Obesity in Wisconsin

Yet on a beautiful summer morning, children who gathered at Community Groundworks’ Troy Kids’ Garden couldn’t get enough vegetables, or in this case, pizza toppings. The group gathered to water and harvest vegetables and herbs, which they happily chopped in the outdoor kitchen. They topped their pizzas with the vegetables and baked them in the garden’s mud oven. To the kids, it was a magical day — harvesting, cooking and even digging for worms. They didn’t realize they were reaping the benefits of an educational garden, a place to try new types of produce and be physically active, and a setting that represents part of the Wisconsin Partnership Program’s multi-faceted approach to obesity prevention in the state.

The University of Wisconsin School of Medicine and Public Health Partnership Program represents a far-reaching commitment to improve the health and well-being of Badger State residents through investments in research, education, prevention practices and interventions, and policy development.

For more than 13 years, the program has supported research grants and community partnerships aimed at preventing and reducing obesity in Wisconsin. Research in schools and neighborhood centers; grants to communities working to improve residents’ health; and support of the Wisconsin School Garden Network and strategic Obesity Prevention Initiative are a sampling of projects the Wisconsin Partnership Program supports in its multifaceted approach to address obesity, among the most complex, pressing health issues.

According to the Survey of the Health of Wisconsin (SHOW), a Partnership-funded population health monitoring program at the UW School of Medicine and Public Health, 39.4 percent of Wisconsin adults are obese. The Wisconsin Department of Health Services (DHS) states that one in four Wisconsin high school students is overweight or obese, and 29 percent of children ages 2 to 4 participating in the Wisconsin Special Supplemental Nutrition Program for Women, Infants and Children are overweight or obese. People who are overweight or obese are at greater risk for type 2 diabetes, cardiovascular disease, asthma, high blood pressure and other chronic illnesses. Also according to the DHS, the annual economic burden to Wisconsin’s health care system is estimated to exceed $1.5 billion.

The obesity epidemic has many contributing factors that go far beyond individual lifestyle choices. Physical environments, access to healthy food, and policy changes within schools and communities across Wisconsin must be part of the broad approach to address obesity.

Research Drives Obesity Prevention

Aaron Carrel, MD (PG ’95, ’98), a Wisconsin Partnership Program grantee and professor in the UW School of Medicine and Public Health Department of Pediatrics, recognizes the importance of a broad approach to obesity. He regularly sees the health risks and consequences of obesity in his practice as a pediatric endocrinologist at the American Family Children’s Hospital and medical director of the UW Health Pediatric Fitness Clinic.

“I see kids who are overweight or obese and at risk for many related problems, including high blood pressure and diabetes,” says Carrel. “But it’s hard to ‘cure’ obesity in a doctor’s office. What a doctor says is important, but what happens outside the clinic — what the patient’s school, peers, community and neighborhood are doing and saying — is as important, if not more so.”

Much of Carrel’s research focuses on increasing physical activity in schools, where children spend most of their time.

“Policies in schools can have active effects, like requiring more minutes for physical education (PE) class, or passive effects, like social supports for kids to participate in physical activity,” he notes.

Through the Wisconsin Partnership for Childhood Fitness Project, Carrel and his collaborators have worked with the Wisconsin Department of Public Instruction and school districts across the state to increase the use of evidence-based approaches to measure the cardiovascular health of middle school students and improve PE programs.

The research has resulted in schools with increased capacity to collect and report fitness data, and enhanced PE programs that implement effective physical activity strategies, interventions and policies. The project’s second phase addresses the unique challenges faced by Wisconsin schools with high populations of students from low socioeconomic groups and racial minorities, for which research indicates higher rates of obesity and lower rates of physical activity. Carrel says the goal is to promote fitness and physical activity rather than weight loss.

“When we promote fitness for all students, we lower the risk of obesity and its related illnesses for everyone,” he explains.

Community Partnerships Work to Prevent Obesity

Jane Busch, a lifelong resident of Cross Plains, Wisconsin, and director of the nonprofit Lifestyle Initiative for Fitness Empowerment (LIFE) Foundation, and academic partner Daniel Jarzemsky, MD (PG ’84), a physician at the UW Health Cross Plains Clinic, are using a two-year, $50,000 Community Opportunity Grant from the Wisconsin Partnership Program to improve nutrition, reduce obesity and increase physical activity in their rural community.

The group uses a social support strategy — which includes a Step Up walking club, nutrition education, fitness classes, weight management monitoring and support groups — and promotes access to fresh, healthy foods. Garden beds at the local senior center’s new community gardens were built at wheelchair and standing height, and the community’s child care center features a new garden and a “Read It, Grow It, Eat It” partnership with a local library and dietician. Many participants have seen impressive results — inches off their waists, lost pounds, better control of diabetes and blood pressure and an improved quality of life.

“I’m so proud of them! They take exercise classes, walk on treadmills, practice portion control and use calorie apps,” says Busch.

The project’s broad approach ensures that residents of all ages and physical abilities have the opportunity to achieve better fitness, nutrition and health.

In 2015, the Wisconsin Partnership Program awarded a $1 million Community Impact Grant to create the Cultivate Health Initiative, a joint project of Community Groundworks and the UW–Madison Environmental Design Lab, to expand the Wisconsin School Garden Network and grow and sustain the garden-based education movement throughout Wisconsin. The project is led by Nathan Larson, director of the Cultivate Health Initiative, and Sam Dennis, Jr., PhD, associate professor in the UW College of Agricultural and Life Sciences’ Department of Landscape Architecture. Evidence increasingly shows that educational gardens improve the health and well-being of children, including choices they make regarding fruits and vegetables.

The Cultivate Health Initiative will provide direct technical assistance to 200 educational garden sites in Wisconsin and resources on best practices in garden-based education to more than 2,000 school teachers, early childhood care providers, parent volunteers and community educators.

“Children spend a significant portion of their time in school, after-school and early-childhood settings,” notes Larson. “And pioneering studies have shown that garden-based education in those settings can improve childhood health through its positive associations with fruit and vegetables and opportunities for physical activity.”

Policy Change Impacts Obesity

The Obesity Prevention Initiative is a cornerstone of the Wisconsin Partnership Program’s strategic efforts to prevent childhood obesity. Launched in 2014, the $8.6 million, five-year initiative provides the infrastructure to bring together communities, agencies, organizations, researchers, UW–Madison faculty and others to:

• develop a childhood obesity surveillance system to track obesity and disseminate information;
• promote statewide messaging and collaboration among groups working to prevent obesity; and
• test and implement novel community-based models for childhood obesity prevention in two Wisconsin counties.

Through research and community engagement, faculty, staff and community members work to promote changes in policy, systems and the environment that will lead to improved health. The initiative’s Wisconsin Health Atlas surveillance tool will equip researchers, educators and public health professionals with data and knowledge to drive local obesity prevention decisions. Sara Lindberg, PhD, director for evaluation and surveillance, says the tool monitors rates of pediatric obesity, evaluates how interventions to combat obesity are working in communities, and helps target interventions by identifying areas that have the greatest risk for obesity and need for resources.

“No comprehensive data sets exist related to children and obesity, as they do for adults” says Lindberg. “Through our novel surveillance system, we will be able to dig deeper into pediatric obesity within communities and schools by monitoring what types of programs and policies they are implementing to promote health.”

In 2015, healthTIDE was launched to promote and support collaboration among groups and organizations working toward policy changes to prevent obesity throughout Wisconsin. It focuses on areas where evidence shows that action can impact change, such as promoting active communities, healthy food choices in restaurants and food retailers, and healthy food and exercise opportunities in schools and early childhood programs.

Faculty and community teams also are working with Marathon and Menominee Counties to pilot innovative models for childhood obesity prevention, based on each county’s needs and resources. This multifaceted effort includes community coalition building, advocacy training, and engagement around data and evidence-based options for health promotion. Hundreds of residents in each county — including parents, teachers, tribal leaders in Menominee, public health leaders in Marathon, clinicians and other change-makers — are collaborating to forge policy, systems and environmental solutions to their health challenges.

Because the initiative is anchored in the UW School of Medicine and Public Health, it has the ability to evaluate what practices are working in communities and course-correct when they are not.

“Working with our community partners promotes not only ‘evidence-based practice’ but also ‘practice-based evidence,’” describes Patrick Remington, MD ’81, MPH, associate dean for public health at the UW School of Medicine and Public Health.

The group’s research and recommendations are designed to inform policy changes that will reduce disparities and impact health.

“Environmental changes, like safe biking and walking routes, and policy changes that provide healthy meals in schools and restaurants give us a tremendous opportunity to improve health by making the healthy choice the easy choice,” says Remington.

Training Lays the Foundation

Through external grants, Patrick McBride, MD ’80, MPH, and Gail Underbakke, RD — co-director of the UW Health Preventive Cardiology Program and a nutritionist in the field, respectively — have teamed up for decades to develop unique, effective ways to teach medical students, residents and fellows about nutrition and other factors, including obesity, that contribute to cardiovascular health problems.

“We’ve integrated nutrition throughout the MD curriculum,” explains McBride, a professor in the Departments of Medicine and Family Medicine and Community Health. “Our medical students have achieved very high national board sub-scores in this field. We’re proud of their nutrition knowledge, and encourage them to use it in their practices.”

Future Outlook

“It is my long-term hope that the projects and research many of us are doing will lead to policy and environmental changes that prevent obesity in Wisconsin,” says Carrel. “The Wisconsin Partnership Program has been a very influential partner in improving health in the state. Its outward-facing grants — which go beyond the lab, into Wisconsin communities — continue to strengthen all of our efforts to combat the complex issue of obesity.”