![]() | Feature: Healthy Living Move for Health | No.49 January 2007 |
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Abstract
Overweight and obesity are now epidemic in the United
States, as they are in many other areas of the world. This article provides
a brief overview of the collaborative approach to intervening against
these health conditions that has been developed by Marshfield Clinic and
the communities of which it is a part. Article
Marshfield, Wisconsin (population 18,796) is
a small town located in the upper mid-western portion of the United
States. The surrounding countryside is dotted with family-owned dairy
farms, which makes the presence of a tertiary care medical center
in this unassuming locality all the more surprising.
Marshfield Clinic is a large, not-for-profit,
physician owned multi-specialty medical practice with facilities located
in more than 30 communities across central, western and northern Wisconsin.
Marshfield, where the main campus of the Clinic is located, is in
many respects a microcosm of the rural northern United States.
In 2001, Clinic cardiologist Charles McCauley,
MD, FACC became alarmed by the increasing prevalence of heart disease
among younger age groups and by the accelerating rates of overweight
and obesity among Marshfield area youth. After obtaining the support
of Clinic leadership, Dr. McCauley organised a community symposium
focusing on this issue in May 2002. The Marshfield Healthy Lifestyles
Initiative was created shortly thereafter, in response to the concerns
raised by Dr. McCauley during this symposium.
The long-term goal of the Healthy Lifestyles
Initiative is to improve community health and promote a healthier
workforce by integrating individual clinical strategies for the prevention
and treatment of obesity with broader population-based interventions,
such as working with schools, community organisations and employers.
In order to accomplish this worthy goal, the Healthy Lifestyles Initiative
was designed to have two distinct arms, each with its unique responsibilities
but ultimately meant to work collaboratively together. The first of
these two arms, the Healthy Lifestyles Program, focuses on the Clinic’s
role as a provider of patient care, as a major employer in the Marshfield
area and as a respected member of the communities it serves. The second
arm, the Healthy Lifestyles - Marshfield Area Coalition, focuses its
efforts on initiatives designed to educate the wider central Wisconsin
community regarding healthful dietary practices and the benefits of
active living.
Since its inception, the Healthy Lifestyles Program
has worked from within the Clinic medical system to address the complex
issues related to the prevention and treatment of overweight, inactivity
and unhealthy eating habits. The program seeks to support Clinic physicians
in their efforts to treat their overweight and obese patients through
continuing medical education, patient education and referral to evidence-based
weight loss programs. The Program also seeks to effect positive behavioral
change among Clinic employees through a variety of strategies, including
“labeling” the calorie and fat content of food served
in the Clinic cafeteria, providing healthier food and beverage items
for retail sale in vending machines and demarcating walking paths
in and around the Clinic building.
The Healthy Lifestyles – Marshfield Area Coalition
was formed to educate the residents of central Wisconsin regarding the
fundamentals of sound nutrition and the benefits of regular leisure-time
physical activity. Members of the Coalition include concerned citizens,
local businesses and schools, local government and civic groups. In the
four years since it was established, membership in the Coalition has tripled,
to more than 230 members. The Coalition uses a committee structure to
identify and implement activities relevant to the four key principles
that serve as the foundation of its message to the community.
Figure 2: ![]() The Key Principles of the Healthy Lifestyles Initiative:
Through
the efforts of the Coalition, an activity resource guide has been published
on the Initiative’s dedicated web site (www.marshfieldhealthylifestyles.org),
and area grocery stores and restaurants are increasingly providing nutritional
information to customers regarding their products. The group partners
with local media to publish a regular newspaper column that highlights
one aspect of how adopting a healthy lifestyle can enhance one’s
well-being. In addition, the Coalition has developed a toolkit, to promote
worksite health and wellness that is available free of charge to area
businesses, and has sponsored a forum on how to effect social change through
public policy. Significantly, the Marshfield School District curriculum
and policies have been revised to reflect the principles promulgated by
the Healthy Lifestyles Initiative.
Marshfield Clinic has a long and illustrious history
of involvement in medical research and discovery, so it is not surprising
that the Healthy Lifestyles Program recognises the importance of research
in the ongoing battle against obesity and overweight. Daniel McCarty,
Ph.D. is an epidemiologist at the Marshfield Clinic Research Foundation,
the largest private research organisation in the state of Wisconsin. Dr.
McCarty’s area of interest includes physical inactivity and related
disease states and he has been instrumental in formulating the Foundation’s
research agenda in this area. Between October 2003 and September 2004,
Dr. McCarty completed a baseline assessment of self-reported health and
the prevalence of risk factors for cardiovascular disease and obesity
related conditions within the Marshfield community. To conduct the research,
Dr. McCarty employed a telephone questionnaire derived from the Behavioral
Risk Factor Surveillance System (BRFSS) developed by the Centers for Disease
Control (CDC) in Atlanta, Georgia, USA. Demographically, Dr. McCarty found
that Marshfield was comparable to the rest of Wisconsin and the USA in
terms of the rate of overweight and obesity, as well as general health
status. The data obtained from the 1463 households surveyed is summarised
in Table 1. These data will serve as a baseline measure against which
future data can be compared.
Research has shown that physical inactivity and
sedentary lifestyles play a significant role in a number of prevalent
disease states, including several with high morbidity, mortality and
societal cost. Consequently, the CDC has recommended that all persons
should participate in regular, “moderately intense” physical
activity on a minimum of 5 days per week. Unfortunately, most of the
area residents surveyed by Dr. McCarty failed to meet this goal. Current
research, conducted by Dr. McCarty and Dr. Jonathan Reeser, seeks
to identify the existing barriers to obtaining regular leisure-time
physical activity among Marshfield area residents. The investigators
hope that these data will be useful to the members of the Coalition,
permitting them to design interventions to overcome the barriers to
activity and thereby improve the health status of central Wisconsin
residents.
The “Barriers to Activity” project
was funded through the Marshfield Clinic Healthy Lifestyles Special
Projects Fund. This fund, established by the Marshfield Clinic to
advance the goals of the Healthy Lifestyles Initiative through research
and outreach, represents an important step in the evolution of the
Healthy Lifestyles Initiative. Examples of other projects that have
recently been funded through the Special Projects Fund include four
patient care improvement projects (including a family-centered pediatric
intervention and enhanced diabetic case management), and six community
health improvement projects (with outcomes ranging from needs assessment
and data collection to pilot activity programs to new community-specific
education materials). Funded projects for 2007 will focus on promoting
healthy lifestyles in three priority areas: schools, clinical practice
and local worksites.
As the Healthy Lifestyles Initiative enters its
fifth year, there is a clear need to assess the efficacy of the various
interventions that have been employed since the program’s inception.
There exists at present only anecdotal evidence to suggest that the
Initiative has had a significant impact on the health and well-being
of Marshfield area residents. A more concrete assessment of the impact
of the existing programs will be possible when Dr. McCarty conducts
the planned follow-up to the BRFSS survey. In the meantime, the Healthy
Lifestyles Program and the Marshfield Area Coalition will continue
to collaborate in an effort to improve the dietary and physical health
of the Marshfield community. Moving forward, the Healthy Initiative
will begin to disseminate what has been learned about the “best
practices” in the fight against obesity and inactivity throughout
the other communities in central, western and northern Wisconsin that
are served by the Marshfield Clinic. Contact
Jonathan C. Reeser, MDPhD
Marshfield Clinic Research Foundation Marshfield USA reeser.jonathan@marshfieldclinic.org ![]() http://www.icsspe.org/portal/index.php?w=1&z=5 |