Evidence-Based - California Hospital, School District Collaborate to Cut Obesity-related Risks

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Evidence-Based - California Hospital, School District Collaborate to Cut Obesity-related Risks

January-February 2009

BY: TEDDI GRANT

Ms. Grant is vice president, marketing/communications for mission and community benefit, Northridge Hospital Medical Center, Northridge, Calif

Norma Escobar, the mother of a fourth grader in North Hills, Calif., recently completed a bilingual cooking class at a local elementary school to learn how to prepare healthier foods. She signed on because all of her family members are overweight and have related health concerns, including diabetes and high blood pressure.

Escobar's completion of the class, co-sponsored by Northridge Hospital Medical Center (a member of Catholic Healthcare West), was a success on many levels. She learned how to integrate more fruits and vegetables, whole grains and healthier oils into her cooking and how to serve foods with less sugar and fewer fatty meats. Escobar is now committed to keeping her family healthier and motivated to continue with healthy cooking habits.

Even better, Escobar reduced her weight from 213 pounds to 203 and lowered her total cholesterol numbers from 201 to 143. (Class participants agree to weekly weigh-ins and to cholesterol and blood sugar screenings the first and last day of the cooking series.)

The six-week class is part of the School Based Diabetes and Obesity Initiative, a collaborative effort led by Northridge Hospital in conjunction with the Los Angeles Unified School District and several partners. Los Angeles County is one of many counties contributing to a national trend of near epidemic levels of childhood obesity and diabetes. The county's health department reports that 25 percent of boys and 18 percent of girls attending fifth, seventh and ninth grades are overweight. If this trend continues, officials estimate that one-third of the county's children born in 2000 will develop Type II diabetes.

The School Based Diabetes and Obesity Initiative, which started in 2006, initially targeted five low-income neighborhoods with the ultimate goal to decrease childhood obesity rates with a multi-faceted program that promotes increased physical activity and improved nutrition. This past year, 18 schools participated in the program, and future expansion is in the works.

The hospital designed a robust program for students to adopt routine exercise and healthy eating habits. The health of parents and teachers, coupled with a supportive environment at home and in school, are important to the growth and development of children. Thus, the involvement of parents and school staff in the initiative is an important program component.

Mounting Evidence
Northridge Hospital, located in the San Fernando Valley of Los Angeles County and serving 2.1 million residents, is engaged as a partner with diverse community stakeholders in a variety of efforts to address the symptoms and underlying causes of persistent health problems in the area. The hospital also collaborates with others in advocating for strategies to improve access to health care for people with unmet health-related needs.

As part of the planning process for the obesity program, Northridge Hospital applied information from Catholic Healthcare West's Community Need Index to pinpoint neighborhoods in the valley where the risks for childhood obesity were the highest. Eighty percent of the area students assessed failed the mandated state-wide California FITNESSGRAM, which is a set of tests designed to evaluate health-related fitness and to assist students in establishing lifetime habits of regular physical activity.

Catholic Healthcare West developed the Community Need Index in 2005 to apply scientific rigor to planning and assessing evidence-based community benefit programs.¹ The index identifies the severity of health disparity for every ZIP code in the United States based on specific barriers to access and is based on overall determinants of health, including income, health insurance, education, culture/language barriers and housing. By analyzing those factors, hospitals and communities are able to demonstrate the link between community need, access to care and preventable hospitalization for conditions that, if effectively diagnosed and managed, should be treatable in an outpatient setting. Many health care systems across the country use this index.²

As the map below indicates, all five of Northridge Hospital Medical Center's major community initiatives use the index as an essential tool to precisely target at-risk communities and to measure the success of each community benefit program. The hospital also uses the index as a tool to initiate new strategic outreach efforts, to form the direction of new programs and to support grant writing work.

Measuring Success
In the School Based Diabetes and Obesity Initiative, progress was measured through pre- and post-surveys, as well as by a reassessment of students' health using the California FITNESSGRAM. As a result of the program, both students and adults realized significant improvements in their health. Successes from the School Based Diabetes and Obesity Initiative program include:

Nutrition-related theatrical performances for 5,095 elementary school students: 96 percent of fifth graders stated their intent to eat more fruits and vegetables and exercise more.
Fitness training for 547 fifth-grade students: 65 percent improved abdominal strength and 45 percent improved body strength.
Obesity clinic established and 84 students and their families referred: 100 percent improved physical activity levels and eating habits; 20 percent received intensive case management.
Physical education equipment and medical scales provided at 16 schools.
Cholesterol screenings: 71 percent decreased their cholesterol levels.
Walking groups for 122 parents: 70 percent increased their cardiovascular capacity.
Physical education for teachers in elementary schools as part of professional development and training.
"Active for Life" evidence-based program for 170 school staff and teachers.
Stress management classes for 125 teachers.
Spanish-language "Chronic Disease Self Management Program" offered to parents and teachers in elementary schools.
Bilingual healthy cooking classes for 376 parents: 73 percent lost weight.

The Future
More than 8,900 people have participated in the School Based Diabetes and Obesity Initiative since its inception three years ago. In 2009, 24 schools will offer the program, up from 18 this year, and plans are in place to expand to 36 schools by 2011.

The program recently engaged the American Heart Association as a new partner. The association will focus their efforts on the health of parents in the school district and will primarily offer educational opportunities aimed at prevention of heart disease.

Physical educational programs are not currently offered in the public school program; academic achievement has been the focus. With the knowledge that physical activity plays an important role in the overall health and well-being of students, the hospital is actively seeking funding to support the integration of an evidence-based physical education program with regular classroom activities.