Shape Up Somerville

Funded by the Centers for Disease Control and Prevention, Shape Up Somerville: Eat Smart. Play Hard. was a 3-year (2002-2005), environmental change intervention designed to prevent obesity in culturally diverse, high-risk, early-elementary school children. Led by Dr. Christina Economos (N96), the Shape Up team developed and implemented strategies designed to create energy balance for 1st-3rd graders in Somerville. In before-, during-, and after-school environments, interventions were focused on increasing the number of physical activity options available to children throughout the day and on improving dietary choices.

First Year Results

In 2003, Tufts researchers found that 46% of Somerville's 1st-3rd grade population were at-risk of overweight or were overweight. They used a measure called BMI-z score (or BMI-for-age percentile) to report changes in weight gain among children who participated in the Shape Up Somerville (SUS) intervention, as compared to children in two socio-demographically similar communities in Massachusetts who did not receive the intervention.

On average, SUS reduced approximately one pound of weight gain over eight months for an eight-year-old child. This may seem small for an individual, but on a population level this reduction in weight gain, observed through a decrease in BMI z-score, would translate into large numbers of children moving out of the overweight category.

Below is a description of each of the interventions that comprised Shape Up Somerville.

School Food Service

Shape Up Somerville worked with the Somerville School Food Service Department to enhance the quality and quantity of healthy foods for students. Activities included:

• A fruit or vegetable was highlighted each month in all ten elementary schools and there were taste tests done during lunch periods at all schools. The children voted on whether or not they would like to have the featured fruits and vegetables on the monthly school menu.
• Colorful educational posters and tabletop tents were displayed around school cafeterias with nutrient and health information for all school staff to read.
• New kitchen preparation and serving equipment were purchased. Food service staff received training on nutrition education, knife skills, and food safety.
• New vegetarian recipes were developed and salads were made fresh each day.
• A la Carte items were changed to meet specific nutritional standards.
• Fresh fruit was made available everyday for breakfast and lunch.
• Ice cream was made available only one day per week and sugared cereals were limited at breakfast.

In 2005, the School Department received a federal grant that has allowed them to continue these initiatives and support a part-time nutritionist to develop new strategies within the Food Service Department.

HEAT Club In-School Curriculum

Over ninety teachers were trained to implement a new, classroom-based health curriculum called The HEAT Club (Health Eating and Active Time). Each lesson focuses on one of four themes: increasing fruit, vegetable, whole grain, and low-fat dairy consumption; decreasing consumption of snacks high in saturated fat and sugar; increasing physical activity; and decreasing sedentary time (i.e. television viewing). The curriculum also has a component called Cool Moves, which features creative ways to incorporate physical activity into the children's classroom hours. Art and Physical Education teachers and librarians received curriculum extensions, which allow teachers and children to extend the lessons and expand on the objectives in creative ways.

HEAT Club After-School Curriculum

During the first intervention year, six after-school programs in Somerville were trained on cooking and nutrition education as well as how to use The HEAT Club After-School curriculum. The curriculum includes 26 lesson plans, which use crafts, cooking demonstrations, and physically active games as creative vehicles for education. Program sites received cooking and physical activity equipment and the program leaders were taught yoga, dance and soccer skills. Each program had a field trip to Gaining Ground, an organic farm in Concord, MA where the children helped harvest crops to take home and donate to local food pantries and soup kitchens. In the second year of the intervention, all fourteen of Somerville's after-school programs were using the curriculum.

I offered a ride to school to my 2nd grader and he said "No, I want to walk." I asked why and he said, "Because I'm learning at school that it's healthier for me to walk to school instead of getting a ride."

My class really enjoys the Heat Club. Children are making connections between our discussions in class and their snack and recess choices on the playground. I'm really pleased to see them learn this life skill.

Parent and Community Outreach

Parents and community members were engaged in a variety of ways. Each month SUS sent home a parent newsletter to over 500 families and a community newsletter to over 200 community members. The newsletters contained updates on the project, health tips, and coupons for healthy foods.

In addition to the newsletter, we reached out to parents through community events, local media outlets, and the Parent Teacher Association. We also held four parent forums for parents in English, Spanish, Portuguese, and Haitian Creole.

The Shape Up team served on several community coalitions that worked creatively toward sustaining the different interventions and sought out funding to support health initiatives.

Finally, we created a healthy meeting guide, a physical activity guide, and a healthy snack list that are posted on the School and City websites and continue to be updated annually.

Shape Up Approved Restaurants

Shape Up Somerville worked with restaurants across the city to enhance food options for people and families who eat out. In 2005, 21 restaurants were "Shape Up Approved". In order for restaurants to be "Approved" they must meet the following criteria:

• Offer low fat dairy products
• Offer some dishes in a smaller portion size
• Offer fruits and vegetables as side dishes
• Have visible signs that highlight healthier options

The Shape Up Somerville Taskforce updated the list and recruited new restaurants to participate.

Walkability/Safe Routes to School

A community walking committee was formed to guide the walking initiative for students. The committee submitted a grant to the Robert Wood Johnson Foundation and received funding through their Active Living by Design (ALbD) initiative in the summer of 2003. Together, the Shape Up team and the Somerville ALbD Partnership hired a Pedestrian/Bike Coordinator for the City and created Safe Routes to School (SR2S) maps using Geographic Informational System (GIS) for each school within a half-mile distance. The SR2S maps were distributed to all parents of 1st-3rd graders and posted on the School and City's website. Other piloted initiatives included a walking school bus and a traffic calming campaign. Parents filled out walkability checklists and with that data we held pedestrian trainings to educate policy makers about the link between city planning and public health issues such as obesity. The Mayor authorized all crosswalks to be re-painted in thermoplastic material and bike racks were being installed at all elementary schools. We continue our work with the Somerville ALbD partnership to extend the community bike path, and to create open spaces and policies supporting pedestrians and bicyclists.

School Nurses/Pediatricians

All Somerville school nurses have been formally trained to collect height and weight on elementary school students each year, as well as how to approach and counsel families who have a child identified as at-risk of or overweight. We also trained over 50 local clinicians and the school nurses on a new toolkit designed to assess and address overweight in children. We worked closely with the Somerville School Physician who helped us organize the 1st Annual Shape Up Somerville 5K in September of 2004. For information on this event, visit www.shapeupsomerville5k.org.

Policy Initiatives

Recognizing that childhood obesity can have serious negative health outcomes, the Somerville School Department has taken a leadership role in preventing childhood obesity. They are committed to making improvements in the areas of nutrition, physical activity, and nutrition education and have created new policies in each of these areas including the comprehensive 2006 Wellness Policy.