Cost-effective, scalable & culturally relevant obesity management delivered in communities

1. Cost-effective, scalable & culturally relevant obesity management delivered in communities June 29, 2011 Teresa Earle, MEND Victor Dominguez, YMCA of Greater Los Angeles

2. MEND Mind Exercise Nutrition Do it! Reduce childhood obesity through innovation, partnerships and practical action

3. Setting Participants Research Content & duration MEND 7-13 • Community • Group-based • Venues include: YMCA, recreation centers, schools, faith-based organizations • Afterschool & primetime evenings (e.g. 5.30 – 7.30pm) and weekends • Low unit cost – peer health educators • 7-13 years • Above healthy weight (> 85th - 99th centile) • Parental attendance required • Siblings included • Parents and children measured • culturally suitable for families from minority ethnic groups-bilingual materials • Developed 2001 • Experienced obesity specialists • 10 years of research and evidence • Largest data from large-scale dissemination in diverse community settings • Aligned to USPSTF recommendations • >40 hrs and 2 yrs maintenance • 10 week intensive phase – multi component • Behavior change strategies • Physical activity • Nutrition counseling and education • Parental efficacy, youth empowerment • Maintenance: up to 24 months support including: • Web-based support, self-directed behavior change, physical activity

4. Behavior change strategies

5. Physical Activity: Spark & Catch curriculums

6. Nutrition education and modeling

7. Nutrition targets and reading labels

8. Explained with high-impact demos…

9. Brought to life in a supermarket…

10. Maintenance and support MEND World Resources Local MEND World activities • Weekly exercise sessions • Promoting community activity • Supporting family networks • Healthy Growth Checks • Health Journey Kit • Challenges+ Magazines • MEND World Website

11. Participant management system

12. 6 month RCT outcomes Sacher et al. Obesity. 2010

13. Start 12 months 12 month outcomes sustained Waist circumference z-score BMI z-score 2.8 2.8 3.0 3.0 0.2 0.5 P<0.001 P<0.001 P<0.001 P<0.001 2.4 2.4 2.3 2.3 Start 12m Start 12m Recoveryheart rate (bpm) Self-esteem score (out of 24) 115 115 19 P=0.026 P=0.026 12 P=0.01 P=0.01 16.7 16.7 95 95 Start 12m Start 12m

14. Emerging US data • Programs in Dallas, Houston, Austin, Waco, • Temple, Los Angeles, Wash. D.C. , New York • Partnerships with local YMCA’s/Parks & Rec

15. US comparative cost-effectiveness

16. A Case Study: Weingart East Los Angeles Y & Southeast-Rio Vista YMCA with The Rose Hills Foundation + MEND 7-13 Program

17. & • There are three essential strategies for the success of The Y and MEND Program partnership • focus on results • shape relationships • structure for resilience • Use of these key strategies enabled our partnership to move quickly and respond effectively to our changing environments

18. Team structure Rose Hills Foundation MEND Operations, Media and Communication, Research and Program Development, Partnership Development YMCA Program Manager Plans and manages all activities around MEND 7-13. May be supported by an Administrative Assistant. MEND Regional Manager Key contact within MEND to assist with Program set up and delivery Nutrition and Mind Theory Leader(s) Leads Mind and Nutrition sessions Exercise Leaders(s) Leads land and water Exercise sessions Program Assistant Assists the Mind and Nutrition Leader MEND 7-13 Participants Families (parents/carers and children participating in MEND 7-13)

19. The YMCA MEND Program has seen measurable changes – children are losing BMI, inches on their waist, eating more nutritious food, engaging in more physical activity, and increasing self and body esteem scores. What more could a funder ask for?

20. Our Impact Nearly 100 community children + their families who attended our bilingual MEND programs over last 16 months showed the following measurable results: • 68% of participants reduced or maintained BMI at 3 mos • Waist circumference decreased by nearly an inch at 3 mos • Children added 2.4 hours more physical activity and decreased sedentary activity by 5.3 hours • Children increased their physical fitness by a reduction in recovery heart rate by 6 beats per minute!

21. Thriving Partnerships 35% of parents indicated no health insurance 30% felt they were underinsured 76% of the children enrolled were obese. Dr. John Tierney from Kaiser Permanente-Sunset volunteered his time to provide complimentary physicals for families registered in MEND.

22. Bite Size: A feature documentary that tackles the problem of childhood obesity head on. The film follows one MEND participant, Moises, as he and his mother gained the support & education they need to change their habits to a more “MEND-friendly” diet and exercise. The film crew witnessed trials and triumphs of Moises and his family, as they learn about health and how to maintain their bodies. Release Date: 2012

23. Defining our Partnership Coming together is a beginning; keeping together is progress; working together is success. -Henry Ford-

24. THANK YOU! Teresa Earle: www.mendfoundation.org Victor Dominguez:www.ymcala.org