Monday, October 24, 3:00 p.m.-4:30
p.m.
Breakthrough: An Integrated Cognitive-Behavioral
Psychosocial, Exercise, and Smart-Eating Intervention With
Internet Coaching To Facilitate Long-Term Weight and Fitness
Management in Obese Teens
Authors
R.M. London1; K.M. Yaeger2.
1Diabetes and Wellness Foundation, Stoughton, WI;
2University of Wisconsin Hospital, Madison, WI.
Background
National health data is telling us that unhealthy
lifestyles are putting teenagers at risk for Type-2 diabetes,
cardiovascular disease, and other preventable diseases. Teens
may find it difficult to manage their health due to
developmental issues, or the influences from their culture,
family, school, or peers. New national and local fitness and
nutrition initiatives do little to help teenagers who are
already overweight. Special programs that help "at-risk" teens
are needed.
Methods
The DaWF piloted an integrated fitness, smart-eating,
and psychosocial weight change program for overweight teens and
their families. The goals of the cognitive-behavioral program
were: (1) reduce barriers to change and increase readiness to
change, (2) improve fitness, (3) reduce weight, (4) improve
decision making, social and coping skills to manage family,
school, and peer influences, (5) improve healthy eating, and (6)
facilitate long-term commitment to a healthy lifestyle. The
14-week program consisted of one required and one optional 1.5
hour group session each week. The required session consisted of
30 minutes of exercise. The remaining 60 minutes consisted of
psychosocial skills training. The optional weekly session
provided time for coached exercise, and family training on
nutrition, fitness, and communication skills. A group website,
iPods, email coaching, and an Internet discussion board were
used to provide support, education, and inspiration.
Results
A review of the pre-post measures used for monitoring
weight, fitness, psychosocial, and self-care knowledge change
will be presented along with the value of using outcome measures
in real-world lifestyle change program.
Discussion
The successes and difficulties of working with obese
teenagers in helping them change will be discussed. Ideas for
therapeutic paradigms to facilitate long-term maintenance of new
healthy lifestyle behaviors into adulthood will also be
presented.
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Healthy Eating and Activity Together (HEAT) Initiative:
Prevention of Childhood Overweight
Authors
M.M. Gottesman1; B.L. Gance-Cleveland2;
K.G. Duderstadt3; M.A. Brady3; C.J.
Montoya4.
1National Association of Pediatric Nurse
Practitioners (NAPNAP), Cherry Hill, NJ;
2NAPNAP, AR;
3NAPNAP, CA;
4NAPNAP, NM.
Background
Childhood overweight affects nearly one in five US
children. The earlier the onset of overweight, the greater the
risk that the child will become an overweight adult with
increased risk for diabetes, hypertension, and heart disease.
Overweight at any age has proven difficult to treat.
Prevention is the key to decreasing the prevalence and
severity of overweight. However, research shows that pediatric
primary care providers often lack the knowledge and resources
to intervene effectively.
Methods
The National Association of Pediatric Nurse
Practitioners has undertaken the Healthy Eating and Activity
Together (HEAT) Initiative, developing an evidence-based
clinical practice guideline focused on prevention and early
identification of childhood overweight. Specific suggestions
for enhancing cultural appropriateness as well as
community-based advocacy strategies are included. Child
development and parent-child communication guidance provide
the context for intervention. To increase the guideline's
usefulness in practice, a resource kit of assessment and
informational materials, a quality improvement-based
implementation protocol, and outlines of motivational
interviewing scripts addressing best choices in nutrition and
physical activity are included.
Results
Pediatric and family nurse practitioner groups and a
panel of interdisciplinary experts in childhood overweight
have reviewed the guideline and resource kit to verify
accuracy of content and clinical usefulness. Because
overweight disproportionately affects minority children, focus
groups of ethnically diverse parents, children, and teens have
reviewed the educational materials and the guideline
recommendations for clarity and appropriateness.
Discussion
Prevention of overweight in children requires both
skilled preventive care for the child and family as well as
community advocacy to change their nutritional and physical
activity environments. Implementation and evaluation of the
guideline's effectiveness will begin nationwide in 2006,
contributing to a measurable reduction in the prevalence of
childhood overweight.
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Wellness Adventures: Diabetes Prevention and Wellness Camp
for Children
Author
N.A. O'Banion, Indian Health Care Resource Center, Tulsa, OK.
Background
Purpose of Program: To teach concepts of diabetes
prevention and wellness to Native American children in an
adventure-based, experiential learning environment. Setting:
Indian Health Care Resource Center of Tulsa (IHCRC), an urban
Indian clinic, collaborated with the Tulsa Public Schools
Challenge Course to provide the adventure-based camp for
children grades 1 – 8 in six sessions of one-week day camp.
Staff: IHCRC's Health Education & Wellness Director, clinic
dietitian, and fitness coordinator teamed with Tulsa Public
School's Challenge Course Coordinator and Challenge Course
instructors. Staff attended curriculum training before camp
sessions began. All Challenge Course instructors are certified
in a 40+ hour training program.
Methods
A Native American specific diabetes/wellness
camp curriculum was developed and implemented. Concepts of
diabetes prevention, nutrition, and physical activity were
taught through adventure-based games, initiatives, and the
high and low elements of a ROPES Challenge Course. Asset
building and resiliency training were also addressed, to
assist participants in developing the foundation needed to
make positive health choices.
Results
Participants demonstrated improved knowledge
on a pre and post nutrition/fitness/diabetes quiz. Parents
reported numerous healthy lifestyle changes, such as children
requesting that pop not be available at home and increased
physical activity. Several Oklahoma tribes received training
in this curriculum.
Discussion
Successes and Lessons Learned: Participants
learned exceptionally well in the adventure-based environment,
with experiential activities as the medium for learning. After
the first year of camp, the number of sessions was doubled to
accommodate all interested participants. In our fourth year of
camp this summer, we will offer a Leadership Camp session,
which will allow the seventh and eighth grade campers to
return as peer mentors to the younger participants. We also
added a weight management camp called "Choices" in 2005.
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Keystone Healthy Zone School Recognition Program
Authors
A. Topper1; L. Bailey-Davis1.
1Pennsylvania Advocates for Nutrition and Activity,
Middletown, PA.
Background
The Pennsylvania Advocates for Nutrition and
Activity's (PANA) Keystone Healthy Zone School Recognition
Program (KHZ) recognizes and rewards schools for making a
commitment to improve nutrition and physical activity.
Methods
The KHZ Program includes an annual assessment about
policies and practices that impact nutrition and physical
activity, incentives, resources, templates, trainings, technical
assistance and mini-grant funding for schools (100 funded
annually at $2,000 each). Schools are encouraged to form a
school health council (SHC) to coordinate programs, policies,
and activities.
Results
In the first year (2003-04 school year), 912 schools
enrolled in the KHZ Program representing 64 of Pennsylvania's 67
counties. One hundred of these schools in 46 counties received
competitive mini-grants. PANA obtains evaluation data at two
levels- state-wide quantitative data via the KHZ assessment; at
the local level, the mini-grant schools provide qualitative and
quantitative data through the KHZ assessment, project reports,
surveys, and in-depth interview methods. Each of the mini-grant
schools established a SHC. Participation in PANA trainings,
meetings, and use of PANA products, was positively associated
with policy and environmental changes and the likelihood of these
changes increased with increase use of PANA resources.
Chi-square analyses showed significant relationships between
existence of a SHC and existence of nutrition policies and
minutes of physical education offered per week in grade 1
through 5. Schools were more likely to have policies when there
was an appointed individual to lead the SHC. Every school made
changes to the school nutrition environment and almost half made
environmental changes to support physical education. Twenty
schools adopted a nutrition policy, sixteen adopted a physical
education policy, and 26 adopted a policy to support increased
physical activity opportunities.
Discussion
The initial results support using a social marketing
approach across multiple scales for collective action among a
focused target audience to create sustainable changes.
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