Community project will help overweight kids shape up
by Helene Ragovin

The statistics about childhood obesity tell an alarming story.

In the 1960s, 4 percent of the nation's 6- to 11-year-olds were overweight. By the early '90s, that number had risen to 11 percent. By 2000, it was slightly more than 15 percent.

Christina Economos © Mark Morelli

"It's clearly a crisis, and we need to react," says Christina Economos, assistant professor at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. "The consequences [of overweight] affect children at an alarming rate, and so many are likely to become overweight adults."

Economos is the principal investigator for a new three-year project aimed at helping parents and children learn strategies to avoid obesity and the health risks associated with excess weight. The study, "Shape Up Somerville: Eat Smart, Play Hard," received a $499,999 grant last fall from the U.S. Department of Health and Human Services to fund its first year; similar funding is expected for the remaining two years.

The project will involve 1,000 children from first- to third-grade who attend public schools in Somerville, Mass., and 2,000 children from two control groups in Brockton and Everett.

The Somerville youngsters will be evaluated to determine their Body Mass Index, which is a measure of relative weight for height. They will then participate in an intervention program designed to teach healthy eating habits and increase physical activity at school and at home.

"This is quite timely, now that the nation is being bombarded with statistics about the increase in obesity, particularly among children," Economos said.

A growing trend
"Shape Up" is modeled after another Tufts study, The BONES Project, a five-year study funded by the National Institutes of Health to promote bone health in early elementary school children. Economos, who is also a scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging, is the principal investigator for BONES.

While working on BONES, "what really stood out was the number of children who were overweight, with low physical activity and poor dietary habits," Economos said. Her observations were not unusual. According to a study by researchers at the Centers for Disease Control (CDC) that was published October 9 in The Journal of the American Medical Association, the prevalence of overweight among U.S. children of all ages has increased significantly since the '60s and early '70s.

Using data from the National Health and Nutrition Examination Survey (NHANES), the researchers found, for example, that 4.6 percent of adolescents studied from 1966 to 1970 were overweight; in 1999-00, it was 15.5 percent. From 1971 to 1974, 5 percent of children ages 2 to 5 were overweight; from 1999-00, 10.4 percent fell into that category. The largest increases were recorded among black and Mexican-American teens.

One of the many health risks associated with obesity in children is an increased chance of developing Type 2, or non-insulin dependent, diabetes. Once uncommon among youngsters, Type 2 now accounts for about 20 percent of all pediatric diabetes cases, according to the American Diabetes Association. Overweight children also have higher rates of elevated cholesterol, high blood pressure, orthopedic problems, liver disease, asthma and sleep apnea. And, according to the CDC, overweight adolescents have a 70 percent chance of becoming overweight adults.

Community approach
As the name implies, "Shape Up Somerville" will be a community-based program. The Tufts researchers will work with school personnel, local pediatricians, restaurants, city government and parents to approach the issue from several different angles.

For example, Economos said, the Tufts team will look for ways to create safe walking routes to the city's 10 elementary schools to increase students' daily physical activity. And they'll work with the school food service to re-package the school lunch to provide healthier, child-friendly options with more fiber and less sugar and fat.

In addition, there will be materials to reinforce the healthy-living lessons: a home "fun activity" video, a newsletter for parents, a resource directory and parent worksheets, a "game show" on community-access television. Parents will be encouraged to remove televisions from children's bedrooms and to help their children cut down on "screen time," whether it's spent on TV shows, video games or computers.

"We will provide suggestions that they can incorporate into their homes and lives," Economos said. "The real thrust of the program is to target environmental changes. If you focus on changing the environment, promoting behavioral change becomes more feasible."

And, the earlier children learn behaviors that promote good health, the better the chance these changes will stick, she said.

Cultural sensitivity
An important part of the program is customizing it for the Somerville school population, which includes many different racial and ethnic groups. The school district is approximately 56 percent white, 15 percent black, 23 percent Hispanic and 6.5 percent Asian.

Materials for parents will be prepared in Spanish, Portuguese and Haitian Creole as well as English, Economos said.

"Materials and messages will be created with an eye toward cultural sensitivity," Economos said. "We would not tell a Portuguese family to start snacking on rice cakes. We want them to maintain their cultural diet, to choose foods that are meaningful to them."

Economos acknowledged that cultural attitudes toward weight and the realities of everyday family life will present challenges for the researchers. "In some ethnic communities, having an overweight child is seen as a positive thing, because it means the child is well-fed," she said. "This reinforces the need to understand how people perceive body weight."

Across boundaries
"Shape Up Somerville" has an interdisciplinary approach, Economos said. The project draws from the Friedman School of Nutrition, the School of Medicine, the Tufts University Center for Children, the University College of Citizenship and Public Service and the Department of Urban and Environmental Policy and Planning.

Along with Economos, the project team will include three other nutrition faculty members—Jeanne Goldberg, Aviva Must and Miriam Nelson—and Elena Naumova, assistant professor of family medicine and community health at the School of Medicine. Donna Mumme, assistant professor of psychology, and Julian Agyeman, assistant professor of urban and environmental policy and planning, will be consultants; two students who are Omidyar Scholars will also contribute.

"It's an incredible undertaking for the entire community," Economos said. And, the idea is not to limit the program to Somerville, but to have it succeed outside the city as well.

"We hope this model is exportable. We hope it can be replicated in other communities," she said. "We have to come up with a better national solution" to the problem of childhood obesity.