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more photosMetolius Elementary School student Larry Andaluz reacts to being splashed by his classmates during a class at the Madras Aquatic Center in 2008. Obesity prevention advocates are hoping to provide kids in Madras with more opportunities for healthy, active lifestyles.
Rob Kerr / The Bulletin
Step by step
With nearly half of Madras students overweight, the city has become the epicenter of a regional effort to combat childhood obesity by creating healthy communities
By Markian Hawryluk / The Bulletin
Published: January 07. 2010 4:00AM PSTThrough the nation's early struggles to address the childhood obesity epidemic, public health experts have learned a critical lesson: Initiatives that focus solely on identifying and intervening with overweight kids aren't likely to be effective. Singling out the bigger kids, however well-intentioned, only comes across as criticism of the children and parents.
Instead, advocates hoping to address the staggering number of kids whose health is threatened by excess weight are turning to a more systemic approach: looking at the environment in which kids live, hoping to remove barriers to healthy lifestyles.
“There's growing recognition nationally that the environment is impacting the choices we make,” said Kate Wells, outreach director for the Heart Institute of the Cascades. “But when you look at the populations who are disproportionately affected by obesity — rural, low-income, ethnic minority populations typically — when you look at their environment where they're living, you see not as many healthful food options, not as much infrastructure for walking and biking and activities of that nature.”
Wells is also the project director for Kids@Heart, a regional collaboration of health advocates from Bend, Redmond, Prineville and Madras, working to change the environment to help kids live healthy, active lives throughout Central Oregon.
They believe such systemic change can be made only through incremental progress and must start with changing the policies that govern our cities, counties and state. In fact, obesity prevention groups have found they must begin one step further back, conducting the research that will provide the data that will convince policymakers to make meaningful change.
At least initially, that effort will be focused on Madras.
First steps
Efforts in Madras started several years ago, when Mountain View Hospital initiated a Community Health Improvement Program under the direction of Beth Ann Beamer, with funding from the Office of Rural Health and Oregon Health & Science University. In 2008, the program received grants from the Northwest Health Foundation to study the extent of the childhood obesity problem locally and to begin to test approaches to address it.
The group collected body mass index data for a sample of 1,000 kids from local Head Start and pre-kindergarten programs through high school. The results showed that in Madras the problem was even greater than elsewhere in the nation.
About 25 percent of Madras students were considered obese and another 20 percent were overweight. Nationally about 13 percent of students are obese and another 16 percent overweight. At Jefferson County Middle School, nearly 1 in 3 students were obese.
Building on those findings, Beamer is implementing several experiments to test different approaches to battle the problem. From the start of the 2009-10 school year, some students in Madras Elementary School have been eating lunch after recess rather than before. Researchers in other states have found that when kids go to recess first, they do not rush through lunch, and they tend to eat a more well-balanced meal, including more protein and calcium and more fruits and vegetables. Madras Elementary has both a test group going to recess before lunch and a control group eating lunch first.
“It's not about having kids consume less. It's about having kids eat a more complete nutritional profile,” Beamer said. “Anecdotally, we've heard from other states that have initiated this change that there are other benefits. Because they ate (a full) lunch, they tend to be more attentive and more focused.”
Lunch after recess may also serve as a cooling off period for kids, allowing them to get back to work faster when they return to the classroom.
This week, the group has started to test the impact of menu labeling in the school cafeteria at Jefferson County Middle School. With the help of a sophisticated software program, the school will track the total number of calories in school lunches consumed by students in January. Then in February, the cafeteria will duplicate January's menu but will post the calorie counts for meals. At the end of the month, they'll compare the total calories consumed in the two months.
“If you get a good sense that children are impacted by that information, we can take that to the City Council and use it in other situations,” Beamer said.
Local challenges
Madras may be the ideal situation in which to test such concepts. The city is small enough to make projects manageable yet is growing in population, requiring the need for further investment in the city's infrastructure. It's a chance for advocates to have an impact on the design of the community early in the process.
The city also has several characteristics linked with obesity. It has a large population of Latinos and Native Americans, ethnic groups that are at higher risk for obesity. And it is a predominantly rural area.
“There's an assumption that's very incorrect that rural children are healthier than urban children,” said Kim Curley, outreach coordinator for Commute Options of Central Oregon and a member of the Kids@Heart steering committee. “We think they have room to run out and play, or they're out baling hay. A lot of them are actually in small towns, with limited outdoor and play opportunities, and transportation problems.”
Curley has been involved in the Safe Routes to School program, which helps teach kids and parents how students can safely walk or bike to school. In Madras, however, all three schools are located on the east side of the city, while a good portion of the students — including more of the lower-income families — live on the west side. Although it's generally less than a mile to school, students must cross U.S Highway 97 to get there.
“That deters people from crossing the road,” Curley said. “So even though the speed limit in Madras is 20 (mph), parents are afraid to have a second-grader cross the street by themselves. Right now, the school district is busing kids two blocks across the highway.”
The city of Madras has applied for funding from the Oregon Department of Transportation that would be used to improve the physical environment around the schools so parents will feel safer sending their kids to school on foot or on bike. Those applications will be reviewed by ODOT next week.
Those steps could include better crosswalks on routes kids take to school, as well as the establishment of trails and pathways that will keep kids off busy roadways.
“In a perfect world,” Curley said, “I'd make this fly-over bridge, like the deer crossings they do on highways.”
Community support
But Curley said that even if the city gets funding for such projects, the partners will still need to conduct education and outreach to convince kids and parents to use them. They're working to drum up community-wide support, such as establishment of neighborhood watch programs that will help to alleviate parents' fears about possible abduction whether on the way to school or while playing outdoors. They're also working with law enforcement officials for additional monitoring and quick response if concerns arise.
“The parents are the biggest piece of this entire issue,” Beamer said.
In fact, it's been hard to convince many parents their children have a weight problem, she said.
“When they get this piece of information from the school district saying that your child's weight is greater than the 90th percentile, they say, ‘Compared to what? So are his cousins and so are the children he plays with,'” Beamer said.
It's one of the reason that Kids@Heart, with the help of the Heart Institute, is trying to shift the debate from weight to heart health. The institute plans to hold a heart health screening at the middle school for both kids and parents, an approach first tested last year at Summit High School in Bend.
According to its medical director, Dr. Bruce Brundage, the Heart Institute's main focus on community programs is going to be on childhood obesity through the Kids@Heart program.
“We think this is a perfect fit for the institute's mission, which is to promote cardiovascular wellness in Central Oregon,” he said. “We have found our community niche.”
Brundage said the scariest thing about the obesity crisis is how quickly it's come on. Doctors are increasingly seeing kids with heart troubles or diabetes, all brought on by excess weight.
“In the preventive medicine community, we realize that we've seen a decrease in the incidence of heart disease over the last decade in this county in large part due to smoking cessation, effective treatment of high blood pressure and effective treatment of (high cholesterol),” he said. “With what's going on with obesity, we're going to wipe all that progress out.”
The institute is now planning several initiatives in Madras, including raising funds to pay for memberships at the Madras Aquatic Center for high-risk kids who can't afford it. The center, which opened just two years ago, is located right next door to the middle school.
If such programs prove effective in Madras, they could wind up being models for the rest of Central Oregon and the state.
“Though our work is focused on Madras and Jefferson County right now, due to the need, we are also looking at strategies that can be implemented throughout Central Oregon,” Wells said. “Things are not going to change overnight, and it's going to take a collection of voices and tactics.”
The Central Oregon region has experienced tremendous growth over the past two decades, however, and millions have been poured into infrastructure such as roads and schools without necessarily considering the health impact. One of the recommendations made by a state task force on obesity earlier this year was for communities and the state to conduct health impact assessments before investing in construction projects.
“A number of decades have gone by without these things being considered,” Beamer said. “So like many communities in the United States, we are retrofitting and it's probably more expensive. We're really blessed in the city of Madras now to have people in decision-making position who understand that healthy considerations are important. Having that leadership piece helps to create energy.”
Curley said the region also tends to attract people who are open to creating more healthy environments. That's not always the case in other parts of the country. “When I've been talking to other states, they can't get the Safe Routes to School program going,” she said.
In Georgia, there's one school that's implemented the program. In Central Oregon alone, there are 13.
“The challenge we face is that it's not going to be a success for 20 years,” Wells said. “I think this nation is waking up, but it's going to take 20 years to really create that will and start making systemic change and policy change to our built environment at the forefront of our thinking.”
Markian Hawryluk can be reached at 541-617-7814 or mhawryluk@bendbulletin.com.
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