SPOTLIGHTS

PEGGY VISIO

Camp Get FIT helping underserved kids lose weight and get healthy

Ten-year-old Pedro Gutierrez used to get out of bed every day and plop down in front of the TV to join Mario on a video-game adventure.

Now his mornings have real adventure – a mile walk with his mother, Christina Trujillo.

And they’re both eating a lot healthier, too.

And it’s all thanks to Camp Get FIT, a program of Methodist Healthcare Ministries of South Texas that aims to reduce children’s risk of obesity-related health problems by combining weekly nutrition meetings at school with a summer weight-loss camp. Pedro Gutierrez was one of 235 children from Carrizo Springs and Crystal City, two largely Latino towns in South Texas, who participated this summer.

“Pedro now wears shorts that he literally has to hold up while he’s running,” said Trujillo. “The program has helped him and a lot of other kids try new foods and stay active, instead of Nintendo and TV all the time. It’s helping us have healthier lives.”

Peggy Visio, a consulting dietitian for Methodist Healthcare Ministries and adjunct assistant professor in the School of Allied Health Sciences at The University of Texas Health Science Center at San Antonio, started Camp Get FIT in South Texas four years ago.

Visio helps children in this largely rural, largely Latino region, where an alarming number of children are obese. About 37 percent of elementary school students in Eagle Pass (where the program started) and 32 percent of students in Crystal City and Carrizo Springs (to which the program expanded for the 2007-2008 school year) have a body mass index (BMI) that classifies them as obese.

Many families in this region are poor. They have limited resources or limited time to help their kids exercise and eat healthy foods, and there are few grocery stores or markets to buy fresh produce and few parks where they can be active.

“Kids sleep ‘til 10 or 11 in the morning because there’s nothing to do [on weekends or summer days],” said Reyna Flores, who worked as a nurse at Camp Get FIT this summer while her two children participated.

In response, the Get FIT program partners with school districts to conduct student BMI assessments. In two elementary schools, parents of students who have a high BMI receive an invitation from the school for weekly parent-child nutrition sessions during the fall and spring semesters. At these sessions, children go to a gym to play a sport or have a “hands-on” nutrition lesson while their parents get nutrition lessons, and then the parents rejoin the children and exercise together.

In the summer, many of the students go to the free, four-week Camp Get FIT.

Camp begins with an overall health assessment. Children participate in yoga, swimming, sports, arts and crafts, nutrition lessons and nature hikes. The program partners with the school district to implement a nutritious summer food program, so camp participants eat from a healthy menu of items, such as low-fat milk, fresh fruits and vegetables, low-sodium entrees made from scratch and high-fiber foods.

Children are urged to “listen to their stomachs” to let them know when they are full.

“After a week of camp, many parents comment that they can see their children’s bellies are much flatter, and their constipation issues are gone. This is because of the camp meals’ fiber content, which also helps them feel full so they don’t eat as much,” Visio said. “A lot of kids will go home and tell their parents what healthy items to get at the store. It’s really amazing.”

Allied health students from the UT Health Science Center at San Antonio and other universities earn credit hours by volunteering as camp counselors and role-modeling healthy behaviors. The allied health students also mentor local high-school students who get stipends to work as camp counselors.

“This helps increase community interaction and sustain the program,” Visio said.

Katherine and Kathleen Benavides, sisters and students at Crystal City High School, worked at the camp this past summer and helped students try new foods and activities.

“It’s really valuable what these kids are learning here. They take it with them and they teach other kids good habits,” said Kathleen Benavides. “Even I learned how to make certain snacks that are healthy.”

And the camp isn’t just for kids, either. Parents are required to attend evening classes that teach nutrition and positive parenting.

“Healthy eating and exercising is a family concern,” Visio said.

Although the camp’s goal is simply to prevent weight gain during the summer months, when some students would otherwise engage in few physical activities, many children actually lose weight. One girl lost 10 pounds in four weeks.

“All the kids’ fitness levels improved,” Visio said. “They have a lot more energy now.”

Visio said she hopes to expand the program to more South Texas communities in the coming years, each time gaining the support of the local school district and school board to be able to sustain the program on a continuing basis.

“You can’t imagine the need in rural communities. There are no YMCA programs, no parks and recreation departments that typically run summer programs for children. Many of these families could not afford them even if they existed,” Visio said. “We want to build the communities up so they can start making strides to reduce childhood obesity levels.”

top^

GLENN FLORES

A pediatrician conducting research on Latino childhood obesity

Conducting research on obesity in Latino children was a natural move for pediatrician and researcher Glenn Flores.

Caring for under-served children has dominated his 14-year medical practice in Boston, Milwaukee, and Dallas. His research interests complement the clinical work: examining racial and ethnic disparities in children’s health; developing and testing community-based interventions to improve underserved children’s health; and insuring uninsured children.

“Several different pathways led to this work [obesity research in Latino children]—my passion for working with children, my passion for public health, and all the issues that came up in my medical practice,” said Dr. Flores, professor of pediatrics at UT Southwestern Medical Center. “I believe there are lots of ways researchers can integrate Latino childhood obesity prevention into their current interests.”

Dr. Flores’ first foray into his new line of research was an application to the Healthy Wisconsin Partnership Program to support a randomized trial of a culturally appropriate weight loss intervention for overweight Latino children. Though he didn’t have an established track record in childhood obesity research, he capitalized on his extensive research experience with Latino children.

“It’s hard to avoid obesity, since Latino kids have some of the highest rates in the U.S. and type 2 diabetes is also big in Latino kids,” he said.

Dr. Flores won the grant and completed the qualitative research phase, but was unable to complete the Milwaukee randomized trial before moving to Dallas. Still, his work on healthy eating, physical activity and weight management for overweight children, stemming from four focus groups of Latino parents, was presented as a platform presentation at the Pediatric Academic Societies’ meeting and will soon be submitted for publication. During the focus groups, parents sampled healthy preparations of traditional Latino cuisine prepare by a Latino chef, such as whole-wheat enchiladas and other healthy alternatives to traditional foods that are high in fat and calories.

“They couldn’t believe the enchiladas were whole-wheat,” he said. “They were open to the idea of substituting foods. We concluded that successful weight-loss management can involve traditional foods, family involvement as well as culturally sensitive innovation.”

In two studies analyzing data on racial/ethnic and language disparities in obesity rates, Dr. Flores found that Latino children and those in households in which Spanish was the primary language had significantly higher adjusted odds of being overweight or obese. In households where Spanish is the primary language, 50.4 percent of Latino children are overweight or obese. In another recent article, Dr. Flores and colleagues found that a multidisciplinary pediatric weight management program can improve the weight status of high-risk populations, including minorities, Medicaid recipients, patients with multiple co-morbidities and cardiovascular risk factors, and the severely obese.

Dr. Flores is continuing to study interventions that address obesity in Latino children in Dallas, where Latinos are the dominant racial/ethnic group.

“We really need to find some effective, culturally-relevant interventions,” he said.

top^

LAWRENCE GREEN

Meet a member of the Salud America! Executive Workgroup

Lawrence Green wanted to be a dentist, just like his uncle. He even worked in his uncle’s dental lab as a high-school senior.

But dentistry wasn’t for him. Neither was being a doctor.

He was discouraged by the lack of attention to the root causes of many basic health problems, and didn’t want to see patients regularly, only to have them return with more of the same issues.

Green first encountered the field of public health while studying hospital administration at the University of California, Berkeley, but he quickly knew it was for him.

“I was exposed to and smitten by the charms of public health, and I still am, to this day,” said Green, who counts his faculty advisors at Berkeley as his most influential mentors alongside his uncles, the dentist, and Tex Winter, who was an assistant basketball coach with the Michael Jordan-era Chicago Bulls and is currently with the Los Angeles Lakers.

Today, Dr. Green is an adjunct professor in the Department of Epidemiology and Biostatistics and the co-leader of the Society, Diversity and Disparities Program of the Comprehensive Cancer Center at the University of California, San Francisco.

Dr. Green has broad experience in health education, prevention, population health, and community interventions for health promotion and risk reduction. He served as the first director of the U.S. Office of Health Information and Health Promotion in the Office of the Assistant Secretary for Health under President Jimmy Carter’s administration. He has been on the public health faculties at Berkeley, Johns Hopkins, Harvard, Texas, Emory and British Columbia. He serves on the editorial boards of the American Journal of Preventive Medicine and 13 other journals in his field, and his textbooks have been widely adopted.

He joined the Centers for Disease Control and Prevention (CDC) in 1999 and held various high-ranking positions, including director of the CDC’s Office of Science and Extramural Research and associate director for prevention research and academic partnerships in the Public Health Practice Program Office.

He is a consultant for Salud America!, which he believes could have a strong impact on getting answers to the fundamental questions behind Latino childhood obesity.

“Most of the research and guidelines for obesity control are limited in the evidence they can offer for interventions, programs and policies, and what little evidence of effectiveness we have does not necessarily address the particular needs of Latino children, who are disproportionately affected by the epidemic,” Dr. Green said. “I hope that lud America! will become the rallying point and the source of practice-based evidence for the development of effective policies, programs and interventions for Latino children.”

top^

RUTH BERGGREN

Future doctors, nurses to model healthy nutrition, physical activity for middle-school children

Teens from a San Antonio barrio will learn about the importance of physical activity, healthy eating and other healthy behaviors from future doctors and nurses this summer, thanks to a new class at The University of Texas Health Science Center at San Antonio.

The “Healthy Choices for Kids” class, developed by the Center for Medical Humanities & Ethics and the School of Nursing, pairs medical and nursing students with San Antonio’s Good Samaritan Center to develop a curriculum to teach and model healthy living practices to middle-school teens at a summer-long day camp.

Ashley Garcia, a second-year medical student at the Health Science Center, said the class is excited to promote good health among community children.

“Kids are very perceptive. They’ll watch what we do. I’ll talk about how I eat, how I fit activity into my day and how I make healthy choices daily,” said Garcia, who is from Victoria, Texas. “The more they can identify with me, the more they’ll take to heart what we have to say.”

Drs. Ruth E. Berggren and Adelita Cantu of the Health Science Center created the class to offer medical and nursing students a hands-on learning experience that allows them to intervene in the local community on behalf of children’s health.

Berggren, colleague Amanda Evrard, and Cantu, who is on the Good Samaritan Center’s Board of Directors, conducted informal interviews with parents who enrolled their children for the center’s camp. They found that parents wanted their children to learn about nutrition and exercise because the obesity rates and diabetes risk among residents in predominantly Latino South Texas are higher than in the rest of Texas.

The medical and nursing students attend lectures about the key health topics identified by parents and spend two months visiting the Good Samaritan Center to develop a camp curriculum.

“A pre-prepared external curriculum is going to be less effective than one developed within the community,” Berggren said. “Change that is believable and sustainable comes from within the group. Otherwise, it’s some kind of external gimmick.”

Students hope they can make a big impact on the health of children and their families.

“I want to be able to get my [future] patients into programs that can effect real change not only in them, but also their family and friends,” Garcia said.

top^

FRANK PENEDO

Meet a member of the Salud America! Executive Workgroup

As an undergraduate student at the University of Miami in the 1990s, Dr. Frank J. Penedo wasn’t sure what health field he wanted to pursue.

Enter Dr. Susan Lutgendorf.

Dr. Lutgendorf, then a graduate student in clinical health psychology, introduced him to the study of the mind-body connection and how psychosocial processes, such as stress and coping, can affect the endocrine and immune systems on one hand and disease processes on the other.

“As a pre-med student, I became passionate about studying the connection between mental and physical health,” said Dr. Penedo, thanks to Dr. Lutgendorf’s mentorship. “Because this is an interdisciplinary field, I have been able to blend my interests in psychology, medicine, culture and health disparities to better understand many different determinants of health and disease. I became very involved in research early on and sought graduate student and faculty mentors in my field.”

Today, Dr. Penedo is working to improve Latino health as an associate professor of clinical health psychology and cancer biology at the Sylvester Comprehensive Cancer Center at the University of Miami.

His research focuses on chronic disease management, psychosocial interventions in chronic disease populations, behavioral medicine and other topics in cancer, health disparities, and other areas.

On the Salud America! Executive Workgroup, Dr. Penedo brings expertise in developing methods to promote nutrition and physical activity and prevent obesity and related chronic diseases that are linguistically and culturally appropriate to the Latino community.

“Any approach must be interdisciplinary and occur at multiple levels—communities, schools and families—if we are to curtail the growing rates of obesity among Latino children,” said Dr. Penedo.

top^

MAYA ROCKEYMOORE

Meet a member of the Salud America! National Advisory Committee

As a student writing her dissertation on the African-American political response to HIV/AIDS in the mid-1990s, Maya Rockeymoore wanted to get more exposure to what was happening at the community level.

So she went to work as an assistant to the director of the Marion County Health Department (MCHD) in Indiana.

“In addition to gaining a better understanding how the politics of HIV/AIDS was playing out at the local level, this experience gave me insight into what it takes to manage the public health needs of a sizable county population, as well as exposure to the politics and policy of public health,” said Rockeymoore, who got her Ph.D. in political science and public policy from Purdue University. “Working at MCHD also allowed me to participate in a number of activities, such as organizing community health events and writing federal grants, that helped enhance my skills and broaden my perspective on a range of environmental and population health issues.”

Dr. Rockeymoore’s time at the MCHD also affirmed her commitment to addressing health issues and health disparities, and she went on to become a respected policy analyst, researcher and advocate with expertise in an array of public policy issues. She has advocated health policies on Capitol Hill and founded her own policy consulting firm.

Today, she directs the Robert Wood Johnson Foundation’s Leadership for Healthy Communities in Washington, D.C., which supports local and state government leaders nationwide in their efforts to reduce childhood obesity through public policies that promote active living, healthy eating and access to healthy foods, especially among children at high risk for obesity, such as African Americans and Latinos.

As a member of the Salud America! National Advisory Committee, Dr. Rockeymoore recognizes that there is a dearth of research focused on Latino childhood obesity and too few Latino researchers, physicians, nutrition experts and policymakers.

She hopes Salud America! can help bridge those gaps.

“I hope that Salud America! can develop a robust research agenda that comes up with compelling findings that build the field of knowledge,” Dr. Rockeymoore said. “Salud America! will work with their partners to link their researchers and research findings to policymakers (Latino and non-Latino) that can use their findings to address barriers to healthy eating and active living.”

top^

ROBERTO TREVINO

Physician-researcher tackling diabetes, obesity among Latino kids

Dr. Roberto Trevino, who emerged from a San Antonio housing project to become a doctor with clinics in the city’s most disadvantaged neighborhoods, got tired of “waiting for diabetic people age 40 and older to walk into the clinic, going blind and losing limbs.”

So, in 1994, he created Bienestar, a school-based diabetes prevention program to boost kids’ fitness and healthy eating.

Today, 27 Texas school districts, many in low-income, Latino areas, use Bienestar to help 150,000 elementary- and middle-school students.

“I felt somebody had to go back into those poor populations and reach out, and start changing behavior at an early age,” said Dr. Trevino, a Salud America! member who runs the San Antonio-based Social & Health Research Center, a nonprofit that aims to prevent diabetes and obesity in communities and schools using health programs like Bienestar.

About 91 percent of all causes of type 2 diabetes are attributed to a diet high in saturated fat and sugar, low dietary fiber intake, low physical activity and overweight, according to a study published in the New England Journal of Medicine in 2001.

Bienestar uses social cognitive theory—the idea that an individual’s knowledge acquisition can be related to observing others in the context of social interactions—to coordinate four social systems that influence children’s health behaviors: health class, physical education, food service and home.

The program produces four types of bilingual materials: health curriculum for children and teachers in each grade from kindergarten through eighth grade; booklets on physical education activities; a cafeteria manual for food service staff; and a curriculum for after-school caretakers. The program records children’s measurements, including body mass index, before the school year starts and again when it ends.

“Students participating in the Bienestar program have reported increased dietary fiber intake, increased fitness levels and decreased blood glucose levels,” said Dr. Trevino.

Outcomes like those, which were published in the Archives of Pediatrics in 2004, led to the development of Bienestar as an approved Texas Education Agency-coordinated school health curriculum that is now used across Texas.

The program’s latest finding is quite surprising—overweight children aren’t necessarily overeating.

That new study, published in the November 2008 issue of the Journal of the American Dietetic Association, found that about one-third of 1,402 San Antonio fourth-graders, mainly from low-income, Latino families surveyed through the Bienestar program, were obese and highly sedentary. But 44 percent of these children actually consumed fewer calories than minimum guidelines, and most of the other 56 percent were within the recommended calorie-intake guidelines.

It’s just that what those children are eating is very unhealthy, such as foods high in saturated fat and sugar, and foods that lack essential nutrients like magnesium, calcium, phosphorus and potassium, said Dr. Trevino, who led the study.

A combination of low levels of physical activity and unhealthy food means that even when kids are eating the recommended number of calories daily, their health may still be at risk, the researchers concluded.

Now Dr. Trevino and his team are working, through Bienestar, to promote calcium-rich foods (milk, yogurt, cheese, white beans, almonds, broccoli, oranges and spinach), phosphorus-rich foods (baked beans, whole wheat bread, oranges, cauliflower and ham), potassium-rich foods (sweet potatoes, white beans, yogurt, tuna, bananas, spinach, peaches, milk and squash) and magnesium-rich foods (bran cereal, oatmeal, spinach, bananas, mixed nuts, chicken and turkey).

Dr. Trevino also is working to extend the Bienestar program in schools in Mexico.

“There’s no limit to where this program can have benefits,” he said.

top^