In 2005, The New England Journal of Medicine published a chilling report on childhood obesity, summarizing its findings with the statement that the current generation of children could be the first in two centuries to have shorter life expectancies than their parents.

The authors of the report predicted that pediatric obesity trends would, if left unchecked, shorten Americans’ lifespans by two to five years — a negative effect greater than that caused by cancer or heart disease.

It was a message that clanged like an alarm bell. It triggered a public health mandate that would, most famously, ignite First Lady Michelle Obama’s famous 2010 “Let’s Move!” campaign along with the related Partnership for a Healthier America (PHA), uniting public and private sectors in combating youth obesity. Those efforts have led to a variety of innovative partnerships, including the recently launched landmark initiative, “Commit to Health,” in which NRPA is partnering with the First Lady, Boys & Girls Clubs of America, and PHA to introduce improved health standards to 5 million children during the critical hours when kids are not in school.

Commit to Health represents a rare intersection of national-level momentum and maturing grassroots efforts. Good standards matter, and park and recreation agencies are poised to play a critical role in bringing healthier standards to millions of American children. The grassroots efforts of two Tennessee communities illustrate well the impact that informed, standard-bearing leadership can make.

Knoxville’s Call to Action

For Joe Walsh, director of Knoxville Parks and Recreation in Tennessee, the 2005 warnings of shortened life expectancies for the younger generation represented a distressing call to action. Tennessee’s staggering (40.9 percent) incidence of overweight or obese youth placed it fourth in the national pediatric obesity epidemic, and the prevalence in Knoxville (39 percent) was not far behind. 

In 2006, when the Knox County Health Department approached Knoxville Parks and Recreation about improving health standards for its afterschool program snacks, the two local agencies came up with a partnership program they named NEAT (Nutrition Education Activity Training). As Kathleen Gibi, public affairs specialist for Knoxville Parks and Recreation, relates, the program began with the modest goal of providing one healthy snack per week and using that snack as an educational springboard, with integrated lessons in nutrition and exercise in six Knoxville community centers.

Building upon that pilot effort, a University of Tennessee department, the Tennessee Nutrition Consumer Education Program, formulated a set of healthy snack criteria to standardize the program. Not long after, NEAT expanded to serve all 12 of Knoxville’s community centers, and a grant through the Tennessee Department of Health helped to sustain the healthy snack efforts.

In 2009, the East Tennessee Children’s Hospital funded the Knox Area Coalition on Childhood Obesity, appointing Walsh to the steering committee. The coalition provided a platform for Knoxville’s park and recreation professionals to tackle higher inner-city obesity rates by introducing those youth to alternative sports. 

The election of a new mayor, Madeline Rogero, in 2011, added to the agency’s momentum. She created a new position in the park and recreation department to step up outreach to youth in underserved neighborhoods. In 2012, local efforts got national recognition when Knoxville and Knox County achieved a first-place ranking in the National League of Cities Let’s Move! Cities, Towns and Counties initiative. 

In 2013, seven years after Walsh and other community leaders began their campaign to improve children’s health in the city, a Knox County Health Department study found that the percentage of overweight or obese school-aged children in the county had dropped from 39 percent to 33.2 percent.

Knox County had begun to turn back the tide of childhood obesity. 

Nashville’s Collaborative Mission 

Just as Tennessee’s climbing childhood obesity moved Joe Walsh to action, so did it motivate Dr. Shari Barkin, a Vanderbilt University pediatric professor, to mobilize a partnership between Nashville’s park leaders and Vanderbilt. 

“In 2008,” Barkin relates, “we launched the Nashville Collaborative, a unique partnership between the Children’s Hospital at Vanderbilt and Metro Parks and Recreation. It was clear that advancing health was an aligned mission for both partners and that together we could develop and test innovative programs to do just this.” 

Paul Widman, then Nashville Metro Parks assistant director, says mutual trust developed during “listening tours” between Dr. Barkin and her team and the Metro Parks and Recreation staff. “She went into our community centers to find out what was working well and what kind of support our program leaders needed to have greater positive impacts on the health of children in Nashville.” 

Barkin and her colleagues discovered that changing a sedentary, “obesogenic” culture requires a firm commitment to standards. “We found,” she says, “that by setting standards for what food could be served and encouraging structured play as part of afterschool programming, we could change youth habits.” In one of the Collaborative’s physical activity projects, for example, Barkin and her team were able to demonstrate that children in structured afterschool play activities were more likely to get an additional 20 minutes of moderate to vigorous physical activity each day. 

“And that,” she emphasizes, “can translate into real health benefits.”

Standards in Action

Walsh’s original notion of a simple one-snack-a-week object lesson evolved into a system of practical, measurable health standards. And Barkin’s vision of an aligned, empirically based community health mission matured into a citywide program/research experiment reaching 1,000 families. 

While Knoxville’s and Nashville’s experiences entailed local initiatives and partnerships, a growing national cooperative effort led by out-of-school-time (OST) public health experts is introducing tested “plug-and-play” standards. And the champions of those new standards are enlisting technical support from specialists while garnering an expanding menu of private and public funding sources. 

Increasingly, communities like Nashville and Knoxville will be able to enrich kids’ afterschool hours with a full arsenal of resources, tools and guidance from national — not just local — leadership. The alliances at the vanguard of the national OST movement embrace not only park and rec agencies, but also such august nongovernmental organizations as the Boys & Girls Clubs of America (BCGA) and the YMCA of the USA. That alliance-driven movement has now found its most influential public consensus-builder and champion so far — First Lady Michelle Obama.

Out-of-School Time: The National Story

One of the organizations at the heart of the healthy OST movement is the Alliance for a Healthier Generation, a joint effort of the American Heart Association and the Clinton Foundation that works alongside community-based organizations to implement healthy standards in the fight against childhood obesity. Anne Ferree, who leads the organization’s healthy OST efforts, offers a unique, “wide-angle” perspective on an issue that most youth advocates get to see only through a local lens. 

Before- and afterschool-time standards, Ferree recounts, evolved out of an initial scrutiny between 2005 and 2008 on children’s time in school. As school data accumulated, researchers’ attention began slowly to shift to how kids were spending their time before and after school — especially their time at community-based sites like parks and recreation community centers, YMCAs, Boys & Girls Clubs, and 4H clubs. In 2009, the movement got its organizational impetus through a Robert Wood Johnson Foundation (RWJF) grant, which resulted in the formation of the Healthy Out-of-School Time Coalition by the National Institute on Out-of-School Time (NIOST), research scientist Dr. Jean Wiecha and the YMCA of the USA. 

“Using as much empirical evidence as possible,” Ferree explains, “the Coalition incorporated practices that were showing progress at the ground level in many states.” The resulting set of healthy eating and physical activity (HEPA) standards was adopted in 2011 by the National AfterSchool Association (NAA). 

HEPA nutrition standards outline best practices for including fruits and vegetables with snacks and meals, eliminating artificial trans fats, serving whole-grain breads/cereals and lean proteins, and providing water and nonfat milk as beverage options. Physical activity standards emphasize minimum 30-minute exercise periods (60 minutes for full-day programs), with moderate to vigorous activity comprising at least half of that time. 

Afterschool Challenges and Opportunities

They’re sound standards by any measure, and since 2011, they have been adopted by not only the NAA, but by numerous youth-serving organizations, including the YMCA of the USA. Yet, as these organizations have discovered, fighting obesity in the hours before and after school requires a creative, thoughtful approach. As Georgia Hall, senior research scientist for NIOST, contends, standards must be actively adopted by a site staff, and then carried out with a teaching-oriented, recreation-embracing mindset. Hall cites studies that show the impact of standards adoption as well as the effectiveness of introducing small, incremental improvements in nutrition and physical activity. 

“Programs don’t need to overhaul their schedule, drop homework or something,” Hall says. “But [rather] just rethink how they can use sedentary time in an enjoyable and useful way.”

As Hall and Ferree are both quick to point out, the next giant task in the national childhood obesity battle is to accelerate broad-scale adoption of the HEPA standards — one rec center, one locality, at a time. 

“It’s not enough to disseminate,” Ferree asserts. “Communities need help implementing.”

A Commitment to Health — Millions Strong

With HEPA adoption having gone mainstream and public and private afterschool programs clamoring for assistance, the timing seemed right for a national-level health partnership targeting kids’ out-of-school time. In 2013, NRPA began discussions with PHA and BGCA with the goal of introducing the new health standards to as many before- and afterschool programs around the country as possible.

On February 25, the fourth anniversary of the Let’s Move! initiative, First Lady Michelle Obama and NRPA announced the launch of “Commit to Health,” a campaign to get kids healthy supported by the Partnership for a Healthier America. Commit to Health will bring healthy eating and physical activity standards to community park and recreation programs throughout the country. 

At the launch event, held at an afterschool program site at Miami’s Gwen Cherry Park, Mrs. Obama gave a speech in which she noted the groundbreaking nature of the partnership and recognizing the importance of programs that prioritize health throughout “the entire arc of [a child’s] day.”

“We’ve revamped our school meal program,” Mrs. Obama said. “[Kids] are getting active through the day, whether that’s during recess, or PE class, or during an exercise break between lessons. And when the school day ends, they’ll head to an afterschool program like this one, and they’ll get even more nutritious food and even more opportunities to get active.”

BCGA, a confederation of local clubs dedicated to building successful futures for at-risk youth, sees the standards as dovetailing with a larger organizational culture of health and achievement. And for NRPA, an organization with roots more than a century old in children’s health reform and recreational access, the new partnership represents more than an innovative answer to a current crisis. It is a continuation of a long commitment to national standards for children’s health. 

BCGA will encourage its 3,400 member clubs nationwide and NRPA will encourage the 2,000 park and recreation sites it serves to create healthier environments for children in out-of-school-time programs. Further, each club or site participating in the Commit to Health program will be encouraged to join the Alliance for a Healthier Generation’s Healthy Out-of-School Time program — an electronic inventory submission system built upon the HEPA standards and USDA Smart Snacks in School Standards.

As NRPA President and CEO Barbara Tulipane observed, “By ensuring that our agencies are providing the highest standards for eating and physical activity, we are investing in our future and generations to come.” In Knoxville and Nashville, nearly a decade of work attests to the power of standards to bring healthy change. And the First Lady’s leadership attests to the hope that a nationwide investment in healthy out-of-school time will add years to the lives of a rising generation of children. 

Maureen Hannan is a freelance writer in northern Virginia and a former Senior Editor of Parks & Recreation Magazine.

 

How Commit to Health Will Reach Five Million Children

Specifically, over the next five years, the partnering organizations will:

• Encourage clubs and sites to join in the national effort to create healthier environments for children in out-of-school-time programs.
• BGCA will encourage 3,400 Boys & Girls Clubs nationwide to join in the national effort to create healthier environments for children in out-of-school-time programs.
• NRPA will encourage 2,000 park and recreation sites to join the national effort to create healthier environments for children in out-of-school-time programs.
• Each club or site will be encouraged to join the Alliance for a Healthier Generation’s Healthy Out-of-School Time program through the electronic submission of a Healthy Out-of-School Time Inventory, which is built upon the National AfterSchool Association Standards for Healthy Eating and Physical Activity and USDA Smart Snacks in School Standards.
• Encourage clubs and sites to adopt healthy eating and physical activity standards.

What Do the Standards Include?

Nutrition

• Serve a fruit or vegetable at every snack and meal.
• Serve only foods with no artificial trans fats.
• Serve only whole grain-rich products.
• Serve only nonfat or reduced-fat yogurt and cheese.
• Serve only lean meat, skinless poultry, seafood, beans/legumes or eggs.
• Serve only packaged snacks or frozen desserts that meet the USDA Smart Snacks in School nutrition standards for foods.
• Provide plain potable water at all times at no cost to youth and staff.
• Serve only water; plain low-fat milk, plain or flavored nonfat milk or milk alternative; 100 percent fruit or vegetable juice with no added sweeteners or 100 percent juice diluted with water with no added sweeteners.

Physical Activity

• Dedicate at least 20 percent or at least 30 minutes of morning or afterschool program time to physical activity and at least 60 minutes for a full-day program.
• Provide physical activities in which youth are moderately to vigorously active for at least 50 percent of the physical activity time.
• Ensure physical activity takes place outdoors whenever possible

Youth and Family Education

• Offer evidence-based nutrition education to youth.
• Offer evidence-based education materials about nutrition and physical activity to families through pamphlets, newsletters, email blasts or other means.

Additionally, NRPA has committed to eliminating access to television and movies at its sites, and limiting digital device time to less than an hour a day, used for homework or activities that engage youth in moderate to vigorous physical activity.