The Department of Health: Childhood Obesity

The Tennessee Department of Health is proposing the development of a coalition with a budget of $100,000 to address the high obesity levels of 10-17-year-old adolescents in four counties in East Tennessee: Claiborne, Grainger, Hancock, and Union. This coalition will use the funding to introduce opportunities for healthier environments within the four counties. The coalition will focus on increasing awareness of the importance of healthy eating and activity habits of 10-17-year-olds in the community. This goal will be accomplished through education and community engagements events.

Tennessee is ranked 1st in obesity in children aged 10-17.1 It is essential to target this age group in order to prevent an increase in over all adult obesity rates in the future. Overweight and obese children are likely to remain obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular disease at a younger age.2 Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.2 In addition, obese children will need more medical treatment, which is likely to add additional stress on the healthcare system. Childhood obesity can profoundly affect children's social, emotional well-being, and self-esteem.2

The coalition’s mission and its goal of offering educational opportunities focused on better nutritional choices are aligned with the objectives found in the Healthy People 2020 report. Objective Nutrition and Weigh Scale-10 is to reduce the proportion of children and adolescents who are considered obese.3 Increasing activity aligns with objective Adolescent Health-2 to increase the proportion of adolescents who participate in extracurricular and/or out-of-school activities.3 The coalition for the reduction of obesity rates of 10-17-year-olds has the potential to positively affect the targeted four county region in East Tennessee.

Executive Summary

The proposed coalition seeks to reduce childhood obesity in 10-17-year olds in Union, Grainger, Claiborne, and Hancock counties in east Tennessee. These four counties present a low socio-economic status and high childhood obesity rate, making them a focus for the proposed coalition. The coalition seeks to involve community members in increasing awareness of the health dangers of childhood obesity and inactivity amongst community members. The coalition plans to increase community awareness through offering educational opportunities in each of the four counties. In addition, annual events featuring healthy food options and fun physical activity opportunities will be used to promote the ease of maintaining a healthy lifestyle.

A coalition should be formed to address obesity in 10-17-year old children in East Tennessee; specifically, the coalition will target four high-risk counties— Union, Grainger, Claiborne, and Hancock. Children who have a body mass index that is above the 95th percentile, when compared to other children of the same age and gender, are classified as obese.4 This is a critical health concern that should be addressed because childhood obesity puts children at a higher risk for type-2 diabetes, asthma, sleep apnea, and adult obesity. 4 Obesity is one of the contributing factors to heart disease and cancer, which are the two leading causes of death in Tennessee.5 The combined overweight and obesity rate in 2016 for 10-17-year-olds in Tennessee was 37.7 percent, which ranks 1st among all states in the United States.1

The proposed coalition will focus on Union, Grainger, Claiborne, and Hancock counties because they are statistically ranked on overall health outcomes in the state of Tennessee at 78th, 83rd, 85th, and 86th, respectively.6 The social and economic factor rankings for these four counties are Union 75th, Grainger 53rd, Claiborne 79th, and Hancock 94th;7 lower socioeconomic status (SES) has been shown to have a relationship to higher risk of childhood obesity in the United States.8 Primary prevention initiatives that address health disparities through creating community partnerships will be the focus of our coalition.

The advantages of forming a coalition are numerous; for example, combining limited resources, both financial and human, with other community outreach organizations.9 Forming a coalition will provide greater influence and credibility within the community; in addition, more diversity of thought and perspective will give the coalition greater insight into the community wants and needs. People from the community who partner with the coalition will have a greater influence within the community than public-health program planners, helping to create buy-in from the community-at-large.

While there are advantages to forming a coalition, there are also challenges that will have to be considered. Some of the areas that will have to be addressed are balancing the wants with the needs of the community; availability of resources may limit the number of initiatives that can be undertaken. The leadership within the coalition will need to be sensitive to the community’s history and culture; it will be important to partner with people who understand the people who live in the four selected counties. Finally, strategically setting the most appropriate size of the coalition’s membership will be important to ensure a manageable balance between diversity of ideas and the ability to come to a consensus on ideas.

The primary functions, roles, and responsibilities of the coalition are to educate, promote, and engage the community on the coalition’s objective to educate obesity. The coalition will educate through the use of workshops that focus on childhood obesity prevention through healthy eating and increased activity, recognizing the life course framework and education as a social determinant of health.10 Research shows that children who eat more nutritious meals and are more physically active perform better in the classroom. Tennessee students struggle to modify behaviors, such as poor eating habits and inactivity, which contribute to development of chronic disease later in life (Wanser, 2018). A national emphasis on childhood obesity has prompted many parent groups to seek out ways to engage in healthy choices for their families; for example, planting a vegetable garden, taking a field trip to a farm or a farmer’s market, and holding a food pyramid potluck at school.12

The lead agency for the proposed coalition will be the Tennessee Department of Health. The Tennessee Department of Health (TDH) was selected as the lead for the coalition because it has several programs that are focused on reducing childhood obesity and inactivity. In addition, the TDH has county health departments within each of the 89 counties, and 6 metro areas, within Tennessee. The local county health departments provide a unique opportunity for the proposed coalition to partner its expertise and share resources.

The key stakeholders for the proposed coalition include a wide-variety of members from the targeted communities; for example, county board of education leaders, local health department personnel, community hospital leaders, local pediatricians, youth group leaders, directors of Boy’s and Girl’s clubs and other after-school programs. Buy-in for the coalition’s goals will be secured by establishing a community connection. Each of the counties will be represented by their mayor, or designee. Keeping the size of the coalition to a smaller number helps the group achieve the established goals more quickly.13 It is important to include diverse members of the community within the coalition to ensure increased community engagement and buy-in.14 The structure of this coalition is characterized by a cooperative strategy. The coalition’s program planners will ensure that formative, process, and outcome evaluations are conducted to ensure the success of the coalition initiatives throughout the implementation and delivery of the program.

The coalition’s mission is to promote healthy lifestyles in children, ages 10-17, by decreasing physical inactivity and encouraging nutritious eating in Grainger, Hancock, Union, Claiborne counties in East Tennessee. The coalition’s vision is to have communities where children can live and play in a healthy environment with access to wholesome foods and opportunities for physical activity. The coalition’s core values are integrity, teamwork, equality, respect, service excellence, and accountability. The coalition must follow its core values to ensure they uphold its mission and achieve its vision. The key operating rules for the partnership will be the same, similar for the four counties. Coalition meetings will be held each month in each county. The director and support staff member will be based at Grainger County Health Department, and travel to coalition meetings in each county.

Meetings will be structured to facilitate purposeful interaction and communication between members.15 The meetings will be facilitated by the director and the support staff member will take minutes during the meetings. All stakeholders will be given the opportunity to speak, offer ideas, and suggestions about how to accomplish the goals of the coalition. The decision-making process for the coalition will be multi-perspective and primarily evidence-based. Evidence-based decision-making uses: the best available peer-reviewed evidence, information systems, program planning frameworks, the community, sound evaluation, and input from key stakeholders.16 Multi-perspective decision making is advantageous because the members of the coalition are coming from different backgrounds and will bring their specialized knowledge and ideas. Group decision making can be disadvantageous if a consensus cannot be reached. The director will ensure that timely group decisions are made.

A critical step in forming and maintaining a successful coalition is establishing the coalition’s identity within the community it seeks to serve. There are several steps that our coalition will undertake to accomplish identity awareness. Once the coalition’s program-planners work with community leaders to conduct a community health assessment, which will establish the needs of the communities the coalition intends to serve, the results of the survey will be shared with local leaders.

It is critically important to choose the most effective leadership for the coalition; therefore, key leaders will be invited to participate in the coalition. As mentioned earlier, these include the directors of the local health departments, local hospital leadership, youth pastors, and key county and city government officials. The coalition program-planners will provide an outline to these key leaders of how the coalition plans to address the health needs of the community, specifically obesity in 10-17-year olds. A local media campaign via radio and newspaper, as well as flyers that will be distributed to local health departments, schools, and doctors’ offices. Workshops and community meetings will be scheduled to introduce the coalition’s plans to form in the local community and to answer any questions that residents might have about the coalition.

Volunteers will be sought for membership to the coalition at each community meeting. In addition, a formal board will be formed from members within the local community. Feedback will be gathered from each meeting that is held and follow up on questions will be timely.

Reference List

1. State Briefs. The State of Obesity. https://stateofobesity.org/states/tn/. Accessed October 4, 2018.
2. Sahoo K, Sahoo B, Choudhury AK, Sofi NY, Kumar R, Bhadoria AS. Childhood obesity: causes and consequences. Journal of Family Medicine and Primary Care. 2015;4(2):187-192. doi:10.4103/2249-4863.154628.
3. Adolescent Health. Healthcare-Associated Infections | Healthy People 2020. https://www.healthypeople.gov/node/3490/objectives. Accessed October 4, 2018.
4. Early Childhood Overweight and Obesity. Tennessee State Government - TN.gov. https://www.tn.gov/health/health-program-areas/fhw/wic/early-childhood-overweight-and-obesity.html. Accessed October 6, 2018.
5. National Center for Health Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/states/tennessee/tennessee.htm. Published April 9, 2018. Accessed October 3, 2018.
6. Rankings. County Health Rankings & Roadmaps. http://www.countyhealthrankings.org/app/tennessee/2018/rankings/outcomes/overall. Accessed October 3, 2018.
7. Rankings. County Health Rankings & Roadmaps. http://www.countyhealthrankings.org/app/tennessee/2018/rankings/factors/4. Accessed October 3, 2018.
8. Wang Y. Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status. International Journal of Epidemiology. 2001;30(5):1129-1136. doi:10.1093/ije/30.5.1129.
9. Cohen L, Baer N, Satterwhite P. Developing effective coalitions: an eight step guide. In: Wurzbach ME, ed. Community Health Education & Promotion: A Guide to Program Design and Evaluation. 2nd ed. Gaithersburg, Md: Aspen Publishers Inc; 2002:144-16.
10. Pérez-Escamilla R, Hospedales J, Contreras A, Kac G. Education for childhood obesity prevention across the life-course: workshop conclusions. International Journal of Obesity Supplements. 2013;3(S1). doi:10.1038/ijosup.2013.7.
11. Ghezzi P. 10 Ways To Promote Healthy Eating. PTO Today. https://www.ptotoday.com/pto-today-articles/article/895-10-ways-to-promote-healthy-eating. Accessed October 16, 2018.
12. Cohen L, Baer N, Satterwhite P. Developing Effective Coalitions: an eight step guide. Prevention Guide. 2002; 11.
13. Faubion RJ, Brown J, Bindler RC, Miller K. Creating a Community Coalition to Prevent Childhood Obesity in Yakima County, Washington: Rev It Up! 2008. Preventing Chronic Disease. 2012;9:E123. doi:10.5888/pcd9.110243.
14. Kegler MC, Steckler A, Malek SH, Mcleroy K. A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina. Health Education Research. 1998;13(2):225-238. doi:10.1093/her/13.2.225.
15. Shi L, Johnson JA, eds. Public Health Administration: Principles for Population-Based Management. 3rd ed. Sudbury, MA: Jones and Bartlett Pub.; 2014.

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