|  | Feature: Healthy Living Move for Health | No.49 January 2007 |
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The Marshfield Healthy Lifestyles Initiative: An Integrated Approach to Fighting the Obesity Epidemic at the Community Level Jonathan C. Reeser,Daniel J. McCarty, MaryAnn T. Lippert & Steven Kirkhorn |
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
Figure 1. Marshfield Clinic is located in central Wisconsin, USA.
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: “Energy in” should equal “energy out” Eat a variety of healthy foods daily Eat appropriate portion sizes Be active for at least 30 minutes daily 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.
Table 1. Self Reported Health Conditions and Behaviors among Residents of Marshfield, Wisconsin “Physically Inactive” was defined as no leisure-time physical activity in the past month “Low Consumption” was defined as fewer than 5 servings of fruits and vegetables per day
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 The Marshfield Healthy Lifestyles Initiative: An Integrated Approach to Fighting the Obesity Epidemic at the Community Level Jonathan C. Reeser,Daniel J. McCarty, MaryAnn T. Lippert & Steven Kirkhorn