County-Level Initiative Reduces Childhood Obesity

Laird Harrison

February 21, 2014

A public health campaign has significantly reduced obesity in King County, Washington, especially among disadvantaged children, officials say.

In school districts targeted by the initiative, the prevalence of obesity in grades 8, 10, and 12 dropped from 10.6% in 2010 to 8.8% in 2012, a statistically significant change, the officials report in an article published in the February 21 issue of the Morbidity and Mortality Weekly Report. Obesity rates stayed fairly constant from 2004 to 2012 in these districts, as in the state and county as a whole.

"We are very pleased to see these trends happening," James W. Krieger, MD, chief of chronic disease and injury prevention at the Seattle and King County Public Health Department, told Medscape Medical News.

The drop in obesity prevalence in the targeted school districts contrasted with other King County school districts, where the rate rose from 6.3% in 2010 to 6.8% in 2012 in grades 8, 10, and 12. That change was not statistically significant.

In the state as a whole, the rate in those grades dipped from 11.5% to 10.9% during the same period, but the change was not statistically significant.

Dr. Krieger said the approach to reducing obesity in King County did not break new ground but was more intensive than similar public health efforts.

Using money from the federal American Recovery and Reinvestment Act of 2009, the county helped schools implement new nutrition standards, recruited students to lead healthy eating and active living promotional campaigns, started farm-to-school programs, improved the quality of physical education (PE), trained school cafeteria staff to cook healthier food, and organized community health coalitions.

"A lot of kids stand around in PE and watch other kids doing things," Dr. Krieger said. His department helped PE teachers organize classes differently and provided them with new equipment, increasing active participation from about 30% to more than 50% of the time the children spent in their classes.

Children took willingly to the innovations, including healthier food. "Our experience is that when you put a salad bar in a school, kids are flocking to it," he continued.

The initiative focused specifically on districts with a high proportion of children from low-income families and families of color because these groups have higher rates of obesity, Dr. Krieger said. The campaign spent $2.8 million on school-based programs during a period of 2 years starting in 2010, he added, which worked out to $19.35 per student.

The money came out of a larger fund of $13 million. The rest of the money went to public education, improving food in hospitals, senior centers and community groups and after school programs, and similar initiatives.

"If you take the approach that you want to change the environment that affects people's activity levels, you can reach a lot of people with a relatively small investment per capita, a much smaller investment than if you enrolled people in 1-on-1 interventions such as diet counseling," Dr. Krieger said.

Other counties could achieve similar results with similar methods, and some in Washington State are already trying, he said.

Meanwhile, King County is hoping to sustain its effort for years to come. That will require finding new sources of funds. At this time, the county is drawing on money allocated for disease prevention through Community Transformation Grants, a provision of the Affordable Care Act.

In the future, Dr. Krieger said he hopes money will come from another provision of the Affordable Care Act: accountable care organizations. These are groups of healthcare providers who get incentives from Medicare and Medicaid to reduce the cost of caring for their patients.

By lowering the prevalence of obesity, the county hopes to lower rates of diabetes and other illnesses, which could save money in healthcare, Dr. Krieger said.

The authors and Dr. Krieger have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2014:63;155-157. Full text


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