Healthy Weight,
Healthy Child Initiative
Identifying Barriers & Interventions Regarding
Healthy Living for Children in Mecklenburg County
A Community Assessment
Developed by Meredith K. Ledford, MPP
Healthy Weight, Healthy Child Initiative Coordinator
July 20, 2010
Healthy Weight, Healthy Child Coalition Steering Committee – Chairs and Co-Chairs
Academia Advisory Group:
Laura Clark, Larry King Center of the Council for Children’s Rights
Beth Racine, University of North Carolina at Charlotte
Health Care Providers Working Group:
Ellen Cary, Teen Health Connections
Traci Lamothe, MD, Novant Health, Inc.
Business Working Group:
Dianne Thomas, Fit City Challenge
Julie Jackman, Fit City Challenge
Media Advisory Group:
Dee Dixon, PRIDE Communications
Bev Kothe, Kothe Qualitative Research
Mary Newsom, Charlotte Observer
Community Organizations Working Group:
Allison Mignery, Mecklenburg County Fruit and Veggie Coalition
Faith Community Working Group:
Chaplain Harry Burns, Novant Health, Inc.
Hazel Dawkins, Friendship Missionary Baptist Church
Government/Elected Officials Working Group:
Chris Campbell, Charlotte Housing Authority
Nykki Hardy, County Manager’s Office
Kevin Monroe, Mayor’s Office
Pre-School-Aged Organizations Working Group:
Janet Singerman, Child Care Resources, Inc.
School-Aged Organizations Working Group:
Melissa Dunlap, Martin Luther King, Jr. Middle School
Claire Tate, Partners in Out-of-School-Time
Race/Ethnicity-Based Organizations Working Group:
Patrick Graham, Urban League of Central Carolinas
Denise Hairston, Black Women’s Health Network
Healthy Weight, Healthy Child Leadership Team
Dr. Jessica Schorr Saxe, Medical Director, Carolinas Health Care System
Kerry Burch, Healthy Carolinians
Pam Elliot, Charlotte-Mecklenburg Schools
Debra Kaclik, Charlotte-Mecklenburg Schools
Mike Kennedy, Mecklenburg County Health Department
Nancy Langenfeld, Charlotte-Mecklenburg Schools
Jon Levin, Mecklenburg County Health Department
This report was made possible through funding from the Kate B. Reynolds Charitable Trust.
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Table of Contents
I. Overview and Purpose of the Initiative..............................................................4
II. Methodology of the Community Assessment ........................................................4
III. Understanding Findings ................................................................................6
PHYSICAL ACTIVITY
Affordability ................................................6
Built Environment/Lack of Resources ..................6
Education ....................................................7
Safety ........................................................7
Schools ......................................................8
Screen Time ................................................8
Societal Pressures ..........................................9
Transportation ..............................................9
NUTRITION
Affordability ................................................9
Built Environment/Lack of Resources ..................10
Education ..................................................10
Schools ......................................................11
Societal Pressures/Enforcements ......................12
IV. Next Steps ..............................................................................................12
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I. Overview and Purpose of Initiative
The past two decades have seen a dramatic increase in the obesity rate in the United States, North Carolina, and Mecklenburg County. In 2008 over 63% of individuals 18 years or older in
the United States were overweight (36.6%) or obese (26.6%). That same year, North Carolina surpassed the national trend with nearly 66% of individuals 18 years or older being overweight
(36.2%) or obese (29.5%).
While adult obesity is of considerable public health concern, the magnitude of pediatric obesity across the country and in North Carolina is increasingly becoming a focus of communities
and stakeholders. More than 1 in 4 students across the country are at an unhealthy weight and these children and adolescents are at an increased risk for health problems during their
youth. For example, obese children and adolescents are more likely to have risk factors associated with cardiovascular disease – such as high blood pressure, high cholesterol, and Type 2
diabetes – than other children and adolescents.
Mecklenburg County brings these statistics into stark focus: in 2009 more than 1 in 4 public high school students (28%) was obese or overweight with the majority being African-American or
Hispanic.
Mecklenburg County is determined to reverse the childhood obesity trend in the community and address the barriers parents, care-givers, children and stakeholders face in eating healthy
and being physically active. Through the Healthy Weight, Healthy Child Initiative – a year-long planning grant funded by the Kate B. Reynolds Charitable Trust – various stakeholders in the
community from health care providers to staff and administrators of schools and preschools; from community, faith and race-based groups to government officials and agencies and
business leaders; and from academia to the media are collaborating to develop an action plan by September 2010 that the county can use to address pediatric obesity and child health. The
action plan will include targeted policies and interventions that stakeholders and the community-at-large have proposed and encouraged to ensure systemic change in areas where children
live, go to school, and play.
One of the first steps in developing an action plan is to conduct a community assessment to understand, gauge, and evaluate the barriers to living healthy in the community and to
identify interventions that will address these barriers. This step ensures that the action plan will include policies, regulations, interventions, and pilot projects that parents, the
community-at-large, and stakeholders have identified to improve nutrition, increase physical activity, and decrease screen time (i.e. time spent in front of the computer and television,
and playing video games) for all children in the community -- for many children who are not at risk of obesity have unhealthy nutrition, inadequate physical activity and excessive screen
time – as well as combat the childhood obesity epidemic.
II. Methodology of the Community Assessment
The Healthy Weight, Healthy Child (HWHC) Community Assessment included five community conversations, input from 5 HWHC Coalition Working Groups, feedback from the HWHC
Coalition Steering Committee, and responses from key informant interviews.
Community Conversations: Throughout the months of April and May 2010, the HWHC Initiative conducted 5 community conversations (i.e. focus groups) to identify barriers caregivers
perceive children and adolescents face in eating healthy, increasing physical activity, and decreasing screen time. Additionally, participants of the community conversations were also asked
to identify interventions they would like to see implemented, improved, and increased in places where children live, go to school, and play. The demographics of participants included
representation from diverse racial/ethnic groups; various household income levels; a wide range of ages (20-65 years old), and different education levels. Some of the specifics of each
conversation can be found below:
Community Conversation 1 (CC1) - CMS Employees: Children and adolescents spend the vast majority of their time in a school environment.Therefore, the HWHC Initiative
conducted a community conversation of 13 CMS employees to gauge their unique perspective on the barriers children face in being physically active and eating nutritiously, as well
as, suggesting interventions that will address these identified barriers. Of the 13 female employees, 12 were mothers, the median age was 38, the average annual household
income range was $40,000-$80,000, and the racial/ethnic breakdown included 11 white females and 2 African-American females. No males participated in the conversation.
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Community Conversation 2 (CC2) – School Health Nurses: School health nurses are on the front line when dealing with child and adolescent health, which is the primary reason
this group was chosen for a community conversation. It included 9 female school health nurses, 8 of whom were mothers. The median age was 35, the average annual household
income range was $80,000-$120,000, and the racial/ethnic breakdown included 7 white females and 2 African-American females. No males participated in the conversation.
Community Conversation 3 (CC3) – Mental Health Professionals: Research and anecdotal evidence illustrate that children and adolescents who are overweight, obese, or have an
unhealthy weight suffer from mental abuse and anguish, including bullying and low self-esteem. Consequently, a select group of mental health professionals were asked to
participate in a community conversation. This conversation included 4 female mental health professionals, 4 of whom were mothers. The median age of the group was 40, the
average annual household income range was $80,000-$120,000, and the racial/ethnic breakdown included 4 white females. No males participated in the conversation.
In the “Understanding Findings” section of this document, community conversation responses are identified using the appropriately abbreviated column (i.e. CC1 includes responses from
the CMS Employees community conversation, etc.).
HWHC Working Groups: The composition of the HWHC Coalition includes representation from 10 stakeholder groups, 8 of which have working groups (i.e. business, community
organizations, faith community, health care providers, government, preschool aged organizations, school-aged organizations, and race/ethnicity-based organizations) and 2 of which serve
in an advisory capacity (i.e. academia and media).
Of the 8 HWHC working groups, 5 HWHC working groups (i.e. business, community organizations, faith community, health care providers, and non-school-aged organizations) submitted a
list of prioritized interventions to address physical activity and healthy eating for children and adolescents. Unlike the community conversations, the working groups were NOT asked to
identify barriers to healthy living, but only to submit a list of interventions that would address healthy living for children specific to their its stakeholder community. For example, the
business working group submitted a list of interventions to address healthy living that the business community specifically could implement, not interventions that other stakeholder groups
could implement.
In the “Understanding Findings” section of the document, working group responses are identified using the “Wkg Group” abbreviated column.
HWHC Steering Committee: On June 7, 2010, the HWHC Steering Committee met with representation from all 10 stakeholder groups, which included the chairs, co-chairs, and other individuals. At this meeting, written feedback was given by representatives from all stakeholder groups on potential interventions that specific stakeholder groups could implement to address healthy living for children and adolescents. This was a time for representatives from one stakeholder group to suggest interventions that another stakeholder could implement. For
example, the health care provider working group gave recommendations of interventions the government and business working groups could implement to improve healthy living opportunities for children and adolescents. Other working groups, as well as the advisory groups did the same.
In the “Understanding Findings” section of the document, steering committee responses are identified using the “St Com” abbreviated column.
Key Informant Interviews: The final component of the community assessment process included conducting 10 key informant interviews of national, state and local experts in the area(s)
of environmental policy for healthy living, food access, public policy makers, government administrators, nutrition and physical activity program experts, and foundations with a focus on
addressing childhood obesity. Key informants included:
National Key Informant
State Key Informant
Local Key Informant
Yael Lehmann, The Food Trust
Susan Richardson, Kate B. Reynolds
Charitable Trust
Dr. Peter Gorman,
Charlotte-Mecklenburg Schools
Dr. E. Winters Mabry,
Mecklenburg County Health Department
Meka Sales, The Duke Endowment
Dr. Daniel Murrey,
Mecklenburg County Commissioner
Priscilla Laula,
Mecklenburg County Health Department
Mildred Thompson, Policy Link
and the Robert Wood Johnson Foundation
Kate Uslan, The Alliance for a
Healthier Generation
North Carolina Physical Activity
and Nutrition (PAN) Branch
In the “Understanding Findings” section of the document, key informant responses are identified using the “Key Inf” abbreviated column.
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III. Understanding Findings
The barriers and interventions identified during the community assessment process are divided into 2 broad categories: physical activity (which includes screen time) and nutrition. Within
each broad category, the interventions and barriers are divided into the following subcategories when applicable: affordability, built environment/lack of resources, education, safety, school
environment, societal pressures, and transportation. By using check marks ( ) throughout the table, the various component(s) of the community assessment (i.e. responses from key
informants, community conversation, working group lists, etc.) identified the specific barrier or intervention to address a certain issue. For example, under the “safety” section of the
Physical Activity category, the five community conversations identified “unsafe neighborhoods” as a barrier to being physically activite. However, only CC4 and CC5 (community
conversation 4 – Hispanic Community and community conversation 5 – African-American Community) suggested increasing neighborhood watch groups as an intervention to address these
barriers – this information can be found and understood by reviewing the following tables and looking for check marks. As mentioned previously, only community conversation
participants identified barriers; key informants, the steering committee, and the working groups were not asked to identify barriers, only interventions.
PHYSICAL ACTIVITY
Affordability
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Barrier 1: “We lack (or know of children’s families that lack)
the disposable income to pay fees for where exercise options
are available, specifically membership fees and rec team fees.”
Intervention 1: Reduce membership/sports fees for qualifying
individuals..
Intervention 2: Provide free sports physicals for children who
want to play school or recreational team sports.
Built Environment/Lack of Resources
Barrier 1: “My neighborhood (or a child’s neighborhood who
I work with) doesn’t have the facilities to be physically active –
we lack parks, rec centers, etc.
Intervention 1: More rec centers to promote physical activity
for children, specifically include activities that would appeal to
teenagers.
Intervention 2: Increase sidewalks/walking routes to and from
schools to encourage walking to school.
Intervention 3: “Schools could enter into an agreement with the
county to allow access to facilities that encourage physical
activity.”
Intervention 4: Allow tax revenue from soft drinks/sugary
drinks to directly fund healthy child initiatives.
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Education
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Barrier 1: “I don’t know what resources are available in the
community (or children I work with say they don’t know what’s
available in their neighborhoods).”
Intervention 1: Resources that provide
information to community members on available resources
Intervention 2: More education to parents about the benefits of
physical activity for their children.
• Utilize faith community to spread this information.
Intervention 3: Through the Worksite Wellness Council, educate
and mentor other businesses or industries on the importance of
having a physically active workforce. This may include
implementing some worksite wellness policies and engaging the
Chamber of Commerce.
Intervention 4: Improve outdoor learning environments by
educating child care providers on how to support children’s
physical activity and healthy eating (i.e. expand the Preventing
Obesity through Design Program).
Intervention 5: Create a clearing for the community and health
professionals to access regarding programs and services available
for healthy eating and physical activity. Include a referral
process for health care providers, such as dieticians.
Safety
Barrier 1: “I live in an unsafe neighborhood (or know of
children who do) and worry about my children playing outside.”
Barrier 2: “I worry about traffic in my neighborhood.”
Intervention 1: Increase sidewalks/walking routes to and from
schools to encourage walking to school.
Intervention 2: Speed limit enforcement in neighborhoods to
increase safety for bicycling and walking.
Intervention 3: More community groups/neighborhood watch
programs to increase safety of neighborhoods.
Intervention 4: More community groups/neighborhood watch
programs to increase safety of neighborhoods, such as dieticians.
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Schools
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Barrier 1: “There is a lack of structured physical education in
schools.”
Barrier 2: “School Athletic programs only focus on the school’s
team sports – they should also have programs for the entire
student body that are not necessarily connected to child
ability.”
Barrier 3: “Children face peer pressure to not be physically
active and participate in activities – some think it’s ‘not cool’.”
Intervention 1: “Enforce regulations in school, regarding daily
physical exercise more consistently (30 minutes per day).”
Intervention 2: “Encourage teachers and administrators to not
“take away PE” as a discipline alternative.”
Intervention 3: “Add afterschool programs that include exercise
components.”
Intervention 4: “Schools could enter into an agreement with
the county to allow access to facilities that encourage physical
activity.”
Screen Time
Barrier 1: “Children spend too much time in front of
televisions, computers, and video games.”
Barrier 2: “Parents turn to computers, television, and video
games as a ‘baby sitter’.”
Barrier 3: “Children like the social connection they get from the
internet. There is pressure to be “on-line” with their peers for
communication, contact, friendships, etc.”
Barrier 4: “There are too many access points available to get
screen time. It creates an easy temptation vs. exercising.”
Barrier 5: “There is no communication given about the benefits
of exercise versus the
detriment of remaining sedentary.”
Barrier 5: “Screen time is addictive in terms of a routine it
creates versus having an exercise routine.”
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Societal Pressures
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Barrier 1: “Because of parental time constraints due to other
obligations (i.e. work, etc), parents don’t have time to
supervise structured exercise time. “
Transportation
Barrier 1: “The lack of transportation to locations where
exercise options are available. “
Intervention 1: Provide transportation to exercise options.
Intervention 2: Consider loaner bike program (like Denver,
Colorado) at strategic locations to get around the city.
NUTRITION
Affordability
Barrier 1: “There’s a need for more affordable healthy options
in the community and in schools. Fast food restaurants are too
convenient.”
Barrier 2: “My grocery store (if there is even one located in the
neighborhood) lacks affordable and nutritious food options.”
Intervention 1: “More affordable options for healthy food
purchase in the community, especially in grocery stores and
schools.”
Intervention 2: Encourage grocery stores and other businesses
that offer healthy options to enter low-income communities.
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Built Environment/Lack of Resources
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Barrier 1: “Fast food chains/restaurants are too convenient in
neighborhoods, influencing impulse buying.”
Intervention 1: “More Health Department sponsored programs
on healthy eating, such as community fairs, neighborhood
educational programs, etc., specifically, would like to see
education on food labeling.”
Intervention 2: “An increase in farmer’s markets through an
incentive program.”
Intervention 3: “More conveniently located farmer’s markets,
especially at places of worship.”
Intervention 4: Community gardens for people who don’t have
yards/know how on how to create a successful garden.
Intervention 5: Limits on the number/location of fast food
restaurants in neighborhoods.
Intervention 6: Create community fruit and veggie gardens
that are assisted by community organizations with the knowhow
on how to make them successful.
Intervention 7: Allow tax revenue from soft drinks/sugary
drinks to directly fund healthy child initiatives.
Education
Barrier 1: “I don’t know what resources are available in the
community (or children I work with say they don’t know what’s
available in their neighborhoods).”
Intervention 1: “More Health Department sponsored programs
on healthy eating, such as community fairs, neighborhood
educational programs, etc.”
Intervention 2: “More publicity about obesity and its effect in
the community, including how to correctly discuss the issue.”
Intervention 3: “The local government’s help in forming support
groups for families with obese youths.”
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CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Intervention 4: Host healthy cooking classes at public
recreation facilities/libraries to encourage healthier and active
lifestyles.
• Food demos on cooking food in a healthy, culturally
appropriate manner.
Intervention 5: Through the Worksite Wellness Council, educate
and mentor other businesses or industries on the importance of
having a workforce who eats nutritiously. May include
implementing some worksite wellness policies and engaging the
Chamber of Commerce.
Intervention 6: Improve outdoor learning environments by
educating child care providers on how to support children’s
physical activity and healthy eating (i.e. expand the Preventing
Obesity through Design Program).
Intervention 7: Continue the hands-on culinary training of the
Healthy Futures Starting in the Kitchen program which trains
child care cooks to create healthy meals.
Intervention 8: Within the faith community, coordinate
educational efforts with health coordinators in congregations,
health agencies, and health trainers. Included in these efforts
are training congregations on how to serve healthier food at
functions and events.
Intervention 9: Create a clearing house for the community and
health professionals to access regarding programs and services
available for healthy eating and physical activity. Include a
referral process for health care providers, such as dieticians.
Intervention 10: Require all restaurants in the county to
implement menu labeling.
Schools
Barrier 1: “Unhealthy school lunch menus.”
Barrier 2: “The food offered at concession stands at school
events.”
Barrier 3: “Sweets are treated as rewards for good behavior or
academic performance.”
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CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
CC1
CC2
CC3
CC4
CC5
Key Info
Wkg Group
St Com
Intervention 1: Create more school fruit and veggie gardens
that are assisted by community organizations with the knowhow
on how to make them successful.
Intervention 2: “There’s a need for more affordable healthy
options in the schools.”
Intervention 3: “School programs that educate children on
healthy eating.”
Intervention 4: Encourage administrators and teachers to
prioritize healthy eating throughout CMS schools.
Intervention 3: Expand SPARK and FitnessGram.
Societal Pressures/Enforcements
Barrier 1: “Marketing and advertising encourage poor eating
habits.”
Barrier 2: “Because of parental time constraints due to other
obligations (i.e. work, etc), children are making unsupervised
food choices that are often unhealthy.”
Barrier 3: “Because of parental time constraints due to other
obligations (i.e. work, etc), parents bring home convenient,
unhealthy food options for meals and snack.”
Barrier 4: Lack of motivation and self-esteem to do anything
about current weight issues.
Intervention 1: Tax on fast food/junk food/soda.
IV. Next Steps
The next step of the Health Weight, Healthy Child Initiative is to develop the community-wide action plan. The community assessment will ensure that the barriers and interventions
identified and/or recommended the most (i.e. the barriers and interventions with the most check marks) are prioritized in the action plan. This prioritization process will ensure that
those interventions will be the interventions prioritized for appropriate funding opportunities. The release of the community action plan is set for September 2010.
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