Tory Rogers, MD
Barbara Bush Children’s Hospital at Maine Medical Center
(207) 662-4982 rogerv@mmc.org
October 7th, 2013
www.letsgo.org
What I want to talk about today?
 What is Let’s Go! – The First 5 years 20062011
– Birth to the awkward tween years
 Let’s Go! 2011-2016 – The Teen years
 Evaluation Data – What is working
 What we could have done better
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Now……
What do you want me to talk
about???
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Let’s Go!
Core Principles
 Environmental and policy change influences behavior change
 Interconnectivity across settings is essential
 Strategies are evidence based and continuously evaluated
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Tools, Resources, and Trainings
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Why Environmental/Policy Change?
Activities
Environments
Policies
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Let’s Go! Key Strategies for Success –
Priority Strategies
1. Provide healthy choices for snacks and celebrations; limit
unhealthy choices.
2. Provide water and low fat-milk; limit or eliminate sugary
beverages.
3. Provide non-food rewards.
4. Provide opportunities for children to get physical activity
every day.
5. Limit screen time.
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Let’s Go! Key Strategies for Success –
Supporting Strategies
6. Participate in local, state and national initiatives that promote HEAL.
7. Engage community partners to help support and promote HEAL at your site.
8. Partner and educate families in adopting and maintaining a lifestyle that
supports HEAL.
9. Implement a staff wellness program that includes HEAL.
10. Collaborate with food and nutrition programs to offer healthy food and
beverage options.
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StoryWalks
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Marketing Campaign
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It Worked!
Environments are Changing
Policies are being Implemented
Healthy Behaviors are increasing
Obesity appears to be leveling off
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Greater Portland Reach
As of June 2011, Let’s Go! had engaged the following in the 12 Greater
Portland communities:
• 56 schools educating more than 23,000 students;
• 8 district-wide school nutrition programs serving over
20,000 students;
• 34 child care programs caring for over 1,400 children;
• 28 after school recreation programs serving over 1,800 students;
• 29 healthcare sites; and
• 7 of Greater Portland’s largest employers.
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60 Let’s Go! Sites (in Greater Portland) Reported
Implementing Let’s Go! Strategies in 2010-11
Elementary
Schools
Strategies
Child Care
Programs
After School
Programs
Number (%) that Implemented Strategy*
Healthy choices for snacks/celebrations
24/29 (83%)
16/16 (100%)
15/15 (100%)
Participate in initiatives that promote HEAL
25/29 (86%)
11/16 (69%)
8/15 (53%)
Include community organizations
12/28 (43%)
6/16 (38%)
11/15 (73%)
Involve and educate families
27/29 (93%)
16/16 (100%)
5/15 (33%)
Encourage water and low fat milk
24/29 (83%)
16/16 (100%)
13/15 (87%)
Discourage the use of food as a reward
26/29 (90%)
16/16 (100%)
12/15 (80%)
Incorporate physical activity into the day
21/28 (75%)
15/16 (94%)
7/15 (47%)
Develop 5-2-1-0 staff wellness program
16/29 (55%)
4/16 (25%)
15/15 (100%)
Collaborate with nutrition program
19/21 (90%)
Not measured
4/15 (27%)
Implement or strengthen wellness policy
16/28 (57%)
6/15 (40%)
Not measured
*Strategy was implemented in year five or sustained from a previous year, in most classrooms or school- or program-wide.
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Let’s Go! School Nutrition Initiative
Let’s Go! led 35 schools in reaching the USDA’s Healthier US School
Challenge.
Healthier US School Challenge Criteria
• A different fruit and vegetable every day
•At least three dark green or orange vegetables per week
•Offer legumes at least once per week
•Offer whole grains three times per week
•Offer only low fat or fat free milk
•Offer nutrition education
•Provide at least 45 minutes of physical education per week
Technical assistance, tools, and resources were provided by Let’s Go!
during workgroup meetings, phone calls and emails as they improved
the nutritional quality of school meals.
Only 2% of schools in the nation have achieved this award.
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There are 14 Let’s Go! Practices
in Greater Portland
A recognized Let’s Go! Healthcare site must meet
basic criteria for the following three components:
1. Connect to their community and the Let’s Go!
community efforts
 Hang a Let’s Go! poster in waiting room and exam rooms
2. Accurately weigh and measure patients
 Determine Body Mass Index (BMI), BMI percentile, and
weight classification in patients > 2 yrs.
3. Have a respectful conversation around weight
 Use the 5210 Healthy Habits Questionnaire
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Parents’ Awareness Increased Significantly
from 2007 to 2011
% Who Heard of Campaign and Message
2007
2009
2011
55%
45% 47%
10%
422%
Increase
422%
Increase
422%
Increase
Let's Go! Campaign
43%
14%
293%
Increase
293%
293%
Increase
Increase
5-2-1-0 Message
Note: In 2007 n=802; in 2009 n=800; in 2011 n=801
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Exposure to Let’s Go! in Multiple Settings
Increased Parents’ Awareness of 5-2-1-0
% Who Heard of 5-2-1-0 Health Message, by Exposure (2011)
85%
64%
34%
No Exposure
153%
153%
153%
Increase
Increase
Increase
1 to 2
3 or more
Number of Settings Exposed to Let's Go!
Note: In 2011 n=801
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Exposure to Let’s Go! in Multiple Settings
Increased Parents’ Knowledge of 5-2-1-0
% Who Provided Correct Numbers for All Four 5-2-1-0
Recommendations, by Exposure (2011)
51%
58%
39%
51%51%
Increase
Increase
No Exposure
1 to 2
3 or more
Number of Settings Exposed to Let's Go!
Note: In 2011 n=801
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Child’s Adherence with “5” and “0” Behaviors
Increased Significantly from 2007 to 2011
% Reported Child (<18 yrs.) Adheres to "5" and "0" Recommendations
2007
2009
2011
69%
66%
63%
26%
63%
22%
63%
18%
Increase
Increase
"5" or More Fruits &
Vegetables Daily
18%18%
Increase
Increase
"0" Sugar Sweetened
Beverages
Note: In 2007 n=802; in 2009 n=800; in 2011 n=801
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Overweight and Obesity Prevalence for Ages 3-18 in Greater
Portland Trended Down, While U.S. Rate Remained the Same
% Overweight and Obese (Age 3-18)
35%
30%
25%
33%
32%
32%
31%
20%
Greater Portland
15%
U.S. (NHANES)
10%
5%
0%
2006
2009
NOTE: NHANES data reflect 2006 and 2008 rates, and include ages 2-19. Greater Portland: In 2006 n=3,051; in 2009 n=3,132.
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Overweight and Obesity Prevalence Decreased
for Females Age 3-5 in Greater Portland
% Overweight and Obese Females 3-5 yrs in Greater Portland
31%
25%
63%
Increase
2006
18%
Increase
2009
Note: In 2006 n=157; in 2009 n=133
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Let’s Go! 2011-2016
Our teen years growing up and out
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Growth of Let's Go! Engaged Sites (2006-2013)
Schools
After School
Child Care
Healthcare
School Nutrition
350
300
250
200
150
100
50
0
2006-2007
2007-2008
2008-2009
2009-2010
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2010-2011
2011-2012
2012-2013
Let’s Go! Dissemination Statewide
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Survey Response Rates
787
Registered Sites
Completed Survey
654
83%
324
261
194
81%
Child Care
166
117
86%
School
92
79%
After School
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152 135
89%
Healthcare
Total
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Let’s Go! Reach Across Four Sectors
(Survey Participants)
Area of Reach
Counties
Towns
Sites
Students/Patients
Child
Care
16
132
261
7,388
After
School School Healthcare
15
15
21
106
59
86
166
92
135
53,626 7,016
343,223
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Implementing Five Priority Strategies
Strategy Implemented*
1. Provide healthy choices for snacks and celebrations; limit
unhealthy choices.**
2. Provide water and low fat milk; limit or eliminate sugary
beverages.***
3. Provide non-food rewards.
4. Provide opportunities for children to get physical activity
every day.
5. Limit recreational screen time.
Child
Care
School
(n =261) (n =166)
After
School
(n =92)
72%
65%
83%
68%
75%
92%
95%
55%
80%
72%
80%
95%
82%
72%
96%
*Implementation in schools and after school programs is in most or all classrooms; child care is program wide.
**This year, the survey included questions about limiting unhealthy choices for snacks and celebrations, but those responses
are not included in the analysis for this strategy; they will be included next year.
***The school and after school surveys did not include a question about milk; it’s a requirement for all schools participating in
the national school meals program.
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Implementing Five Supporting Strategies
Strategy Implemented*
6. Participate in local, state, or national initiatives that
support healthy eating and active living.
7. Engage community partners to help support healthy eating
and active living at your site.
8. Partner with and educate families in adopting and
maintaining a lifestyle that supports healthy eating and
active living.
9. Implement a staff wellness program that includes healthy
eating and active living.
10. Collaborate with Food Nutrition Programs to offer healthy
food and beverage options.
Child
Care
School
(n =261) (n =166)
After
School
(n =92)
51%
61%
61%
43%
63%
55%
70%
66%
54%
56%
55%
32%
63%
64%
65%
*Implementation in schools and after school programs is in most or all classrooms; child care is program wide.
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Policies are Changing
(Schools & After School Programs)*
Due to their involvement with Let’s Go! in the past year:
 56% of schools did more to implement the district wellness policy and its
recommendations around physical activity and healthy eating (n=166).
 49% of schools reported their district strengthened their wellness policy to
support the 5-2-1-0 messages or strategies (n=166).
 61% of after school programs either created, implemented or strengthened
an existing wellness policy and its recommendations around physical activity
and healthy eating (n=92).
*This policy question was not included in the child care survey this year.
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Healthcare Practices Meeting Basic Criteria
Meet BASIC Criteria for Three Components
Healthcare Healthcare
(n =135)
(n =99)
2012-2013 2011-2012
1. Connect to your community & the Let's Go! Community Efforts
Let's Go! poster is displayed in practice waiting area.
96%
86%
Let's Go! poster is displayed in all exam rooms.
76%
43%
96%
86%
71%
55%
2. Accurately weigh & measure patients
At well child visits, all providers routinely have BMI determined for
patients age two years and older.
3. Have a respectful conversation around weight
At well child visits, all providers routinely counsel on HEAL using the
5-2-1-0 Healthy Habits Questionnaire.
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Reach of School Nutrition Workgroups
Let's Go! School
Startup Year Districts Schools
Nutrition Workgroup
Greater Portland
2007-2008
12
76
Southern Maine
2010-2011
12
64
Somerset
2010-2011
7
27
Lincoln/Knox
2012-2013
6
32
Oxford/Androscoggin 2012-2013
9
53
Total
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252
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Students
31,557
27,307
7,168
7,818
20,303
94,153
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Nudging Kids Toward Healthy Choices
Changes made as a result of school nutrition initiative:
 Decreased the portion size of a la carte items.
 Increased number of locations that fruit is available.
 Moved healthier items to high traffic areas.
 Offered cut up fruit such as apples and oranges.
 Put healthy options at eye level.
 Added new entrees or sides.
 Offered free samples of new menu items.
 Encouraged staff to use verbal reminders to encourage fruit and
vegetable consumption.
 Required cash for a la carte or less healthy items.
Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools; response rate
was 100%. Questions were grouped around six categories of best practices: manage portion size, increase convenience of
healthier items, improve visibility, enhance taste expectations, utilize suggestive selling, and set smart pricing strategies.
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Impact of School Nutrition Program Changes
% of Schools Reporting Change (n=25)
Purchase of whole grains increased
Purchase of produce increased
Students are making healthier choices
Students liked at least some of the changes
72%
100%
88%
100%
Note: Members of the Let’s Go! Somerset Workgroup completed a smarter lunchroom survey in May 2013 for 25 schools;
response rate was 100%.
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Let’s Go! Recognition Program
Sites of Distinction
Eligibility for Schools, Child Care and After School Programs:
 Implement all 5 priority strategies: BRONZE
 1-4 enforced written policies: SILVER
 All 5 enforced written policies: GOLD
Note: Written policies will be reviewed by Let’s Go! staff.
Eligibility for Healthcare Practices:
 Display a Let’s Go! poster in the waiting room and all exam rooms
where pediatric patients are seen.
 All providers determine BMI for patients age two years and older.
 All providers use the 5-2-1-0 Healthy Habits Questionnaire at well
child visits.
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Let’s Go! Sites of Distinction
787
Registered Sites
Recognized Sites
324
287
194
92
28%
Child Care
152
117
57
61
77
29%
52%
51%
School
After School
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Healthcare
36%
Total
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Let’s Go! Is Changing Environments











About 7 in 10 child care sites are providing healthy choices for snacks and celebrations and
opportunities for recommended levels of physical activity.
Nearly all child care sites rarely or never use food to encourage positive behavior.
The vast majority of child care sites are limiting screen time.
More than two thirds of schools are providing healthy choices for snacks and celebrations and are
limiting unhealthy choices.
More than 7 in 10 schools have implemented strategies around physical activity, water and sugarsweetened beverages, and screen time.
In the past two years, purchase of whole grains and produce has increased in over 100 schools that
have been part of the Let’s Go! school nutrition program.
About three-quarters of school nutrition programs are certified in the new federal meal pattern.
The vast majority of after school programs have implemented all five priority strategies.
Nearly all healthcare practices display the Let’s Go! poster in their waiting areas and routinely
determine BMI for their pediatric patients.
Over three quarters of healthcare practices display the Let’s Go! poster in all exam rooms where
children are seen.
In 7 in 10 healthcare practices, all providers routinely use the 5-2-1-0 Healthy Habits survey.
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Our Work is Not Done
 More trainings are needed around wellness policies.
– Schools located within the same school district in as many as 23 of 55
districts reported different policy information.
 Increase the reach of School Nutrition Workgroups.
– Establish workgroups across all regions of the state.
– Continue trainings for Dissemination Partners to facilitate workgroups
in their regions.
 More trainings are needed in the healthcare sector.
– Especially with larger practices (>5 clinicians).
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Key Learnings…….
 Consistency in message and approach is
critical
 Working across a community wherever kids
live, learn, work and play is essential
 It’s the environment, not the activities that
matter most
 Partnerships and Collaboration are paramount
 Innovation and risk taking have been key to
our success
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Some of our challenges (mistakes)
 Not fully understanding and acknowledging
the current efforts on the ground
 Moving too fast and getting ahead of people
 Trying to please everybody
 Making things too complicated
 Not publishing sooner
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Local and State Partners

Let’s Go! Dissemination Partners, including participating Healthy Maine Partnerships
and health care systems

Participating Schools, Child Care Programs, Healthcare Practices, After School
Programs, Employers and Communities

Maine Center for Disease Control and Prevention

Maine Department of Education

Maine Bureau of Parks and Lands

Maine Department of Health and Human Services, including Maine Head Star

University of Maine Cooperative Extension

Maine Dairy and Nutrition Council

Community based programs working to increase physical activity and healthy eating
in Maine,) for ex. WinterKids

Maine After School Network
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National Partners
 National Initiative for Children’s Healthcare Quality (NICHQ)
 Let’s Move
 American Academy of Pediatrics (AAP)
 American Medical Association (AMA)
 National Convergence Partnership
 Innovators and Risk Takers all over the country
And You!
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Let’s Go! Is Generously Funded by Our:
Founding Partners
Platinum Sponsors
Gold Sponsors
Walmart
Jane’s Trust
Silver Sponsors
The Bingham Program, Convergence Partnership,
The Mattina R. Proctor Foundation, Sam L. Cohen Foundation
Bronze Sponsors
Additional Funders
Francis Hollis Brain Foundation,
Poland Spring, Rite Aid Foundation,
Visiting Board of BBCH,
Estate of Mary R. Hodes
American Academy of Pediatrics/Healthy Active Living, Fairchild Semiconductor, Leonard C. & Mildred F. Ferguson
Foundation, Maine Department of Health & Human Services/ARRA, The Rite Aid Foundation
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Comments
Thoughts
Questions
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