In April of 2010, the City of Montgomery got what Mayor Todd Strange refers to as, a wake-up call that hurt our feelings. In its latest survey, Gallup-Healthways ranked the Montgomery metropolitan area as being tied with Stockton, California for having the highest obesity rate in the nation: 34.6%! The report identified more than 180 metropolitan areas and further stated Montgomery metro residents ranked 171st for healthy behaviors, ranked 156th for physical health and was worse than the national average when it comes to: diabetes, hypertension, high cholesterol, percent of people who have money for enough food, percent of people who have suffered heart attacks and percent of people who have health insurance.
Mayor Strange appointed a Health and Fitness “Czar” to address the issue and search for ways to lower the percentage of people whose Body Mass Index (or B.M.I.) indicates they are obese.
Among the most prominent early partners were Dr. Miriam “Mim” Gaines and Molly Killman from the Alabama Department of Public Health’s (ADPH) office of Nutrition and Physical Activity. Gaines and Killman offered a crash course on the topic of obesity as a public health issue and listed intervention strategies that were successfully implemented elsewhere in the country.
Several points became apparent: the simplest way to battle obesity is to get individuals to burn more calories than they consume; there are limited methods that governments have to compel citizens to have active lifestyles or eat healthier diets; and making progress in the Montgomery metro area (also known as the River Region) was going to require a comprehensive plan with many partners. Thus the River Region Obesity Task Force (RROTF) was formed.
RROTF membership was open to any group or individual with a desire to address the obesity issue. The first meeting was attended by hospital executives, school officials, dietitians, fitness coaches, nutrition experts, municipal, county and state officials, university and college representatives and even salespeople from weight loss product lines!
The huge response was overwhelming. To prevent paralysis, the Central Alabama Regional Planning and Development Commission (CARPDC) was contracted to bring organizational expertise and help secure grant funding to underwrite projects and programs.
Among CARPDC’s first accomplishments was securing a grant from the Alabama Department of Transportation to implement Safe Walk to School programs across the metro area. Superintendents in six systems agreed to identify schools in their districts that would participate in National Walk or Bike to School Day. Door prizes were given to every student who took part and random drawings for free bicycles and helmets at schools with the highest engagement helped ensure robust participation. Parents were encouraged to walk with their children to school. Students who rode school buses were delivered one-half mile away from campus and walked with school appointed chaperones. Schools located on streets with too much traffic, coordinated walk routes on their campuses for students to complete before the first class. The school events were covered by the local media and helped to heighten awareness of the dangers of childhood obesity. Walk or Bike to School Day has become an annual event. To date, dozens of schools have taken place in RROTF coordinated activities engaging thousands of River Region students.
To heighten awareness of fitness and nutrition issues, RROTF entered into an agreement with WSFA-TV, the area’s NBC affiliate. Every first Friday of the month, the station’s 11:00 a.m. newscast runs a segment titled “Fitness First Fridays”. Topics have included: how to count calories, exercise gear for cold weather, maintaining a healthy diet during the holiday season, promotion of upcoming health/fitness events, the sugar content of foods and drinks, etc. Tonya Terry, WSFA’s popular female anchor used one segment to introduce her own health initiative: Women Out Walking (WOW) to encourage women to walk regularly.
Media attention of the obesity issue served as a catalyst that encouraged the development of public fitness events. Organizers often seek and receive RROTF promotional assistance. The “Health Czar” also serves as a liaison with the City of Montgomery to help ensure the permitting process is followed and any needed City services are secured. New events such as the Montgomery Half-Marathon (with accompanying 5K and kid’s mile races), Dragonboat Races on the Alabama River, the LifeSouth Kids Marathon (first 25 miles completed incrementally on an individual basis), the Montgomery Corporate Challenge and a new triathlon competition enjoyed tremendous public support. There are races taking place nearly every week of the year in the Montgomery metropolitan area. In March of 2014 the City of Montgomery hosted its first full marathon!
Isolated, single events can attract motivated individuals to move toward a healthy lifestyle; but a widespread, community-wide shift requires a wide net that analyzes environmental and systemic conditions that are contributing to obesity. This led the RROTF to complete an exercise prescribed by the Centers for Disease Control (CDC) called the CHANGE tool. CHANGE stands for Community Health Assessment aNd Group Evaluation. Day long meetings were held in each of the counties of the River Region to learn citizen perceptions of the top obstacles in the fight against obesity.
CHANGE exercises attracted 145 participants representing 85 groups and individuals.
The responses were eye-opening and provided an invaluable insight to help guide future projects and policies. For instance, governments cannot merely build walking trails and bike paths, residents have to feel that the exercise areas are safe from crime before they’ll utilize them. The CHANGE tool revealed that the River Region is weak in every area assessed by the CHANGE Tool (responses were below the 60% threshold mark that represents satisfactory in every category!).
After the CHANGE data were collected and analyzed, action plans tailored to each of the counties could be devised to promote strategies to reduce obesity. The RROTF is currently developing its community action plan. While the action plan is not yet finalized, some examples of proposed action items include:
1. Review school wellness policies and update them as needed. Facilitate and monitor the active use of wellness policies in 6 school systems over 3 years.
2. Encourage local governments to enhance safety at places where people can exercise within 24 months.
3. Assure that smoking ordinances are passed at the local level within 3 years.
4. Develop wellness goals and strategies in 27 local River Region governments and at least 15 other private employers over 3 years. Encourage and facilitate the use of insurance incentive policies for wellness and tobacco use as well as pooling of resources to develop employee clinics.
5. Work with health care providers in the River Region to streamline policies and resources relative to chronic disease management. Streamlining will occur within 24 months and will include working with Private Hospitals/Health Systems; FQHC’s; Alabama Department of Public Health; nurses from school systems; non-profit agencies; nursing schools and professional associations of physicians.
6. Assure that all 6 public school systems in the River Region have at least 30 minutes of Physical Education (PE) per day for elementary and middle school students within three years.
7. Facilitate the development of community level resources in physical activity, nutrition and chronic disease management. Roll-out initial, county level resource lists within 3 months, with updates at least quarterly.
Another key reality in controlling obesity is the need to adopt laws and ordinances that can only be enacted by elected officials. The RROTF sought and received advocacy training for Alabama groups from Tandeka LLC, a Robert Wood Johnson Foundation grantee. The three day symposium outlined strategies to cultivate grassroots support and provided step-by-step instructions of how to lobby legislative bodies.
The Task Force has quarterly meetings during which new projects and developments are announced and attendees can share projects, problem-solving strategies and grant opportunities. The successful completion of a pedestrian path in one community inspired residents in another community to pursue a similar project.
This type of peer support is a source of inspiration and motivates task force members to be ambitious. In August of 2011, the true spirit of the RROTF was present when an effort called “Let’s Move the River Region” was held with the objective of conducting physical activities for the entire family in every community in the River Region. City governments, churches and schools opened their facilities in the morning for group exercises. In the afternoon, everyone was encouraged to come to the basketball arena on the campus of Alabama State University for additional activities, speeches and giveaways. The concept was conceived by a college student and had a planning committee that consisted of RROTF members, local vendors and others. The effort coincided with First Lady Michelle Obama’s “Let’s Move” campaign and was filled with energy and enthusiasm.
Maintaining public and media attention on obesity-related issues will continue to be an objective of the RROTF. Doing so will help ensure that any individual or group has a fertile environment in which to propose ideas and strategies that lead to healthier lifestyles.
The work of the River Region Obesity Task Force may never come to an end, but meaningful progress in this area is being made. The Gallup-Healthways poll has shown annual declines in the metro area obesity rate: 34.6% for 2009, 33.4% for 2010, 30.9% for 2011 and 27.1% for 2012 (the last year for which results have been released). The drop of 7.5 percentage points translates to 30,000 fewer obese people. Positive movement has also taken place in the percentages of people who: exercise frequently (from 43.3% to 51.5%) and eat produce regularly (from 52.7% to 58.6%).