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Mobilize Youth: One Approach to Childhood Obesity

I Introduction

In the past two decades, childhood obesity has emerged as one of the biggest issues in health promotion. Of 34 nations surveyed, Canada ranked fifth in the rise of childhood obesity. (1) The 2004 Canadian Community Health Survey found that 26% of Canadian children were overweight and 8% were obese. (1)

Research (2) in the United States finds that 70% of obese adolescents become obese adults and experience a much higher rate of degenerative diseases. To extrapolate, it appears that if we do not reverse the present trend, 75% of the next adult generation will be obese or overweight.

The "Genuine Progress Index Measuring Sustainable Development" reported as far back as 2001 that obesity costs the Ontario economy between $2.2 and $2.5 billion or 0.7% to 0.8% of the province's total annual Gross Domestic Product. But what is important to the health promotion field is that funding for health promotion and disease prevention accounted for just 2.6% of Ontario's health budget with 97.4% going to illness treatment.

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II  What is MobilizeYouth?

MobilizeYouth was founded in 2005 as a response to the problem of childhood obesity. MobilizeYouth is a for-profit, hands-on health program for obese and overweight children between the ages of 8 and 16. It is a multidisciplinary 4-month program designed specifically for overweight youth and their parents, usually the mother. The program consists of a 50-minute, three times weekly (minimum twice weekly) customized fitness training program; group and one-on-one nutrition sessions focusing on information and behaviour (kids' personal issues); and moms' practical meal planning sessions with a nutrition chef.

All participants are assessed monthly as to weight, height, waist, hips, legs, and arms. Many kids dread the monthly assessments, so we take care to treat measurement only as a guide to progress.

To date, MobilizeYouth has served over 50 kids and teens. Typical participants are overwhelmingly inactive, significantly overweight, have low-self esteem and in all cases, have poor eating habits. Many have gone through nutrition and other medical clinics with little success. Most of their parents are also overweight. Most work and many who seek support are single women who have little control over their children's eating habits and lack of physical activity.

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III    Who is MobilizeYouth?

Our experts include a leadership-award-winning physical education graduate from the University of Toronto, who had been a provincial athlete and is now a pediatric nurse at The Hospital for Sick Children, an experienced nutritionist in the field of long-term care and diabetes, and physical education and kinesiology coaches experienced in coaching youth.

Most MobilizeYouth coaches have stayed longer than 8 months, with new coaches and university student placements joining the team regularly. The Equilibrium Nutrition team numbers three now and is growing to meet the needs of teens, pre-teens, moms and post maintenance

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IV    What Works

Because everyone associated with MobilizeYouth is so passionate about helping youth, it is only fitting to share the learning experiences and successes with the health promotion community.

Access Is Not Enough

MobilizeYouth began by conducting one-and-a-half-years' research (3) with family practitioners, pediatricians, specialists, nutritionists, policy makers, educators, and parents. Our research showed that most community centres, after-school programs, and kids' gyms attracted the general youth population but not obese kids or overweight adult women--their parents. Clearly, availability of physical recreation facilities may not be the problem in meeting the needs of inactive, overweight children. Rather, there is a surprising lack of a coordinated effort to address that cohort. Pediatricians, frustrated at years of failure in improving the fitness of overweight patients, hesitated at the time to make referrals to MobilizeYouth in the absence of a proven track record and because of the cost--and unfortunately continue to withhold much needed support.
 
As a privately run program relying on referrals, MobilizeYouth must charge a fee. We initially adjusted the monthly fee--now at $240 ($30 for each session twice weekly; the third session of the week is at no cost). The monthly rate becomes $216 for the following 4 months to encourage retention, which is the key to success. Often, it must be pointed out to parents commenting on the cost that besides being an investment in his or her child, it far outweighs the huge spending incurred on fast and prepared food, nutritionists' fees, gym memberships and weight-watchers, diets, and costs related to weight illnesses. We have chosen to partially subsidize several families.

A Multidisciplinary Approach

Research (4) shows that long-lasting success is best achieved over time by a multi-disciplinary approach. It is therefore an uphill battle on multiple fronts: self confidence, physical fitness, making better eating choices, and more. However, results are possible, and there's every reason to try.

Our philosophy is that there are no silver bullets towards becoming a healthier person. It takes continuous work. Kids learn early on that the focus is not on weight but on making the connection between being fit, feeling good about themselves, and learning how to maintain good health. Based on our analysis, high-tech fads such as dancing mats and video games may help in the short run but do not encourage long-term results. The goal is to motivate kids and their parents to carry on as much physical activity outside the MobilizeYouth program. To that end, we offer non-competitive sports along with hiking, field drills, aquatics, boxing, and spinning, with the main focus on strength training.
 
A Coaching Approach

MobilizeYouth staff and trainees have gained insight into the radical difference in coaching overweight youth and adolescents compared with those who do not have weight and emotional issues, and self-image problems and those who have endured bullying and teasing and peer pressure to be unreasonably thin.

Coaching staff reports that the MobilizeYouth program is one of the most labour-intensive undertakings they have ever experienced. They see firsthand the tremendous effort it takes to motivate this group to keep going. Parents may understand future health risks, but it is very challenging for children to see the long-term future--but they do know that they want to look good, be better at gym, and be accepted.

Communication between coaches and youths is crucial. The kids attending typically come in with emotional baggage (low self-esteem, having been bullied at school), fatigue (sugar spikes, trouble sleeping), and tenuous interest in exercise (so needing lots of motivation). Frequently they come in yawning, are "exhausted" from school, don't want to go outside in great weather, and "don't do running." Often, the lethargy dissipates once they get going, but the effort to create that mindset is so complex, frustrating, and difficult, that everyone is left limp at the end of a session.

A Family-Centred Approach

We have learned the hard way that parental involvement is vital for the success of the program. Parents of MobilizeYouth work out at no cost while their children are occupied! As well, most parents acknowledge that they need to drastically change the mealtime dynamic, which means a commitment to the weekly parents' sessions. Yet, this remains one of the most difficult areas to overcome: changing how the family shops, eats, supports their overweight child's lifestyle change, and becomes open to alternative products.

When parents enrol their kids without their kids' agreement, the program works only in the short term. The expected duration for most kids in the program is 8 months, with some staying a year. However, a 22% retention rate in the program (beyond the initial 4-month session) is typical, underscoring the effort (and expense) required in marketing.

Age and Gender

Younger kids, 9 to 13 years old, whose parents are involved, make the quickest progress throughout the 4-month session. Mixing pre-teen boys and girls into the same group works, but some unmotivated, primarily older, boys prefer male coaches and seem to do better when they work out with male coaches. Boys more than girls are very self-conscious about disrobing for swimming.

It is crucial to break up the younger kids and teens and maintenance group for the nutrition sessions.

Environment

The environment is non-clinical and non-competitive so that visibly overweight youth and their parents (usually moms) feel comfortable and accepted. Some centres are more conducive than others to this kind of program that requires management cooperation, allocation of member facilities, and adult membership understanding that the program helps overweight youth.

Our original location is a north Toronto fitness centre, which agreed to accommodate the pilot program rent-free for 6 months. Through marketing and the after-school and weekend attendance, a greater public has learned about the centre and will join as members in the future. A rental arrangement has been implemented at the start of the year. In fall 2007, the program will expand to another additional location, the Columbus Centre, and possibly a third.

Outcomes

Weight loss comes slowly, unless, as in some participants, it happens very quickly and then stops. As the core of our program, weight training may raise endurance and build muscle, but it also maintains the weight at a certain level--a surprise and disappointment to kids who work very hard.

We have seen both physical and diet changes in our young participants and know that for some families, we have made a difference in their lifestyle habits. Thirty-six per cent of kids have succeeded--dropping waist inches, showing increased self-confidence, and improving the management of early onset diabetes. They have carried physical activity and fitness outside the program in ways such as first-time sports tryouts--and success in making the team! They have engaged in city-wide fundraising walks/biking, and one child won the Athlete of the Year Award at school. There are noticeably altered eating habits, and parent testimonials on mealtime changes.

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V    No Easy Solution

An integrated, child obesity-specific program such as MobilizeYouth in two or three locations may change a few lives here and there. However, for the Ontario population at large to reverse its obesity risks, it is necessary to have a coordinated health strategy. We believe that all sectors--private, public, government, education and community--must work together now in a combined effort to design, fund, and implement an infrastructure capable of addressing this issue.

We envision a model of coordinated, accessible, and affordable child obesity-specific programs in community centres, implemented by organizations using a multi-disciplinary, family-centred approach and managed by the centre. Public policy would dictate that eligible not-for-profit centres, interested in an obesity program, could apply for funding towards purchase of the program and funds for their own internal start-up. Health care practitioners coordinating programs in public health units and community health centres could be the bridge between identification of interested community centres, MobilizeYouth, and implementation of the program, acting as an ongoing family referral conduit. The corporate community could act as sponsors in a matching dollar situation for low-income families needing the program.

This strategy would be not unlike the £14 million multi-component obesity intervention network that exists in centres throughout England, funded through grants from Big Lottery, corporations, and public sector partners such as local neighbourhood organizations, city councils, cores trusts, and housing organizations.
 
MobilizeYouth is standardized, replicable, and scalable, allowing for continuous improvement, and is cost-effective to government and private sector funders. Families attending at a non-profit centre would pay a lesser fee than to a private organization; centres would provide invaluable access to a fitness, nutrition, and behavioural therapy in their neighbourhoods while increasing their own membership. For corporate sponsors, underwriting such an initiative for the not-for-profit centres could be claimed as a marketing expense. Licensing would entail a full composite of program and operations manual, staff training, assistance in funding proposals and marketing kit, links to the MobilizeYouth website and print materials, and ongoing consultation.

There is no easy solution when it comes to changing human behaviour, especially in the overweight adult and youth population. However, making every concerted effort may actually prove easier than contending with a future 75% of the adult population being overweight with serious health, medical, social, and financial problems. MobilizeYouth could represent a head start in a public plan to prevent a situation of this magnitude.

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VI References

1. 2004 Canada Health Survey. http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/index_e.html. Accessed June 21, 2007.

2. The Cost of Obesity in Ontario.GPI Atlantic. January 2001.

3. American College of Sports Medicine's Health and Fitness Journal. Vol 7:17:22

3. Mobilize Youth consulted with a large community throughout the GTA, Mississauga, Hamilton, Burlington, with fitness coaches, therapists, and fitness facility managers as well as Canadian and US researchers, family practitioners, and families at the Pediatric Nutrition Clinic, North York General Hospital and The Hospital for Sick Children; sports medicine specialists; dietitians; sports coaches; Municipal Parks & Recreation policy makers; family service agencies; community centres in Toronto, Mississauga, Hamilton, Burlington; school boards; Home & School Associations; food companies; insurance providers; and young people in focus groups.

4. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children. CMAJ, 2007 Apr 10;176(8):S1-13.