View this as a PDF file: START Now Program Rationale
A Rationale for START Now: An Obesity Prevention Program at Penn-Trafford High School in Westmoreland County, PA
The Big Problem
In the United States (U.S.), 72% of adults and one in three children are overweight or obese (Centers for Disease Control and Prevention [CDC], 2020a, Francis et al., 2019). Overweight and obesity are associated with serious short- and long-term health consequences, from psychosocial issues to increased risk of chronic disease, including type 2 diabetes, heart disease, stroke, and certain types of cancer (CDC, 2020b). Many of these diseases are leading causes of preventable, premature death (CDC, 2020b). Obesity and overweight also have a staggering economic cost. The healthcare costs of obesity are estimated at $147 billion per year in the U.S. – that’s nearly $4,700 per second (CDC, 2020b)!
The prevalence of childhood obesity is particularly alarming, as overweight and obese youth are more likely to become obese adults, to have difficulty losing weight in adulthood, and to have children who are also obese (Pandita et al., 2016). Youth obesity is most prevalent among adolescents aged 12 to 19, and thus, Healthy People 2020 objectives include reducing obesity and preventing inappropriate weight gain among this age group (Ruiz et al., 2019; Office of Disease Prevention and Health Promotion [ODPHP], 2020). Adolescence is also a critical developmental period during which autonomy develops and lasting health behaviors may be formed (Brown et al., 2017; Flodgren et al., 2010). Research shows that preventive interventions that occur during this “window of opportunity” may be particularly effective in positively shaping long-term health behaviors (Flodgren et al., 2010).
The Local Issue
Locally, overweight and obesity are serious health threats facing the residents of Westmoreland County, Pennsylvania (PA). Reducing obesity is one of the state’s top five health priorities, but there is significant work to be done (LiveHealthyPA, n.d.). Currently, only 31% (±2) of PA adults are at a healthy weight, and state-level Healthy People 2020 goals for reducing adult and adolescent obesity have not been met (Pennsylvania Department of Health [PDH], 2019). The economic burden of obesity in PA is enormous, with annual healthcare costs estimated at $5.3 billion; on a per resident basis, these costs top those of 38 other states (Wang et al., 2015). In Westmoreland County, 67% of adults are overweight or obese, and the leading causes of death (heart disease and cancer) are associated with these conditions (PDH, 2020). Further, 30% of PA high school students are overweight or obese and, between 2009 and 2019, the prevalence of obesity among white PA high schoolers rose from 10.5% to 14.8% (CDC, 2019a). This is of high concern, given the demographics of Westmoreland County (95% white) and the risks that adolescent overweight and obesity pose now and in adulthood (USCB, 2019b).
Proposed Solution: START Now
To address overweight and obesity in Westmoreland County, it’s recommended that the Pennsylvania Department of Health fund the development of Supporting Teens for A healthieR Tomorrow (START) Now. START Now is a school-based program for adolescents aged 14 to 18 that’s aimed at the primary prevention of overweight and obesity. To confirm best practices and prove program value, a 1-year pilot at Penn-Trafford High School (PTHS) is recommended. With nearly 1,300 students, PTHS plays a central role in local teens’ lives, and evidence shows that school can be an effective environment in which to promote health behavior changes (CDC, 2018). In total, 300 students are expected to participate in the PTHS pilot. Consistent with CDC (2018) recommendations, teens won’t be selected for START Now based on BMI or weight status, and physical appearance will not be emphasized. Rather, the program will be anchored in the classroom during regular health courses, and will promote the development and maintenance of healthy dietary and physical activity habits in all PTHS students (CDC, 2018).
START Now is a multi-component program that will increase students’ knowledge and skills around healthy eating and adequate physical activity, influence the home environment through parent-targeted education, and increase access to healthful foods at PTHS. The program’s primary component will be aimed directly at teens, rather than relying on knowledge transfer through parents or others; evidence shows that this is important due to adolescents’ growing autonomy and intrinsic motivation (Weihrauch-Blüher et al., 2018). However, parental involvement is also associated with lower obesity rates, so START Now will provide separate nutrition education to PTHS parents and guardians (Gray et al., 2019). In addition, START Now will aim to improve the healthfulness of the school food environment, as this has been associated with lower youth obesity rates (Gray et al., 2019). Following evaluation of the pilot, START Now may be adapted and extended to other Westmoreland County high schools.
Benefits to Pennsylvania
START Now can benefit the state of Pennsylvania by helping to reduce the significant human and economic costs of overweight and obesity in Westmoreland County, both now and in the future. Said another way, preventing adolescent overweight and obesity also addresses adult obesity and its consequences, helping to alleviate the state’s $5.3 billion burden (Pandita et al., 2016). Although overweight and obesity are complex issues with a variety of behavioral, environmental, and genetic determinants, evidence shows that healthy dietary behaviors and adequate physical activity are crucial to prevent and manage these conditions, and that adolescence is a critical period in which to instill healthy habits (CDC, 2018; Flodgren et al., 2010). Evidence also shows that school-based obesity prevention programs can be not just cost-effective, but cost-saving (CDC, 2018). Investing in START Now today will benefit the state of Pennsylvania for years to come.
Recipe for Success
START Now has strong potential for success at PTHS and in greater Westmoreland County. First, the program speaks directly to adolescents, rather than relying on knowledge transfer through others; evidence shows that this is important for success (Weihrauch-Blüher et al., 2018). Second, START Now uses a multi-component approach that addresses both dietary habits and physical activity – a best practice in youth obesity prevention (Psaltopoulou et al., 2019). And finally, the program promotes a more healthful school food environment, which has been linked to lower obesity rates (Gray et al., 2019). The obesity epidemic isn’t relenting – there’s no better time than now to invest in a healthier future for Westmoreland County!
References
Centers for Disease Control and Prevention. (2018, September 18). Childhood obesity prevention. https://www.cdc.gov/healthyschools/obesity/index.htm
Centers for Disease Control and Prevention. (2019). High school YRBS – Pennsylvania 2019 results. U.S. Department of Health and Human Services. https://nccd.cdc.gov/youthonline/App/Results.aspx?LID=PA
Centers for Disease Control and Prevention. (2019b, June 24). Childhood obesity facts. https://www.cdc.gov/obesity/data/childhood.html
Centers for Disease Control and Prevention. (2020a, February 28). Obesity and overweight. National Center for Health Statistics. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm
Centers for Disease Control and Prevention. (2020b, June 29). Adult obesity facts. https://www.cdc.gov/obesity/data/adult.html
Flodgren, G. M., Helleve, A., Lobstein, T., Rutter, H., & Klepp, K. (2020). Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews. Obesity Reviews. https://doi.org/10.1111/obr.13102
Francis, E., Hogentogler, R., Hoke, A., Buckley, J., Hwang, G., Lehman, E., & Kraschnewski, J. L. (2019). The Healthy Champions program in Pennsylvania schools: Assessment, awareness, and improvement of school wellness. Preventive Medicine Reports, 16. https://doi.org/10.1016/j.pmedr.2019.101018
Gray, H. L., Buro, A. W., Barrera Ikan, J., Wang, W., & Stern, M. (2019). School‐level factors associated with obesity: A systematic review of longitudinal studies. Obesity Reviews, 20(7), 1016–1032. https://doi.org/10.1111/obr.12852
LiveHealthyPA. (n.d.). Public health 3.0. Commonwealth of Pennsylvania. Retrieved November 3, 2020, from https://www.livehealthypa.com/community/public-health-3-0
Pandita, A., Sharma, D., Pandita, D., Pawar, S., Kaul, A., & Tariq, M. (2016). Childhood obesity: Prevention is better than cure. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 9, 83. https://doi.org/10.2147/dmso.s90783
Pennsylvania Department of Health. (2019, October). Nutrition and weight status. Pennsylvania Healthy People, State Level. https://www.health.pa.gov/topics/HealthStatistics/HealthyPeople/Documents/current/state/nutrition-and-weight-status.aspx
Pennsylvania Department of Health. (2020, October 22). Pennsylvania County Health Profiles: Westmoreland. https://www.health.pa.gov/topics/HealthStatistics/VitalStatistics/CountyHealthProfiles/Documents/current/Westmoreland.aspx
Psaltopoulou, T., Tzanninis, S., Ntanasis-Stathopoulos, I., Panotopoulos, G., Kostopoulou, M., Tzanninis, I.-G., Tsagianni, A., & Sergentanis, T. N. (2019). Prevention and treatment of childhood and adolescent obesity: A systematic review of meta-analyses. World Journal of Pediatrics, 15(4), 350–381. https://doi.org/10.1007/s12519-019-00266-y
Ruiz, L. D., Zuelch, M. L., Dimitratos, S. M., & Scherr, R. E. (2019). Adolescent obesity: Diet quality, psychosocial health, and cardiometabolic risk factors. Nutrients, 12(1), 43. https://doi.org/10.3390/nu12010043
Wang, Y. C., Pamplin, J., Long, M. W., Ward, Z. J., Gortmaker, S. L., & Andreyeva, T. (2015). Severe obesity in adults cost state Medicaid programs nearly $8 billion in 2013. Health Affairs, 34(11), 1923–1931. https://doi.org/10.1377/hlthaff.2015.0633
Weihrauch-Blüher, S., Kromeyer-Hauschild, K., Graf, C., Widhalm, K., Korsten-Reck, U., Jödicke, B., Markert, J., Müller, M. J., Moss, A., Wabitsch, M., & Wiegand, S. (2018). Current guidelines for obesity prevention in childhood and adolescence. Obesity Facts, 11(3), 263–276. https://doi.org/10.1159/000486512