Team Tip-Top Shape

1. Team Tip-Top Shape Say YES to better health. Bateman 2012 Trina Boone • Kayla Cruse • Megan Dunlevy• Katie Dykes

2. Table of Contents Executive Summary…………………………………………….. 1 Situation Analysis………………………………………………...2 Research……………………………………………………………… 3 Target Audience………………………………………………….. 4 Objectives/Strategies/Tactics/Outcomes ……………..4-8 Conclusion………………………………………………………….. 9 Appendix……………………………………………………………. 10-46 Research Analysis………………………………..10-14 Survey Results……………………………………..14-30 Budget…………………………………………………30 Timeline……………………………………………….31 Worksheets………………………………………….32-36 Media List…………………………………………….37 Client List………………………………………….....37 Newsletter……………………………………………38-41 Campaign Highlights.………………………......42 Social Media…………………………………………43-46

3. Executive Summary Childhood obesity is a rapidly growing problem because many children and teens eat poorly and engage in little physical activity. More importantly, they lack education in these two areas and fail to realize the seriousness of childhood obesity. The 2012 Bateman Case Study Competition recognized the extent of this problem and challenged Western Kentucky University’s Team Tip-Top Shape to raise awareness among children of the consequences of obesity, inform them on how to adopt a healthier lifestyle and provide incentives to take action now. Our team worked with the Youth Encouragement Services (YES) Lindsley Center in Nashville, Tenn., approximately an hour south of our campus in Bowling Green, Ky. Our team conducted both primary and secondary research in order to familiarize ourselves with the issue of obesity as well as the students’ awareness level. By distributing surveys electronically to the students, we discovered they were unaware of the severity of obesity and that they face many obstacles to living a healthy lifestyle. Team Tip-Top Shape implemented a campaign to increase the amount of physical activity as well as to encourage healthier eating habits among the students in grades seventh through 12th at YES. Team Tip-Top Shape addressed ways for students to make healthier decisions when grocery shopping and cooking. We brought in guest speakers from the community and hosted various interactive activities to engage the students.   By implementing this campaign, Team Tip-Top Shape enabled the students to take control of their eating habits by educating them on the nutritional value of foods. We exposed the participants to reasonable, healthy alternatives and encouraged them to say Yesto a healthier lifestyle. 1

4. Situation Analysis Childhood obesity is a rising nationwide epidemic. According to the National Health and Nutrition Examination Survey, approximately 17 percent of children and adolescents ages two through 19 are obese. This problem is significant in Tennessee where one third of the children are obese. In a survey distributed to students in grades seventh through 12th, we were able to identify a lack of obesity awareness as an issue facing their age group. Over half of the respondents were unable to correctly identify the definition of obesity. Eighty percent of the respondents believed they were a healthy weight when in fact 27 percent of those students were overweight or obese based on their BMI. Team Tip-Top Shape focused our efforts on YES, a small after-school center that provides educational and recreational programs to students ages six to 18 in an effort to keep them off the streets. We chose to conduct our campaign in Tennessee to avoid the volume of other WKU Bateman teams contacting organizations in Bowling Green. The students at the Center are predominately African American and come from low-income families, 75 percent of whom live below the poverty level, according to the Center’s website. Research shows that the rate of obesity among African American children in Tennessee is more than double the average rate. Food deserts, an area with limited access to affordable and nutritious food, are also a major contributor to obesity as a whole in inner city Nashville and affect lower-income neighborhoods and communities. The Lindsley Center serves two housing projects, J.C. Napier and Tony Sudekum, where the average family income is $9,500 and 92 percent are single-parent families. 2

5. Research Secondary   To better understand the issue of childhood obesity, our team conducted secondary research. We found that single parent families are less likely to serve healthy food, most likely due to time constraints. This in turn causes the rate of obesity among these children to be higher than the general population. Obesity rates also tend to be higher among minorities and low-income children. Exposure to food advertisements and high calorie products at school are labeled as factors contributing to the growing problem of obesity. Research shows that junk food, unlike healthy food, is conveniently located and is far more accessible, particularly in schools. As a result, students struggle to make healthy eating decisions. Research shows this can be detrimental to students’ future and lead to many non-health related problems later in life. People who are persistently overweight are likely not to pursue education beyond high school, to receive welfare or unemployment compensations and to have no partner.Primary To conduct our primary research we distributed a survey to 30 students. We found that the majority of students did not feel obesity was a prominent issue facing their age group. As a result they were, for the most part, unaware of how many children are in fact overweight and could not identify the correct definition of obesity when asked to do so. Although the students did recognize the importance of physical activity to their health, 30 percent did not think their weight affected their health. Since our secondary research highlighted the role parents play in their children’s health, we also distributed surveys to the students’ parents. Eighty three percent of those surveyed were single parents. Like their children, they ranked obesity low among the issues facing children. However, they felt that a child’s eating habits have more effect on whether or not a child is obese. Seventy four percent of the parents serve their children fast food at least once a week. 3

6. Target Audience The primary audience for Team Tip-Top Shape’s campaign was students in grades seventh through 12th at the YES LindsleyCenter. These children fit the demographic that our research showed had higher rates of obesity. Team Tip-Top Shape also sought to raise awareness among the local community of Middle Tennessee. Objectives/Strategies/ Tactics/Outcomes Objective 1: To raise awareness among students at YES by engaging 50 percent of the target audience in three or more activities. Team Tip-Top Shape wanted to host a series of events throughout the month of February. We wanted to establish a bond with the students at YES and prove to them that we were invested in helping them change their lifestyle. We also felt that due to the distance and the time of year in which the campaign was held, if inclement weather did occur, the loss of one event would not negatively affect the entire campaign. Strategy 1: Provide students with opportunities to engage in physical activities. Implement a pedometer challenge to track students’ daily physical activity.Team Tip-Top Shape wanted to engage the students at YES in physical activity outside of their typical daily activities. We also wanted to educate students on the health benefits of doing these activities. Some of the things they learned were how many calories they burn in a minute and how much physical activity they participate in and the impact it can have. We implemented a pedometer challenge that lasted throughout the entirety of the campaign and encouraged the students to participate in various events in an effort to win prizes. 4

7. On the date of the campaign kickoff we introduced the challenge to the students, taught them how to properly use the pedometers and conducted our first activity. Students were given a worksheet and asked to estimate how many steps they would take to carry out everyday activities at YES such as walking to the bus stop and traveling to various locations in the Center. The students then compared their estimations to the actual number of steps. Another pedometer activity educated the students on burning calories. Students were provided the food label for a snack they would typically eat and they were asked to do some form of physical activity in an attempt to burn the amount of calories they would have consumed. Aside from these activities, the students also wore their pedometers during such sessions as Black Girls RUN! and a game of kickball to track their physical activity. The students’ steps were recorded at the end of each session. At the finale event, the three students with the highest total number of steps were awarded prizes. Engage students in physical activity with a representative from the Black Girls RUN! organization.Black Girls RUN! is an organization geared towards tackling the obesity problem facing the African American community and encourages runners, new and old, by providing them with the resources they need to live a healthier life. Kim Glenn is a runner associated with the Nashville branch of Black Girls RUN! and travels to various institutions to speak to children on the importance of physical activity, knowledge and self-worth. We invited her to speak to the students at YES. She began with a discussion of self-worth, goals and values. She had all the students repeat a mission statement, “My mind is valuable, my body is valuable and my dreams are valuable.”From there the students were asked to stand on one end of room and run to Kim and back if the things she voiced were pertinent to their goals. This activity had the students being active and thinking about their futures. The session concluded with a discussion in which the students were asked to highlight things they liked about themselves. 5

8. Strategy 2: Educate students on nutrition and healthy food choices. Invite a dietitian student to lead students on a tour around a local grocery store. Bryce Andrews, a WKU nutrition and dietetics student, served as a tour guide through a local Kroger. He took them through the fruits and vegetables, grains, meats and dairy sections and explained that the perimeter of the store offered the healthiest options. Then the group walked through a few of the aisles where Bryce explained that foods high in sugar, fat and calories were located there. Team Tip-Top Shape provided samples for the students so they would have the opportunity to try some of the items that Bryce spoke about. Strategy 3: Provide students with healthy alternatives in their typical diet. Allow students to participate in a healthy cooking demonstration. Sandra Bush, an Extension Program Community Nutrition Educator for the University of Tennessee Institute of Agriculture, came to YES to teach the students about nutritious foods they can easily prepare for themselves. Sandra discussed the food groups with the students. She asked the students for examples of food they eat often and offered healthier alternatives to many of their favorite snacks and meals. She also taught them how to make a simple, nutritious meal for themselves. Her meal of choice was a healthy quesadilla containing corn, black beans, salsa and cheese. She explained each ingredient and allowed the students to prepare their own quesadillas. She also served them a mix of Juicy Juice and ginger ale. She explained that this was a much better substitute for the calories and sugar that are found in soda. Provide healthy snacks to the students. Team Tip-Top Shape was able to provide the students at YES with healthier snack alternatives. As mentioned before, the cooking demonstration offered a quesadilla as a snack and healthy snacks were offered to the students at the Kroger tour. Other snacks that were served included fruit snacks, juice boxes, light popcorn and the Juicy Juice and ginger ale mix. Our goal was to constantly remind them about healthy eating and offer them snacks that were healthier than the tempting options at YES. 6

9. The majority of the snacks offered at YES are donations. As a result, YES may be able to offer a more nutritious snack like Kashi bars one day, but may serve an unhealthy item like potato chips the next day. Strategy 4: Provide students with the means to educate parents and guardians on their involvement in the campaign Develop a newsletter for families highlighting the campaign activities.Team Tip-Top Shape created a newsletter that was issued to the students at the finale event. This newsletter was intended to serve as a program review for the students and their parents. It highlighted the events that took place as well as their feedback on the events. We included photographs that were taken throughout the program as an illustration of each event. The newsletter also recognized the winners of the pedometer contest. Team Tip-Top Shape aimed to generate discussion between the children and their parents and as a result raise awareness among the parents as well as the students. Objective 1 Outcome: Yes, we did reach our objective. Due to the inconsistency of the students’ attendance, we aimed for a 50 percent attendance rate of the students. Team Tip-Top Shape was able to engage a total of 19 different students in at least one of the six events we hosted. Fifty three percent of those students attended three times or more. Thirty seven percent of the students missed two events or less. The cooking session on February 13 attracted the largest numbers of students. During the finale event Team Tip-Top Shape conducted a focus group with the students. Kimberly Glenn, from Black Girls RUN! returned and reiterated the importance of physical activity and healthy eating. Students also discussed the campaign messages and how they can implement them in their own lives. From the focus group, we gathered that the students were receptive to what we presented throughout the month, but were still hesitant on if they could implement the tips on healthy life changes. 7

10. Objective 2: To provide YES Lindsley Center with at least 10 community contacts in an attempt to build partnerships.Strategy 1: Engage the community in Team Tip-Top Shape’s childhood obesity campaign.Provide YES Lindsley Center with community contacts.Throughout our campaign, Team Tip-Top Shape encountered many individuals and organizations in the community who were willing to help in preventing childhood obesity. We worked with many of these people in our campaign but built relationships with several others. From this we were able to provide YES with a valuable list of future partners, sponsors and volunteers.For a complete list of these contacts see page 37 of the Appendix. Contact local media to notify them of the campaign.Team Tip-Top Shape attempted to engage the community in our campaign to raise awareness of childhood obesity by contacting various media outlets. We drafted a press release that was pitched to news stations, newspapers and specialized media in both Nashville and Bowling Green. Unfortunately, due to the large volume of competition for news and the size of the Nashville market, we didn’t receive media coverage.Objective 2 Outcome:Yes, we did reach our objective. In the process of organizing a variety of events for the campaign, Team Tip-Top Shape was able to establish connections with many community members and organizations. In total, Team Tip-Top Shape was able to provide Daryl Elliott, Director of the Lindsley Center, a list of 19 contacts. Not only were we able to provide YES with the contact information of the individuals and organizations that participated, but we were able to establish the opportunity to work with others in the future. 8

11. Conclusion Team Tip-Top Shape set out to change the way students at YES Lindsley Center think about childhood obesity. What we encountered were many factors that impact their lives, both negatively and positively. We discovered that their lifestyle is a result of not just their choices, but the choices of those around them, their geographical location and the resources available to them. Team Tip-Top Shape encouraged the students to take their lifestyle into their own hands and make the decision to live healthier.   The educational events we conducted equipped the students with the knowledge they need to pick healthy alternatives and showed them how to use the resources available to their advantage. It also increased their awareness of the issue of obesity. On our post-campaign survey that was distributed to the students, we saw an increase in the number of students who accurately answered the questions concerning obesity correctly. Fifteen percent more students was able to correctly identify the percentage of students their age that are overweight. Four percent more students were able to choose the correct definition of obesity when asked. Team Tip-Top Shape encouraged the students at YES Lindsley Center to think beyond obesity to how what they eat, what they do and how they live affects their health, body and future. 9

12. Appendix • Research Analysis Key Facts • Secondary Research: • Parental recognition is a key factor in effecting change. Parental involvement is identified as crucial in obtaining favorable outcomes from interventions aimed at achieving sustained weight management in children. • Parental style is identified as influential in establishing children’s eating patterns, with both over-controlling and under-controlling parental attitudes linked with undesirable child outcomes. • Parents are instrumental in molding the food related attitudes and behaviors children form. They create the family mealtime environment and influence rituals around eating. • Many parents believe that their child’s obesity stems from a lack of exercise, not a poor diet. • Children that are obese are more likely to partake in high-risk behaviors such as smoking and consuming alcohol. • Of all children, 25 to 30 percent are affected by obesity though it remains under diagnosed and under treated. • Hormonal and genetic factors rarely are the cause of childhood obesity. • Children are exposed to an estimated 10,000 advertisements for food per year; 95 percent of which are for fast food, candy, sugared cereal and soft drinks. • Evidence suggests that the consumption of beverages, especially sweetened beverages, is linked with increases in BMI and obesity. • Obesity rates are higher among minority and low-income children than among children as a whole. • Cross-sectional study showed obese adolescents eat no more junk food than non-obese adolescents. However, there is a relationship between BMI and soda. • Changes in children’s environment upset energy balance and contribute to obesity. • Increasing availability of energy-dense, high-calorie food and drinks at school contribute to obesity. 10

13. Changes in family, increase in dual-career or single parent working • families may increase demand for food away from home or pre-prepared • foods. • Approximately 41 percent of all students are at risk for obesity or being overweight. • Studies find that better access to a supermarket is associated with reduced risk of obesity and better access to convenience stores is associated with increased risk of obesity. • Thirty percent of children 12 to 19 are overweight. • Overweight children are more likely to suffer from Type 2 diabetes, high cholesterol, high blood pressure, early maturation and orthopedic problems. The long-term health consequences of childhood obesity include increased risk of diabetes, stroke, arthritis, heart attack and colon, prostate and breast cancer. • People who are persistently overweight are less likely to pursue any education beyond high school, to be receiving welfare or unemployment compensation and to have no current partner. • Approximately one third of the youth in Tennessee are obese. • In 2007, only 18.3 percent of Tennessee high school students ate the recommended amount of fruits and vegetables. • Fifty percent of South Nashville residents traveled two hours round-trip to shop at the nearest supermarket. • Of all U.S. households, 2.3 million, two percent, live more than a mile from a supermarket and don’t have access to a vehicle. • Two percent of Davidson County residents—more than 16,000 people—had no car and lived more than a mile away from the nearest supermarket. • Edgehill, North Nashville and sections of East Nashville are considered food deserts, which are areas where the primary food options are convenience stores and fast food restaurants. Additionally, many residents do not have their own means of transportation. 11

14. Primary Research: • Students: • Three percent of students admit that they have been a victim of bullying because of their weight. • Seventy seven percent of students admit that they have witnessed a classmate being bullied because of their weight. • Fifty three percent of students believe that their parents have the most control over what they eat. • Forty percent of students chose the correct definition of obesity. • Twenty percent of students said they have been on a diet. • Thirty percent of students say they eat a home cooked meal with their family every night. • Eighty percent of students believe they are a healthy weight. • Twenty seven percent of students, based on their given height and weight, are considered overweight by BMI chart. • Four percent of students, based on their given height and weight, are considered obese by BMI chart. • Seventy seven percent of students eat dinner from a fast food restaurant at least once a week. • Twenty five percent of students eat dinner from a fast food restaurant more than twice a week. 12

15. Students post-campaign: • Forty-four percent correctly identified the definition of obesity. • Forty-four percent correctly identified the percentage of children their children’s age that are overweight. • Sixty-seven percent correctly answered that pretzels were the best snack. • Seventy-eight percent correctly answered that the best meat was grilled chicken. • Thirty-three percent correctly answered that green beans were the best side. • Sixty-seven percent correctly answered that Gatorade was the best drink before a basketball game. • Forty-four percent believe that their school lunches are healthy. • Eighty-nine percent were very or slightly comfortable with reading food labels. • Focus Group: • Students said that the Kroger field trip made them not want to eat foods such as chicken nuggets, hot dogs and bologna. • The pedometer exercise made them consider how many steps they take at school each day. • They were surprised that the sugars in bread could lead to diabetes, because they thought that bread was a very healthy food. • The children said that the programming made them care and be more aware of healthy eating and exercise. • The students said that as a result of programming they are outside more, biking, playing basketball and are eating healthier. • One girl said that she was hesitant to change her diet. She said that she was already skinny and that she doesn’t need to lose anymore weight. • Another student said that their mom buys what they want and they are picky so do not want to try anything new. • The students said that they will only have one semester of physical education during their time in high school. • They have one semester of wellness, but the class does not deal with nutrition and eating habits. • Drink machines at their school feature only diet sodas and zero calorie drinks, however, their vending machines are filled with all kinds of unhealthy snacks. 13

16. Parents: • Eleven percent correctly identified the percentage of children their children’s age that are overweight. • Fifty-eight percent believed that eating habits had more of an impact • than exercise. • Twenty-six percent said they, on average, did not eat any fast food for dinner. • Thirteen percent ate fast food three or more times a week. • Forty-eight percent prepared a home cooked meal one to two times a week. • Seventeen percent prepared a home cooked meal every night. • Thirteen percent had been told their child was obese. • Of those obese children, 66.7 percent were given healthier food and 50 percent increased their exercise level. • Thirty-five percent think that nutritional value is the most important • factor when it comes to food for their children. • Twenty percent think cost is the most important factor and another • 20 percent think it’s what the child will eat. • Ninety-seven percent of parents were African American. • Eighty-three percent were single. • Eighty-three percent had three to five children. • Survey Results • Student Pre-Campaign: 14

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23. Students Post-Campaign 21

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32. Budget In-Kind Donations:Target: Guesstures, Work Out DVD, Subway Card        $50Kroger food donation:                        $25Walgreens: 10 disposable cameras:                 $130CVS: Five disposable cameras:                                                     $30NFL Alumni 1: Blue bags, lanyards                $28NFL Alumni 2: drawstring bags, active wear towels         $80NFL TN Chapter: Mini footballs:                     $60Blue Cross Blue Shield: Pedometers:                  $175UT Extension: Beans, Corn, tortillas, salsa:             $10________________________________________________________Total:                                    $588Out of pocket:Introduction snack:                              $10Cooking: Cheese, Juice and Ginger Ale:                  $8Best Buy: Puma Earphones:                      $20Strawberry Kit:                               $10________________________________________________________Total:                                      $48 30

33. Timeline 31

34. Worksheets Worksheet used to introduce pedometers. 32

35. Worksheet provided by Sandra Bush for cooking session. 33

36. Recipe provided by Sandra Bush for cooking session. 34

37. Worksheet provided by Sandra Bush for cooking session. 35

38. Worksheet used in food label pedometer challenge. 36

39. Media List Partner List 37

40. Newsletter 38

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44. Campaign Highlights Left: Group member Trina Boone hands out samples during the Kroger tour. Right: Group members Kayla Cruse and Megan Dunlevy hand out prizes during the finale. Left: Group member Katie Dykes helps a student with a pedometer worksheet. Right: Students cooking healthy quesadillas with Sandra Bush. 42

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