Choose Health!

A new program seeks to reduce obesity among children and to provide education about healthy lifestyles.

For 12 days this past summer, 360 4-H club members strapped on pedometers and logged 5,923 miles tromping around the New York State Fair in Syracuse, N.Y.

It was, after all, a matter of pride.

"The kids went all out to see who could walk the most steps for their county," said Barbara Schirmer, New York State program leader for 4-H Youth Development, one of the master minds behind the Choose Health walking challenge. "At the end of every day the county totals were posted in the 4-H building for all to see."

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Capitalizing on the naturally competitive nature of young people as a way to get them moving is one of the strategies employed in Choose Health, a Cornell Cooperative Extension 4-H program aimed at reducing childhood obesity and educating children about healthy lifestyles.

Josh Skorton and his dad, David, the president of Cornell University, took the challenge, too.

"The time to make changes is early in life, and this is a great motivational tool," Skorton, a cardiologist who works with children, told reporters at the fair. "So many things in our lives conspire against us being-healthy. People can make the fair a healthy experience by walking around a lot and choosing wisely what they eat. It's an uphill battle we all have to fight, and the 4-H program is making it easier."

It took a Genesee County 4-H member with a passion for global positioning systems (GPS) to figure out how to help people cat smarter at a fair notorious for its calorie-laden temptations. Emma Long, a high school junior, and her crew visited all the concessionaires and created an interactive map with pulldown menus that listed the locations of nutritious options from fruit smoothies and tossed salads to roasted corn and Maryland-style crab cakes. The map was up and running on banks of computers inside the 4-H building for fairgoers to consult.

In the United States today the rates of obesity for children from preschool age to their teens has nearly tripled since the late 1970s. Scientists estimate that if current trends are not reversed, one in three children born in the United States in the year 2000 will become diabetic. Although a focus of 4-H activities for more than 100 years, health, the fourth "H" in the pledge, has become more important than ever.

"Although we've done many things over the years in Cornell Cooperative Extension programming with young people, the incidence of childhood obesity has continued to rise," Schirmer said. "We're working hard to retool, to develop strategies that reach more people and will be more effective."

Research presented at the Ecology of Obesity Conference convened by the College of Human Ecology in June 2005 shows that taking a proactive approach, emphasizing physical activity, healthy eating, and changes in the home, school, and community environments has the best chance for success, explaines Josephine Swanson, assistant dean in the college and associate director of Cornell Cooperative Extension (CCE). The approach to Choose Health--the name was coined by 4-H members and adopted by CCE's statewide healthy lifestyles initiative--is based on the idea of making health the default, Swanson said. She cites research findings presented in a recent issue of the Journal of Law, Medicine, and Ethics, in particular the article "Actions Necessary to Prevent Childhood Obesity: Creating a Climate of Change."

"The idea is that rather than chiding people by saying 'Lose weight!' or 'Don't be so sedentary!' we need to create a climate in which choosing healthy behaviors becomes the norm," Swanson said. "And we need to make changes not only in the home and in schools but also in communities as well so that it's easier to choose health."

Helene Dillard, director of Cornell Cooperative Extension, has authorized funding to support a CCE nutrition leader in each extension office across the state to take the Division of Nutritional Sciences online course Preventing Childhood Obesity: An Ecological Approach. In the course, nutrition leaders learn how to identify, prioritize, and address the underlying factors contributing to childhood obesity in their community.

"The information in the course will better equip our nutritionists to work in communities at a preventive level using an approach that makes healthy choices easier," Swanson said.

The course, which is taught by Christina Stark, an extension associate in the Division of Nutritional Sciences, has been shown to help professionals take this new approach. For example, 90 percent of participants who completed a post-course survey felt fairly or extremely confident in their ability to develop an action plan to address childhood obesity in their communities, compared with 29 percent before taking the course. In addition, 92 percent of participants reported confidence in their ability to develop effective community collaborations that support healthy eating and active living, compared with 25 percent before. Follow-up survey results show that six months later, 78 percent had applied what they learned in the course, and 70 percent had implemented at least some of their action plans.

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In August 2007, CCE convened a statewide childhood obesity prevention mini-summit that resulted in 14 multicounty action plans. The planning groups are seeking funding from foundations and other competitive sources to support these comprehensive activities, as well as state funding that may become available through partnering with the New York State Department of Health. Meanwhile CCE maintains its commitment to reducing the incidence of childhood obesity through its ongoing programs across the state and in New York City. In November 2007 Schirmer's office held a statewide health forum for 4-H adult and teen volunteers to focus on ways to implement Choose Health. Wendy Wolfe, a research associate in the Division of Nutritional Sciences who co-chairs the Healthy Lifestyles Program work Team, reviewed research-based strategies that 4-H can use for reversing the child obesity trends. In her keynote address she recommended that 4-H members get involved in advocating for low-cost physical activity programs available to all, as well as creating more walk-friendly communities, including safe ways to walk or bike to school. Youth can also join with adults to sponsor farmers' markets and community gardens. Patricia Thonney, an extension associate within the division who provides leadership for 4-H Youth Development, and others conducted workshops on the wide range of curriculum and resources available to 4-H leaders. Among the most powerful ideas were the most straightforward.

"Most of all, we want 4-H participants to model good behaviors," Schirmer said, "so at 4-H club meetings we are encouraging that nutritious snacks be served and some type of fun physical activity be included."

As Swanson is quick to point out, it is not enough to encourage healthy choices at home--4-H needs to be involved in schools and in the communities as well. To this end, 4-H is developing a Choose Health Ambassador program by which young people reach out to other young people.

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"We believe that teenagers who have been trained in delivering messages about healthy eating and physical activity can have a special impact on younger children," Schirmer said. A case in point is the game where teens have third-graders guess how much sugar is in different beverages by piling sugar cubes next to glasses of soda, fruit punch, and fruit juice. It's pretty eye-opening. Invariably the elementary schoolers underestimate how much sugar each beverage contains.

"This is a graphic way that kids help other kids think about the choices they make," Schirmer explains. Outside the classroom, 4-H club members can be influential with school officials to rid unhealthy choices from vending machines and offering healthy snacks at sporting events.

Meanwhile, plans are fully under way for new Choose Health activities at the state fair. This year fairgoers can take a multicultural look at how crops common to New York State--corn being one--are prepared in healthful ways by other cultures within the United States and abroad.

"On the activity side we plan to have dance groups from different countries teach us some new ways of moving," Schirmer said. "It'll give Choose Health a new flavor."

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"The obesity epidemic is the result of a modern-day mismatch between our biology and our environment, which has created a perfect storm," explained James O. Hill, professor of pediatrics and medicine and director of the Center for Human Nutrition at the University of Colorado, in a keynote address at the Ecology of Obesity Conference convened by the college in June 2005. "The focus must be on prevention because prevention is the most efficient way to address obesity." For a full report of research presented at the conference, see Human Ecology 33:3.

For more information:

Barbara Schimer

[e-mail]

Josephine Swanson

[e-mail]

Wendy Wolfe

[e-mail]

www.4hchoosehealth.blogspot.com/

I pledge my head to clearer thinking

my heart to greater loyalty

my hands to larger service

and my health to better living for my club, my community, my country, and my world

--4-H pledge