Childhood Obesity Prevention for the Greater Kansas City Area
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KANSAS CITY CHILDHOOD OBESITY COLLABORATIVE-WEIGHING IN
Childhood Obesity
Prevention for the
Greater Kansas City Area
Inventory of Community Capacity and Assets
2011
CHILDREN’S MERCY HOSPITALS AND CLINICS-2401 GILLHAM – KANSAS CITY MO 64108
Contents
INTRODUCTION ..........................................................................................................................................................4
The Problem ...........................................................................................................................................................4
Purpose and Objectives ..........................................................................................................................................4
Definition—Childhood Obesity Prevention ............................................................................................................4
Criteria for Inclusion in the Community Capacity and Asset Inventory .................................................................5
Process to Collect Asset Information .....................................................................................................................6
RESULTS ......................................................................................................................................................................6
Inventory Categories ..............................................................................................................................................6
Population, Racial/Ethnic and Income Groups Served ...........................................................................................8
Information Needs and Communication Channels. ...............................................................................................9
Programs ............................................................................................................................................................. 10
Collaboration ....................................................................................................................................................... 11
Resources and Assets .......................................................................................................................................... 13
Priority Activities Related to Childhood Obesity ................................................................................................. 13
Other.................................................................................................................................................................... 15
DISCUSSION ............................................................................................................................................................. 16
Population group focus ....................................................................................................................................... 16
School-age children ......................................................................................................................................... 17
Pregnancy ........................................................................................................................................................ 18
Breastfeeding .................................................................................................................................................. 19
Infancy and Early Childhood ............................................................................................................................ 20
Other Issues Related to Childhood Obesity Prevention Capacity ....................................................................... 22
Information Needs........................................................................................................................................... 22
Capacity to Track Childhood Obesity Indicators.............................................................................................. 22
Communication-Message Dissemination ........................................................................................................ 23
Systems Approach ........................................................................................................................................... 24
Governance Framework .................................................................................................................................. 25
Treatment ........................................................................................................................................................ 26
Works Cited ............................................................................................................................................................. 26
APPENDIX 1-Interview Tool ..................................................................................................................................... 29
APPENDIX 2-Agencies and Organizations Interviewed ........................................................................................... 34APPENDIX 3-Agencies and Organizations Interviewed by Population Group ......................................................... 35 APPENDIX 4-State and National Agencies, Organizations and Programs ............................................................... 36 APPENDIX 5-Programs by Strategies ....................................................................................................................... 44 This report was written by staff from Kansas City Childhood Obesity Collaborative-Weighing In based at Children’s Mercy Hospitals and Clinics with support from the Health Care Foundation of Greater Kansas City. The opinions expressed in this report are those of the author and do not necessarily reflect the views of the Foundation. September 2011 For questions about the content of the report, contact: Deborah Markenson, MS, RD, LD Kansas City Childhood Obesity Collaborative-Weighing In Children’s Mercy Hospitals and Clinics Telephone: 816-234-9223 E-mail: dmarkenson@cmh.edu
INTRODUCTION The Problem There is deep concern about the health of our children and the epidemic of childhood obesity. Kansas City data reflect that 31% of low-income children under five years of age are overweight or obese (1) and for older children, Score 1 for Health found that 41% of school-age children they assessed were overweight, obese or very obese. (2). These children are at risk for early development of diabetes, heart disease and other serious health and social problems. As stated by Melody Barnes, Chair of the White House Task Force on Childhood Obesity in its Report to the President, “This is not the future we want for our children, and it is a burden for our health care system that we cannot bear. Nearly $150 billion per year is now being spent to treat obesity-related medical conditions.” This translates annually to an estimated $212 million in medical spending attributable to obesity in Kansas City, Mo. (3), (4) The problem requires serious attention and fortunately, as stated by the White House Report, there are clear, concrete steps we can take as a society to help our children reach adulthood at a healthy weight. (5) This community capacity inventory was done to help identify the current capacity within the Greater Kansas City area to address childhood obesity and inform future directions for the Kansas City Childhood Obesity Collaborative-Weighing In and other interested parties. This report details the results of the capacity assessment along with specific recommendations on next steps for three population groups—prenatal, early childhood and school-age. In addition, the report outlines infrastructure and general support recommendations for next steps that build on current capacity and help us advance collective efforts to take “clear, concrete steps” to seriously address childhood obesity and create a region where our children can enjoy optimal growth and development. Purpose and Objectives Compile a composite of Greater Kansas City’s community capacity and assets impacting childhood obesity in order to support planning and collaborative prevention efforts. 1. Identify, describe and categorize the capacity and types of activities in which stakeholders, institutions and associations are currently engaged in the Greater Kansas City area related to childhood obesity. 2. Subdivide community assets to address childhood obesity into population groups, namely, prenatal, early childhood (children 0-5 years), and school-aged (children 6-18 years). 3. Identify existing interdependencies and areas primed for creating collaboration to better address childhood obesity. 4. Identify existing resources for sustainable interventions in areas of policy, influence on social norms, leadership and commitment to prevention of childhood obesity. 5. List, describe and categorize the current and future information needs reported by key stakeholders, institutions and associations for addressing childhood obesity. Definition—Childhood Obesity Prevention This inventory includes those individuals or organizations that are engaged in childhood obesity prevention, conduct or participate in activities that address healthy eating, active living and management of a child’s weight. These efforts could be part of research, policy, program, advocacy, or environmental initiatives and could impact
Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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one or more population groups, including parents or caregivers, pregnant women, and children, birth through
18 years of age. (6) Prevention may include these specific activities:
Research to identify effective programs or approaches for addressing childhood obesity or associated risk
factors;
Programs to encourage children and/or their caregivers to maintain a proper balance between food
(energy intake) and physical activity (energy expenditure )to support growth and healthy development, or
manage obesity;
Environment changes to address diet or physical activity risk factors for childhood obesity.
“Environment" means the built or physical environment (i.e., sidewalks, parks, recreation facilities) and
the non-built or social environment (i.e., availability of fruits and vegetables, crime rate); or
Policy changes to decrease the prevalence of childhood obesity, including policies to address diet or
physical activity. Policy means any decisions, guidelines, recommendations or requirements that exist
within an organization, setting or local community, as well as policies at the state or national level.
Criteria for Inclusion in the Community Capacity and Asset Inventory
Singular and collective actions of many agencies, organizations, institutions and governmental entities may
impact children’s growth, development and healthy weight status in the Greater Kansas City area. For the
purpose of this review, criteria were established to help identify those agencies that are taking specific actions
that contribute to the prevention of childhood obesity. The following characteristics were used to determine
which agencies and individuals were included in this review:
Show interest and influence others on the issue;
Demonstrate history of involvement in childhood obesity prevention activities;
Conduct related scope of services (e.g., healthy eating, active living);
Have current capacity (i.e., expertise, staff) to deliver services;
Were either a not-for-profit or governmental agency;
Have authority or oversight related to enforcement of laws, regulations or policies to address childhood
obesity and its risks; and/or
Provide resources or supports for childhood obesity prevention in the Greater Kansas City area.
Agencies which exhibited one or more of these criteria in relation to childhood obesity prevention were included
to the extent that they were identified through this inventory process. This review focused on supports
available for Jackson County, Missouri and Wyandotte County, Kansas since there were finite resources available
to conduct this review and the rates for childhood obesity and its risks are higher in these two counties
compared to others in the region. The author recognizes that there are other agencies that represent capacity to
address childhood obesity in these counties and within the metro-wide area. In addition, this review focused on
the prevention aspects of childhood obesity and did not collect information on programs designed primarily to
treat and manage childhood obesity. Also, physical assets (such as parks, bike paths, or sidewalks) were not
captured in this community asset inventory.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Process to Collect Asset Information
Community childhood prevention asset information was collected through direct interviews and review of
information available on these agencies’ websites. An interview tool (Appendix 1) was developed and used to
provide a consistent way to collect key information for the community capacity and asset profile. Information
on state and federal level programs that oversee or provide supports for childhood obesity prevention efforts is
also included. This information was collected from state and federal websites and from information directly
obtained from staff in the Kansas and Missouri State offices.
RESULTS
A total of 25 entities are included based on information collected from interviews. (Appendix 2 and 3) In
addition, information was collected from an additional 38 state and national programs from their websites
(Appendix 4). Based on the information collected, assets and capacity are categorized into two broad
categories: 1) type of agency or organization and 2) population group.
Inventory Categories: Kansas City Collaboratives–Distinct membership collaborations whose mission
relate to or directly support efforts to prevent childhood obesity were included in this category. There are
overlaps in memberships between these collaboratives. Four collaboratives are included in this review.
1. Building a Healthier Heartland
2. Greater Kansas City Food Policy Coalition
3. Kansas City Childhood Obesity Collaborative-Weighing In
4. Mother and Child Health Coalition
Figure 1. Kansas City Collaboratives Addressing Childhood Obesity Prevention Issues
Greater KC Food Policy
Coalition
KC Childhood
Building a
Obesity
Healthier
Collaborative-
Heartland
Weighing In
Mother and Child Health
CoalitionChildhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Community Agencies
Community Agencies - Not-for-profit organizations providing services primarily in the Kansas City metro area
were included in this category. Representatives from these eight organizations were interviewed:
5. Blue KC
6. Children’s Mercy Family Health Partners
7. Health Care Foundation of Greater Kansas City
8. KC Healthy Kids
9. Menorah Legacy Foundation
10. Mid America Regional Council –including Early Learning and Head Start
11. Mid-America Coalition on Health Care
12. YMCA of Greater Kansas City
Agencies Supporting Schools – There are a number of programs or agencies that provide specific supports to
schools to improve nutrition, meals, physical activity, physical education, health education and health.
Representatives from each of these organizations were interviewed:
13. Alliance for a Healthier Generation
Children’s Mercy Family Health Partners (also reflected in the community group)
14. Energy Balance 4 Kids
15. Junior League of Kansas City (The League’s childhood obesity prevention supports are primarily
school based)
16. Kansas Coordinated School Health Services
17. PE4Life
18. Score 1 For Health
Local Public Health Agencies - Based in a county or municipality, these entities provide a set of services and
oversight as authorized by statutes, ordinances or regulations to protect and improve the population’s health:
19. Independence City, (MO) Health Department
20. Jackson County,( MO) Health Department
21. Kansas City,( MO) Health Department
22. Unified Government of Wyandotte County, (KS) Health Department
State or Federal Government or National Initiative – These programs or agencies are state or federal based and
provide services or oversight within authority granted by state or federal law, regulations and policy. Interviews
were conducted with representatives from the following organizations:
23. US Department of Health and Human Services
24. University Extension (MO)
25. University of Kansas
Kansas Coordinated School Health Services (also shown in school supports section)Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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The following are a list of primarily government based supports that were not directly interviewed but their
respective resources and programs are available to aid local efforts, considered to be of value, and included in
general inventory (Appendix 4)
Federal Government Supports
Let’s Move Initiative
Centers for Disease Control and Prevention
Division of Nutrition and Physical Activity
Pediatric Nutrition Surveillance System
Pregnancy Surveillance System
Division of Adolescent and School Health Programs , including Youth Risk Behavior Surveillance
System, School Health Policies and Programs and others
Behavioral Risk Factor Surveillance System
The Community Guide
US Department of Health and Human Services-Agency for Healthcare Research and Quality (AHRQ)
Innovations Exchange: Paths to healthy weight
Federal Government Supports with Administering State Agencies
USDA (US, KS, MO, local agency administering program where applicable)
Special Nutrition Assistance Program (SNAP)
School Meals Program – School Breakfast and Lunch
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
Child and Adult Care Food Program (CACFP)
Summer Food Service Program (SFSP)
State specific supports
Coordinated School Health Services(MO and KS)
Missouri Council on Activity and Nutrition
National Non-Profits
Robert Wood Johnson Foundation
National Collaborative on Childhood Obesity Research (NCCOR)
National Institute of Health Care Quality (NICHQ)-Healthy Weight Collaborative and Childhood Obesity
Action Network (COAN)
Yale Rudd Center for Food Policy and Obesity
Alliance for a Healthier Generation
Population, Racial/Ethnic and Income Groups Served
Each interviewee was asked to identify which of the following population group(s) they served: prenatal
(pregnant women); parents or caregivers for children, 0-18 years of age; early childhood-infants to five years ofChildhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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age; kindergarten through 12th grade-school-age children; or general- serve all populations or not specific to any
one population. The results are shown in Table 1 and the name of the agencies by population group is included
in Appendix 3. Sixteen (64%) reported that they served all population groups, four reported that they focused
on 0 to 5 years of age, nine addressed school-age children, six served parents, and one addressed the prenatal
population.
Table 1 Number of Agencies Serving Each Population Group
Population Group Number Percent
Prenatal 1 4%
0 to 5 years 4 16%
Kindergarten through 12th Grade 9 36%
Parents 6 24%
All Population Groups 16 64%
All interviewees reported that they served all racial/ethnic groups with none serving primarily either African
American or Hispanic. Six (24%) stated that they had a higher proportion of African American and/or Hispanic
individuals but did not primarily serve that group. Interviewees were also asked to identify which income levels
their agency served from four options that ranged from all income levels to high income levels. A total of 17
(68%) served all income levels and eight (32%) served primarily low income levels.
Information Needs and Communication Channels.
Organizations were asked whether they have the types of information needed to support current activities and
program objectives related to lowering risks and rates of childhood obesity. A total of 16 agencies (67%) stated
that, in general, they had sufficient information and 8 agencies (33%) stated that they did not have sufficient
information or would like to have more specific information to support current activities and program
objectives. A total of 13 agencies (54%) identified barriers to access or the use of information. The two main
barriers noted were 1) limited availability of information on childhood obesity prevalence, and 2) lack of staff
time and expertise to find and interpret information to support program efforts. It was also noted by a
membership organization that there was a loss of continuity in transfer of information due to board member
and volunteer turnover.
All interviewees were asked if they needed information or had information to share in four specific areas and
their responses are shown in Table 2 below. The type of information most needed related to what programs
and approaches are effective, followed by prevalence data for local areas, and specific information about other
resources or programs available for the Greater Kansas City area. When each interviewee was then asked to
identify their top three priorities for information needed to support their agency’s childhood obesity activities,
those specific items aligned with the prior categories. The top specific need was for information on how to
conduct effective programs, followed by obesity prevalence data with preferences for it packaged at a local
level, e.g., by school, by neighborhood, by city. A close third was a need for information on resources andChildhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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programs available in the metro area. In addition, several stated that it would be of value to know priority areas
for collaboration and how they could best complement existing efforts to prevent obesity. Over half of the
respondents have information they can share but there is wide variance in the types, comparability, and ability
to compile this information in a consistent manner.
Table 2 Childhood Obesity Information Needs and Priorities
Information Need more Have Priority
information information can
(N=25) share
(N=25)
1. Information to understand or describe the extent to 20 (80%) 15 (68%) 1
which obesity prevention programs and treatments
are effective (i.e. solutions and effectiveness)
2. The prevalence and incidence of childhood obesity in 19 (76%) 16 (64%) 2
your target area
3. Information about obesity-related programs, activities 17 (68%) 14 (56%) 3
and resources in your area (i.e., linkages and
resources)
4. How obesity impacts a child's health and well-being 11 (44%) 10 (40%)
over time (i.e., disease burden)
Almost half of the interviewees reported that they disseminated regular newsletters (most were electronic) to
members or constituent groups. All reported that they had websites and one-third reported that they used
social media (e.g., Facebook, blogs, Twitter). All indicated they would be willing to distribute information about
childhood obesity or specific actions being taken in the Greater Kansas City area that would be of interest to
their staff, members or residents.
Programs
Information was collected on the types of services, programs and activities that each agency conducted related
to childhood obesity. A total of 73 programs or activities were reported with more detailed information about
objectives, target population, frequency and means to determine effectiveness detailed for three-fourths of
these programs. There were varying types of activities, ranging from screening to programs designed to change
behaviors or improve knowledge. Others targeted policies or environmental changes to modify behaviors and
risks for childhood obesity, including environmental changes to address diet or physical activity risk factors.
Table 3 below classifies the approaches into 12 different strategy categories, of which 6 are current strategies
recommended by the Centers for Disease Control and Prevention (CDC) to address childhood obesity. (7) A total
of 26 programs (36%) were within CDC’s recommended strategy listing. A full listing of the programs is found in
Appendix 5.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Table 3 – Number of Programs Arranged by Community Strategies
Programs %
by
Community Strategies to Prevent Obesity Strategy
CDC Recommended Community Strategy Categories
Promote the availability of affordable healthy food and beverages 9
Create safe communities that support physical activity 7
Encourage communities to organize for change 6
Encourage physical activity or limit sedentary activity among children and youth 3
Support healthy food and beverage choices 1
Encourage breastfeeding 0
Total Programs within CDC Recommended Strategies 26 36%
Other Strategies
School focused 14
Screening and treatment 9
Research based efforts 8
Education programs and other activities 6
Infant and early childhood focused 6
Funding support 4
Total Programs within Other Strategies 47 64%
Total Programs 73
Collaboration
All interviewed indicated that they currently collaborate with others within the community on childhood obesity
prevention efforts for the Greater Kansas City area. A total of 68 different agencies or types of agencies were
listed as collaborators. There was no list from which to choose; interviewees simply identified those agencies
with which they collaborated. Eleven interviewed (44%) indicated they collaborate with schools. The specific
agencies most frequently listed as those with which interviewees collaborated included KC Healthy Kids (40%-
10); Building a Healthier Heartland (28%-7) Weighing In, Children’s Mercy Hospitals and Clinics, the Greater
Kansas City Food Policy Coalition, and the Mother and Child Health Coalition (all 24%-6); and local public health
agencies (20%-5).Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Table 4 Agencies Reported as Collaborators and Frequencies by Those Interviewed (N=25)
Agencies with which Number Percent
Interviewees (N=25) Collaborated of times
reported
School(s)/School Districts 11 44%
KC Healthy Kids 10 40%
Building a Better Heartland 7 28%
Food Policy Coalition 6 24%
Weighing In 6 24%
Children’s Mercy Hospital and Clinics 6 24%
Mother and Child Health Coalition 6 24%
Local Public Health Agency 5 20%
University of Kansas 4 16%
Mo Council on Activity and Nutrition (MoCAN) 4 16%
MU Extension 3 13%
Beans and Greens Program 3 13%
All indicated that they would be willing to collaborate on new or other childhood obesity prevention strategies.
School-based projects led the list as most frequently identified type of new project or broader collaboration that
the agencies would be willing to add. Many referenced the importance of making sure new collaborations used
evidence based approaches that would complement existing efforts. Specific items identified included Walking
School Bus, calorie counts on menus, and eliminating trans fats in non-chain restaurants on a metro wide basis.
One interviewee indicated a willingness to provide seed money to local innovative, trailblazing programs. Those
programs’ successes, in turn, would better position them to attract support from other funders. This individual
indicated interest in fostering “the excellence that is part of this area” and believed those in the Midwest were
too hesitant to embrace their strengths and be “great."
The interviewees were asked to rank how feasible it would be for their organization to get involved in more
collaborative projects related to childhood obesity on a scale of 1 to 10 (10 being the highest). Responses
ranged from 3 to 10 with 8 as the average.
Responders identified who they viewed as a leader or organization that is influential in advancing the Greater
Kansas City area’s ability to prevent childhood obesity and critical to have on board for collaborations. These
responses are shown in Table 5 below. A total of 43 different organizations, categories and individuals were
identified. Children’s Mercy Hospitals and Clinics was the organization most frequently identified by 64% of the
responders. The other top leaders were Weighing In and KC Healthy Kids, both at 36%, schools (32%), University
of Kansas (28%), and Building a Healthier Heartland and local public health agencies (both-24%). Dr. Sarah
Hampl was the only individual identified multiple times.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Table 5 Agencies Identified as Influential Leaders in Advancing Childhood Obesity Prevention Efforts as
Percent of Total Interviews (N=25)
Influential Leaders or Organizations Number of Percent
interviewees
that listed
Children's Mercy Hospitals and Clinics 16 64%
Weighing In 9 36%
KC Healthy Kids 9 36%
School(s)/School Districts 8 32%
University of Kansas 7 28%
Building a Healthier Heartland 6 24%
Local Public Health Agencies 6 24%
Health Foundations 5 20%
Sarah Hampl, M.D. 4 16%
Chamber of Commerce 3 12%
Mid America Regional Council 3 12%
Resources and Assets
Each person was asked to identify their organization’s most valuable resources and strongest assets and the
following themes were found in the responses:
Broad network and reach,
Expertise and willingness to provide technical assistance,
Funding,
Reputation and top quality staff,
Resources and supports for evidence-based school approaches,
Students and scholars from university-based organizations,
Visionary leadership and committed boards interested in addressing childhood obesity, and
Volunteer pool.
Those interviewed indicated that there was significant potential for additional childhood obesity collaboration.
While the collective values could not be quantified, 23 out of 25 reported that they would be willing to devote
funds, resources or staff time for a collaborative project on childhood obesity.
Priority Activities Related to Childhood Obesity
Interviewees were asked to identify the top three priority activities to prevent childhood obesity. A diverse
array of activities was reported. The most frequent types of activities related to schools, community
collaboration, and activities focused on policy and environmental changes and these were fairly evenly
distributed between categories. Table 6 depicts a matrix of these activities grouped by setting and focus area.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Table 6 Matrix of Priority Activities Reported
Setting School Neighborhood Community-Region Other
Type of
Activity
General Provide technical Support neighborhood Create sustainable Support Head Start and
assistance and resource based initiatives corridors child care initiatives
supports Increase community Support linkage between Educate employers on
Support after school mobilization on HE/AL schools and worksites/ health plan design
programs Conduct adult and youth corporate support Collect and analyze data
Launch and maintain HE/AL programs Work to align activities Increase public awareness
school-based programs, Increase and strengthen of problem and solution
Secure school district community health planning Market services and
support Collaborate with others on provide rationale for use
Conduct youth HE/AL activities Seek and maintain funding
empowerment program Provide technical to support activities
Change school assistance and resource Survive tight times
environments and policies supports Educate and provide
Conduct school-based Establish enforceable policy resources to healthcare
screenings and refer at risk professionals
for weight management Increase community Provide health coaching
treatment gardening Advocate for insurance
Provide counseling for coverage for weight
overweight/ obese children management services
and their families
Healthy Conduct nutrition education Increase access to local, Improve access to local Change mindset on use of
Eating (HE) Establish school gardens affordable healthy food foods fresh fruits and vegetables
Provide nutrition counseling Promote purchase of local
foods in institutions
Expand Beans and Greens
program
Establish Food Policy
Coalition
Active Document impact of Advocate for livable streets
Living (AL) physical activity levels on and improved parks
academic success Promote use of walking Support Metro Green Trail
Increase physical activity trails System
opportunities
Add walking trails
Those interviewed were asked to indicate whether they anticipated changes in their priorities or activities
relating to childhood obesity and why they anticipated those changes. While several indicated that they could
not predict those changes, most reflected that these activities would remain a priority and that efforts would
become more effective not only from improved alignments with others but also from enhanced insights
regarding what works. Several others indicated that they anticipated a continued shift from programs to
broader scale policy and others expected that health care reform may impact access to health care and how
treatment is managed, which in turn may impact prevention activities. The key types of changes anticipated as
they relate to childhood obesity activities are depicted in Figure 2.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Figure 2. Proportional Reflection of Changes Forecast by Interviewees
Align and increase collective
efforts (8)
Become more effective (6)
Keep childhood obesity
prevention as ongoing priority (4)
Shift from program to policy &
environment focus (2)
Adapt based on health care
reform (3)
Not sure (2)
Other
A total of 23 (92%) indicated they would like to see an ongoing process to update an inventory of assets or
community resources available to prevent childhood obesity for the Greater Kansas City area.
Individuals were asked for other comments related to their organizations’ childhood obesity activities. The
general themes and some quotes are included in Table 7. The primary themes reinforced by those interviewed
include maximizing the use of their respective resources and working collaboratively to address childhood
obesity.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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Table 7 General Comments
Theme (Number) Quotes
Strong support for ongoing Like bi-state working relationship and ability of region to identify common
efforts and collaboration (6) needs and issues. There is an openness and willingness to share and
partner in the area.
"Want to be at the table." Have broad range of resources and expertise
and comprehensive array of community programs that can be tailored and
adapted to match needs of area/community/school/setting.
Very serious about childhood obesity, focus of the board and CEO, part of
[the organization’s] national movement.
Much more effective to be collaborative. Need to make changes in the
system with clear focal points.
Committed to maximizing the Our programs facilitate integration and maximize current use of
use of their resources and resources.
supporting others (6)
Would like firmer funding to A lot of us are on soft money--would like to have longer term initiatives,
support childhood obesity real concern about throwing money at non-sustainable efforts.
resources (2) Would like to see community listing of those that have interest in funding
childhood obesity initiatives.
Expand and focus efforts (2) Would like to see more done with child care and school partners
Would like to do more in this arena. Recognize the First Lady's efforts and
I have real concerns regarding what our children are eating.
DISCUSSION
Population group focus
This report organizes the childhood obesity prevention capacity by three population groups, namely prenatal,
early childhood and school age. Risks for childhood obesity are known for each of these groups and evidence is
growing on approaches that are promising or have proven to lower risks for obesity. This population focus
provides a manageable route to review the current capacity and consider next steps that build and leverage our
current capacity to address the complex problem of childhood obesity in more effective and efficient ways.
Valuable capacity represented by Greater Kansas City area agencies and organizations include or primarily focus
on environmental and policy changes to improve healthy eating and active living for all population groups. These
approaches benefit all population groups. KC Healthy Kids, The Greater Food Policy Coalition, Building a
Healthier Heartland and the local public health agencies, to name a few, represent important capacity focused
on the environment and policy domains. These approaches are complementary and reinforce the population
focused efforts.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
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School-age children
The population group for which this inventory reflects the largest capacity is for school-age children. It is
important to note that no one from a school or school district was interviewed but all of those interviewed
supported schools, with six of the interviewees primarily focused on schools and an additional four agencies also
reporting supports for this group. While there were some overlaps in school-based resources and supports,
efforts are coordinated and represent capacity that can be further leveraged by promoting the availability of
these agencies’ services and selecting one or two strategies to coordinate across agencies for the Greater Kansas
City area. In addition, some of those that served all population groups were not aware of the services and
programs available from the school-focused agencies. These agencies could help promote services available
from those specializing in supports for schools, thus helping more schools access those specialized resources.
This in turn could free up time for the agencies serving all groups to focus efforts on areas with fewer resources.
It is also noted that those specializing in school programs and activities are better equipped to assess what each
individual school district and their respective schools need, and consequently tailor supports and resources
provided. There is a wide range of needs among school districts so this tailored approach is helpful.
The most frequent program category was school programs (19% of all programs) and the most frequently
reported collaboration was with schools, with 11 or 44% reporting that they collaborated with schools. In
addition, activities in schools setting were high among those activities reported as priorities to prevent
childhood obesity and there were a diverse array of these activities. This is clear evidence that schools are
currently a focus for obesity prevention efforts and—given the number of school-age children in Kansas City, the
existing mechanisms in schools for education and reinforcement of healthy behaviors, the increased insights we
have on what is effective and the enhanced academic success experienced by physically active and well-
nourished children—schools should remain a focus area.
The Healthy, Hunger-Free Kids Act of 2010 authorized funding for federal school meal and child nutrition
programs and increases access to healthy food for low-income children. This bill reauthorized child nutrition
programs for five years and included $4.5 billion in new funding for these programs over 10 years.
Reauthorization strengthens programs and regulations to implement the provisions of this Act are expected in
2012. (8) "The Healthy, Hunger-Free Kids Act makes the most significant investment in the National School
Lunch program in more than 30 years,” according to U.S. Secretary of Education Arne Duncan. (9)
Some new requirements that will improve nutrition and reduce risks for childhood obesity include these steps:
Gives USDA the authority to set nutritional standards for all foods regularly sold in schools during the
school day, including vending machines, the “a la carte” lunch lines, and school stores.
Provides additional funding to schools that meet updated nutritional standards for federally-
subsidized lunches. This is an historic investment, the first real reimbursement rate increase in more
than 30 years.
Helps communities establish local farm to school networks, create school gardens, and ensures that
more local foods are used in the school setting.
Expands access to drinking water in schools, particularly during meal times.
Sets basic standards for school wellness policies including goals for nutrition promotion and education
and physical activity, while still permitting local flexibility to tailor the policies to their particular needs.
Increases the number of eligible children enrolled in school meal programs by using Medicaid data to
directly certify children who meet income requirements.Childhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
Page 18
Allows more universal meal access for eligible students in high poverty communities by eliminating
paper applications and using census data to determine school-wide income eligibility.
Expands USDA authority to support meals served to at-risk children in afterschool programs.
While national efforts are increasing, state support for coordinated school health services has decreased in
recent years. Missouri has staff available through the Missouri Department
of Health and Senior Services to support school health services but funding
and direct grants to schools have been decreased. The Missouri Department
of Elementary and Secondary Education do not have dedicated staff for
coordinated school health services.
Kansas has supported school health services since 2003. While the program
received a budget cut this year (10) supports remain and Kansas Health
Foundation is funding efforts to compile measures of fitness, including weight
related to academic achievement. The Kansas Department of Education also
tracks self-reported ratings of school districts wellness policies by basic,
advanced or exemplary using the state's School Wellness Policy Model
guidelines. (11)
Recommendations to increase capacity for school-based activities:
1. Compile and disseminate a document that lists and describes the agencies and programs available to
support schools and how to access those services.
2. Assess and track school policies using the online Kansas school wellness policy tracking resource and other
sources to capture the current status of policies.
3. Conduct planning to compile the Greater Kansas City area’s action plan to enhance school policies,
environments and practices. This should focus on helping schools meet the new regulations and policies
that will be required by the Healthy, Hunger Free Kids Act of 2010. Kansas City has notable capacity and
commitment to collaboration in providing supports for schools. This will be an asset to help schools meet
the new higher-bar expectations that will be required.
4. Link and coordinate plans for schools as appropriate with other community policy and environment focused
initiatives to reinforce school actions.
5. Compile succinct position paper summarizing school-based strategies, actions and benefits.
6. Establish consistent messages for use by schools and multiple community school partner groups on food and
fitness issues to effectively communicate and reinforce actions being taken to improve healthy eating and
active living and lower risks for obesity.
Pregnancy
Mothers’ pre-conception weight and weight gain during pregnancy are two of the most important prenatal
determinants of childhood obesity. (5) The Mother and Child Health Coalition was the only agency represented
in this inventory that served the prenatal population but their capacity to address the prenatal determinants of
childhood obesity could be considered quite extensive in view of the over 200 member agencies reflected in
their network from the Greater Kansas City area. Targeted and effective services are also available through the
WIC programs in the area for low-income pregnant women.
There have been dramatic changes in the population of women having babies. American women are now a
more diverse group; they are having more twin and triplet pregnancies, and they tend to be older when theyChildhood Obesity Prevention-Inventory of Community Capacity and Assets
Greater Kansas City Area
Page 19
become pregnant. Women today are also heavier; a greater percentage is entering pregnancy overweight or
obese, and many are gaining too much weight during pregnancy. Many of these changes carry the added burden
of chronic disease, which can put the mother and her baby’s health at risk. New guidelines and insights for how
much weight a woman should gain during pregnancy were issued by the Institute of Medicine in 2009. (12)
Recommendations to strengthen capacity to reduce a child’s risks for obesity prior to and during pregnancy
1. Build on the current infrastructure and supports made available through the Mother and Child Health
Coalition, Weighing In, and local WIC programs to:
a. Review existing approaches and identify ways to increase the number of pregnant women and women
planning pregnancies who have access to information and
supports to conceive at a healthy weight and maintain a
healthy weight during pregnancy. Identify recommended White House Task Force on Childhood
policies and procedures to enhance supports to increase Obesity-Report to the President
the proportion of women who are at a healthy weight and
have a healthy weight gain during pregnancy. Recommendation 1.1: Pregnant women
b. Assess specific training and resources available to agencies and women planning a pregnancy should
serving this target population and augment if needed to be informed of the importance of
enhance approaches to support healthy weights of conceiving at a healthy weight and having
a healthy weight gain during pregnancy,
pregnant women.
based on the relevant recommendations of
2. Take actions to track trends of women’s pre-pregnancy weight
the Institute of Medicine. Specifically,
and weight gain during pregnancy for the greater Kansas City health care providers, as well as …local
area in order to further refine actions needed and evaluate agencies, medical societies, and
which actions are effective. organizations that serve pregnant women or
those planning pregnancies should provide
Breastfeeding information concerning the importance of
Breastfeeding has been linked to healthy weight children in conceiving at a normal BMI and having a
multiple epidemiologic studies. Systematic reviews also indicate healthy weight gain during pregnancy. (5)
that support programs in health-care settings (e.g., Baby-Friendly
Hospital Initiative –BFHI-
http://www.babyfriendlyusa.org/eng/index.html ) are effective in
increasing rates of breastfeeding initiation and in preventing early
cessation of breastfeeding. (7).
At the national level efforts are increasing to support breastfeeding. The White House Task Force on Childhood
Obesity in their Report to the President recommended that hospitals and health care providers should use
maternity care practices that empower new mothers to breastfeed, such as the Baby-Friendly hospital
standards. (5) Healthy People 2020 goals have specific objectives to increase the proportion of infants being
breastfed. (13) The Surgeon General’s Call to Action to Support Breastfeeding has specific recommendations for
mothers and families, health care providers, communities, employers, public health and researchers to increase
the number of infants that are breastfed. (14). The Healthy, Hunger Free Kids Act of 2010 also expands support
for breastfeeding through the WIC program. In addition, health care reform requirements (Section 4207 of the
Patient Protection and Affordable Care Act ) amended the Fair Labor Standards Act (FLSA), or federal wage and
hour law to require employers to provide reasonable break time and a private, non-bathroom place for nursingChildhood Obesity Prevention-Inventory of Community Capacity and Assets Greater Kansas City Area Page 20 mothers to express breast milk during the workday, for one year after the child’s birth. The new requirements became effective when the Affordable Care Act was signed into law on March 23, 2010. CDC’s recent report card on rates of breastfeeding at six months shows both Kansas (41.0) and Missouri (35.1) lagging behind the U.S. rate of 44.3 percent. (15) In the Kansas City area there are supports for breastfeeding such as those provided by agencies offering WIC services, availability of community breastfeeding classes, social media networks for new parents, local mother to mother support groups, training on the new requirements for employers to support breastfeeding employees, and efforts at hospitals to support breastfeeding mothers and their infants. Specifics on these efforts were not captured as part of this survey. The agencies interviewed for this inventory did not indicate evidence of community wide efforts to accelerate the implementation of the Baby-Friendly Hospital Initiative. Only two agencies reported limited activities related to breastfeeding. Concerted efforts to coordinate broader community-based efforts to increase breastfeeding were not reported but training was made available on the new requirements for employers to support their breastfeeding employees. Recommendations for increasing capacity to support of breastfeeding 1. Build on current infrastructure and resources through the Mother and Child Health Coalition and identify feasible actions to increase the number of hospitals in the Greater Kansas City area that are interested and pursuing a Baby-Friendly Designation. Strive to have hospitals in the region on the map within the next two years. (http://www.babyfriendlyusa.org/eng/03.html) 2. Identify if Kansas City employers are experiencing any barriers or problems in providing supports for their employees who are breastfeeding and if they are, explore ways to assure needed and reasonable supports for women in the workforce who are breastfeeding. 3. Convene representatives from child care agencies to compile strategies to identify and implement “baby- friendly” guidelines to support breast fed infants and their mothers to increase the proportion of mothers who are able to breastfeed for longer periods. Infancy and Early Childhood The data reveal that the problem of obesity in infancy and early childhood is pervasive and growing. Almost one-fourth of children aged 2-5 are overweight or obese and the proportions of overweight and obese children in this age group have doubled in 30 years (16). The childhood obesity epidemic requires a sense of urgency and new avenues for prevention focused on the first 5 years of life. (17) Development is more rapid during these early years than at any other time after birth, and young children’s early experiences are “built into their bodies,” affecting neural, metabolic, and behavioral systems in ways that can influence the risk for obesity, health, and well-being through the life span. (18), (19), (20) A number of key factors influence the risk for obesity in an infant or young child, including prenatal influences, eating patterns, physical activity and sedentary behaviors, sleep patterns, and marketing and screen time. Young children are totally dependent on parents, caregivers and others to provide environments and support practices that shape these factors. Only four or 16% of the agencies assessed as part of this obesity prevention inventory focused on the early childhood population group. While an additional sixteen agencies supported all populations (including early childhood), there were limited programs or activities reported for this age group. Collectively, agencies
Childhood Obesity Prevention-Inventory of Community Capacity and Assets Greater Kansas City Area Page 21 reported a total of six programs that focused on infants and/or early childhood. The Mid-America Regional Council (MARC) that serves as the Head Start Administrator for the Missouri region represents solid interest and capacity to address risks for childhood obesity for the area’s children with the highest risks. There are other strong agencies and organizations addressing early childhood and child care issues for this region that were not included in this survey, e.g., resource and referral services for parents and child care providers. Weighing In’s Early Childhood Working Group has representatives from those agencies and their participation reflects additional capacity that will be essential to advancing Kansas City’s efforts to prevent childhood obesity during this critical early growth and development stage. Recently, the Greater Kansas City Obesity Collaborative1 was one of ten teams selected nationally to participate in the Healthy Weight Collaborative, a project created by the Affordable Care Act and supported through the Prevention and Public Health Fund. The Kansas City team will link constituents from three sectors—primary care, public health and community-based organizations—in innovative partnerships in the Kansas City area. This team is exploring a target population of children 2-5 years of age and their families for its initial goals to expand obesity treatment and prevention efforts beyond the walls of a clinician’s office and into the community. The Healthy, Hunger Free Kids Act of 2010 also has provisions supporting nutrition and wellness in child care settings through the federally-subsidized Child and Adult Care Food Program. The White House Task Force on Childhood Obesity (5) recently published IOM recommendations on Early Childhood Obesity Prevention Policies (17). These clearly underscore strategies that can build on Kansas City’s current capacity and strengthen obesity prevention practices that need to begin in early life. Recommendations for increasing capacity to support obesity prevention practices for children under five years of age 1. Assess current standards and practices within child care settings and organizations supporting these settings. Select specific actions to increase the proportion of child care facilities that follow best practices and establish and maintain policies and child care environments that support physical activity, nutrition, healthy feeding practices and professional development opportunities for staff. 2. Review current licensing standards and the Quality Rating and Improvement System to identify to what degree these processes support evolving program practices regarding nutrition, feeding practices, physical activity, and screen time in early education and child care settings. 3. Track and share progress of the Greater Kansas City Obesity Collaborative to develop and test new approaches to achieve and maintain healthy weight for children and families using quality improvement methods. This initiative will focus on best ways to assess overweight and obesity risks among children, refine treatment protocols and guidelines for those with a body mass index (BMI) ≥85th and 95th percentiles, and refine best approaches for the family as a whole. This effort will help identify ways to replicate best 1 The Kansas City Obesity Collaborative core team members consist of representatives from the following agencies: Children’s Mercy Hospitals and Clinics-Primary Care Clinics, Children’s Mercy Family Health Partners, Kansas City Childhood Obesity Collaborative—Weighing In, Kansas City (MO) Health Department, the YMCA of Greater Kansas City, and KC Healthy Kids. The team will use quality improvement methods to develop and test new approaches to achieve and maintain healthy weight for children and families.
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