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							Shape Up Somerville: One Community Preventing Childhood Obesity
National League of Cities Conference Boston, MA August 12, 2008
Mayor Joseph Curtatone, Somerville, MA Jessica Collins, Director, Partners for a Healthier Community, Inc. Anthony Pierantozzi, Superintendent of Schools, Somerville, MA Mary Jo McLarney, Director of Food Services, Somerville Public Schools

Shape Up Somerville: Eat Smart. Play Hard. The Ripple that Became a Wave!

About Shape Up Somerville
WHAT: An environmental intervention to prevent childhood obesity WHO: 1st – 3rd grade children in Somerville, MA and two control communities

WHERE: Homes, before, during, and after school programs, and the community

GOALS: 1) Create opportunities for children to expend an additional 125 kcal/day over baseline to achieve energy balance 2) Create sustainable infrastructure that encourages physical activity and healthy eating

SUS Schematic
Somerville Year 1 (2002-03) Year 2 (2003-04) Year 3 (2004-05) Recruit, plan intervention & baseline testing Implement program & intervention testing Light Intervention and follow up measurement Controls: Recruit & baseline testing Monitor controls Monitor controls

Somerville, MA
• ~ 78,000 pop • 4.1 square miles • 3% open space • 83% traffic cut- thru • Heart disease / lung cancer leading cause of death

Social Fabric
•Gentrification & increasing immigrant population •Community coalition rich • Few $ resources •65% of students eligible for free/reduced meals •50+ reported languages spoken at home

Baseline data Fall 2003: Prevalence of Overweight among Somerville 1st - 3rd Graders
60 50 40 30 20

53%
underweight not at risk at risk overweight
Underweight: < 5th %ile Not at risk: > 5th to <85th %ile At risk: ≥ 85th to < 95th %tile Overweight: ≥ 95th %ile Reference: NHANES 2000

20%
10 0

26%

1%
10/1/2003

Spanish Speaking boys 49% overweight English Speaking boys 22% overweight

Early Morning Environment

At Home
Safe Routes to School Maps ↑ Walking to School (-30 kcals) Healthier Home Breakfast ↑ Fiber, ↓ Sugar, ↓ Fat Appropriate Portion Sizes

Before School Program
Healthier School Breakfast ↑ Fiber, ↓ Sugar, ↓ Fat Appropriate Portion Sizes Increased Fresh Fruits Breakfast Coordinator

During School Environment

Physical Activity Equipment for Recess
Physical Activity (- 25 kcals)

Classroom Micro Units
Physical Activity (- 25 kcals) 5 days/wk (10 min) Nutrition & Physical Activity Education 1 day/wk (30 min)

Healthier School Lunch
Fiber, Sugar, Fat Increased Fresh Fruits & Vegetables Appropriate Portion Sizes Improved Presentation and Atmosphere Social Marketing in Cafeteria Alternative “Healthier” A La Carte Items New Food Service Equipment

Healthier Fundraising Alternatives Professional Development
Teachers Administrators Food Service Staff PE Teachers

Afternoon Environment

At home Safe Routes to School Maps ↑ Walking Home (-30 kcals) Healthy Home Snack ↑ Fiber, ↓ Sugar, ↓ Fat Home Environment (~15 kcal) Parent Newsletter w/ coupons Growth Reports ↓ Screen Time Promotional Gifts

After School Program Curriculum: Cooking Lessons Physical Activity (-30 kcals) Nutrition Education Professional Development Community Environment Community “Champions” Restaurant Participation Pediatrician Training & Support Community TV Appearances Ethnic Group Outreach Community PA Resource Guide Community Events

Reinforcing Environments

A Community-Based Environmental Change Intervention Reduces BMI z-Score in Children: Shape Up Somerville 1st Year Results
Christina D. Economos, Ph.D., Raymond R Hyatt, Jeanne P Goldberg, Aviva Must, Elena N Naumova, Jessica J Collins, Miriam E Nelson Friedman School of Nutrition Science and Policy , School of Medicine, Tufts cine University, Boston MA Tufts University
R06/CCR121519-01 from the Centers for Disease Control and Prevention. Additional support was provided by Blue Cross Blue Shield of Massachusetts, United Way of Mass Bay, The Potato Board, Stonyfield Farm, and Dole Foods.

Primary Outcome Results
We effectively decreased BMI z-score in a group of high risk children through a community-based environmental change intervention.

Community Results
Engaged 90 teachers in 100% of 1-3 grade classrooms (N=81) Participated/conducted 100 community events Held 4 parent forums for non-English speakers Trained 50 medical professionals Increased walking to school by 5% Recruited 21 restaurants Reached 811 families through 9 parent newsletters, Reached 353 partners through 6 community newsletters Reached over 20,000 through a monthly media piece (11 mos) Recruited all 14 after-school programs Developed community-wide policies to promote and sustain change (Wellness Policy, Pedestrian Safety) Helped bring in an additional $1.5 million

School District Support of ShapeUp Goals & Initiatives
Somerville School Wellness Policy
A District-wide commitment to improving the areas of nutrition, nutrition education, physical activity and physical education for all staff and students. (implemented Sept. 2006) Objectives Provide nutritious meals each day Provide safe and enjoyable experiences for physical activity Improve learning through better nutrition and physical activity Help Somerville’s children develop healthy eating and physical activity habits through instruction and role modeling in a healthy environment Make the wellness policy available to all on the District website and in Parent and Guardian Information Guides Review the wellness policy annually with all District Administrators during Leadership Meetings

Wellness Policy Highlights
School Food Service Fresh fruit is served daily at school breakfast and lunch. A La Carte food items meet the guidelines established by Massachusetts Action for Healthy Kids. Health education training is offered annually to school food service staff. Classroom Snacks A list of recommended snacks is disseminated to parents and teachers annually from Food Service for children’s snacks. Candy is not to be used as a reward for children’s accomplishments. Physical Education and Health Services Physical education is required in grades K through 8. Fitness testing is incorporated into all PE services at all schools.

Wellness Policy Highlights
School Environment School fundraisers involving food can only be held after school lunch is over and fundraisers are encouraged to sell foods from the recommended snack list. Principals are encouraged to provide recess before lunch. Students are encouraged to walk, bike or actively commute to school. Schools will continue to participate in the “Safe Routes to School Program” and distribute maps annually. Height and Weight data is collected annually on all children in Grades K through 8. The Somerville School Committee approved a preference for local vendors in produce contracts to support purchase of local products and agriculture (June, 2008)

Staff Trainings & Wellness Opportunities
Professional development and training on nutrition education, knife skills, & food presentation. Programs for personal development (yoga, strength training and apple picking). Monthly manager’s meeting with review of District & department policies, recipe demonstration, staff taste tests, marketing and purchasing. Staff involvement in decision making on new menu items

New Equipment Purchases
Combination oven, walk-in freezers/refrigerators, warmers/grills, slicers, peelers, refrigerated delivery trucks, marketing and merchandising materials

Grant Funding : Student & Community Outreach
Audio/Visuals Vegetable of the Month Cafeteria taste tests School gardens School contests Newsletters Food Service Menus/Web Info

Family Outreach
Child’s Health Report Card sent home (4 languages) Newsletters every other month (basic reading) TV Turnoff Week (sensitivity to working parents) School Events (making everyone feel welcome)

School Food Service

Keep it edible (major meal a day) Taste tests Culturally appropriate menu items/condiments Student advisory groups Staff professional development Marketing scheme

Somerville Food Service Department
Department Overview
$2.75 million annual operating budget. Services 11 Somerville schools, 4 Community and Charter schools and 18 Head Start locations (6,100 students total) plus full summer service. Central production system with 7 satellite locations and 8 full service kitchens. 60 food service personnel Average daily service: 1,700 universal free breakfasts 3,650 lunches 630 after school snacks 1,358 summer lunches and 498 summer breakfast/day 2006-2007 food expenditures exceeded $1 million dollars

Potential Challenges of Providing Healthy Food In Schools
Cost - Economics determine menu Decreased student acceptability of healthy choices resulting in decreased meal participation Unskilled labor pool/poor recipe execution Facility & infrastructure issues (Schools lack space, storage equipment, computers) Staff resistance to change Insufficient student lunch time

Achieving Healthy Changes (2002-2008)
1. 2. 3. 4. 5. 6. 7.

Focus on improved food/menu quality Continuous infrastructure/facility improvement Increased system sales/controlled system costs Continuous staff training/monthly manager’s meetings District support of program policies Grant funding (Shape Up Somerville, PEP, Growing Healthy) Student/teacher nutrition education (taste tests)

Focus on Improved Menu and Food Quality
Decreased a-la-carte offerings Introduced fresh fruit daily at breakfast & lunch Expanded lunch choices in all schools Introduced daily fresh salad selection Continuous recipe development Chef consultants - Staff culinary training Use of fresh ingredients, fruits, vegetables, whole grains and olive oil Established purchasing system for local produce Staff & Student taste tests

A La Carte Snack Sales Data
• Sales fell from Sept. 2003 to Dec. 2003, making about $7,000 - $9,000/month less in revenues compared to 2002 data. • Sales began increasing in winter of 2004, showing increased student acceptance for new mix of products • As of Oct. 2004 sales are now fairly even with sales prior to intervention • Data is consistent with trends reported from other school systems. Revenue totals include Paid Lunches, Milk Purchases, and Teacher Sales in addition to A La Carte sales
Revenues per day by school year

1400 Revenue 1200 1000 800 600
September October November December January February March Revenue per Day School year 2002-2003

Months

Revenue per Day School year 2003-2004

Efforts to Improve Food Quality
Lunch Menu Changes
Fresh entrée salads served in grades 4-12 , 4x/week. Increased use of fresh ingredients in recipes (vegetarian chili, roasted squash, baked potato with broccoli and cheese, tomato, basil and mozzarella salad, cucumber dill salad, fresh corn on the cob, broccoli & lemon zest). Increased whole grains, vegetarian options and fresh vegetable side servings. Featured vegetable of the month offered weekly.

Chef Consultants Hired To:
Focus on recipe development Work with staff to increase knowledge and improve culinary skills. Demo & taste new recipes with staff at monthly manager meetings. Conduct recipe demos and taste tests for students.

Produce Contract with Local Farm
Local produce purchases have increased each year and in 20072008 local produce became more cost effective to purchase than purchasing from a large distributor

Community Leaders are key!
Partner with targeted CBOs Ethnic Celebrations Faith Based Organizations Tailor around their issues

2004, 2005, 2006, 2007

Community Partnerships
• Tufts University • Somerville Public Schools • Somerville Youth Network • MA Dept. of Health • Cambridge Health Alliance • Institute for Community Health • Groundwork Somerville • Active Living by Design

Sustainability: Programs
City support of Farmers Markets and Community Gardens SUS Coordinator at Health Department City employee benefit policy - $200/year reimbursement Shape Up Somerville-approved restaurants (21)

Sustainability: Policy
Creation of Office of Sustainability & Environment
Environmental Strategic Plan

Community Wellness Policy / Pedestrian Safety Taskforce
Safe-START

Zoning laws requiring support of “Active Living” Extension of Green Line and Community Path

Sustainability / OSE
Office of Sustainability & Environment
Open space for active living Enhancing infrastructure
“green” buildings permeable sidewalks increase tree inventory by 20% in FY09

Open Space and Recreation Plan
4.2 square miles, 4.7 % open space 18 renovations by end of ‘08

Sustainability / Safe-START
Long-term & immediate improvements
thermoplastic sidewalks traffic calming tables bike lanes

Major roadway & infrastructure changes
Somerville Ave. Assembly Square Union Square

Pedestrian safety improvements Promoting & supporting walkability

Wellness Policy: a team effort

“Most people think the battle against obesity takes willpower. But the City of Somerville knows it

takes the will of an entire community.”
- The Wall Street Journal

What Makes It All Work
Willingness to embrace change at all levels Continuous communication, education & training Modeling and reinforcement of governmental and community policies Collaborations and partnerships with schools, community leaders, parents and community groups Continuous reinvestment in program facilities, equipment and infrastructure Grant Funding: Shape Up Somerville, PEP, Growing Healthy Planning and a positive, proactive approach to problem solving Always keeping the kids first

Somerville Resources Available Online
• School menus • Wellness Policy • Recommended Snack List • Vegetable of the Month posters and recipes • Other nutrition outreach materials

Visit: http://www.somerville.k12.ma.us Departments Food Services