Pulse
Perfect Blend
In St. Cloud, physicians, hospitals and clinics, schools, community groups, and even a grocery chain are rallying to fight childhood obesity.
By Kim Kiser
When Jodi Rohe takes her 11-year-old daughter and 7-year-old son grocery shopping, she tells them they can pick out any cereal they want as long as it has a number of 30 or higher.
The number is the product’s NuVal score. The scores, which are used in Coborn’s grocery stores in St. Cloud where they live, indicate a food’s overall nutritional value. The system was designed by David Katz, M.D., M.P.H., of the Yale-Griffin Prevention Research Center and introduced at Coborn’s in October 2010. The higher the number, the better the nutritional content. (Post’s Shredded Wheat’ N Bran has a score of 91, for example, while Quaker’s Life cereal has a score of 25.) “My kids can’t read a nutritional panel, but they do know there’s a difference between a 10 and a 50,” Rohe says.
Counting the Cost
$83 billion - the amount U.S. hospitals spent in 2008 caring for people with diabetes
1 in 5 - hospitalizations in 2008 that involved a person with diabetes
25% more - the average additional cost of hospital stays for people with diabetes ($10,937 versus $8,746)
60% - the proportion of cost of hospital stays for people with diabetes paid by Medicare (private insurance, 23% and Medicaid, 10%)
Source: Agency for Healthcare Research and Quality data for 2008 (most recent year)
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The use of NuVal scores is just one project being promoted by Better Living: Exercise and Nutrition Daily (BLEND), for which Rohe is the coordinator. The goal of BLEND, which is supported by the CentraCare Health Foundation, is to reduce obesity rates among children. “Physicians are frustrated by the issue of childhood obesity,” says David Tilstra, M.D., a pediatrician and geneticist with the CentraCare Women and Children’s Clinic in St. Cloud, who talked about BLEND at the Institute for Clinical Systems Improvement’s annual colloquium in May. “Two minutes of counseling won’t change their lifestyle.”
Tilstra, who is also medical director for CentraCare Clinic and who helped initiate BLEND, was hearing from his colleagues about the number of overweight children they were seeing in their practices. “They were seeing the same trends as the rest of the country: an increased number of kids with obesity, and younger and younger kids with adult diabetes and other complications,” he says.
According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the last 30 years. The percentage of obese children ages 6 to 11 years of age increased from 6.5 in 1980 to 19.6 in 2008. The percentage of obese adolescents rose from 5 to 18.1 during the same period. “As medical director, people were coming to me saying we should be looking at doing a project around childhood obesity,” he says. In 2005, Tilstra brought together representatives from area clinics and schools to discuss ways to address the problem. But he knew the medical community couldn’t tackle it alone, and neither could the schools.
The following year, he convened a group that included physical therapists, school nurses and dietitians, and representatives from area businesses and nonprofit organizations including the YMCA, Boy Scouts, United Way, and the Central Minnesota Initiative Foundation. They set a goal of reducing childhood obesity by 10 percent by 2016 and decided to focus on changing the environment as well as behaviors. “We really had no idea where we could go or what we could accomplish,” Tilstra says.
In 2007, with $309,000 from the CentraCare Health Foundation to fund the initiative for three years, they hired Rohe, who previously had run the Smoke Free Communities coalition in St. Cloud, to work with other groups to promote BLEND’s agenda. “We didn’t want to compete,” she says, “we wanted to build on what was working well.”
Going it Together
One of BLEND’s first partnerships was with St. Cloud State University on its Earth Day half-marathon, which included a kids’ 1K run and expo in addition to the adult race. In the past, the expo had featured crafts and a petting zoo. BLEND wanted to change the focus to health and fitness. So they teamed up with Coborn’s to set up an area where kids and their parents could taste healthful foods. “Jicama was one example of something people liked,” Rohe says. They also set up stations where kids could try activities such as bouncing on BOSU balls and riding stationary bikes.
In addition, they used the 2010 half marathon events to kick off the BLEND Fit Kids Club. Kids who complete certain BLEND-endorsed activities can earn awards. The incentives seem to have worked. In 2010, 400 youngsters took part in the Earth Day 1K kids’ run. In 2011, nearly 700 completed it.
BLEND also got involved with National Family Dinner Night, an effort to encourage families to share a meal. Working with Coborn’s and their suppliers, BLEND offered recipes and coupons to families so they could make a healthful dinner for under $10. Rohe says sales of items such as yogurt went up more than 300 percent in response.
In 2007, Coborn’s and BLEND did a 13-week study involving more than 300 children from five St. Cloud-area child-care centers. The children and their parents took part in educational activities around promoting good nutritional choices. Coborn’s also delivered samples of healthful foods to the centers so that the children could try them. “All sites we evaluated were seeing slight or significant changes in terms of parents learning about healthy snack options and the importance of daily physical activity,” Rohe says.
Since then, Coborn’s and BLEND have partnered with Benton County to bring the program to 20 child-care centers. Rohe says they now target not only parents but also child-care providers and facility directors. “It has evolved to where there’s talk about creating policies around physical activity and food: What’s being served for breakfast? As snacks? What’s acceptable for birthday celebrations? How many minutes of physical activity should kids get each day?”
BLEND staff also worked with the Benton County Public Health Department to promote a walk-at-school initiative. The idea is to encourage schools to replace fundraisers that involve selling pizza, candy, cookie dough, and other foods with walk-a-thons. South Junior High School began doing walk-a-thons several years ago. The first one raised $8,000 for the school; this past year’s raised more than $33,000.
Rohe and others affiliated with BLEND worked with the staff from South to create a guide for other schools interested in doing a walk-a-thon. This past school year, eight schools from the St. Cloud, Sauk Rapids, and Avon-Albany school districts held walk-a-thons. “It’s easier for schools,” Rohe says. “And it promotes physical activity while reducing the sale of unhealthy foods.”
Doctors Do Their Part
BLEND has also involved physicians. One initiative was getting clinics to measure children’s body mass index (BMI). “In the past, we haven’t done that,” Tilstra says. “We need to make sure people are looking beyond height and weight when they are seeing kids.” He says physicians often fail to identify kids with high BMIs—especially in the 5- to 8-year-old group. “It’s surprising who is actually overweight,” he says. “You can’t just eyeball the patient.”
In addition, Tilstra says a group of providers led by David Smith, M.D., a pediatrician with St. Cloud Medical Group, created “Rx 5210,” which is based on work of the American Academy of Pediatrics and providers in Maine and is a way to help parents remember that kids should have five or more servings of fruit and vegetables a day, limit screen time to two hours a day or less, get at least one hour of physical activity a day, and consume zero calories from sugar-sweetened beverages. “We put this together on a prescription pad to distribute to parents like a prescription,” Tilstra says. “It’s an easy way to remind them of the basics of a healthy lifestyle.”
Tilstra says they have been distributing the prescription pads with the 5210 message for about a year. “We’ve done small surveys just to see what uptake we had. About 75 percent of the physicians who got them are using them in one way or another,” he says.
As for whether BLEND will meet its 2016 goal, Tilstra says it’s hard to tell yet. (Last year, the CentraCare Health Foundation did provide $680,000 to fund the project for another three years.) From what his group has seen, however, the rate of childhood obesity isn’t shooting up at the rate it was when they started BLEND. “It looks like the curve has somewhat flattened,” he says.