Helping Communities Reduce Childhood Obesity

She felt self-conscious when she participated in physical activities. She was always teased about her size. She said she felt sad” every day about her weight.

She was 8.

Dr. Sarah Armstrong, director of Duke University School of Medicine’s Healthy Lifestyles clinic, hears those stories all too often. North Carolina has one of the highest obesity rates in the country, and Armstrong sees the epidemic of childhood obesity firsthand.

In 2006, she helped launch Healthy Lifestyles for children and adolescents and has since developed a community-based wellness program for its participants. She and her team are now focused on replicating that community effort in other areas.

The goal is to reduce obesity, improve health and prevent chronic disease among vulnerable children in the Carolinas. Nearly $750,000 in funding from The Duke Endowment is supporting the work.

We were offering a safe space where families could exercise and learn together and get motivated about behavior changes.

Dr. Sarah Armstrong, Director of Duke University School of Medicine’s Healthy Lifestyles

A Safe Space

The model links a health care clinic with a recreation center and promotes community collaboration to deliver family wellness programming.

In Durham, it’s called Bull City Fit, and it serves low-income and uninsured children who have already developed obesity. Participants join through the Healthy Lifestyles clinic, a one-year intervention for children with a body mass index (BMI) over the 95th percentile.

When the program got underway in a makeshift gym at a children’s hospital, organizers were surprised that so many families signed up.

Kids told us this was the only place they could be active and not feel awkward or self-conscious, and their parents echoed that,” says Armstrong, a pediatric physician. We were offering a safe space where families could exercise and learn together and get motivated about behavior changes.”

Bull City Fit is now housed in space provided by Durham Parks and Recreation. Local groups help with programs and staffing. The Healthy Lifestyles clinic provides medical expertise. Children and caregivers come for supervised exercise classes, cooking and gardening demonstrations, and support groups. Best of all, it’s free.

There’s a public perception that obese children are simply overweight and that’s their problem,” Armstrong says. But many of these children have high blood pressure, high cholesterol, and type 2 diabetes. There’s a serious underlying medical component to what we do.”

Replication Efforts Underway

With the grant from The Duke Endowment to Duke University Health System, Dr. Sarah Armstrong and her team are developing templates and other resources to one day replicate this community-based pediatric obesity program in existing communities that are part of the Endowment’s Healthy People, Healthy Carolinas initiative, which was launched in 2015.

By investing in effective prevention programs and community partnerships, we believe we can help people keep manageable health concerns from developing into chronic problems,” says Lin Hollowell, director of the Endowment’s Health Care program area. Engaging children and families in healthy habits will enhance their quality of life for years to come.”

With rates of diabetes, heart disease and unhealthy weight persistently high across the Carolinas, the Healthy People, Healthy Carolinas initiative is helping communities implement evidence-based programs that focus on promoting healthy lifestyles.

Through local coalitions, the initiative involves leaders from area organizations in developing ways to engage residents in their health.

Program goals include:

  • Increase the number of highly effective community coalitions
  • Increase the number of community residents engaged in health promoting activities
  • Demonstrate the impact of health improvement efforts

Performance metrics will be monitored to help the coalitions improve and learn.

Quality of Life

In North Carolina, 28 percent of high school students and 22 percent of children entering kindergarten are overweight or obese. Nationally, one in six children are obese; the number climbs to one in four among low-income and minority families.

Since Bull City Fit began in 2012, more than 5,000 children and parents have participated. Each night, as many as 40 families show up to play games, try a sport, or learn new tips for healthy eating.

Creating an environment where you can play soccer and not be self-conscious and actually get the ball and score a goal and have your team supporting you instead of judging you is a really special thing,” says Lauren Sibley, program coordinator.

Six-year-old Jana agrees. It doesn’t matter if you can run fast or if you are young or old,” she says. Everyone works together and has fun together.”

The staff keeps cheering me on so I can do it,” says Karol, 11. It makes me want to come every day.”

Armstrong and other researchers have completed a randomized controlled trial to determine the effectiveness of this integrated model of obesity treatment. Results are promising, and will be published soon.

This is so much more than getting children to lose weight,” Armstrong says. This program helps communities and families create healthier habits — both now and throughout life.”

This is so much more than getting children to lose weight. This program helps communities and families create healthier habits — both now and throughout life.”

— Dr. Sarah Armstrong

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