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Teddy Klug
Fernando Ona
PH 0221
February 5, 2015
The Partnership for a Healthy Mississippi
Background and Problem Assessment:
Childhood obesity has been labeled an epidemic in the United States and numbers continue
to rise annually. In Mississippi, over 44% of children are overweight or obese, and the state is
ranked 51st with the highest rate of childhood obesity in the US (National Survey of Children’s
Health, 2007). Childhood obesity is defined as having a BMI above the 95th percentile for peers of
the same age and sex (Barlow, 2007). Over 54% of black children are overweight or obese
compared to just over 36% of white children (Mississippi State Fact Sheet, 2008). If not confronted
early on, childhood obesity can lead to physical and emotional consequences, such as high
cholesterol, high blood pressure, heart diseases, bone diseases, low self-esteem and a decline in
cognitive function (CDC, 2013).
A sedentary lifestyle is a major behavioral risk factor associated with childhood obesity.
(Karnik & Kanekar, 2012). Almost 15% of children aged 6-17 in Mississippi spend more than four
hours in front of a television or computer screen (National Survey of Children’s Health, 2007). For
some children in the US, the inability to eat healthy foods at home and at school is a significant
factor. Overconsumption of high-fat and high-calorie foods has been strongly linked to childhood
obesity (Story, 2009). In addition, for many children throughout both rural and urban parts of the
United States, there are so-called food deserts, where affordable and nutritious foods are difficult to
find, particularly for those who do not have access to transportation (Schwartz, 1993). For many
children, the surplus of advertisements concerning fast-food restaurants determines the conception
of normal eating and consumption practices (American Psychological Association, 2004).
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The target populations for this particular health promotion program, The Partnership for a
Healthy Mississippi, are children (ages 8-11) in the Mississippi Delta public school system and their
parents. While there are racial disparities regarding childhood obesity, this program will target all
students and their parents in order to reduce rates of childhood obesity in future years. The
program will be conducted in schools, since children consume 35-47% of their calories at school
(Cluss, Fee, Culyba, Bhat & Owen, 2013).
The Partnership for a Healthy Mississippi will be focused across the Washington County
area of Greenville, Mississippi. The program will target third and fourth grade students, parents,
and school staff simultaneously. The program strategy will focus on changing eating habits in
children, particularly reducing calorie intake from fat and increasing fruit and vegetable
consumption. In order to reach these goals, the program will utilize classroom instruction, a weekly
newsletter and posters and brochures. A reduction in the high rate of childhood obesity in
Washington County will not only prevent a number of possible future health complications, such as
heart diseases and depression, but also reduce the financial burden on the health care system in the
state of Mississippi.
Key Stakeholders:
a. Parents:
Parents are vital stakeholders in our program. Parents set examples for their children by modeling
healthy eating habits. We realize the fact that a parent’s life is often quite busy and hectic. Despite
good intentions, many parents do not know how to start or how to correctly maintain healthy
eating habits. It is therefore crucial to collaborate with parents in our program by involving them in
periodic healthy eating seminars and sending them weekly newsletters. Parents will act as vehicles
to send our messages to their children and to the community.
b. Schools:
Children spend a great proportion of their time at school, where their personalities, behaviors and
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habits are shaped and influenced. Children eat and play at school, so it is critical that schools have
low-calorie and nutritious meals, as well as high quality physical education incorporated into the
curriculum. Thanks to the effort of the first lady, Michelle Obama, to address childhood obesity,
Congress passed the Healthy, Hunger-Free Kids Act (HHFKA) in 2010, designed to revamp schoolmeal programs (USDA, 2010).
c. Mississippi Governor:
Long before the activation of the HHFKA, Mississippi acknowledged that their state was in the midst
of a childhood obesity crisis. A collaboration was conducted by Dr. Lynn House, Mississippi’s
Interim State Superintendent of Education, with the then State Governor Haley Barbour. They
partnered with local organizations, such as the Bower Foundation and the Bauru Foundation, to
pass the Healthy Student Act (HSA) in 2007. The HSA secured commitments from local school
boards and districts to implement healthy eating environments in Mississippi schools (Mississippi
Department of Education, 2008).
d. Mississippi Department of Education, Office of Healthy Schools:
The director of Child Nutrition and Healthy Schools at the Mississippi Department of Education said
that schools in Mississippi now incorporate more fruits, vegetables, and whole grains in their lunch
programs. In addition, steamers have replaced fryers in many schools. The HSA of Mississippi was
successful in reducing the rate of childhood obesity among high school students by 13% (from
43.0% in 2005 to 37.3% in 2011) (MSDH report, 2012).
Overall Strategy:
Mississippi has the highest rate of childhood obesity in the United States at about 44%,
compared to the 31% national average. Since children consume 35%-47% of their total caloric
intake at school, it’s the best place to focus a nutritional intervention to target childhood obesity
(Cluss, Fee, Culyba, Bhat & Owen, 2013). Making school lunches more healthful and providing
children and parents with nutritional education will help to decrease obesity prevalence in
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Washington County and Greenville, Mississippi. The Partnership for a Healthy Mississippi will be
focusing on the 8-11 age group and across all racial and economic groups, since the rate of
childhood obesity is already high among all demographic characteristics. The project will
implement a health promotion program that will increase healthy eating and physical activity
patterns. By reducing the rate of childhood obesity in Washington County in their early formative
years, The Partnership for a Healthy Mississippi will be able to prevent or reduce the short and
long-term health consequences that will inevitably affect individuals, the community and society at
large.
Methods and Program Description:
a. Specific Aims:
1. By January 2017, students will consume no more than 35% of their calorie intake from
unsaturated fat and no more than 10% of their calorie intake from saturated fat, with most fats
coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and
vegetable oils (Cohen, 2013).
2. By January 2017, there will be a 15% increase in fruit and vegetable consumption in children,
from 9% to 24% (Stocksdale, 2010).
3. By January 2017, there will be an increase, from 23% to 46%, in the number of students who
participate in quality physical education classes for 60 minutes per day (Ogden, 2000).
b. Possible Obstacles:
The target populations for this health promotion program are children (ages 8-11) in the
Washington County and Greenville, Mississippi, public school system, as well as their parents. While
there are clearly racial disparities regarding childhood obesity, this program will target all students
and their parents in order to reduce rates of childhood obesity in future years. The Partnership for
a Healthy Mississippi chose this age range since dietary and physical activity behaviors start to
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develop in these years and interventions designed to influence and build healthy behaviors at this
point have the potential for more long-term impacts (Branscum & Sharma, 2012). The program will
be conducted in schools, since children consume 35-47% of their calories at school (Cluss, Fee,
Culyba, Bhat & Owen, 2013). This intervention will develop new life-skills for children that will
enable them to exhibit more control over their food choices and eating habits. Additionally, by
involving parents, the new habits will be enforced at school and home. Ideally, parents will be very
involved in these new healthy behavior changes. Still, The Partnership for a Healthy Mississippi
refuses to recognize that this could be difficult. With many parents working multiple jobs or being
busy with the necessities of life and survival, such changes and consistent eating practices would
require a lot of support and attention that might not be available or provided. Simple recipes that
do not require a lot of supervision or parental involvement are ideal. It is also important that the
recipes sent home are both healthy and low-cost, since many families operate on tight budgets.
It is also important to remember that many parents may not have the skills required to cook
for their children, and The Partnership for a Healthy Mississippi fails to recognize this fact. The
recipes sent home through The Partnership for a Healthy Mississippi should include simple, stepby-step instructions that are easy to follow, with foods that are easy to recognize. Also, community
collaborations (i.e. faith-based organizations) may be utilized to provide an adult cooking class to
help parents build more food preparation skills.
Finally, The Partnership for a Healthy Mississippi cites that a student’s taste preference is a
barrier for consumption, particularly for vegetables. However, nutrition researchers have shown
that if children are repeatedly exposed to new food that they will be more willing to accept them
(Woo Baidal, 2014).
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References
American Psychological Association (2004). Report of the APA task force on advertising and children.
Retrieved from http://www.apa.org/pi/families/resources/advertising-children.pdf.
Barlow, S.E., and the Expert Committee. (2007). Expert committee recommendations regarding the
prevention, assessment, and treatment of child and adolescent overweight and obesity:
summary report. Pediatrics, 120 Supplement December 2007:S164—S192.
Branscum, P. & Sharma, M. (2012). After-school based obesity prevention interventions: A
comprehensive review of the literature. International Journal of Environmental Research and
Public Health, 9(4): 1438-57.
CDC. Progress on childhood Obesity; CDC Vital Signs. (2013, August 6). Retrieved October 6, 2014,
from http://www.cdc.gov/VitalSigns/ChildhoodObesity/.
Cluss, P.A., Fee, L., Culyba, R.J., Bhat, K.B., Owen, K. (2013). Effect of food service nutrition
improvements on elementary school cafeteria lunch purchase patterns. Journal of School
Health, 84: 355-362.
Cohen JF1, Richardson S2, Parker E2, Catalano PJ3, Rimm EB4 (2013). Impact of the new U.S.
Department of Agriculture school meal standards on food selection, consumption, and
waste. American Journal of Preventive Medicine, 46(4): 388-94.
Karnik, S. Kanekar, A. (2012). Childhood obesity: a global public health crisis. International Journal
of Preventative Medicine, 3(1): 1-7.
Kern, E., Chan, N.L., Fleming, D.W., & Krieger, J.W. (2014) Declines in student obesity prevalence
associated with a prevention initiative - King County, Washington, 2012. Centers for Disease
Control and Prevention (CDC).
Mississippi Department of Education, Office of Healthy Schools. (2008). Retrieved from
http://www.healthyschoolsms.org/ohs_main/MShealthystudentsact.htm.
Mississippi State Department of Health. (2012). Mississippi's obesity rate declines among high
school students over the past two years. Retrieved from
http://www.msdh.state.ms.us/msdhsite/_static/23,13173,341,610.html.
Mississippi State Fact Sheet. (2008). Retrieved November 3, 2014 from
http://www.childhealthdata.org/docs/nsch-docs/mississippi-pdf.pdf.
National Survey of Children’s Health. (2007). Data analysis provided by the Child and Adolescent
Health Measurement Initiative, Data Resource Center. Retrieved from
http://www.childhealthdata.org/.
Ogden, et al (2000). Prevalence and trends in overweight among US children and adolescents.
Journal of the American Medical Association. 2002; 288:1728–1732.
Schwartz,
J.
(1993,
September
30).
Obesity
affects
economic,
social
status.
The
Washingt
on
Post,
pp.A1,
A4.
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Stocksdale, C. (2011). 10 states with the deadliest eating habits. Retrieved from
http://finance.yahoo.com/news/pf_article_112083.html
Story, M., Nanney, M. S., & Schwartz, M. B. (2009). Schools and obesity prevention: creating school
environments and policies to promote healthy eating and physical activity. The Milbank
Quarterly, 87(1), 71–100. doi:10.1111/j.1468-0009.2009.00548.x
United States Department Agriculture. (2010). Health hunger-free kids act. Retrieved from
http://www.fns.usda.gov/tags/healthy-hunger-free-kids-act-0.
Woo Baidal, J., & Taveras, E. (2014) Protecting progress against childhood obesity - The National
School Lunch Program . New England Journal of Medicine; 371:1862-1865.
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