers – Funding partnership
including the Central Benefits Health Care Foundation,
The Columbus Foundation United Way of Central Ohio, and Nationwide Children’s
Ohio State University Research Foundation – Hospital. See page 23 for program description.
Supported the Food Fit program serving children at
risk of obesity. See page 15 for program description.

United Way of Central Ohio, Inc. – Two grants to

support the Health Funder’s Collaborative to improve
the health of Franklin County residents by reducing the
incidence of overweight and obesity.

Page 26
To learn more: Ohio Business
Columbus Medical Association Roundtable: Advocating
for Children’s Health
614-240-7410 Last year, the Ohio Business Roundtable launched a
major initiative that seeks to identify and implement
Osteopathic Heritage Foundations
short- and long-term strategies to address Ohio’s
growing childhood obesity epidemic. The initiative
is led by Dr. Steve Allen, CEO of Nationwide
The Columbus Foundation Children’s Hospital (on behalf of all children’s hospitals across the state) and Toby Cosgrove,
614-251-4000 CEO of the Cleveland Clinic.

United Way of Central Ohio Key partners include Ohio Action for Healthy Kids, American Heart Association, Cardinal Health
614-228-8700 Foundation, Children’s Hunger Alliance,
Nationwide Better Health, Ohio Department of
Health, Ohio Children’s Hospital Association and
Ohio Hospital Association.

The initial focus of the initiative will be major state

legislation addressing school nutrition, physical
education and BMI/fitnessgram screening assessment
standards that the Ohio Business Roundtable is
preparing and expects to release during the first half
of 2009. The initiative will also consider actions
employers can take to address childhood obesity
among their employees and their dependents.
Learning to make healthy snack choices.
Photo courtesy of United Way of Central Ohio.

Page 27

Recommendations for Addressing

Pediatric Obesity
For the Family
Eat a quality diet.
Follow the U.S. Dietary Guidelines. Incorporate five servings of fruits and
vegetables per day, try to use whole grains when possible. Include low-fat
(skim, 1%, or 2%) dairy products, and concentrate on low-fat protein sources
(lean meats, fish, beans and nuts). Limit consumption of juice, soft drinks,
fast food, and fried foods. Being aware of correct portion size is also helpful.
Portion sizes vary with age; for adolescents and adults, one-half cup generally
represents one serving of pasta or rice and 4 ounces (the size of the palm of
your hand) represents a serving of meat or protein. Remember that the amount
of calories—especially in sugars and fats—that can safely be consumed each
day depends on the person’s activity level.

Be better consumers.
Learn to read a food label and look for products with less than 30 percent of
calories coming from fats, and seek out food with high percentages of vitamins
and minerals. Reading the nutrition information panel will help identify empty
calories—those with high calories but no vitamins or minerals. Eliminating
empty calories helps ensure that every food and drink contributes to a quality
daily diet.

Processed foods tend to be less healthful and should be avoided. You can
identify processed foods as those containing multiple ingredients that are
difficult to pronounce and possibly unfamiliar to you. Healthful foods tend to
contain ingredients that are known to you. Shopping more around the outside
edges of the grocery store (fruits, vegetables, meat, freezer, dairy sections) and
less in the inside aisles (packaged foods) will promote a more nutritionally
balanced diet.

Two helpful web sites: and

Page 28
Eat together as a family.
Restart the tradition of a family dinner together without the TV.

Cut sweet drinks.

Substitute sweet drinks and juices with water or other drinks with
no calories.

Know your child’s Body Mass Index (BMI).

The American Academy of Pediatrics recommends using BMI to
screen for overweight children beginning at age 2 and through
age 19. Discuss your child’s BMI with your family doctor.

Stay away from fast food.

Eat fast food rarely. When you do, pick the restaurant and your
food carefully. Look up the nutrition information (available at
the counter) to know how many calories you’re eating. Stick to
non-supersized portions. Downsize your selections using the
junior menu. Add fruit or a baked potato rather than fries. Add
vegetables and fruits at every opportunity. Avoid non-diet sodas
and desserts.

For Schools
Measure and intervene.
Increase school based BMI screening connected with
the medical practices to form a seamless system of early
identification and intervention.

Increase opportunities for physical activity.

Ensure daily recess in all elementary and middle schools.
Implement Take 10! This program encourages taking two
10-minute breaks in the school day for moderate to vigorous
activity in the classroom.

Page 29
Ensure all food and drink choices are healthy.
School nutrition standards should be established for all non-USDA
food in schools, including vended, a la carte, school store and

Advocate and provide learning opportunities.

Schools should incorporate healthy eating and physical activity
behaviors into their lessons. Afterschool programs will provide nutritious
food choices and a safe environment for learning and physical activity.
Parents, school agencies and schools should advocate, support and
implement programs which provide a healthier environment.

For Other Organizations

Healthy lifestyle behaviors start early.
Meals and snacks at child care centers should comply with the USDA
guidelines. Child care providers need to be trained on best practices in
nutrition and physical activity for the young child.

Faith-based organizations can reach out to families.

Faith-based organizations are a trusted source of support for families.
They offer an excellent venue for screening, educational and health
promotion programs.

Health care providers need to screen all children

for obesity.
Along with screening children using body mass index, they should
counsel families on strategies to prevent childhood obesity. Health
care providers should receive training on evidenced-based obesity
management guidelines. In addition, they must be involved in basic,
translational and clinical research programs that advance our knowledge
on causes, prevention and treatment of childhood obesity.

Page 30
For Communities
Neighborhood groups are credible advocates.
Along with working toward safe sidewalks, parks, and neighborhood
physical activity programs, neighborhood groups can work in
collaboration with stores and local farmers to increase availability
of fresh fruits and vegetables.

Food industry can help improve food choices.

The food industry should offer a variety of healthy food options
and provide information on nutrient quality, e.g., require
restaurants to list calorie content of food items.

Employers must get in on the action.

Businesses should support employee activity through corporate
steps challenges, Eco-bucks programs, walking and cycling clubs
during lunch hour, and other programs that get people moving.

For Society
Engage the media to increase awareness about
obesity and co-morbid conditions.
Assist with health promotion messages on healthy lifestyle

Implement a comprehensive community plan.

Community leaders, business leaders, hospitals, government and
other stakeholders need a coalition to develop and implement
a Columbus community plan to promote optimal nutrition and
daily activities.

Page 31
Support the recommendations of the Ohio Activity
This recently enacted program of the Ohio Parks and Recreation
Department will include communities working on creating a built
environment that entices its citizens outside using parks,
walkways, bike and roller-blade paths, and skateboard parks.
Building downtown grottos that showcase sculpture, fountains
and parkland to draw workers and visitors out onto the streets is
also advocated.

Advocate for local, state and federal government

Enact policies that create and improve resources for physical
activity in schools, workplaces and neighborhoods. Advocate for
legislation that supports reimbursement for obesity-related office
visits; improve access to nutritious food choices for children who
are affected by food insecurity; and promote diversification of
healthy and culturally appropriate food options in the Women,
Infant and Child (WIC) program.

Support legislation to improve the built environment in

communities, such as safe sidewalks. There must be uniform
access to green spaces, parks and recreation centers in all
Note: Recommendations were developed by physicians at the Center for Healthy Weight and
Nutrition at Nationwide Children’s Hospital and incorporate several recommendations from a
report “Healthy & Fit: A Community Action Plan for Franklin County Children & Families by
the Osteopathic Heritage Foundations and Children’s Hunger Alliance.”

Page 32
Page 33
700 Children’s Drive
Columbus, Ohio 43205