American Cancer Society guideline for diet and physical activity for cancer prevention.

The American Cancer Society (ACS) publishes the Diet and Physical Activity Guideline to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. This guideline is developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflects the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS guideline focuses on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. This 2020 ACS guideline is consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes as well as for general health promotion, as defined by the 2015 to 2020 Dietary Guidelines for Americans and the 2018 Physical Activity Guidelines for Americans.

Increasing Community Readiness for Childhood Obesity Prevention: A Case Study of Four Communities in Georgia.

The community readiness model (CRM) was used to assess changes in community readiness across four counties in Georgia that were targeted as part of a 3-year Childhood Obesity Prevention Program. Key respondent interviews were conducted with community stakeholders in 2012 (n = 20) and 2017 (n = 18) using a semistructured questionnaire assessing six dimensions of community readiness (i.e., community efforts, community knowledge of efforts, leadership, community climate, community knowledge about the issue, and resources available to support efforts). Interviews were analyzed using the CRM scoring protocol and qualitative methods. Paired t tests were used to compare mean score differences between baseline and follow-up assessments. At baseline, overall mean readiness scores for the four counties ranged from 4.52 to 5.05 on the CRM 9-point scale. At follow-up, overall readiness scores ranged from 6.01 to 6.97 out of 9.00. Data revealed a statistically significant improvement in scores across all communities (+1.70, p = .007; 95% confidence interval [0.87, 2.51]). Data also revealed statistically significant improvements in every dimension of readiness, except community knowledge of the issue. Information gleaned from interviews suggested that investing in staff to support efforts, building awareness to shift the community climate, and cross sector collaboration contributed to improved community readiness among the study communities. The provision of technical assistance, peer learning opportunities, and financial support as part of a cooperative grant initiative holds promise for increasing the capacity of community coalitions to advance childhood obesity prevention efforts in their local communities.

Ten Years of TAKE 10!(®): Integrating physical activity with academic concepts in elementary school classrooms.

OBJECTIVE: Current literature supports the link between physical activity (PA) or fitness and a child's ability to achieve academically; however, little structured activity time is incorporated into elementary school classrooms. This paper explores the impact of a classroom-based PA program, TAKE 10!, and health-academic integration through existing state and federal policy and programming. METHODS: Evidence from journal articles, published abstracts, and reports were examined to summarize the impact of TAKE 10! on student health and other outcomes. This paper reviews 10 years of TAKE 10! studies and makes recommendations for future research. RESULTS: Teachers are willing and able to implement classroom-based PA integrated with grade-specific lessons (4.2 days/wk). Children participating in the TAKE 10! program experience higher PA levels (13%>), reduced time-off-task (20.5%), and improved reading, math, spelling and composite scores (p<0.01). Furthermore, students achieved moderate energy expenditure levels (6.16 to 6.42 METs) and studies suggest that BMI may be positively impacted (decreases in BMI z score over 2 years [P<0.01]). CONCLUSION: TAKE 10! demonstrates that integrating movement with academics in elementary school classrooms is feasible, helps students focus on learning, and enables them to realize improved PA levels while also helping schools achieve wellness policies.

Training health care professionals to manage overweight adolescents: experience in rural Georgia communities.

CONTEXT: The obesity epidemic threatens the present and future health of adolescents in the United States. Yet, health care providers lack specific training for pediatric obesity assessment and management. PURPOSE: This study examined the adherence of rural Georgia primary care practitioners to an overweight adolescent management protocol. The study also documented the prevalence of obesity-associated physiological and behavioral risk factors among overweight adolescent patients. METHODS: Ten rural clinics (58 providers) were recruited and received a 90-minute adolescent overweight assessment and management training session. Select biochemical, dietary, physical activity, and physical inactivity behaviors were assessed in overweight adolescent patients. Medical charts were abstracted to assess practitioner compliance with an overweight assessment protocol and patient adherence to a 16-week follow-up visit. FINDINGS: Providers were receptive to training and complied with the recommended protocol. Eighty-five overweight adolescents were assessed, but only 49 (57%) completed the scheduled 16-week follow-up visit. Physical, biochemical, and behavioral assessments revealed that 13%-27% of the participants had abnormal levels of lipids, fasting glucose, and glucose/insulin ratio, and 80.5% had waist circumferences above the 90th percentile. CONCLUSIONS: Practitioners complied with the assessment and follow-up protocol, leading to the discovery of previously unrecognized risk factors in many overweight adolescent patients. Lack of patient adherence to follow-up was the greatest limiting factor for obesity management. Further efforts are needed to implement and evaluate training to improve the management of adolescent overweight, especially in rural communities.

Improving providers' assessment and management of childhood overweight: results of an intervention.

OBJECTIVE: Pediatric primary care providers' adherence to recommendations for the assessment and management of childhood overweight is low. There are scarce data addressing how to improve provider practices. This study evaluated the effect of provider training and office-based tool dissemination on pediatric providers' assessment and management of childhood overweight. METHODS: Provider practices before and after training and office-based tool dissemination were compared. Participants were resident and faculty providers at 6 urban, community-based primary care clinics affiliated with an academic medical center. Three months after completion of two 1-hour training sessions, clinic sites were provided with tools in bulk, and office staff were coached to distribute the tools during patient encounters. Provider practices were ascertained by medical record abstraction at baseline and at 3 and 6 months. The proportion of medical records with documentation of recommended practices, including recording of body mass index percentile (BMI%), obtaining a nutrition-activity history, and providing nutrition-activity counseling, was compared with chi(2) tests and logistic regression. RESULTS: During the initial 3 months after training, provider documentation of recommended practices did not significantly improve compared with baseline. During the subsequent 3 months, after office-based distribution of tools, provider documentation of recommended practices improved significantly compared with baseline (28.8% vs 11.6% for BMI% [P < .001], 80.2% vs 49.8% for nutrition-activity history [P < .001], and 47.7% vs 33.3% for nutrition-activity counseling [P < .001]). CONCLUSIONS: Pediatric providers' adherence to recommendations for the assessment and management of childhood overweight may improve with provider training linked to the office-based distribution of tools to promote performance of recommendations.

Systems Thinking and Simulation Modeling to Inform Childhood Obesity Policy and Practice.

OBJECTIVES: In 2007, 31.7% of Georgia adolescents in grades 9-12 were overweight or obese. Understanding the impact of policies and interventions on obesity prevalence among young people can help determine statewide public health and policy strategies. This article describes a systems model, originally launched in 2008 and updated in 2014, that simulates the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. METHODS: In 2008, using information from peer-reviewed reports and quantitative estimates by experts in childhood obesity, physical activity, nutrition, and health economics and policy, a group of legislators, legislative staff members, and experts trained in systems thinking and system dynamics modeling constructed a model simulating the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. Use of the 2008 model contributed to passage of a bill requiring annual fitness testing of schoolchildren and stricter enforcement of physical education requirements. We updated the model in 2014. RESULTS: With no policy change, the updated model projects that the prevalence of obesity among children and adolescents aged ≤18 in Georgia would hold at 18% from 2014 through 2034. Mandating daily school physical education (which would reduce prevalence to 12%) and integrating moderate to vigorous physical activity into elementary classrooms (which would reduce prevalence to 10%) would have the largest projected impact. Enacting all policies simultaneously would lower the prevalence of childhood obesity from 18% to 3%. CONCLUSIONS: Systems thinking, especially with simulation models, facilitates understanding of complex health policy problems. Using a simulation model to educate legislators, educators, and health experts about the policies that have the greatest short- and long-term impact should encourage strategic investment in low-cost, high-return policies.

Design and implementation of training to improve management of pediatric overweight.

INTRODUCTION: Clinicians report a low proficiency in treating overweight children and using behavioral management strategies. This paper documents the design and implementation of a training program to improve clinicians' skills in the assessment and behavioral management of pediatric overweight. METHODS: Two one-hour CME trainings were designed using published guidelines, research findings, and expert committee recommendations. The trainings were provided to clinicians of a managed care pediatric department, utilizing novel screening and counseling tools, and interactive exercises. Surveys and focus groups were conducted 3 and 6 months post intervention to examine clinician attitudes and practices regarding the screening and counseling tools. RESULTS: Post intervention, the majority of clinicians agreed that the clinical practice guidelines (Pediatric Obesity Practice Resource) and BMI-for-age percentile provided useful information for clinical practice. Clinicians reported an increased utilization of the recommended screening tools and changes in office practices to implement these tools. They offered suggestions to improve the ease of use of the tools and to overcome perceived clinician and/or patient barriers. DISCUSSION: A brief, cost effective, multi-faceted training and provision of counseling tools were perceived as helpful to clinical practice. Useful lessons were learned about tool design and ways to fit tools into practice. Training the entire health care team is advantageous to the adoption of new tools and practices.

Get healthy together: a program to improve counseling for childhood obesity in community-based WIC clinics.

Counseling parents of overweight children is a sensitive issue that has been reported to be difficult for many health professionals. The Get Healthy Together (GHT) project involved an 18-month intervention that provided skills training and new tools to Women, Infants, and Children (WIC) program staff and a staff wellness program to improve the physical self-concept and functioning of WIC employees. All WIC staff from the 48 WIC clinics in New Mexico participated in this study. The design used random assignment to intervention or control condition. Staff participating in the Get Healthy Together project reported improved confidence in their ability to counsel parents of overweight children and improved counseling skills related to health behaviors. Use of the innovative tools provided visual aids that helped parents understand the health implications of their child's weight without the parents becoming defensive. These tools are publicly available in English and Spanish on the WIC Works Sharing Gallery (website: http://www.nal.usda.gov/wicworks/Sharing_Center/gallery/healthytogether.html).

Innovative tools help counselors discuss childhood obesity with parents.

BACKGROUND: Childhood overweight and obesity pose potential health risks for many children under the age of 5 years. Women, Infants, and Children (WIC) nutritionists are in a unique position to help reduce this problem because of their frequent counseling contacts with clients during certification visits. Therefore, four new tools to facilitate nutritional counseling of parents of overweight children during certifications were developed and systematically evaluated. METHODS: The Nutrition and Activity Self-History (NASH) form, Report Card/Action Plan (ReCAP), Talking Tips, and Healthy Weight Poster were evaluated by WIC nutritionists via an online survey. Anchors on the Likert scale were 0 for Strongly Disagree to 6 for Strongly Agree. Four regional focus groups were also conducted. Data were analyzed descriptively. RESULTS: The response rate on the survey was 83% (n=63). Focus groups were comprised of staff that volunteered to participate (n=34). The NASH form, which replaces a food frequency questionnaire for identifying nutrition risk, had a mean rating of 5.20 as "Helpful when counseling about weight." The ReCAP, Talking Tips, and Healthy Weight Poster achieved mean ratings of 5.70, 4.75, and 5.30, respectively, in this category. Focus group responses were very positive about the usefulness of the ReCAP and Healthy Weight Poster to visually convey the concept of BMI percentile for age using a green, yellow, and red color-coded "traffic light" approach to showing healthy versus unhealthy BMI values. CONCLUSIONS: WIC programs and other pediatric health care settings may want to consider adopting these innovative tools to better serve their clients and address pediatric overweight in the populations they serve.

Míranos! Look at us, we are healthy! An environmental approach to early childhood obesity prevention.

BACKGROUND: Obesity prevention research is sparse in young children at risk for obesity. This study tested the effectiveness of a culturally tailored, multicomponent prevention intervention to promote healthy weight gain and gross motor development in low-income preschool age children. METHODS: Study participants were predominantly Mexican-American children (n = 423; mean age = 4.1; 62% in normal weight range) enrolled in Head Start. The study was conducted using a quasi-experimental pretest/posttest design with two treatment groups and a comparison group. A center-based intervention included an age-appropriate gross motor program with structured outdoor play, supplemental classroom activities, and staff development. A combined center- and home-based intervention added peer-led parent education to create a broad supportive environment in the center and at home. Primary outcomes were weight-based z-scores and raw scores of gross motor skills of the Learning Achievement Profile Version 3. RESULTS: Favorable changes occurred in z-scores for weight (one-tailed p < 0.04) for age and gender among children in the combined center- and home-based intervention compared to comparison children at posttest. Higher gains of gross motor skills were found in children in the combined center- and home-based (p < 0.001) and the center-based intervention (p < 0.01). Children in both intervention groups showed increases in outdoor physical activity and consumption of healthy food. Process evaluation data showed high levels of protocol implementation fidelity and program participation of children, Head Start staff, and parents. CONCLUSION: The study demonstrated great promise in creating a health-conducive environment that positively impacts weight and gross motor skill development in children at risk for obesity. Program efficacy should be tested in a randomized trial.

Motivational interviewing skills are positively associated with nutritionist self-efficacy.

OBJECTIVE: To examine the relationships between physical and social self-concepts, motivational interviewing (MI), and nutrition assessment skills with dimensions of counseling self-efficacy. DESIGN: Cross-sectional survey. SETTING: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics. PARTICIPANTS: Sixty-five WIC nutritionists. MAIN OUTCOME MEASURES: Counseling self-efficacy on topics related to physical activity and nutritional behaviors and in the presence of language and cultural differences. ANALYSIS: Multiple linear regression. RESULTS: Nutritionists' perception of their own MI skills was positively associated with their self-efficacy for counseling clients of a culture different than their own, when counseling about physical activity, and when counseling about nutrition behavior. Hispanic ethnicity and social self-concept were positively associated with counseling self-efficacy when culture differences were present. Physical self-concept was positively associated with self-efficacy related to physical activity topics. Nutrition assessment skill was negatively associated with self-efficacy for working with non-English-speaking clients. CONCLUSIONS AND IMPLICATIONS: Development of MI skills and strategies to improve social and physical self-concept may increase WIC nutritionists' counseling self-efficacy, particularly when counseling clients from diverse backgrounds.

Increasing physical activity in preschool: a pilot study to evaluate animal trackers.

OBJECTIVE: This report describes a pilot study to evaluate Animal Trackers (AT), a preschool program designed to (1) increase structured physical activity (PA) during the preschool day; (2) increase practice of gross motor skills; (3) provide teachers with an easy-to-use PA program regardless of teacher experience; and (4) implement a teacher walking intervention. DESIGN: Pilot observational study in volunteer preschools. SETTING: Nine preschools in New Mexico. PARTICIPANTS: Two-hundred seventy 3- to 5-year-old children and 32 teachers. INTERVENTION: Daily 10-minute classroom activities for children. MAIN OUTCOME MEASURE: Implementation and duration of AT activities, teacher preparation time, and added weekly time spent in structured PA. ANALYSIS: Process evaluation to track program implementation, and pre-post measures to assess outcomes. RESULTS: AT activities were implemented 4.1 times per week (11.4 minutes/activity), with 7 minutes teacher preparation time. Overall, AT added 47 minutes of structured PA per week for children. CONCLUSIONS AND IMPLICATIONS: The AT program increased structured PA time in preschools. Teachers felt that AT was developmentally appropriate; that children enjoyed the activities; and that the children's motor skills improved. Results of the pilot study are encouraging, since research suggests that even small increases in PA could help prevent obesity.