Drumming to A Drumming to A Healthy Beat: An Healthy Beat: An Innovative Health Innovative Health

Management Management ProgramProgram

Kimberlee Wyche-Etheridge, MD, MPHKimberlee Wyche-Etheridge, MD, MPHLateesa Posey-Edwards, APRN, BCLateesa Posey-Edwards, APRN, BC

CityMatCH 2007CityMatCH 2007

ObjectivesObjectives• To give an overview of why programs

like this are beneficial• To demonstrate a fun and innovative

way to address obesity• To point out successes and

limitations • To outline how lessons learned will

be used to move the program forward

The EpidemicThe Epidemic• “This generation of youth will be the

first in history that has the potential of living fewer years than their parents”

» Federal government

The EpidemicThe Epidemic• Since 1960 the prevalence of obesity in the US ages 12-19 has

tripled• In 2003 Nashville ranked 43rd in the Nation for overall health • According to the 2003 Youth Risk Behavior Survey:

– 13% of Nashville youth admit to being obese– 16% at risk for overweight– 21% of Nashville’s AA youth are overweight and 18% are

obese vs. 13% and 10% of Caucasian youth– 68% of AA youth indicated watching over 3 hours of TV/day

Vs. 34% of Caucasian youth• According to Local elementary school data:

– 28% of elementary students are overweight, and 20% are at risk for overweight. This is up from 22% and 16% 3 years ago.

• We are super sizing our youth

1995

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1995, 2005

(*BMI 30, or about 30 lbs overweight for 5’4” person)

2005

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

The EpidemicThe Epidemic CDC notes:

– An unhealthy diet and lack of physical activity can be contributing factors in many chronic diseases and conditions, including type 2 diabetes, stroke, hypertension, heart disease, breast cancer, colon cancer, gall bladder disease, depression, and arthritis..

The EpidemicThe Epidemic• Health and Education are linked:

– Health goes hand in hand with educational attainment. Therefore, a student who is not healthy, is less likely to excel in school

– Children who are overweight in Kindergarten tend to score lower on math and reading tests

The EpidemicThe Epidemic• African Americans (AA) suffer from

conditions related to obesity at a higher rate than Caucasians

• In order to decrease this disparity, it is important to reduce the number of obese and overweight AA people, while improving the quality of life for the general population

BarriersBarriers• Strong interconnection between AA

lifestyle and culture• Not a strong relationship between

cultural identity and health consciousness

The ResponseThe Response• Target AA female youth who are

overweight, and at risk of becoming obese• Provide daily physical exercise in the form

of structured cultural dance• Provide nutrition education through

weekly interactive activities focusing on the psychosocial aspects that lead to poor dietary choices

• Participate in self esteem building through the use of drama and Rights of Passage program

Drumming to a Healthy BeatDrumming to a Healthy Beat• Partners:

– Village Cultural Arts Center – Metro Public Health Department– Family Empowerment Services– Community Medical Providers– TN State University Food Stamp

Nutrition Education Program

Drumming to a Healthy BeatDrumming to a Healthy Beat• Program Design

– Identify and recruit a cohort of AA girls ages 10-13 who attend school in 3 target zip code areas identified as “high risk”

Drumming to a Healthy Drumming to a Healthy Beat: GoalsBeat: Goals

• Goal 1:To decrease the age appropriate Body Mass index of each participant to a healthy level – Objective 1: Increase physical activity of

program participants to meet daily recommendations

– Objective 2: Monitor key health indicators monthly to include wt, bp, BMI

Drumming to a Healthy Drumming to a Healthy Beat: GoalsBeat: Goals

• Goal 2: To improve the self-esteem and academic performance of young girls through empowerment – Objective 1: Facilitate group sessions to

address some of the major psycho-social issues affecting unhealthy diets and other behaviors

– Objective 2: Provide monitored homework time to strengthen academic performance

– Objective 3: Engage participant’s parents in a series of sessions around adolescent development, health and nutrition

Drumming to a Healthy Drumming to a Healthy Beat: GoalsBeat: Goals

• Goal 3: To guide youth toward making smarter food choices for a healthier future – Objective 1: Engage participants in topic

related sessions around healthy eating and activity

Drumming to a Healthy Drumming to a Healthy Beat: Planned ActivitiesBeat: Planned Activities

• ‘Tween girls with BMI’s >95th% identified by school nurse

• Each girl receives a physical exam, and monthly wt and bp checks

• Girls are transported to the Village after school each day

• Guided homework and healthy snack time while preparing for exercise

• 60 minute African dance or Afrocize class each day• 60 minute weekly “Rights of Passage class”• 60 minute 2X weekly interactive nutrition classes

using the Power of Choice curriculum • Monthly parents’ meeting • Quarterly report card submission

Drumming to a Healthy Drumming to a Healthy Beat: Reality ActivitiesBeat: Reality Activities

• ‘Tween girls with BMI’s >95th% identified by school nurse * avg BMI at start was 32, a lot higher than anticipated

• Girls are transported to the Village after school each day * there was interest at too many schools to pick up with limited van space

• Guided homework and healthy snack time while preparing for exercise * girls could buy unhealthy snacks at school and would sneak them during the program

• 60 minute African dance or Afrocize class each day * several girls complained to their mothers about having to exercise, and they were allowed to drop out of the program

• Monthly parents’ meeting * parental commitment was lacking making it difficult to reinforce lessons at home

Drumming to a Healthy Drumming to a Healthy Beat: Results Beat: Results

• Education– Avg GA changed from a 2.0 to a 2.8

• Self Esteem– At beginning girls were self conscious and didn’t

participate in school activities. Now they are trying out for plays and dance programs

– Improved attitude and respectfulness towards each other and school

– By the end of the program girls were performing at village functions

• Nutrition– Girls were knowledgeable about the new food pyramid

and portion control/size (however they did not practice this at home)

Drumming to a Healthy Drumming to a Healthy Beat: Results Beat: Results

• BMI– Average BMI 31.9 at start. At end,

average BMI 33.3 4% increase – Girls noted that clothing fit better, and

they could wear more “cute” styles

Drumming to a Healthy Drumming to a Healthy Beat: ConclusionsBeat: Conclusions

• BMI measures may not be the best measure of success for obesity programs

• Parental involvement is essential• Creating a comfortable environment

is important

Drumming to a Healthy Drumming to a Healthy Beat: Next StepsBeat: Next Steps

• Identify additional sources of funding to continue program

• Target students from only a few schools

• Make parental involvement mandatory

• Maybe work to get PE credit for school