Development of a well-being initiative in schools to fight against childhood obesity
Researchers at the Medical University of South Carolina describe the development of a school-based wellness initiative to tackle childhood obesity by the MUSC Boeing Center for Children’s Wellness (BCCW) in the November issue of the Journal of School Health. Launched in 2007, the program is now available in 200 schools in 20 school districts across South Carolina, thanks to its flexible delivery model. Schools choose from a menu of intervention options to tailor a wellness approach that suits them.
It was South Carolina’s 2005 ranking eighth among the worst countries for childhood obesity that underscored the urgency of the problem and galvanized action around the problem. “
Janice Key, MD, director of the BCCW, main author of the article
According to Key, it became clear from the start that schools were the place where obesity could best be tackled.
âThe kids are there most of the day so they eat there and they have the opportunity to exercise while they’re in school,â Key said. “It is especially important for anything related to healthy lifestyles to include schools.”
For these reasons, the state has mandated school health advisory councils to oversee wellness policy and initiatives at the school district level. However, most of these initiatives were never implemented by schools.
The problem was not a lack of evidence-based strategies to reduce obesity and improve well-being. Over the years, many strategies have been tested in small studies and recommended by public health authorities. The challenge was to get schools to implement them.
âUnfortunately, the recommendations would be published and sit on a shelf somewhere and never get implemented,â Key said. “There was a disconnect between all of this proven stuff and what was going on in the real world.”
To address this mismatch, the BCCW shifted its focus in 2011 from the direct provision of wellness interventions to an implementation strategy that encouraged schools to take more ownership.
The BCCW team consulted with Cathy Melvin, Ph.D., an Implementation Scientist who is now Director of the Community Engagement Core, which supports the Community-Engaged Scholars Program (CES-P) at South Carolina Clinical & Translational Research. (SCTR) Institute. As an implementation scientist, she studies ways to apply evidence-based strategies to the real world. Key and Melvin spent the next decade perfecting the program’s delivery model.
âDr Key and I agreed to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) model as a guiding framework for measuring the implementation of the BCCW program,â said Melvin, senior author of the article. âRE-AIM allows us to focus on understanding how to effect ‘real world’ change at the individual and organizational levels in schools across our state. “
All participating schools now have their own wellness committees, most of which include a health professional. Key and his team found that the inclusion of health professionals leads schools to implement 25% more wellness initiatives. These committees support wellness initiatives, choosing the ones that best suit their schools from a menu of evidence-based options on a school wellness checklist. These can include policy changes, such as choosing a reward based on exercise rather than food; changes to systems, such as having health professionals on the school wellness committee; and environmental changes, such as the elimination of sugar-sweetened drink vending machines. In addition to students, teachers and staff are also welcome to participate in wellness initiatives.
âThe staff and teachers are all excited about becoming healthier,â Key said. “I like the fact that it’s really a culture change.”
Schools receive points based on the number, impact and difficulty of the interventions they put in place. They compete with other schools to see which can get the most points. Winners receive funds that can be used for a future wellness intervention of their choice.
To gain buy-in from school administrators, it was also important to identify parameters of success that would be meaningful to them. To find out what metrics they might be interested in, in 2013, Key partnered with Robert Stevens, Ph.D., then of the Charleston County School District, in a study funded by TBS’s CES-P.
Key attributes this collaboration with Stevens a crucial role in the success of the program. Stevens continues to work with the SCTR as a member of the CES-P Review Team and the SCTR Translational Research Community Advisory Board.
Recent research shows that school administrators are interested not only in health, but also in educational outcomes, such as graduation rates. According to the program’s 2020 impact statement, obesity among fifth-graders in Charleston County schools has declined by 38% since 2008. Academic outcomes have also improved: attendance is higher, and school attendance is higher. suspensions and expulsions are lower in schools that have participated longer. For every four years of participation, attendance rates have increased by half a percent. This translates to 33 additional student days for a school with an enrollment of 200 students. For every 50 points a school scored on the School’s Well-Being Checklist, graduation rates increased by 1.5%. This would translate to 10 more students graduating from a high school with a class of 300 graduates.
What story does this data tell?
For Key, it’s easy. “A healthy child learns better,” she said.
Key thinks the model BCCW has developed over the years is easy to implement and would like to see it spread to more schools across the state.
âMore funding would allow us to go to all the districts and have an even bigger impact,â Key said.
Key, JD, et al. (2021) Development of an innovative and unique comprehensive school health initiative involving community health professionals. Journal of School Health. doi.org/10.1111/josh.13081.