1	"MCHB/DHSPS March 2005 Webcast" MCHB/DHSPS March 2005 Webcast “Promoting a Healthy Weight in Women” March 15th, 2005
2	2005 Dietary Guidelines for Americans Barbara Schneeman, Ph.D. Director, Office of Nutrition Products, Labeling and Dietary Supplements CFSAN-FDA
3	What are the Dietary Guidelines? Science-based advice for ages 2+ Promote health, prevent chronic disease Basis of Federal nutrition policy/programs HHS/USDA – Legislated review every 5 yrs.
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9	Important components of the 2005 Dietary Guidelines process. Three publications illustrate 3 phases of the process Advisory committee: Evidence-based review of science Policy document drafted and peer-reviewed by Federal agencies Consumer brochure The 2005 Dietary Guidelines is targeted toward policy makers, educators and health care providers
10	Format for the 2005 Dietary Guidelines Executive summary Ten chapters (9 areas of recommendations) Key recommendations in each chapter 23 for the General population 41 including specific populations Appendixes with tables Glossary
11	Nine Focus Areas Adequate Nutrients Within Calorie Needs Weight Management Physical Activity Food Groups To Encourage Fats Carbohydrates Sodium and Potassium Alcoholic Beverages Food Safety
12	Highlights in each chapter
13	Highlights continued . . .
14	Some of the specific populations identified in the Key Recommendations People over 50 years old Women who may become pregnant Pregnant or lactating women Children Dark-skinned individuals; individuals with insufficient UVB radiation Those who need to lose weight; overweight children; those who are overweight and with chronic disease Individuals with hypertension and risk of hypertension (blacks, middle-aged and older adults).
15	Food Groups 1980-1995: Eat a variety of foods 2000: Let the Pyramid guide your food choices 2005 Adequate nutrients within calorie needs 2 Key Recommendations that focus on nutrient dense choices and food guides (USDA patterns and DASH) Specific population groups: Over 50 y (B12); Women of child-bearing age (Iron, folic acid); Older adults, dark skin (vitamin D) Food groups to encourage 4 Key recommendations on fruits, vegetables, whole grains, and milk Children as a specific population group
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17	Finding Your Way to a Healthier You Feel better today. Stay healthy for tomorrow Make smart choices from every food group. Links to Food Guidance system Find your balance between food and physical activity Get the most nutrition out of your calories Focuses on using the food label and Nutrition Facts Panel.
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20	Applying the Messages in the Dietary Guidelines for Americans Consumer research Motivation is essential. Trust is important. The more and individual knows, the more choices they have. Keep it simple, but true to the science. Implementation Tools DASH eating plan Food Label USDA Food Guidance System (Spring 2005) Toolkit for nutrition professionals
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22	¡A Tu Salud, San Marcos! Innovative Approaches to Promoting a Healthy Weight in Women U.S. Department of Health and Human Services Maternal and Child Health Bureau CFDA: 93.110
23	Project Directors Texas State University
24	City of San Marcos Parks and Recreation
25	Overview Problem Population Program description Pilot study Ongoing intervention Lessons learned
26	Obesity in Texas The Rate is Higher in San Marcos
27	¡A Tu Salud, San Marcos! Goals Reach and retain Improve fitness and diet Decrease body weight Coordinate health care
28	Overall Design Recruit Pre-test Intervene Post-test Modify
29	Intervention Exercise Group exercise Walk-fit Nutrition Lessons Healthy snacks Behavior Supportive counseling
30	Weekly Education Classes Culturally Sensitive Risk of Overweight: A Focus on Diabetes A Snapshot of Your Diet: Where to Go From Here! Serving Sizes: How to Eat Food on the Go! (Restaurants) Exercise in Daily Life Eating Good Carbohydrates! Fats – Good and Bad
31	Weekly Snacks Re‘fried’ Beans Brown Spanish Rice Yogurt/Pineapple Smoothie Building a Salad Breakfast Plate Fast Food Tacos
32	Pilot Four Weeks (n=9) Purpose Identify strengths and weaknesses Actions IRB Set up office Create forms Translate forms Develop website Hire and train staff Set up child care Implement intervention
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35	Selected Outcomes Pilot Anthropometrics Body Mass index ê by 2% Waist-to-Hip ratio ê by 3% % Body Fat ê by 11% Fitness Aerobic Fitness é by 10% Push-ups é by 54% Sit-and-Reach é by 9%
36	The First Full Program 1/10/05 - 3/6/05 Research Design Control (n=16) Exercise & Education (n=9) Exercise & Education Supportive Group Counseling (n=10)
37	Preliminary Results Full Program Average weekly attendance 3.1 exercise classes per week Average weight loss 2.3% (0 – 9.5 lb)
38	Problem / Solutions Attrition 13 women completed the program 68% Retention Improvements Begin with more women (n=35) Motivational counseling during pre-test More incentives “Awards Night”
39	Lessons Learned Child Care Body Image Incentives Food Men
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41	Acknowledgements ¡A Tu Salud! Staff Nicole Gregg Carolyn Clay James Garcia Angela Fulton Lynn Zipoy Angela Weston Cynthia Saenz Shannon Barrington Katherine Callaway Stacia Miller Jennifer Ahrens Erika Barajas Jenny Cardenas Sandy Wyers Ashley Colpaart Ashley Mueller Ashley Newcomb Lara Hickman
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43	NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES, INC. WOW! Women of Wellness Program Joye E. Toombs, Project Director Letitia M. Nall, Nutrition Coach Najah Muhammad, Administrative Assistant
44	NorthEast Ohio Neighborhood Health Services, Inc. Our Vision is to achieve Healthy Families, Healthy Communities
45	NorthEast Ohio Neighborhood Health Services, Inc. Our Mission “to lead the local health care industry in providing quality, patient centered, family oriented, and comprehensive health services designed around the identified needs of its service population.“
46	NorthEast Ohio Neighborhood Health Services, Inc. Our History Organized in 1967 as a private non-profit Funded through the Office on Economic Opportunity
47	NorthEast Ohio Neighborhood Health Services, Inc. Our Health Centers
48	NorthEast Ohio Neighborhood Health Services, Inc. Who We Serve… Our Patients: FY 2004 NEON served over 40,500 users
49	NorthEast Ohio Neighborhood Health Services, Inc. Our Services Lifespan Approach Maximize Access Medical Home Prevention Focused Holistic Model
50	NorthEast Ohio Neighborhood Health Services, Inc. Comprehensive Services Primary Care Services for adults and children Adult Medicine Pediatrics Family Medicine Perinatal Clinical Care Gynecology & Family Planning HIV/STD Testing Mammography Ultrasound Services Laboratory & X-ray
51	NorthEast Ohio Neighborhood Health Services, Inc. Comprehensive Services Dental Optometry Pharmacy Behavioral Health Nutrition Health Education Social Work Flex sigmoidoscopy Dermatology Referral Services
52	"Programs & Services" Programs & Services Comprehensive Perinatal Care Program CFHS Perinatal, Pediatric and Adolescent Outreach Program Healthy Family/Healthy Start BPHC Diabetes & Asthma Collaboratives Shaw High School Wellness Center Job Corps Wellness Center Nursing Home Services Senior Plus Program Seniors In Touch Program Substance Abuse Initiative BEST Program Cuyahoga County BCCP Women, Infants and Children Program National Community Center of Excellence in Women’s Health Women of Wellness (WOW) Program
53	WOW! MISSION TO PROMOTE THE HEALTHY WEIGHT OF AFRICAN-AMERICAN FEMALES THROUGH AN INTERGENERATIONAL APPROACH TO LEARNING ABOUT PROPER NUTRITION AND PHYSICAL FITNESS.
54	GOALS AND OBJECTIVES TO ENCOURGAGE AFRICAN-AMERICAN WOMEN AND GIRLS TO ACHIEVE AND MAINTAIN A HEALTHY WEIGHT. INCREASE THE NUMBER OF AFRICAN-AMERICAN FEMALES WHO ARE MAKING PROGRESS IN ACHIEVING A HEALTY WEIGHT.
55	WOW! Women of Wellness Program Model
56	PROVIDER TRAINING PROVIDED TO ALL NEON CLINICAL STAFF OBESITY GUIDELINES “THE PRACTICAL GUIDE: IDENTIFICATON, EVALUATION, AND TREATMENT OF OVERWEIGHT AND OBESITY OF ADULTS” BMI Guidelines
57	PROVIDER TRAINNG BEHAVIOR MODIFICATION The Transtheoretical Model of Behavior Change (Prochaska) Pre-Contemplation Contemplation Preparation Action Maintenance Transformation The Five A’s Assess/Ask Advise Agree Assist Arrange
58	METHOD OF EVALUATION Attendance records Pre and Post Test of Learning Objectives
59	PRIMARY CARE SERVICES NEON Providers provide a more enhanced emphasis on obesity assessment and management for women/girls. Globally assess patient at each visit Appropriate recommendation and/or referral given to overweight/obese women.
60	METHOD OF EVALUATION Chart reviews once a year to monitor adherence
61	PATIENT LEARNING CENTERS Computerized kiosk/information booth Designed for WOW! Participants to interact with self-paced learning material, educational resources in a non-threatening manner. Narrated power point presentation Exercise videos to provide awareness of physical activity options.
62	PATIENT LEARNING CENTERS GOAL: To reach 10% 1,400 of the approximately 14,000 women (18-59 years of age) who assess services at NEON. BENEFITS INTERACTIVE TIME EFFICIENT SELF-PACED METHOD OF EVALUATION TRACK LOG ON PRE AND POST TEST INTERVIEW SURVEYS , FIRST SIX MONTHS
63	WOW! WORKSHOPS
64	GOALS FOR ACHEIVEMENT Increase knowledge of nutrition and physical activity Establishment of personal weight/fitness goals Involvement with wellness activities on an ongoing basis Increased commitment to their personal health
65	Introduction to Workshops & Initial Assessments BMI-weight/height Knowledge of nutrition Exercise Practices Self-esteem, body image Family Culture eating habits scheduling formal eating time
66	Nutrition Classes Lecture Obesity Risk Food Guide Pyramid Portion Control Food Label Healthy Snacks Disease Model Meal Planning Shopping on a Budget Food Safety Eating Disorders Basic Nutrition Review
67	Group Fitness Challenge 4 Group Fitness Challenges Nutrition Label Game Team Building A Food Pyramid Design a One Minute Commercial Price is Right Budget Shopping
68	Traveling Kitchen A cooking demonstration of healthy meals and snacks will be presented. Students will be able to test taste these delectable meals and receive recipes on how to prepare them.
69	PHYSICAL ACTIVITY Aerobics-high, low Kickboxing Palates/Stretch Weight training/Muscle strength Walking/Jogging Tai Chi African Dance
70	WELLNESS ACTIVITIES HEALING BENEFITS OF TEAS SELF-PAMPERING MEDITATION RELAXATION TECHNIQUES BODY IMAGE ANALYSIS JOURNALING STRESS MANAGEMENT
71	FIELD TRIPS WEST/EAST SIDE MARKET HEALTHSPACE LOCAL RECREATION FACILITIES
72	METODS OF EVALUATION Referral records Initial intake Attendance Records Initial Assessment Forms Pre and Post Test Participant Survey Form Six month follow-up
73	W0W! ACCOMPLISHMENTS TO DATE Advisory Board established. 18 members 4 patients Provider Training implementing guidelines approx. 100 referrals to date WOW! Workshops-inception March 8, 2005. Promoting Program Community Wide Addressing Community Civic Groups Flyers to local churches Ongoing collaboration with the National Community Center of Excellence in Women’s Health
74	Mujer,Te Ayudaremos Alcanzar un Peso Saludable Maria M. Fessia, R.D., L.D.N. Project Manager Holyoke Health Center
75	Holyoke Health Center 35 years providing care in downtown Holyoke, MA 150 employees 25 medical and dental providers On-site retail pharmacy 60,000 visits/year JCAHO accredited
76	Providing Care in the Poorest Community in the State: Holyoke’s State Rankings at-a-Glance Highest overall mortality rate Highest mortality rates from heart disease and diabetes Highest rate of teen births Highest rate of AIDS- and HIV-related death Highest alcohol- and drug-related deaths Highest rates of suicide and homicide 5th in overall cancer death rates
77	Our Project Goals Work with obese Latina women between 18-45 years old to improve and maintain positive behavior changes and lose weight Improve Health Literacy through Bilingual Education Improve access and participation in physical activities Establish support groups Support behavioral change through counseling and stress reduction
78	Our Team
79	Focus Group Findings Food demos with low calorie, culturally appropriate recipes that are easy to prepare Motivational discussions and seminars, particularly about becoming physically active. Yoga Information about how to exercise at home Information about the nutritional values of Puerto Rican foods Make it FUN
80	Promotora de Salud Training Ongoing 9-week training program in Spanish Recruitment for candidates Volunteers identified Close working relationships with our Diabetes Program and diabetes promotoras for training and support Curriculum: Su Corazon Su Vida
81	Recruitment and Enrollment In-house referrals (54 current referrals) Midwifery Care of Holyoke Eligibility for women 18-45 years old Holyoke resident BMI of 25 or higher Desire and willingness to make positive changes in their life Exercise Clearance from provider
82	Individual Interview with Nutritionist Nutrition Assessment Body Composition Analysis with Tanita Scale Fat Percentage, Fat Mass, Free Fat Mass ( muscle, bone, water) Weight , Height, BMI Body Measurements : Waist and Hips Diet History Eating behavior Eating habits, food preferences, dislikes, Lab data Bilingual/ Bicultural Nutrition Education Patient Goal Setting
83	Programmatic Interventions Breakfast and Lunch Clubs Promotoras de Salud Bilingual/Bicultural Nutrition Education Exercise Classes: yoga, weights, walking, aerobics YMCA Certified Aerobic Instruction Supermarket Tours Individual and Group Counseling Staff Training Support Groups
84	Breakfast and Lunch Clubs Food Portion Controls Cooking Techniques for Losing Weight Menu Planning Low Calorie Recipes Nutritional Values Exercise
85	Incentives for Program Participants Each participant receives a special Patient Kit including: Pedometer Measuring tape Personal Card to track goals and measurements of weight, waist and hips
86	Getting Motivated and Ready for Action in March 2005 Kick-off with Mall Walk with Mayor and City Councilors Motivational speakers before event Community Involvements with local sponsors providing free fruit smoothies and raffling 4 $50 gift certificates for fitness gear Media Coverage Cheerleading and motivation by YMCA aerobics instructor for the walkers
87	Weekly Calendar of Programs
88	The Future . . . Additional nutritionist hired More Promotora training YMCA certified training for our Lifestyle Coordinator in April 2005 Meeting and coordination of service for pre- and post-natal women (Holyoke Midwifery) Stress Management Group with mental health organization (MSPCC)
89	"Bright Futures for Women’s Health" Bright Futures for Women’s Health and Wellness MCHCOM.COM ~ March 15, 2005 Sabrina Matoff, M.A. Acting Director U.S. Department of Health and Human Services Health Resources and Services Administration Office of Women’s Health
90	Bright Futures for Women’s Health & Wellness Bright Futures for Women’s Health and Wellness (BFWHW), sponsored by HRSA MCHB, builds on Bright Futures for Infants, Children and Adolescents. BFWHW provides materials for women and healthcare professionals to support increased delivery of preventive health services to women throughout the lifespan. BFWHW supports community-wide health promotion activities for women.
91	BFWHW Tools Physical Activity and Healthy Eating Self-Assessment Tools in English and Spanish Adolescent Wallet Card Community Toolkit Reaching Your Goal Tip Sheets Provider Training and Counseling Support Tool Mental Health and Wellness Perinatal Mental Health and Wellness
92	BFWHW Adolescent Tools Physical Activity & Health Eating Guide & Wallet Card for Young Women Purpose: Encourage a dialogue between adolescent female patients ages 11-20 and their health care providers, and help patients set realistic behavior change goals. Guide sections Patient assessment questions Provider discussion leads Recommendations Wallet Card is an additional take home item to reinforce information contained in the Guide. Starter sets are available from the HRSA Information Center (1-888-ASK HRSA) as well as online at http://www.hrsa.gov/WomensHealth/mybrightfuture/menu.html Outreach to national and state health organizations, Federally Qualified Health Centers, adolescent practice journals, health professional associations.
93	BFWHW Recommended Flow in Clinical Setting
94	Contact Information HRSA Office of Women’s Health 5600 Fishers Lane, Room 18A-44 Rockville, MD 20857 301-443-8695 phone 301-443-8587 fax www.hrsa.gov/womenshealth