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Community rallies to fight obesity in Cleveland's urban youth

Cleveland's childhood overweight and obesity rate is approximately 40 percent and show no sign of plateauing. A team of local researchers has set out to tackle the problem using a comprehensive and pioneering approach, which includes child and family behavioral interventions and partnerships with the Cleveland Metropolitan School District (CMSD) and the YMCA of Greater Cleveland (YMCA). The $12.5 million National Institutes of Health (NIH)-funded program will be led by Case Western Reserve University with clinical expertise provided by University Hospitals (UH) Rainbow Babies & Children's Hospital. It is one of only four programs selected across the country to participate in the NIH's national Childhood Obesity Prevention and Treatment Research (COPTR) initiative. As multiple factors contribute to childhood obesity, the Case Western Reserve program will assess the effectiveness of a multi-factorial approach using three behavioral interventions within children's school and community environments to treat obesity and reduce rates of elevated blood pressure.

"Obesity is often associated with high blood pressure. Both obesity and high blood pressure can lead to complications, and may even cause premature death. Cleveland's youth have substantial needs as they battle against obesity. This program uses a unique approach to provide children and families the tools they need to promote healthy choices and reduce obesity all involving their homes, schools, and communities," says Leona Cuttler, MD, William T. Dahms Professor of Pediatrics and professor of bioethics at Case Western Reserve School of Medicine; chief of pediatric endocrinology, diabetes, and metabolism, and director of the Center for Child Health and Policy at UH Rainbow Babies & Children's Hospital. Dr. Cuttler is one of three principal investigators for the study. "This project incorporates several innovations and can establish a replicable system of aligned programs that have major impact on pediatric obesity. The program has the potential to alter both policy and practice."

The goals of the seven-year project are to reduce obesity and high blood pressure by increasing physical activity, along with healthy eating, sleep, and stress management. Four hundred and fifty overweight and obese students from 50 CMSD schools will participate in the study. The students will be recruited through a screening program established through an existing partnership between CMSD and Case Western Reserve Frances Payne Bolton School of Nursing. Each student will be randomized into one of three groups that offer different behavioral interventions focusing on the child and his/her family: 1.) HealthyCHANGE a behavioral approach focusing on building skills and increasing intrinsic motivation; 2.) SystemCHANGE a behavioral approach focusing on redesign of the family environment and daily routines; 3.) Customary Care a traditional approach, focused primarily on providing educational materials, using those methods currently practiced in intervention programs.

Half of the participating CMSD schools participate in the YMCA's successful We Run This City (WRTC) Youth Marathon program. They will receive nutrition education, a fresh produce "Try It" program, and additional programmatic support for the WRTC program.

Cleveland's COPTR initiative builds on existing successful programs and partnerships to facilitate the research:

  • UH Rainbow Babies & Children's Hospital has championed the fight against pediatric obesity for many years. For example, one of the program's three behavioral interventions, HealthyCHANGE, was developed and initially tested at the hospital. In addition, it developed and implemented the successful Healthy Kids, Healthy Weight program for overweight children and youth. The Center for Child Health and Policy, directed by Dr. Cuttler, is at the forefront of many initiatives and policy analyses that address childhood obesity in Cleveland, the state, and country. In addition, the policy center received an award from The Centers for Disease Control and Prevention to establish a center of excellence in childhood obesity and diabetes the Center for Childhood Diabetes, Activity, and Nutrition. Directed by Dr. Cuttler, it partners with several community groups to address obesity and diabetes.

  • For the past eight years, Frances Payne Bolton nursing students have been conducting district-wide blood pressure screenings on CMSD students under the direction of Marilyn Lotas, PhD, RN, associate dean in the Frances Payne Bolton School of Nursing. The COPTR Cleveland program will apply a new approach to promote healthy living designed by researchers at the School of Nursing in which families engage in redesign of the daily routines that comprise their lifestyles.

  • The Prevention Research Center for Healthy Neighborhoods (PRCHN), based at Case Western Reserve School of Medicine, addresses chronic health issues in disadvantaged neighborhoods in Greater Cleveland. Under the direction of Dr. Elaine Borawski, principal investigator and co-director of the PRCHN, the community core of the study will coordinate efforts with the community and school stakeholders and provide evidence-based programming support to the WRTC program.

"The COPTR program in Cleveland is a multi-level approach to a multi-level problem. It was the strength of our institutions' existing relationships which set our community apart from others. Given the magnitude of our obesity problem, we are bringing together top experts to devise a sustainable solution for our children," says Shirley M. Moore, RN, PhD, Edward J. and Louise Mellen Professor of Nursing, associate dean for research, and director of the Center of Excellence in Self-Management Research at Case Western Reserve Frances Payne Bolton School of Nursing. Dr. Moore is a principal investigator of the study.

A major factor in this study is the central role played by Cleveland's young people and their families. They will participate in focus groups to co-design the study, tailoring it to the lifestyle and needs of Cleveland's overweight/obese students. The students' families will be involved at every level too, including invitations to regular meetings, the opportunity to provide feedback on the study's structure and participating in the interventions. This input will ensure the program is designed to be age and ethnicity appropriate, accommodating all levels of ability. Finally, a community advisory board will be created to counsel the study's leaders.

"We expect the findings of our program and those of the other COPTR studies to contribute to the national discussion on childhood obesity in urban youth. Cleveland's program provides a unique opportunity where research can inform policy," concludes Elaine A. Borawski, PhD, one of the study's principal investigators and associate professor of epidemiology and biostatistics at Case Western Reserve School of Medicine.


Contact: Jessica Studeny
Case Western Reserve University

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