August 2010
Healthy Kids in Hampton Roads:
Galvanizing communities to end childhood obesity
Galvanizing the Faith Community
Turning to the Right Policies
The Virginia Interfaith Center is proud to be a part of the
growing number of collaborations throughout Virginia to
combat the childhood obesity epidemic. This disease threatens
our children and the future of our communities. In schools
across the Commonwealth, the foods that
are served are not healthy or nutritional.
In rural and even urban communities
the accessibility of healthy fruits and
vegetables is a barrier. Physical activity is
lacking in our children’s lives. We know
the causes are avoidable, and as leaders
in our communities, and particularly for
congregations and as parents, we must
address the issue of childhood obesity
with confidence, knowing that the power of community can
make a difference.
This culminating document from nearly two years of
organizing in Western Tidewater, is the product of listening
to and learning from communities in need. I want to thank
the faith community within the Western Tidewater region for
their dedication to this work. This grassroots effort has truly
galvanized community members to tackle the issue and press
for systemic change. The research and community engagement
that have occurred in the last two years would not have been
possible without the dedication and drive of individuals from all
backgrounds, and it is essential that we continue to persevere
together to give our children the brightest and healthiest future
possible.
We can end childhood obesity but it will take the energy and
drive of each of us.
As a pediatrician by trade, I have had a front row seat over the
past quarter century to watch the inception and development
of a new and deadly American epidemic: childhood obesity.
Children who grow up overweight are far more likely to have
health problems as adults than are those
who maintain a lower body mass, and
even though we are in an age with better
information and more food choices than
any other time in history, we are losing
our collective battle against weight
problems. As a doctor, I feel that I have
a moral obligation to do what I can to
help address this problem, and help give
children a chance at a better future, for
their own sake. As a state Senator, I feel that I have an obligation
to my constituents and taxpayers to help combat childhood
obesity so that all of us can avoid paying more in taxes and
health insurance premiums to treat preventable conditions down
the road. The solutions seem simple on the surface. Through
proper nutrition, education, and exercise, we can make our
children healthier. The difficulty, however, is in figuring out
how we provide these resources and services to kids. Parents,
schools, and communities all should play a role, and the best
strategies may be different in different settings. As a member
of the board of trustees for the Virginia Foundation for Healthy
Youth (VFHY), I am proud to say that our efforts have helped
reduce youth smoking by roughly half over the past decade.
VFHY is now taking on this challenge of childhood obesity,
and I believe that through hard work, and the concern and
contributions of groups like the Virginia Interfaith Center for
Public Policy, we will turn Virginia in the right direction.
C. Douglas Smith
President & CEO
Virginia Interfaith Center for Public Policy
LEARN.
PRAY.
ACT.
The Hon. Ralph Northam
Virginia Senate, 6th District.
Introduction
The United States of America is in danger of raising the first
generation of children who will live sicker and die younger than the
generation before them. This is a frightening prospect, and because of
this, the Virginia Interfaith Center for Public Policy, together with the
WHRO Center for Regional Citizenship, has engaged in a campaign to
combat childhood obesity.
Since January 2008, the Interfaith Center has been reaching out to
partners and has had a regional organizer on the ground in the Western
Tidewater area working with faith communities, civic leaders and other
groups to create local capacity to address childhood obesity and to
gain ground-level community insight and understanding of the issues
involved. Our goals in this work have been to develop an empowered
community with an organic interest in childhood obesity while
developing applicable public policy solutions reflective of the real needs
of families in Western Tidewater. We believe that this will create the
required structures for long-term implementation of policy solutions.
The first year of the project focused on reaching out to the faith
community to develop a leadership core known as the Interfaith
Coalition to Combat Childhood Obesity and a second group, the
African American Faith and Fitness Roundtable, a group of African
American faith leaders with professional backgrounds, faith traditions,
and interests. With these two groups in place, we then set out to build
and organize a faith-based coalition connecting with 131 faith-based
organizations throughout rural Western Tidewater with a particular
focus on African American communities. Our work in the field gave rise
to a third structure, the African American Faith and Fitness Women’s
Fellowship, which has been instrumental in our continued success in
creating a community with organic interest in the subject and which
will carry forward the work of policy advocacy and implementation at
the local and state level. All of the women are strong civic, business and
educational leaders from communities throughout Western Tidewater.
Through our two-year engagement with the community through
these leadership structures, we conducted a series of discussions
that helped inform our initial impressions regarding policy concerns
relevant to rural communities of color; documented feedback; bridged
into relevant secular institutions; conducted asset mapping exercises;
identified structural and environmental changes desirable within
the rural context; and established 68 new relationships with secular
partners. In this report, we present the problem of childhood obesity,
what we learned from our work on the ground, and our assessment of
the path forward for crafting and implementing effective policies that
will help our communities be healthier places for all of us.
The Problem
State Level
The obesity crisis in the Commonwealth of Virginia is one which
requires immediate attention. Childhood obesity is indeed a health
crisis which threatens family stability and the overall quality of life for
communities across the state.
According to the Virginia Department of Health, 61.6 percent of
Virginia’s adult residents are overweight and 31 percent of youth are
categorized as either overweight or obese. In their seminal study, F is for
Fat: How Obesity Threatens America’s Future, the Trust for America’s Health
and the Robert Wood Johnson Foundation conclude that the current
obesity trend threatens the nation as a whole. According to the study,
obesity rates among adults have increased in 28 states over the last year.
Virginia is among 16 Southern states which have the highest obesity rates
in the country. Other data and statistical sources such as the Women
Infant and Children (WIC) program also reveal startling numbers. The
latest enrollment data available from Virginia’s WIC program indicates
that 16 percent of participants ages 2-5 are overweight, while 12 percent
are “at risk” for becoming overweight.1 Further, the American Journal
for Preventative Medicine shows that the U.S. prevalence of obesity
climbed from 14.1 percent of the population in 1993, to 26.7 percent in
2008 – an 89.9 percent increase.
The facts are astounding:
• In terms of chronic health disease data, 28% of Virginia’s
population has high blood pressure. Further, research indicates
that obesity is often a precursor to diabetes, and coronary heart
disease. In 2008, the Virginia Department of Health’s chronic
disease indicators reports showed that over 153 persons per
100,000 have diabetes.
• In 2003, 30 percent of youth, ages 10 to 17, were overweight or
obese.2 And Virginia – in comparison to other states – ranked 30th
in childhood obesity prevalence.3
• In 2007, 31 percent of young people, ages 10 to 17, were overweight
or obese and the state ranked 27th in childhood obesity prevalence.4
• In 2005, annual obesity-related hospital costs for children and
adolescents nationwide were $238 million, nearly doubling
between 2001 and 2005. Presently, Virginia has the 14th highest
obesity related health care costs in the U.S.: $1.6 billion annually.
Research indicates that obese children tend to miss, on average, two
additional days of school every year as compared to their non-obese peers.
Childhood obesity also disproportionately burdens low-income Virginians
and communities of color. Other sources indicate racial disparities,
showing that 24.7 percent of white children ages 10 to 17 are currently
overweight or obese, as compared to 35.4 percent of African American
children and 29.9 percent of Hispanic children.5
While Virginia has devoted time and resources to address childhood
obesity, the current funding levels for the associated programs remain
inadequate and further funding reductions may erode progress. Recent
efforts to raise awareness and educate communities about the crisis,
such as convening a statewide conference, are necessary and important.
Yet there remains a considerable amount of work that needs to be done
in order to change the trajectory of life events that result from obesity,
particularly for children who will experience the long-term economic and
social impacts of today’s problems for years to come.
Local Level
The cities and counties of Western Tidewater are all working hard to
find ways and means to combat childhood obesity. In terms of childhood
obesity prevention infrastructure, some cities are further along in their
understanding, knowledge and experience. For example, the City of
1
Suffolk considers obesity one of its most important health priorities. The
Suffolk Partnership for a Healthy Community, an independant 501(c)3
organization, was established in 1998 to mobilize community resources
toward making life better for residents of Suffolk. The partnership
commissioned a public health study using the Mobilizing for Action
Through Planning and Partnerships (MAPP) planning space model.
MAPP is a planning tool developed by National Association of County
and City Health Officials (NACCHO), the Centers for Disease Control
and Prevention (CDC), and the U.S. Department of Health and Human
Services-Health Resources and Service Administration (HRSA).
In terms of the issue lifecycle, Western Tidewater communities
are operating at varying stages of understanding, education and ability
to tackle childhood obesity. Our research and field work indicates
that rural communities, villages and neighborhoods require the most
resources and attention, particularly given their geographic isolation.
These specific “pockets” have significant barriers to access in terms of
availability of fresh, wholesome and nutritious food sources. In contrast,
the neighborhoods with the higher per capita incomes such as Northern
Suffolk enjoy the benefits of adequate, or near-adequate access to grocery
stores, food distribution systems and established exercise venues. It is
vitally important to note that a city’s median income may not tell the
full story about the level of systemic lack at neighborhood and/or village
level. Across Western Tidewater, small, tightly knit neighborhoods and
communities must find ways to survive in “food deserts,” areas with
insufficient supply and access to healthy and nutritious foods.
In terms of health statistics, Western Tidewater’s health indicators
show cause for concern. According to the Virginia Department of
Health, almost 63 percent of the individuals living in the community
are considered overweight, and 31 percent are obese. Moreover,
28.7 percent of its residents have high blood pressure. Recent studies
indicate 46 percent of adults are physically inactive. Of the 35 health
districts in Virginia, Western Tidewater ranks 17th in terms of obese
and overweight. Even more disturbing is the fact that less than 20
percent of the area’s adult residents eat the recommended daily
allowance of fruits and vegetables.
According to the Suffolk Partnership 2009 study, childhood obesity
prevention is one of the region’s most important priorities in terms of
chronic disease incidence rates. Their findings also show that roadways
and convenient public transportation systems are inadequate, which
can hinder access to food and opportunities for physical activity. This
is consistent with our findings and the feedback we received from key
participants in both the faith and secular communities. The MAPP report
also finds that addressing the lack of education around nutrition, exercise
and obesity among children is a paramount concern. Recurring comments
from our work with faith leaders and youth affirms the desire to see real
improvements in recreational space and the overall built environments.
Our Work & What We Heard
Community Overview
Western Tidewater comprises six rural localities – two cities
(Suffolk and Franklin) and four counties (Isle of Wight, South
Hampton, Surry and Sussex) – located in the Hampton Roads region
2
of Virginia. The area covers 1,603 square miles and has a population
of 163,995. For perspective, the City of Suffolk (400 square miles)
and South Hampton County (600 square miles) together account for
just under two-thirds of the Western Tidewater area. While Western
Tidewater is part of the greater and expanding Hampton Roads region,
the area maintains a strong rural character and is home to hundreds of
farms and significant agricultural production.
Still, there are a few neighborhoods that are characterized as
suburban with higher per capita incomes as compared to the rest of
the region. For example, the median income in the City of Suffolk is
just over $54,000, while in neighboring Norfolk, median income is
just over $31,000. In addition, although the City of Suffolk supports
an expanding suburban community, much of the city’s land mass
comprises rural farm land where residents still live in small villages
and enclaves.
The area is 57 percent Caucasian and 40 percent African
American. The County of Sussex, and the City of Franklin have
the highest concentration of African Americans (58 percent and 53
percent, respectively). Surry County, one of the most rural of the four
counties, has the next highest population of African Americans.
As a result of the region’s expanding suburban base, the poverty
index is relatively low. The overall poverty rate is 12.6 percent with
Sussex County having the highest poverty rate (20.7 percent), and Isle
of Wight with the lowest (7.8 percent). According to a 2009 Hampton
Roads Planning District Commission report, the total number of
persons living in poverty is 19,994.
Engaging the Faith Community
While the area is predominantly Protestant Christian, with most
of those congregations identifying as Baptist, there are congregations
from other mainline Protestant denominations including Episcopal,
Presbyterian, Lutheran and Methodist, as well as a few Roman Catholic
congregations and an African American Jewish temple. The area does
not have an active Muslim community.
In partnership with WHRO, we intentionally focused the
research efforts on those sectors of the community that have direct
involvement, influence on, and concern about how the current
policy environment impacts low-income families, and communities
in general. We used qualitative research methods to gain greater
understanding and insight into the beliefs, attitudes, opinions and
feelings of a variety of stakeholder groups, seeking to get at a deeper
truth as it relates to obesity using the pathway of the faith community.
There were multiple stakeholder groups who were instrumental
in facilitating the research and data collection process. Through the
work of the OBICI Healthcare Foundation, the Suffolk Partnership
and the City of Suffolk Department of Health, we were able to
obtain key data related to childhood obesity. Obici provided funding
support for a three year study in the City of Suffolk, which revealed
information regarding gaps in obesity prevention services, as well as
vitally important overweight and obesity statistics and prevalence data.
To avoid a duplication of effort, we narrowed the scope of our project
to include only the following key stakeholder groups: 1) Faith and
congregational leaders; 2) Secular practitioners; and 3) Youth.
Faith and congregational leaders are those individuals who are
either the titular head of a congregation or who play a key leadership
role in its day-to-day operations, including in some cases key ministry
area leaders. Beyond the faith community, we reached into the secular
community to include nonprofit executives and managers, health and
wellness practitioners, and agency staff. Through one-on-one meetings
and scheduled discussions we received valuable insight and feedback.
Finally, youth 11-14 years old participated in a series of discussion
groups and a one-day health and fitness forum.
Each target stakeholder group was asked a series of questions
crafted to suit the unique role they play in the community, and seven
churches were selected to host discussion groups. These churches were
selected because of their distinct ability to influence citizens within
their respective communities. Since recent data indicates that lowincome racial minorities are at highest risk of childhood obesity, five
of the churches were situated in communities of color (i.e. African
American), and two were predominately Caucasian.
Faith Community
Over the course of 18 months, faith leaders were invited to
participate in multiple information-gathering activities such as group
discussions, and one-on-one interviews. During the initial phases
of the project, 92 key participant interviews were conducted with
ministerial leaders from Western Tidewater.
The leaders expressed frustration with the barriers they face
as a consequence of structural poverty across three areas: access,
environment and their potential to help. For example, transportation
emerged as a theme. Participants said that the absence of affordable and
easily accessible transportation makes it difficult for residents to get
to the grocery stores that are often more than 30-40 miles away from
their homes.
One participant quipped: “What are you talking about eating
healthy foods? First I have to find someone to get me to the store,
which is close to impossible because everyone I know either has no
vehicle, or it broke down, and then once I get to the store, I can’t
afford anything no way, so I get what I know I can afford for me and my
family, and that’s just the way it is for now.”
But there were other concerns expressed about how structural or
systemic poverty manifests itself in terms of dietary options in schools.
Another respondent shared his concern about the kind of food he
has seen in the schools, stating: “First of all, I am sick and tired of my
children being called fat. Have you seen the stuff in the cafeteria? Each
line–the so-called good food line–which has a bunch of ‘pretty junk in
it,’ and then the line for the poor kids is even worse with something
that looks like macaroni and cheese, and some sort of greasy sausage
looking thing, and some fries. I don’t know how to deal with that
because my children have to eat something.”
As pathways toward solutions, the faith community recommended:
1.Increase the number and variety of fresh fruits and vegetable access
points throughout the community, including adding grocery stores.
2.Improve the physical infrastructure in the neighborhoods (i.e. built
environment); play areas.
3.Leverage the faith community’s access to children and make funding
available to install or upgrade the built environments on and around
congregational property.
Secular Leaders
We talked with 71 representatives from the secular community.
Most of the leaders were either nonprofit executives or health
practitioners. We also engaged health promotion experts from the
Virginia Department of Health and the Consortium for Infant and
Child Health (CINCH) at Eastern Virginia Medical School. The
expertise and insight from these participants was key to gaining a
better understanding of what specific policies require advocacy support
from healthcare professionals. In addition to conducting one-on-one
interviews with various individuals, we also facilitated a discussion
group for the secular leaders.
Themes that emerged from the secular stakeholder community
include organizational coordination and a focus on nutritional
requirements of school lunches. For example during our group
discussion, one participant said: “I want to see us working together in
a cohesive manner, not hit or miss, which is what it seems like we are
doing now. There is too much focus on grant territories, not on getting at
the underlying factors causing this horrible situation.”
Additionally, several participants shared their concern about
the lack of attention being given to early childhood prevention and
intervention programming at the state level. Current budget cuts to
schools, health services projects, and early childcare facilities are causing
obesity rates to increase. As one participant noted, “Look, it’s like this
–We either pay today or pay tomorrow in increased heart problems,
unhealthy kids, and diabetes. We need prevention money so we can get
more educational programs into the school, communities, and childcare
facilities. It’s not a good situation right now.”
Specific recommendations from this group included:
1.Create a specific funding category at the state level specifically
for childhood obesity prevention, and target funds towards most
vulnerable communities.
2.Facilitate more effective collaboration among stakeholder groups
and partners.
3.Support increased education about adverse food marketing and
advertising that lead to overweight and obesity.
Youth
During the final phase of the outreach process, 89 youth attended
the First Annual Youth Advocacy and Education Obesity Summit in
rural Southeastern Virginia. The summit galvanized the community
around childhood obesity prevention with specific attention given to
documenting the beliefs, concerns and ideas of youth between the
ages of 11 and 14. The event was sponsored by the African American
Women’s Fellowship
Generally, the youth shared their thoughts, ideas and beliefs about
how childhood obesity impacts them individually, their families and
the community at-large. They were particularly forthcoming about the
school environment, and the challenges they face in terms of access
to nutritional meals.Youth used characteristically strong, descriptive
language to tell their story: school food is “too fatty, sloppy and greasy”;
3
“definitely unhealthy, youth don’t like it.”
The youth also shared their thoughts about the role of adults and
parental influence. Some youth said: “They tell you to go play outside,
but we never see them playing or exercising–what’s wrong with that
picture?”; “They buy unhealthy stuff for us–they control what we eat.”
Although their opinions were strong, they also were able to
articulate some of the positive benefits of having adult role models
and parental involvement. For instance, some recommended that
parents could assign chores around the house as a means of encouraging
movement and physical activity.
Specific recommendations from youth include:
1.Involve youth in designing and planning prevention programs to
ensure they are culturally and age appropriate.
2.Change the food offerings in schools and community centers,
including congregations, so that the nutritious options are more
appealing and integrated into other times throughout the day, not
just during the scheduled lunch time.
3.Reinstate recess in schools and/or structured fitness times
throughout the day.
4.Increase parental involvement in nutrition, food preparation and
involve them in educating their families and children.
5.Make exercise fun and exciting.
6.Discontinue serving high fat, high calorie foods in schools.
Observations
In our work to educate and organize the faith community around
the issue of childhood obesity, we found many regional impediments to
healthy eating and exercise, and we identified a range of opportunities for
behavioral and policy change in three primary areas of policy concern:
public awareness, access to healthy food, and physical activity.
Public Awareness
In Western Tidewater, and the Commonwealth at-large, there remains
a significant and continuing need to raise public awareness of childhood
obesity.While presently underutilized, the faith community is well
positioned to play an active role in public education. However, engaging the
faith community for this purpose will require the support
and guidance of other entities with expertise in relevant fields, specifically,
the Virginia Cooperative Extension.
The Virginia Cooperative Extension, which has a notable presence
in the Western Tidewater region, is a leading state agency for crafting and
implementing wellness, nutrition, and physical activity programs to combat
the obesity epidemic.6 To expand the reach of its resources, and establish
the faith community’s role in raising awareness, there is an opportunity for
increased collaboration between the agency and area congregations, and to
advance public policy to sustain these working relationships.
Western Tidewater congregations have long-standing relationships
with local Cooperative Extension agents. Faith community leaders and
Extension agents could leverage these relationships by co-sponsoring
educational workshops and training seminars featuring those individuals.
Through educational workshops, agents and other partnering agencies
can paint a more complete picture of the region’s existing food deficits
and help faith leaders and congregations develop plans for filling the gaps.
4
Extension agents could provide information on existing nutrition standards
for school meals through these gatherings and highlight new legislation
that requires the Department of Health and the Department of Education
to develop guidelines for competitive foods sold in schools. Successful
education outreach would help focus communities more accurately on
the areas where policies are in place but need implementation and where
policies need development.
At the family systems level, the need for more educational
programming about effective meal planning and preparation is necessary.
Caregivers, parents and adult role models should be encouraged to
participate in such programs so that they are better able to make sure
nutritious food is available to children.The faith community can play a
critical role in this process by offering such programs, and promoting
the message throughout the community. Raising awareness of healthier
cooking options for church meals and menu planning could have a broad
and beneficial effect on the community.
In addition, educational workshops and training seminars could
offer information on community gardens tailored to the level of interest
expressed by individual congregations. At some events, representatives
from the Virginia Cooperative Extension and partnering agencies
could provide guidance on how to use church property, or neighboring
land, to grow fruits and vegetables. At others, extension agents could
highlight innovative methods through which congregations can partner
with farmers, or other neighbors, to use existing gardens as a training
ground for nutrition education.
Finally, workshops and seminars could help the faith community
increase physical activity within their churches and within the
community at large. Extension agents and representatives from the
Department of Health could provide strategies for improving physical
fitness through interactive sessions and hands-on activities.
In addition, legislation enacted during the 2010 session of the Virginia
General Assembly could serve as a springboard for
congregational events to raise awareness about childhood obesity:
January 20 is Healthy Youth Day, created to celebrate children making
sound lifestyle choices, such as eating healthy foods, exercising
regularly, and not using tobacco products7; April 25 is Youth Fitness
Day, seeking to encourage young people, and other citizens of the
Commonwealth, to engage in physical activity to maintain healthy
living8; the second full week of November is Virginia Farm-to-School
Week.9 Virginia Farm-to-School Week encourages local school divisions
to promote daily physical activity and reduce childhood obesity.10
Against this backdrop lie multiple opportunities for faith communities
to be part of the wider community’s effort to learn about and promote
good habits that combat childhood obesity.
Access to Fresh, Wholesome & Nutritious Foods
The Center’s two-year-long observation reveals that a majority of
rural Western Tidewater is a food desert paradoxically located within a
production oasis.
In 2007, the latest year for which data is available, a total of
1,125 acres of vegetables were harvested across five of the region’s
six localities.11 Residents, however, often struggle to access fresh
produce. In several of the communities, there are no large or mid-size
grocery stores– less than one per 1,000 residents – ceding the market
to smaller convenience stores. Most of the communities use either
mom and pop stores, or corner stores to purchase their weekly food
provisions. These stores very rarely, if ever, stock fresh foods choosing
instead to stock foods with a long shelf life and low keep-fresh
requirements. The food tends to be what is referred to as “thrift food”
which is several days old, and has very low nutritional value.
Congregations should ensure that there are no significant policy
barriers to establishing congregational/church-based fresh food
distribution systems. Communities in Western Tidewater may benefit
from improved zoning and mixed-use ordinances which could help
promote church-based distribution systems.
Examples of zoning-related options available that some cities
include are: establishing new “community or congregational garden”
districts within the zoning code and encouraging farmers’ markets by
making market activities explicitly-permitted uses within commercial
districts. Other options may involve using zoning codes to include
fresh food distribution points on congregational land or incentivizing
the development of full service grocery stores in underserved areas
or encouraging healthy mobile food vending. These sorts of innovative
zoning and ordinance policies will likely lead to improvements in the
overall food environments in communities most at risk.
Transportation continues to be a major barrier as well. This
situation seems to be consistent with national data and trends as it
relates to rural poverty and obesity trends as a whole. Geographic
isolation contributes to social and economic disparities, making it
extremely difficult for rural citizens to gain access to a consistent
source of healthy and nutritious foods.
Moreover, nearly 20 percent, or more, of low income households
without a car are located more than a mile from a grocery store.12 The
faith community has capacity to help bridge existing gaps. The most
logical starting points for achieving measurable progress in this area are
Virginia’s Farm-to-School Program and local farmers markets.
Increase participation inVirginia’s Farm-To-School Program
Virginia currently operates a Farm-To-School Program that links
local farmers with area schools to incorporate more locally grown
fruits and vegetables into school meals.13 The Virginia Department
of Agriculture and Consumer Services administers the program and
maintains a Web site that lists schools, farms, and distributors that
participate in the initiative.14 Based on the most recent list, there
are no school divisions or farmers from the Western Tidewater area
participating in the program.15 To achieve maximum impact a deadline
could be established for getting all public schools in areas at high risk
for childhood obesity to participate in the Farm-to-School program.
A series of educational workshops and events that feature
Virginia’s Farm-to-School Program as one of multiple vehicles
for improving access to healthy foods could be a good first step in
building awareness of the program and identify likely participant
farmers and schools. During these workshops, representatives from
the Virginia Department of Agriculture and Consumer Services
should provide information on how the program works and how
congregations can play a role in getting area farmers and schools to
participate. By devoting time and labor to increase enrollment, and
otherwise aid the initiative, the faith community can invest in the
success of the Farm-To-School program.
Establish new farmers’ markets and increase accessibility
Presently, only half the localities in the Western Tidewater area
have a farmer’s market.16 With a regional population around 165,000
and few grocery stores, additional units are needed. To address this
problem, leaders should consider establishing farmer’s markets in Isle
of Wight, Sussex, and Surry – localities that currently lack them.17
Additionally, existing and new markets should be made more accessible
to low-income families with limited access to transportation by adding
a mobile component to their operations, possibly bringing available
products out into the communities.
In addition, the Virginia Department of Agriculture and
Consumer Services, the Virginia Cooperative Extension, and managers
of existing farmers’ markets could help congregations acquire the
knowledge and technical support needed to establish and anchor
farmers’ markets in underserved areas.
Active Living & Built Environment
Residents of the Western Tidewater area recognize that increased
physical activity is essential to fighting childhood obesity. However,
recreation and fitness facilities are few and far between in the Western
Tidewater area with less than one venue for every 1,000 residents.18
The overall lack of recreational facilities and sports fields throughout
the region make it difficult for families to get the amount of exercise
they need to maintain optimal health.
As congregations are significant community gathering locations,
pastors, ministry leaders, and zoning experts should work together
to identify impediments to the development of recreational facilities
on church property and, where they exist, amend them to allow
congregations to erect recreational and fitness facilities on their
property. All too often, churches and congregations are not included
in land use and zoning policy planning that promote active living in
communities most at-risk.
Furthermore, where facilities do exist, fees often function as a
barrier to access, particularly for low-income families. To tackle the
monetary barrier to entry, congregations could explore public-private
partnerships to help reduce or remove membership costs.
Improve Standards in Public Schools
Participants reported that the quality of food in public systems,
particularly in the schools, is less than desirable in terms of nutritional
value. Parents indicate that, “Too much greasy, unhealthy stuff is being
served. I wouldn’t even eat the stuff. Why should I want my child [to
eat that stuff?] Are we setting our children up for failure?”
While in school, more than 90 percent of children eat lunch,
close to 20 percent eat breakfast, and approximately 40 percent have
a snack.19 The food students consume in school can make up as much
as 40 percent of their daily energy intake.20 Presently, at least 20 states
and the District of Columbia have set nutritional guidelines for school
lunches, breakfasts, and snacks that are more stringent than existing
5
USDA requirements.21 Virginia, however, continues to follow the federal
government’s standards, which have not been updated to ensure that
nutritious foods are served in schools.22 Rigorous nutritional standards
are essential to combating childhood obesity and require Virginia to
update the expectations it has for food quality and ingredients. Virginia
lawmakers should consider establishing guidelines that exceed the
limited standards established by the federal government.
In addition, at least 29 states and the District of Columbia limit
when and where competitive foods may be sold beyond federal
requirements.23 Virginia recently enacted a law to establish nutritional
guidelines for competitive foods, and the Board of Education, in
cooperation with the Department of Health, have been mandated to
adopt either the Alliance for a Healthier Generation’s Competitive
Foods Guidelines or the Institute of Medicine’s Recommended
Standards for Competitive Foods in Schools as the initial statewide
standard for competitive foods. The Board must report this decision to
the General Assembly by December 1, 2011.
Body Mass Index
Body mass index (BMI) is a measure of whether a person’s weight
is healthy in proportion to height.24 It is widely accepted as a reliable
indicator of body fat content and a screening tool for weight categories
that can lead to health problems.25 Twenty states across the nation
collect body mass index data for children and adolescents.26 Presently,
Virginia does not collect BMI, but should do so in order to establish
adequate data to monitor progress on obesity.
Use of this screening tool is supported by the Institute of
Medicine and also several federal agencies.27 Although this issue
may be of concern to some, and this policy item was not specifically
recommended by the stakeholder groups, schools have been screening
children for medical issues for many years now with such common
screenings as eye and ear exams. According to the National Governor’s
Association Center for Best Practices’ study, Shaping a Healthier
Generation, collecting BMI data would not only increase awareness of
weight issues, but also of general health, including awareness of the risk
for diabetes and heart disease, factors that have become more apparent
in the lives of our children across the nation.
Preserve funding for the Virginia Cooperative Extension
Recognizing that childhood obesity is a growing epidemic in the
Commonwealth, the Virginia Cooperative Extension has developed
programs to promote good nutrition and increase physical activity.28
Virginia’s budget crisis, however, could undermine the viability of
these initiatives. During the 2010 legislative session, state lawmakers
cut funding for the agency by nearly $3 million.29 Additional cuts
would severely impact the ability to deliver information and provide
services. To maintain this valuable resource, particularly in vulnerable
communities, funding for this agency should be increased, or at a
minimum, should be preserved at existing levels for the remainder of
the 2010-2012 biennium.
6
Initiative & Policy Recommendations
Consistent with the observations laid out in this report, the
following initiatives and policy recommendations should be considered
and implemented.
Public Awareness
• Increase collaboration between the Virginia Cooperative Extension
and area congregations.
Cosponsor educational workshops and training seminars
• Effective meal planning and preparation.
• Physical fitness and exercise
• Promote implementation of existing policies and nutrition standards
for school meals.
• Explore use of congregational space for community gardens.
• Explore partnerships with local farmers to teach gardening basics.
• Use legislation enacted during the 2010 session of the Virginia
General Assembly as a springboard for congregational events to raise
awareness about childhood obesity:
• January 20 is Healthy Youth Day, created to celebrate children
making sound lifestyle choices, such as eating healthy foods,
exercising regularly, and not using tobacco products.
• April 25 is Youth Fitness Day, seeking to encourage young
people, and other citizens of the Commonwealth, to engage in
physical activity to maintain healthy living.
• The second full week of November is Virginia Farm-toSchool Week. Virginia Farm-to-School Week encourages local
school divisions to promote daily physical activity and reduce
childhood obesity.
Access to Fresh, Wholesome & Nutritious Foods
• Examine local zoning and mixed-use ordinances for barriers to
establishing congregational/church-based fresh food production and
distribution systems.
• Implement Virginia’s Farm-to-School Program.
• Establish farmers markets in Isle of Wight, Sussex and Surry.
• Add mobile component to existing farmers’ markets to extend
product availability into the community.
• Create congregational capacity to establish farmers’ markets.
Active Living & Built Environment
• Examine local zoning and mixed-use ordinances for barriers to the
development of recreational facilities on church property.
• Include congregations in land use planning and zoning policy
development to promote active living.
• Explore public-private partnerships to help reduce or remove
membership costs at fitness facilities.
Improve Standards in Public Schools
• Revise set nutritional guidelines for school lunches, breakfasts, and
snacks that exceed the limited standards established by the federal
government through the USDA.
Endnotes
1 V irginia Department of Health. CHAMPION Obesity Prevention Plan. Retrieved 8/2/10 from http://www.vahealth.
org/NuPAFP/Champion/championplan.htm
2 Childhood Obesity Action Network. State Obesity Profiles, 2008. National Initiative for Children’s Healthcare
Quality, Child Policy Research Center, and Child and Adolescent Health Measurement Initiative. Retrieved
08/02/10 from http://www.nschdata.org/Content/ObesityReportCards.aspx
3 Ibid.
4 Childhood Obesity Action Network. State Obesity Profiles, 2009. National Initiative for Children’s Healthcare
Quality, Child Policy Research Center, and Child and Adolescent Health Measurement Initiative. Retrieved
08/02/10 from http://www.nschdata.org/Content/07ObesityReportCards.aspx
5 The Trust for America’s Health and the Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens
America’s Future 2010. Retrieved 8/2/10 from http://healthyamericans.org/reports/obesity2010/
6 Virginia Cooperative Extension. (Available at http://pubs.ext.vt.edu/index.html)
7 Virginia Senate Joint Resolution No. 124, (2010). Available at http://leg1.state.va.us/cgi-bin/legp504.
exe?101+ful+SJ124ER
8 Virginia House Joint Resolution No. 198, (2010). Available at http://leg1.state.va.us/cgi-bin/legp504.
exe?101+ful+HJ198
9 Virginia House Joint Resolution No. 95, (2010). Available at http://leg1.state.va.us/cgi-bin/legp504.
exe?101+ful+HJ95
10 V irginia Senate Joint Resolution No. 85, (2010). Available at http://leg1.state.va.us/cgi-bin/legp504.
exe?101+ful+SJ85
11 United States Department of Agriculture, Food Atlas. (Available at http://maps.ers.usda.gov/FoodAtlas/foodenv5.
aspx)
12 Ibid.
13 Virginia Department of Agriculture and Consumer Services, Farm-to-School Program (Available at http://www.
vdacs.virginia.gov/marketing/farm.shtml).
14 Ibid.
15 Ibid.
16 Virginia Department of Tourism, Virginia’s Farmers Markets (Available at http://www.virginia.org/site/features.
asp?FeatureID=467).
17 Ibid.
18 United States Department of Agriculture, Food Atlas. (Available at http://maps.ers.usda.gov/FoodAtlas/foodenv5.
aspx)
19 Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America’s Future 2010. Retrieved 8/2/10
from http://healthyamericans.org/reports/obesity2010/
20 Ibid.
21 Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America’s Future 2010. Retrieved 8/2/10
from http://healthyamericans.org/reports/obesity2010/
22 National Governor’s Association Center for Best Practices. Shaping a Healthier Generation: Successful State
Strategies to Prevent Childhood Obesity. Retrieved 8/2/10 from http://www.rwjf.org/childhoodobesity/product.
jsp?id=48568
23 Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America’s Future 2010. Retrieved 8/2/10
from http://healthyamericans.org/reports/obesity2010/
24 National Conference of State Legislatures. Promoting Healthy Communities and Reducing Childhood Obesity,
Legislative Options 2009. Retrieved 8/2/10 from http://www.rwjf.org/childhoodobesity/product.jsp?id=40908
25 Ibid.
26 Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America’s Future 2010. Retrieved 8/2/10
from http://healthyamericans.org/reports/obesity2010/
27 National Governor’s Association Center for Best Practices. Shaping a Healthier Generation: Successful State
Strategies to Prevent Childhood Obesity. Retrieved 8/2/10 from http://www.rwjf.org/childhoodobesity/product.
jsp?id=48568
28 Virginia Cooperative Extension. (Available at http://www.ext.vt.edu/news/mediakits/nutritionexercise.html)
29 Virginia State Budget. 2008-2010 Biennium (Available at http://leg1.state.va.us/cgi-bin/legp504.
exe?101+bud+B1-A229); 2010-2012 Biennium (Available at http://leg1.state.va.us/cgi-bin/legp504.
exe?101+bud+21-A229)
• Adopt either the Alliance for a Healthier Generation’s Competitive
Foods Guidelines or the Institute of Medicine’s Recommended
Standards for Competitive Foods in Schools as the initial statewide
standard for competitive foods.
• Begin collecting Body Mass Index (BMI) data for children and
adolescents.
Preserve funding for the Virginia Cooperative Extension
• Maintain or increase funding for this agency for the remainder of the
2010-2012 biennium.
Conclusion
Childhood obesity has become increasingly problematic in the
Commonwealth of Virginia. However, the collaboration of numerous
stakeholders can address and lessen the problem through public
awareness, advocacy, policy changes, and policy implementation.
Stakeholders include the faith community, health educators, policymakers, public agencies and the residents of the various communities
that comprise the Western Tidewater area. Focusing on both
congregational and family systems is crucial, while also recognizing
that policy developed at local and state levels will be an integral vehicle
to create change.
Residents of rural communities often have strong ties with policymakers. This potential for collaboration provides great opportunities to
identify specific issues that contribute to increased rates of childhood
obesity in those areas. Residents associated with the faith community
can also utilize their relationships within the congregation to facilitate
change in their churches and communities. Empowerment of
community members is imperative to addressing childhood obesity
because solutions must be implemented on an ongoing basis, leading to
long-term systemic and structural change.
Change must begin within local communities, and broadening
public awareness of this epidemic is essential to furthering the cause.
Increasing access to healthy foods can be accomplished in multiple
ways, but once again, must begin at the local level. Physical activity
must be increased within schools, congregations, and communities
as a whole. Improving nutritional standards in public schools is vital
to ensuring that our children are not only fed healthy foods, but are
also being educated at an early age on the importance of nutrition
and physical activity. Supporting organizations that are working to
fight this epidemic with our monetary donations, personal talents and
resources, and time contributions are essential in enabling change. The
consequences of inaction are too great, not only for our generation,
but also for the future.
Support for this work was provided by a grant from the Robert
Wood Johnson Foundation.
7
Appendices
Appendix I: Existing State Policies and Programs
State lawmakers have employed a broad range of strategies to
reverse Virginia’s childhood obesity epidemic. They have studied the
issue exhaustively, passed resolutions supporting public awareness
efforts year-round, and enacted legislation to increase access to healthy
foods and promote physical activity, particularly in schools.
The executive branch is also actively engaged in the fight against
childhood obesity. Multiple state agencies have launched initiatives to
help communities tackle this complex challenge.
Highlighted below are state laws crafted to combat Virginia’s
childhood obesity epidemic and programs implemented by state
agencies to address this multi-faceted challenge.
Efforts to Study the Epidemic
Virginia has done its homework on childhood obesity. In 2003,
the state’s Commission on Youth studied the issue and produced a
report covering much ground, namely: the prevalence, causes, and
consequences of overweight and obesity; the ways through which
parents and schools can improve the health and nutrition of our
youth; and the statewide initiatives designed to tackle the epidemic.30
More recently, in 2007 the General Assembly established a joint
subcommittee to examine methods of combating childhood obesity
in public schools.31 At the conclusion of its review, that group
produced three policy recommendations; two of which the General
Assembly enacted.32
Efforts to Increase Physical Activity
Physical activity is a key component of proper weight management
and overall health. Virginia’s youth, however, like children and adolescents
in other states, lead increasingly sedentary lifestyles. Research indicates
that television, video games, and the Internet have replaced sports, dance,
bicycling, and other forms of physical activity as favorite youth pastimes.33
In recent years,Virginia lawmakers have taken steps to reverse this trend.
Physical Education
The U.S. Surgeon General recommends that children engage in
at least 60 minutes of moderate physical activity on most days. Today,
however, only 42 percent of children ages 6 to 11 and only 8 percent of
adolescents ages 12 to 19 meet these guidelines.34 Research suggests
that students who spend more time in physical education or other
school based physical activity can improve their fitness levels and scores
on standardized achievement test.35
Against this backdrop, in 2008 Virginia lawmakers added 30
minutes of physical activity to school curricula, aiming to achieve
at least 150 minutes per week through a combination of physical
education classes and extracurricular activities.36
Best Practices Database
In 2008, Virginia also enacted a law that required the Department
of Education to develop and manage a database –accessible to all
8
local school divisions and the Department of Health – that contains
best practices for promoting nutrition and physical activity.37 Among
other items, the database includes fitness-test results from local school
divisions and descriptions of successful programs and policies that have
been implemented.38 Information is submitted on a voluntary basis,
as local school divisions are encouraged, but not required, to provide
material for the database.39
Virginia recognizes the importance of interagency collaboration in
the fight against this growing epidemic. In 2007, the General Assembly
enacted a law requiring the Superintendent of Public Instruction and
the State Health Commissioner to work together to combat childhood
obesity and other chronic health conditions that affect school-age
children.40 The key objective of this policy is to make clear that both
agencies have an active role to play in combating childhood obesity.41
Efforts to Increase Access to Healthy Food
Like physical activity, a well-balanced diet is essential to proper weight
management and good health. Today’s youth, however, regularly eat
meals containing excessive amounts of sugar, fat, and/or high calorie
foods with limited nutritional value.42 Even more alarming, healthier
options are difficult to come by in some geographic regions.43
In recent years, Virginia lawmakers have taken concrete steps to curtail
these problems.
Farm to School
Policies that increase local sources of food will provide consumers with
healthier choices, farmers with more marketing opportunities, and
communities with powerful economic development opportunities.44
With this understanding, Virginia established a farm-to-school program
in 2008.45 Like similar efforts across the nation, the initiative links small
farmers with local schools. The state Department of Agriculture and
Consumer Services administers the program and employs a coordinator
to market and facilitate it in public and private grade schools, as well as
colleges and universities. As part of the initiative, the agency maintains
a website that identifies schools, farms, and distributors with an
expressed interest in participating.46 The information displayed serves
a “match-making” function.47 In addition to lists, the farm-to-school
website includes a manual on food distribution and food safety for
farmers and school food service directors, tools for calculating costs,
tips on how to establish local programs, and instructional materials to
support nutrition education efforts.48
The Department of Agriculture and Consumer Services has also
established a farm-to-school week as part of the overall program.49 The
agency launched this effort in 2009 and attracted participation from at
least one school district in each region of the state.50 Local newspapers
and blogs showcased the various activities hosted by these schools.51
Nutrition Standards for Competitive Foods
Students often consume up to 50 percent of their daily calories in
school.52 Changes in school food policies can improve nutrition, reduce
consumption of empty calories and potentially reduce excess weight
over time.53 With this in mind, state lawmakers turned their attention
to the school environment again in effort to combat childhood obesity.
Specifically, the General Assembly passed a new law governing foods
offered in competition to reimbursable school meals, such as those sold
in vending machines and school stores.54 The new policy requires the
Board of Education, in cooperation with the Department of Health, to
issue and periodically update regulations setting nutritional guidelines
for all competitive foods sold to students during regular school hours.55
The bill also requires the Board to adopt either the Alliance for a
Healthier Generation’s Competitive Foods Guidelines or the Institute of
Medicine’s Recommended Standards for Competitive Foods in Schools
as the initial statewide standard and to report to the General Assembly
on the final regulations by December 1, 2011.56
Efforts to Raise Awareness
Virginia lawmakers have set the stage for drawing public attention
to childhood obesity. To raise awareness, the General Assembly passed
four resolutions – this year alone – expressing support for a varied mix
of approaches to tackling the epidemic. One established a Healthy Youth
Day to celebrate children making sound lifestyle choices such as eating
healthy foods, exercising regularly, and not using tobacco products.57
Another created a Youth Fitness Day, seeking to encourage young people
and others to maintain healthy living by engaging in physical activity.58
The third measure established a statewide Farm-to-School Week to
connect schools directly with community farmers; enable schools to
more easily purchase fresh, local produce; and positively impact the
lifelong healthy eating behaviors of our children.59 And the final measure
encourages local school divisions to promote daily physical activity and
reduce childhood obesity.60 In previous years, the General Assembly
passed resolutions designating a National School Breakfast Week and a
Healthy Students; Healthy Virginians Week.61 Scheduled throughout the
year, and set to be honored annually, these observances create multiple
opportunities to educate the public about childhood obesity.
To further raise awareness, the General Assembly has expanded
the Virginia Tobacco Settlement Foundation’s mission to cover
childhood obesity prevention.62 Prior to this move, the Foundation
devoted its resources, exclusively, to reducing and preventing youth
tobacco use.63 Because of its marked success, state lawmakers added
childhood obesity prevention to its purview, authorized the use
of tobacco settlement funds for related efforts, and renamed the
organization the Virginia Foundation for Healthy Youth in 2009.64
The Virginia Foundation for HealthyYouth will work to promote
good nutrition and physical activity. Its existing website includes tips for
parents, families, communities and schools to help children and teens
eat right, get fit, and learn to lead healthy lifestyles.65 Moreover, the
Foundation’s Board of Trustees is currently working to develop a strategic
plan to address the problem of childhood obesity across Virginia.66
Transit-Oriented Development
To effectively combat childhood obesity, neighborhoods must
be structured to encourage physical activity. Virginia’s Office of
Intermodal Planning and Investment has an essential role to play in this
regard. In 2007, the General Assembly modified its purpose, making
the office responsible for coordinating the inclusion of adequate
pedestrian, bicycle, and other forms of non-motorized transportation
in Virginia’s six-year improvement program and other state and
regional transportation plans.67
Statewide Initiatives to Address Childhood Obesity
State lawmakers are not alone in the fight against childhood
obesity. State agencies are also engaged, sponsoring multiple initiatives
to curb the epidemic. Discussed below are key programs and players.
CHAMPION
The Virginia Department of Health works to implement Virginia’s
childhood obesity plan.68 Through an innovative initiative most
commonly referred to as CHAMPION (the Commonwealth’s Health
Approach and Mobilization Plan for Inactivity, Obesity, and Nutrition),
the agency works with communities across the state to curb overweight
and obesity.69 CHAMPION relies on proven strategies to create a healthy
nutritional environment and appropriately emphasize physical activity.
During the initiative’s first year, the Health Department partnered with
the Virginia Breastfeeding Advisory Committee to establish work lactation
support programs.70 The agency also provided technical assistance and
training to advance BodyWorks – a program designed to help parents
of adolescents improve family eating and physical activity habits. The
Department of Health makes funding available for community groups to
implement CHAMPION recommended programs.71
Healthy Virginians
The Healthy Virginians program, led by the Governor’s office,
promotes healthy lifestyles in our workplaces, our schools and among
families who receive health care through Medicaid.72 It links state
employees to informational programs and onsite bi-annual health
screenings, which test blood pressure, cholesterol, and blood glucose.73
The program also encourages state employees to use a daily 15-minute
break for walking or other exercise and to participate in the America
on the Move program to record daily activity.74
To promote good nutrition and increased physical activity in
schools, Healthy Virginians works to expand participation in our state’s
School Breakfast program and promotes the Governor’s Nutrition and
Physical Activity Scorecard, an initiative that recognizes and rewards
schools for encouraging healthy habits.75 This web-based program
allows schools to compete locally and statewide to see which is
healthiest.76 Points are awarded according to implementation of best
practices, including:
• Providing a minimum of 30 minutes daily recess that promotes
physical activity;
• Encouraging middle and high school students to design their own
individualized exercise plans;
• Creating school- and community-based Fitness or Nutrition Nights;
• Allowing only foods which meet minimum nutritional standards to
be provided or sold during the school day; and
• Selling only 100% fruit juice, water, or low-fat milk.77
Schools earn points by completing the scorecard and receive a Gold,
Silver, or Bronze award for exemplary health practices if qualified by
their scores.78
9
Safe Routes to School
Safe Routes to School is a federally-funded program designed
to: enable and encourage children, including those with disabilities,
to walk and bicycle to school; make bicycling and walking to school
a safer and more appealing transportation alternative, thereby
encouraging a healthy and active lifestyle from an early age; and
facilitate the planning, development, and implementation of projects
and activities that will improve safety and reduce traffic, fuel
consumption, and air pollution in the vicinity of schools.79 The Virginia
Department of Transportation helps localities achieve these goals and
administers funds for the program. Presently, twenty-six communities
across the state participate in Safe Routes to School.80
Virginia Action for Healthy Kids
Action for Healthy Kids is the nation’s leading non-profit
and largest volunteer network fighting childhood obesity and
undernourishment by partnering with schools to improve nutrition
and physical activity. Virginia is home to one of 51 teams that currently
operate across the country.81 The Virginia team maintains a website
that includes tips on how parents can be active with their children;
how families and schools can use alternatives to food to reward
good behavior; how school fundraising efforts can promote good
health; and how school parties and celebrations can be healthy and
fun. The website also includes results from the team’s 2006 parental
engagement project targeting rural schools.82
During the 2009-2010 school year, Virginia Action for Healthy
Kids partnered with the Virginia PTA to promote the Fuel Up to Play
60 initiative to schools across the state.83 Its primary goal was to
bring parents, teachers, school nurses, school nutrition directors, and
students together to increase wellness policy implementation around
the Commonwealth.84
The Virginia Cooperative Extension:
The Virginia Cooperative Extension is an educational outreach
program of Virginia’s land-grant universities – Virginia Tech and
Virginia State.85 It is also affiliated with the National Institute for Food
and Agriculture.86 Each year, the Extension delivers research-based
programs to citizens across the state, grounded in four subject areas:
family and consumer sciences, 4-H youth development, agriculture and
natural resources, and community viability.87 In 2008 alone, more than
1.7 million people were reached through its face-to-face initiatives.88
Presently, the Virginia Cooperative Extension’s childhood
obesity efforts include a Family Nutrition Program designed to help
low income families and children learn to eat healthier and move
more.89 To qualify, individuals must be eligible for the Supplemental
Nutrition Assistance Program (SNAP) or WIC.90 Most local Extension
Offices have a program assistant available to provide guidance and
resources.91 Key areas of focus include community gardening and meal
preparation.92 Instruction is provided through one-on-one training,
community groups, or in-school enrichment.93
The Virginia Cooperative Extension also sponsors a physical
activity program called FIT Extension.94 Fit Extension aims to get
10
Virginians to engage in at least 30 minutes of moderate intensity
physical activity five or more days each week. It also seeks to increase
fruit and vegetable consumption.95 The program runs for eight weeks
during spring and requires participants to join six-member teams
comprised of friends, co-workers, or family members.96 The teams
set goals, report their achievements, and have their progress featured
weekly on the program’s website.97 At the end of the eight-week
period, Fit Extension recognizes teams who meet their goals.98
Appendix II: Community Stakeholder Feedback
Over the course of two years we engaged three stakeholder
groups through one on one interviews and group gatherings. The
verbatim comments below come from those meetings and form the
basis for our assessment of the community’s views on the issue and
solutions for the problems of obesity.
Stakeholder Group 1: Faith Community
Issue: Access to healthy food
Feedback:
• Not enough consistent access to fresh and nutritious food sources
• Lack of grocery stores and/or markets, particularly in the most
rural neighborhoods and communities
• Too far to drive or gain access; considerable transportation barriers
• Food is way too costly even when accessible, particularly for
single-headed households
• Lack of access to funding and essential planning tables
• Lack of effective and consistent healthy food distribution systems
(i.e. there are no formal systems for getting food to churches and
getting residents to churches and food kitchens)
• Lack of access to key decision makers at the local, state, and
national levels
• Food is way too costly even when accessible, particularly for
single-headed households
• Lack of access to funding and essential planning tables
• Lack of effective and consistent healthy food distribution systems
(i.e. there are no formal systems for getting food to churches and
getting residents to churches and food kitchens)
• Lack of access to key decision makers at the local, state, and
national levels
• Not taken seriously as solution providers
Issue: Access to recreational activities
Feedback:
• Too many communities lack access to recreational activities
• Joining fees are too costly, or offerings are inconsistent with the
financial and economic realities of impoverished and vulnerable
populations
• Lack of authentic partnering agreements featuring faith leaders and
community stakeholders in communities of color
• Lack of culturally relevant and effective programming to address
childhood obesity in a long-term manner
Issue: Schools and places where children play and access food
Feedback:
• Too many food access points containing unhealthy food options,
such as vending machines
• Lack of parental involvement in designing, implementing, and
sustaining solutions
• Need to strengthen or maintain Cooperative Extension services in
vulnerable communities throughout Western Tidewater, both at the
local and state level
• Insufficient funding levels to promote nutrition and healthy
lifestyles via the Cooperative Extension
• Lack of consistent nutrition and healthy lifestyle education in
churches
• Lack of “homegrown” educators, facilitators, and information
sources for self-empowerment
Issue: Built Environment
Feedback:
• Too few, if any, play areas
• Play areas and physical activity infrastructures are too far apart in
terms of square miles, making consistent physical activity difficult
• Lack of education and awareness about joint-use or mixed use
agreements
• Lack of faith-based inclusion in key decision-making processes with
respect to joint-use agreements and zoning ordinances
• Lack of vision for leveraging church buildings, infrastructure,
and properties as possible sites for community-wide recreational
facilities, fun places to play, obtaining nutritious meals
• Lack of funding and resources to support the development of
playground equipments and other elements of the built environment
Issue: Advertising, Marketing, andVending
Feedback:
• Way too many advertisements promoting unhealthy food choices
• Media images
• Too many fast food establishments as opposed to healthy food options
• Barriers to funding for churches and places of worship to assist
with developing social marketing campaigns that promote healthy
alternatives
Priorities:
• Lack of grocery stores and/or markets, particularly in the most
rural neighborhoods and communities
• Barriers to engaging in physical activity
• Lack of parental involvement in designing, implementing, and
sustaining solutions
• Too few play areas
Stakeholder Group 2: Secular Leaders
Who are we and what do we care about?
• Families
• Single mothers/Grandmas
• Resource Mobilizers
• Extension Agents
• Public Health Practitioners
• Early Childhood Developer
• Person with personal experience as an obese child, dealing with
socio-emotional affects
• Care about early childcare investment; former teacher
• Farmer, extension agent
• Mom/wife; care about child health
• Social Justice issue
• Nursing coordinator; parent involvement
• Media/Public health; food activism
• Public change/policy and education
Issue:What are some key environmental factors contributing to
childhood obesity?
Feedback:
• Poverty (Highest)
• Built environment (2nd )
• Food marketing/advertising (3rd )
• Geography
• Lack of access to fresh fruits/vegetables
• Lack of access to safe places to play/physical activity
• Attitude; and parental education and awareness across all factors
Issue:What seems to be working in terms of combating childhood
obesity in Western Tidewater?
Feedback:
• Offer vs serving strategies, more schools trending in this direction,
especially in Isle of Wight
• National champion (i.e. Michelle Obama), and recent media attention
• Push toward buy fresh, buy local
• Improvements in awareness levels in schools; and willingness to
initiate healthier alternatives
• Quality Childcare
• Making the healthier choices easier
Issue:What’s not working?
Feedback:
• Parental time deficits
• Legal implications for schools (e.g. BMI)
• Too little options for daycare, or in-home after care
• Positive reinforcements for consumption of unhealthy food options
• Social norming
• Lack of effective transportation policy to create environments
facilitating physical activity
• Lack of understanding regarding food contents, labeling and
ingredients
• Bad food too accessible
• Accessibility vs. affordability dilemma
• Integration of national, community, family systems and local
policy planning
11
Issue: How do we help move the needle towards improving outcomes?
Feedback:
• Too many pieces of the puzzle
• Mental health, early childcare, continuum, parental, school
standards, physical education, medical, helping professions
• Must find ways to increase collaborative energy amongst all
stakeholders
• Focus on the socio-ecological model
• Everyone must have a role, and ask where can I best fit
• Set up universal guide posts and standards
• Identify universal metrics in order to collect data and stats
• Improve interagency communication and collaboration across all
levels, including funders
• Facilitate sharing of knowledge, information and resources
• Make sure families, parents and youth have proper tools for
decision-making
Stakeholder Group 3: Youth
Issue: In a perfect world, what would your community have to do
to reduce childhood obesity? What would that world look like?
Feedback
• Picnics with nutritious food options, more fruits and vegetables
instead of just meat and hamburger
• Lots of fun and playgrounds everywhere
• Getting along (with no gangs)
• Stop world hunger
Issue:Why do you think so many young folks are gaining weight,
or are not as physically active anymore?
Feedback:
• They see someone eating
• Addicted to food (they like the way it tastes way too much)
• Parents give guidance on what to eat not kids
• Lazy
• A lack of physical activity
• Can’t stop eating
• Sleeping after eating
• Boredom
• Thinking food solves problems
• Watching too much TV
• Giving up on themselves
• Teasing, stigmatized, sad and depressed
Issue: How about in the school setting& what are we eating? Do
you consider it nutritious?
Feedback:
• Food is definitely unhealthy
• Lack of choices
• Some children bring unhealthy food from home, and some bring
healthier foods from home
• Fattening, lots of greasy, sloppy food
• Should bring salads
12
• Kids choose the less nutritious options
• Always a bunch of meat, no fruit
• Youth don’t like the food
• Youth don’t recognize healthy options
• Too much frozen food
Issue:What’s very important to you in terms of getting to a better
place regarding active living and childhood obesity?
Feedback:
• More fun exercise options
• Eat healthier foods/Eat less unhealthy foods
• Determination (make your mind up to eat better foods)
• Get out of the house, and turn off the TV
• Pay attention to what you are eating
•Make better choices
• More sports activity
• Diet
• Riding bikes, and dancing
• Eat only to store fat (in case you are unable to eat, or afford good
food at some point)
• Eat more fruit
Issue:What about your friends and peers. How do they discuss
issues related to active living?
Feedback
• They want to Dance
• Want to have more fun activities
• We want to play outside, but where it is appealing
• Playing sports
• Swimming
• Jogging
• Walking and running
• More basketball
• Wii games
• Working out and push-ups
Issue:What about parental influence? Is there a role for parents?
Feedback
• They buy healthy and unhealthy foods
• They control what we eat
• They will tell you go play outside. Can we do more activities with
them, like walking the dog, or something?
• Some of them eat bad stuff, like chips
• Make sure they eat fruit and veggies
• They could assign chores around the house
Issue: Okay now, what is your idea of perfect world?
Feedback
• Eating fruits and veggies
• Burning some calories
• Doing much more exercise
•TO KNOW THAT YOU ARE HEALTHY!
• Getting plenty, and much more rest
Endnotes
30 Virginia Commission on Youth. Childhood Obesity, Final Report, 2003.
31 Virginia General Assembly, HJ 637, 2007.
32 Joint Subcommittee Studying Childhood Obesity in Virginia s Schools. Meeting Summary, 2007. Retrieved
8/2/10 from http://dls.state.va.us/GROUPS/childobesity/meetings.htm; Virginia General Assembly, HB 242, 2008;
Virginia General Assembly, HB 246, 2008.
33 Robert Wood Johnson Foundation. F as in Fat: How Obesity Threatens America s Future 2010. Retrieved 8/2/10
from http://healthyamericans.org/reports/obesity2010/
34 National Governor s Association Center for Best Practices. Shaping a Healthier Generation: Successful State
Strategies to Prevent Childhood Obesity. Retrieved 8/2/10 from http://www.rwjf.org/childhoodobesity/product.
jsp?id=48568
35 Journal of Adolescent Health Supplement. Adolescent Obesity: Towards Evidence-Based Policy and Environment
Solutions. Retrieved 8/2/10 from http://www.rwjf.org/childhoodobesity/product.jsp?id=48309
36 Virginia General Assembly, HB 242, 2008.
37 Virginia General Assembly, HB 246, 2008.
38 Ibid.
39 Ibid.
40 Virginia General Assembly, HB 2214, 2007.
41 Interview. Jessica Eades, Staff Attorney, Virginia Division of Legislative Services, 2010.
42 Bridging the Gap and the Robert Wood Johnson Foundation. School Policies and Practices to Improve Health
and Prevent Obesity: National Elementary School Survey Results. Retrieved 8/2/10 from http://www.rwjf.org/
childhoodobesity/product.jsp?id=64429
43 United States Department of Agriculture, Economic Research Service. Access to Affordable and Nutritious Food
Measuring and Understanding Food Deserts and Their Consequences. Retrieved 8/2/10 from http://www.ers.
usda.gov/publications/ap/ap036/
44 Robert Wood Johnson Foundation, Leadership for Healthy Communities. Action Strategies Toolkit, A Guide for
Local and State Leaders Working to Create Healthy Communities and Prevent Childhood Obesity. Retrieved 8/2/10
from http://www.rwjf.org/childhoodobesity/product.jsp?id=42514
45 Virginia General Assembly, SB 797, 2008.
46 Virginia Department of Agriculture and Consumer Services, Farm-to-School Webpage. http://www.vdacs.virginia.
gov/marketing/farm.shtml
47 Ibid.
48 Ibid.
49 Ibid.
50 Ibid.
51 Ibid.
52 U.S. Department of Agriculture. School Nutrition Dietary Assessment Study-II: Summary of Findings. Accessed
8/2/10.
53 Robert Wood Johnson Foundation, Leadership for Healthy Communities. Action Strategies Toolkit, A Guide for
Local and State Leaders Working to Create Healthy Communities and Prevent Childhood Obesity. Retrieved 8/2/10
from http://www.rwjf.org/childhoodobesity/product.jsp?id=42514
54 Virginia General Assembly, SB 414, 2010.
55 Ibid.
56 Ibid.
57 Virginia General Assembly, SJ 124, 2010.
58 Virginia General Assembly, HJ 198, 2010.
59 Virginia General Assembly, HJ 95, 2010.
60 Virginia General Assembly, SJ 85, 2010.
61 Virginia General Assembly, SJ 239, 2009; Virginia General Assembly, HJ 726, 2007.
62 Virginia General Assembly, HB 2456, 2009.
63 Virginia Foundation for Healthy Youth Website http://www.healthyyouthva.org/about.asp
64 Ibid.
65 Virginia Foundation for Healthy Youth Website http://www.healthyyouthva.org/vyop/
66 Ibid.
67 Virginia General Assembly, HB 2850, 2007.
68 Virginia Department of Health Website, http://www.vahealth.org/NuPAFP/Champion/index.htm.
69 Ibid.
70 Virginia Department of Health, CHAMPION Obesity Prevention Plan, Accessed http://www.vahealth.org/NuPAFP/
Champion/championplan.htm
71 Ibid.
72 Healthy Virginians Website http://www.healthyvirginians.virginia.gov/
73 Healthy Virginians Website http://www.healthyvirginians.virginia.gov/Employees/index.cfm
74 Ibid.
75 Virginia Foundation for Healthy Youth Website http://www.healthyvirginians.virginia.gov/Students/index.cfm
78 Ibid.
79 Ibid.
78 Ibid.
79 Virginia Safe Routes to School Website, http://saferoutesvirginia.wordpress.com/
80 Virginia Department of Transportation, Safe Routes to School Program Website, http://www.vdot.virginia.gov/
programs/ted_Rt2_school_pro.asp
81 Virginia Action for Healthy Kids Website http://take.actionforhealthykids.org/site/Clubs?club_id=1211&pg=main
82 Ibid.
83 Ibid.
84 Ibid.
85 Virginia Cooperative Extension. (Available at http://www.ext.vt.edu/about)
86 Ibid.
87 Ibid.
88 Ibid.
89 Virginia Cooperative Extension, Family Nutrition Program Website http://www.fcs.ext.vt.edu/fnh/fnp/index.html
90 Ibid.
91 Ibid.
92 Ibid.
93 Ibid.
94 Virginia Cooperative Extension, FIT Extension Website http://www.fitextension.ext.vt.edu/?q=node/2
95 Ibid.
96 Ibid.
97 Ibid.
98 Ibid.
• To know and understand the food pyramid
• Taking care of my body
• Start a garden
• NO CANCER, AIDS & just a healthy world!
• Look up website with/healthy ideas
• World peace
• Feedback from educational workshop sessions
13