HL 367 Major Project Winter 2014 Mission: To Promote Healthy Lifestyles in Obese Families through Education

Michele Kolin

Kayla Stanley

http://www.fooddrinkeurope.eu/industry-infocus/topic/promoting-balanced-diets-and-healthy-lifestyles/

www.nhlbi.nih.gov 1

Table of contents Intro Section 1: Mission Section 2: Review of the Related Literature Section 3: Synthesis of Literature Section 4: Evaluation Design/ Mission Fit Section 5: Marketing and Communication Section 6: Granting Agency Section 7: Webliography Section 8: Reflection Section 9: PowerPoint Page 3 Page 4 Page 6 Page 22 Page 35 Page 36 Page 37 Page 38 Page 41 Page 43

Introduction My name is Kayla Stanley and I am a senior at Northern Michigan University. I am majoring with a Bachelors in Community Health Education. I am from Dallas, TX but currently go to school at Northern Michigan. However, Texas is still home for me . When I am not studying, I enjoy my free time outdoors; walking my pup, hiking or going to the beach. I love being physically active and lifting weights at the gym, running outside, or doing yoga. I have a strong passion for maintaining a healthy lifestyle. I enjoy eating healthy and love to cook! My biggest goal is to graduate in May, 2014 and become a personal trainer so I can help others with their fitness goals and motivate them along the way. I am interested in this mission because I have a strong passion in helping people reach their fitness goals. I also love to help with diet and coming up with fun healthy food choices that pertain to anyone and everyone!

My name is Michele Kolin and I am a senior at Northern Michigan University studying Management of Health & Fitness. I was born and raised in Michigan and am originally from Ypsilanti. At work you can catch me in the fitness studio teaching Cycling, in the pool teaching swimming lessons, or in the classroom teaching CPR. I enjoying swimming, biking, lifting weights, and playing piano. I also thoroughly enjoy competing in long endurance races, such as triathlons and open water swims. My passion is in aquatics, and someday I hope to be an Aquatic Director. I graduate in May, 2014 and hope to relocate to pursue my dream and passion. I am interested in this mission because I would like to make an impact on a familys life. Obesity is a huge issue in the United States. Children suffer from obesity, and it is not entirely their fault. It reflects on the parents and their secondary lifestyles.

Section 1: Mission 1.) What is our mission? Our mission is to promote healthy lifestyles in obese families through education. What are the variables in our mission? a. Dependent Variable: healthy lifestyles b. Target Population: obese families c. Independent Variable: education 3.) In what agency could we realize our mission? a. We could realize our mission at the YMCA, located within Marquette County. The YMCA welcomes children and families of all ages to come and engage in physical activities, sports and programs. The YMCAs mission is to put Christian principles into practice through programs that help healthy spirit, mind and body for all." http://www.ymcamqt.org/

2.)

4. What job could we have in this agency and what is the job description for that job?

a. A job/ position that would allow us to carry out our mission would be Program Director for Youth and Families. A program director is someone who plans, organizes, coordinates, and participates in the development and implementation of recreation programs for patron groups of specialty areas. The program director is responsible for childcare, camp, and youth and family programs. (YMCA of San Diego, 2010)
Retrieved from: http://ch.tbe.taleo.net/CH15/ats/careers/requisition.jsp?org=YMCASANDI EGO&cws=1&rid=2593

4b.) What is our job for this particular project? a. Our job is to develop a fitness program and evaluation plan to meet our mission of promoting healthy lifestyles in obese families through education. Assess the need to promote healthy lifestyles in obese families. Identify measurable objectives to reflect a promotion of healthy lifestyles in obese families. Plan an evidence based program shown to promote healthy lifestyles in obese families. Implement the fitness program to promote healthy lifestyles in obese families. Evaluate our program to see if the objectives were met to promote healthy lifestyles in obese families, and, therefore, that we met our mission.

Section 2: Review of the Related Literature 5. What is our Mission and the four questions for analyzing the literature in order to develop our program plan and evaluation plan in order to do our job as listed in 4b? Our Mission is: To promote healthy lifestyles in obese families through education. The mission variables are: DV= Healthy lifestyles TP= Obese families IV= Education The four Questions: To analyze the literature for relevant information, our four questions with our mission dv and tp in are: Does the piece identify the need to change healthy lifestyles in obese families? Does the piece theoretically define healthy lifestyles? Does the piece tell us how to measure healthy lifestyles? Does the piece give us a model program or educational program that has shown to change healthy lifestyles?

1. Which pieces shall we use to analyze the literature to develop our program plan and evaluation plan designed to meet our mission? We shall use the following pieces:

1. Arne Astrup. (2001). Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity. Retrieved from, http://journals.cambridge.org/action/displayAbstract?fromPage=online &aid=1357356

Abstract: The prevalence of obesity is increasing rapidly in all age groups in most EU-countries and is one of the fastest growing epidemics, now affecting 1040% of the adult population. Obesity increases the risk of serious co-morbidities such as type 2 diabetes, cardiovascular disease, certain cancers and reduced life expectancy, and these complications may account for 510% of all health costs in EU countries. The risk of diabetes is particularly increased by obesity, and 8095% of the increase in diabetes can be attributed to obesity and overweight with abdominal fat distribution. There is robust evidence from cross-sectional and longitudinal studies to support that an energy-dense, high fat diet and physical inactivity are independent risk factors for weight gain and obesity. Furthermore, interaction between dietary fat and physical fitness determine fat balance, so that the obesity promoting effect of a high fat diet is enhanced in susceptible subjects, particularly in sedentary individuals with a genetic predisposition to obesity. Ad libitum consumption of diets low in fat and high in protein and complex carbohydrates, with a low glycemic index, contributes to the prevention of weight gain in normal weight subjects. It also causes a spontaneous weight loss of 34 kg in overweight subjects, and has beneficial effects on risk factors for diabetes and CVD. To prevent obesity and diabetes there are grounds for recommending the combination of increasing daily physical activity level to a PAL-value of at least 1.8 and reducing dietary fat content to 2025 energy-% in sedentary subjects, and to 2535% in more physically active individuals. Does the piece identify the need to change healthy lifestyles in obese families? Yes, this piece shows the need to promote healthy lifestyles in obese families through education. This piece indicates the need to promote healthy lifestyles in obese families through education because its educating in how America has become obese. Does the piece theoretically define healthy lifestyles? No, this piece does not theoretically define healthy lifestyles. Does the piece tell us how to measure healthy lifestyles? Yes, this piece measures healthy lifestyles by showing the percentage of obesity in our country. Does the piece give us a model program or educational program that has shown to change healthy lifestyles? No, this piece does not provide a model to promote healthy lifestyles in obese families through education.

2. B Caballero. (2004). Obesity Prevention in Children: Opportunities and Challenges. International Journal of Obesity, S90-S95. Retrieved from: http://www.nature.com/ijo/journal/v28/n3s/full/0802797a.html Abstract: OBJECTIVE: Longitudinal survey data from a number of countries confirm that the number of overweight children continues to increase at alarming rates, and even developing countries are experiencing a rise in their overweight population. There is ample consensus that prevention strategies are essential to turn the tide of the obesity epidemic, and yet there are still relatively few proven prevention approaches for children. This paper briefly discusses some of the common features of childhood obesity prevention programs, focusing on the experience in the US and Canada. APPROACH: Most prevention programs include at least one of the following components: dietary changes, physical activity, behavior and social modifications, and family participation. School-based prevention programs may also include elements related to the school environment and personnel. Primary prevention programs cannot usually restrict caloric intake, but may effectively reduce the energy intake by reducing the energy density of foods, increasing offering of fresh fruits and vegetables, using low-calorie versions of products, and reducing offering of energy-dense food items. Physical activity interventions have recently focused more on reducing inactive time, particularly television viewing. Results from recent studies have reported success in reducing excess weight gain in preadolescents by restricting TV viewing. SUMMARY: Integrating all the activities of a multi-component prevention intervention, and delivering and sustaining it in different environments, continues to be a major challenge for health professionals as well as for parents, educators, and children themselves. Still, encouraging progress has been made in several areas, and the increased awareness of the problem of childhood obesity by all concerned will continue to foster our efforts in this area. Does the piece identify the need to change healthy lifestyles in obese families? Yes, integrating all the activities of a multi-component prevention intervention, and delivering and sustaining it in different environments, continues to be a major challenge for health professionals as well as for
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parents, educators, and children themselves. Still, encouraging progress has been made in several areas, and the increased awareness of the problem of childhood obesity by all concerned will continue to foster our efforts in this area. Does the piece theoretically define healthy lifestyles? No, it does not theoretically define healthy lifestyles. Does the piece tell us how to measure healthy lifestyles? No, it does not tell us how to measure healthy lifestyles. Does the piece give us a model program or educational program that has shown to change healthy lifestyles? Yes, most prevention programs include at least one of the following components: dietary changes, physical activity, behavior and social modifications, and family participation. School-based prevention programs may also include elements related to the school environment and personnel. Primary prevention programs cannot usually restrict caloric intake, but may effectively reduce the energy intake by reducing the energy density of foods, increasing offering of fresh fruits and vegetables, using low-calorie versions of products, and reducing offering of energy-dense food items. 3. C. Luley, A. Blaik, S. Aronica, J. Dierkes, S. Kropf, and S. Westphal. (2010). Evaluatin of Three New Strategies to Fight Obesity in Families. Journal of Nutrition and Metabolism, Volume 2010, 10 pages. Retrieved from: http://www.hindawi.com/journals/jnme/2010/751905/abs/ Abstract: To evaluate 3 strategies to reduce weight in obese families. Research design and methods. 142 obese parents and 119 obese children kept a fat-calorie restriction diet. On top of this diet, the families were randomized in a three-factorial design to one or more of three weight-loss strategies: (1) an additional diet preferring carbohydrates having a low glycemic index (dual diet), (2) financial incentive, and (3) telemonitoring of weight and physical activity. Results. All children improved their BMI-SDS by0 . 1 8 0 . 2 5 ( < . 0 0 1) independently of the weight-loss strategy. In parents, relative losses of weight (kg) were 6.4% versus 4.0% for dual diet versus calorie restriction ( = . 0 2 9), 6.9% versus 3.4% for with or without financial
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incentive ( = . 0 0 2), and 8.0% versus 4.8% for with or without telemonitoring ( = . 0 3 3). The weight loss after financial incentive plus dual diet plus telemonitoring was 14.4%.Conclusions. All strategies were effective in adults, in particular when combined. Children improved their BMI-SDS regardless of the strategy. Does the piece identify the need to change healthy lifestyles in obese families? Yes, 142 obese parents and 119 obese children kept a fat-calorie restriction diet. Does the piece theoretically define healthy lifestyles? No, it does not theoretically define healthy lifestyles. Does the piece tell us how to measure healthy lifestyles? No, it does not tell us how to measure healthy lifestyles. Does the piece give us a program model or educational model that has shown to change healthy lifestyles? Yes, on top of this diet, the families were randomized in a threefactorial design to one or more of three weight-loss strategies: (1) an additional diet preferring carbohydrates having a low glycemic index (dual diet), (2) financial incentive, and (3) telemonitoring of weight and physical activity. Results. All children improved their BMI-SDS by0 . 1 8 0 . 2 5 ( < . 0 0 1) independently of the weight-loss strategy. In parents, relative losses of weight (kg) were 6.4% versus 4.0% for dual diet versus calorie restriction ( = . 0 2 9), 6.9% versus 3.4% for with or without financial incentive ( = . 0 0 2), and 8.0% versus 4.8% for with or without telemonitoring ( = . 0 3 3). 4. Elsevier. (2002). Childhood obesity: public-health crisis, common sense cure. The Lancet, 473-482. Retrieved from, http://www.sciencedirect.com/science/article/pii/S0140673602096782 Abstract: During the past two decades, the prevalence of obesity in children has risen greatly worldwide. Obesity in childhood causes a wide range of serious complications, and increases the risk of premature illness and death later in life, raising public-health concerns. Results of research have provided new insights into the physiological basis of bodyweight regulation. However, treatment for childhood obesity remains largely ineffective. In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors for which straightforward, if politically difficult, solutions exist. Historically, a fat child meant a healthy child, one who was likely to survive the rigors of
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undernourishment and infection. In the past decade, however, excessive fatness has arguably become the primary childhood health problem in developed nations and, to some degree, in other parts of the world. Here we review the scope of the problem and discuss developments in establishment of cause, prevention, and treatment of obesity. We argue that fundamental changes in the social environment will be needed to combat this emerging public-health crisis. Does the piece show the need to promote healthy lifestyles in obese families? Yes, the piece shows the need to promote healthy lifestyles in obese families. Does the piece theoretically define healthy lifestyles? Yes, the piece theoretically defines healthy lifestyles. This piece involves all the factors of a healthy lifestyle through obesity. Does the piece tell us how to measure healthy lifestyles? Yes, the piece measures healthy lifestyles. This piece studied all the factors regarding obesity. Does the piece give us a model program or educational program that has shown to change healthy lifestyles? Yes, this piece includes models of the complications of childhood obesity and global increases in obesity.

5. Epstein. (November 21, 1990). Ten-Year Follow-up of Behavioral, Family-Based Treatment for Obese Children. The Journal of the American Medical Association, Vol. 264, No. 19. Retrieved from: http://jama.jamanetwork.com/article.aspx?articleid=383979 Abstract: Using a prospective, randomized, controlled design, we examined the effects of behavioral family-based treatment on percent overweight and growth over 10 years in obese 6- to 12-year-old children. Obese children and their parents were randomized to three groups that were provided similar diet, exercise, and behavior management training but differed in the reinforcement for weight loss and behavior change. The child and parent group reinforced parent and child behavior change and weight loss, the child group reinforced child behavior change and weight loss, and the nonspecific control group reinforced families for attendance. Children in the child and
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parent group showed significantly greater decreases in percent overweight after 5 and 10 years (-11.2% and -7.5%, respectively) than children in the nonspecific control group ( + 7.9% and + 14.3%, respectively). Children in the child group showed increases in percent overweight after 5 and 10 years ( + 2.7% and +4.5%, respectively) that were midway between those for the child and parent and nonspecific groups and not significantly different from either. At 10 years, child height was related strongly to the height of the parent of the same sex (r=.78): children were 1.8 cm taller than their parents, with no differences in height between groups.

6. Kolata. (January, 29th 2014). Obesity Is Found to Gain Its Hold in Earliest Years. The New York Times. http://www.nytimes.com/2014/01/30/science/obesity-takes-holdearly-in-life-study-finds.html?ref=health&_r=1 7. Dr. Leonard H. Epstein*, Constance C. Gordy, Hollie A. Raynor, Marlene Beddome, Colleen K. Kilanowski, Rocco Paluch. (2012). Increasing Fruit and Vegetable Intake and Decreasing Fat and Sugar Intake in Families at Risk for Childhood Obesity. Wiley Online Library, Obesity Research, Volume 9, Issue 3, Pages 171-178. Retrieved from: http://onlinelibrary.wiley.com/doi/10.1038/oby.2001.18/full Abstract: Objective: The goal of this study was to evaluate the effect of a parent-focused behavioral intervention on parent and child eating changes and on percentage of overweight changes in families that contain at least one obese parent and a non-obese child. Research Methods and Procedures: Families with obese parents and nonobese children were randomized to groups in which parents were provided a comprehensive behavioral weight-control program and were encouraged to increase fruit and vegetable intake or decrease intake of high-fat/high-sugar foods. Child materials targeted the same dietary changes as their parents without caloric restriction. Results: Changes over 1 year showed that treatment influenced targeted parent and child fruit and vegetable intake and high-fat/high-sugar intake, with the Increase Fruit and Vegetable group also decreasing their
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consumption of high-fat/high-sugar foods. Parents in the increased fruit and vegetable group showed significantly greater decreases in percentage of overweight than parents in the decreased high-fat/high-sugar group. Discussion: These results suggest that focusing on increasing intake of healthy foods may be a useful approach for nutritional change in obese parents and their children

8. Lyznicki JM. (2001). Obesity: assessment and management in primary care. American Family Physician. Retrieved from, http://europepmc.org/abstract/MED/11417771/reload=0;jsessionid=A BgEKoUsk9HduYVrU50y.0 Abstract: Obesity is a complex, multifactorial condition in which excess body fat may put a person at health risk. National data indicate that the prevalence of obesity in the United States is increasing in children and adults. Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction. Physicians and other health professionals have an important role in promoting preventive measures and encouraging positive lifestyle behaviors, as well as identifying and treating obesity-safe and effective weight loss and weight maintenance programs. Recent evidence-based guidelines from the National Heart, Lung, and Blood Institute, as well as recommendations from the American Academy of Pediatrics, American Association of Clinical Endocrinologists/American College of Endocrinology, American Obesity Association, U.S. Clinical Preventive Services Task Force, Institute of Medicine, and World Health Organization can be consulted for information and guidance on the identification and management of overweight and obese patients. Does the piece identify the need to change healthy lifestyles in obese families?
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Yes, reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Does the piece theoretically define healthy lifestyles? No, it does not theoretically define healthy lifestyles. Does the piece tell us how to measure healthy lifestyles? No, it does not. Does the piece give us a model program or education program that has shown to change healthy lifestyles? Yes, Physicians and other health professionals have an important role in promoting preventive measures and encouraging positive lifestyle behaviors, as well as identifying and treating obesity-safe and effective weight loss and weight maintenance programs.

9. Melinda Southern. (2004). Obesity Prevention in Children: Physical Activity and Nutrition. Science Direct, Volume 20, issue 7-8. Retrieved from: http://www.sciencedirect.com/science/article/pii/S089990070400098X Abstract: The current environmental experience of young children includes few opportunities for physical activity and an overabundance of high calorie foods. Sedentary lifestyles and poor nutrition challenge children who are predisposed to metabolic disorders. Obesity is a logical response to this challenge. To prevent clinically significant obesity and later metabolic disease in predisposed youth, all sectors of society must work together to support strategies to change public opinion and behavior across the life span. Parental education in all medical settings is strongly recommended, especially if the parent(s) are obese, beginning with the first pregnancy visit to the physician. Schools should be primary targets for efforts to educate parents concerning the reduction of TV, computer games, and unhealthy snacks. Schools should be encouraged to adopt vending machine policies that promote healthy drinks and food in appropriate portion sizes and discouraged from providing unhealthy food as rewards for positive behavior or academic accomplishment. Schools should provide daily physical education and frequent periods of unstructured play in young children. Clinical treatment should be both encouraged and financially supported in
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children who are already overweight. Community wide efforts to increase awareness and promote environments that encourage physical activity and healthy nutrition are needed. 10. Susan T Borra. (2003). Developing health messages: Qualitative studies with children, parents, and teachers help identify communications opportunities for healthful lifestyles and the prevention of obesity. Journal of the American Dietetic Association, pp 721-728. Retrieved from, http://www.sciencedirect.com/science/article/pii/S000282230300292X

Abstract: Childhood overweight is at an all-time high in the United States. In an effort to better understand children's, parents', and teachers' attitudes, perceptions, and behaviors about preventing overweight in childhood and to explore potential avenues for communicating overweight prevention messages, we conducted qualitative research with these three groups in 2000. Our research consisted of three progressive phases, each building on information obtained from the previous phase: Phase 1, 16 focus groups (N = 112); Phase 2, in-home observations, in-depth interviews, and diaries (N = 6 families); Phase 3, 10 qualitative interview sessions (N = 46). Both parents and children indicated that encouragement and small victories to sustain involvement in getting more fit were critical to success. The findings also suggest that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals. Parents need to learn how to talk about eating and exercise habits with their children in positive and encouraging ways and to learn how to help their children maintain efforts to get fit. Teachers consider it essential that parents support healthful lifestyles at home. Parents and children need positive, realistic approaches to getting fit, such as answers to questions about healthful lifestyles; ideas for physical games and activities the family can enjoy together; attainable goals and small steps to healthful eating; healthful meal, snack, and recipe suggestions; incentive ideas for getting kids active; and referral services for local support groups. Parents and children need to work together in addressing the overweight prevention issue and need effective tools to facilitate this cooperative effort. Does the piece identify the need to change healthy lifestyles in obese families?
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Yes, Both parents and children indicated that encouragement and small victories to sustain involvement in getting more fit were critical to success. The findings also suggest that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals. Does the piece theoretically define healthy lifestyles? No it does not theoretically define healthy lifestyles. Does the piece tell us how to measure healthy lifestyles? No, it does not tell us how to measure healthy lifestyles. Does the piece give us a model program or educational program that has shown to change healthy lifestyles? No, it does not give us any models.

11. Steven L. Gortmaker. (1996). Television Viewing as a Cause of Increasing Obesity Among Children in the United States, 1986-1990. Jama Pediatrics, Vol 150, No.4. Retrieved by: http://archpedi.jamanetwork.com/article.aspx?articleid=517896 Abstract: Background and Methods: The prevalence of obesity among children and adolescents has increased, and television viewing has been suggested as a cause. We examined the relation between hours of television viewed and the prevalence of overweight in 1990, and the incidence and remission of overweight from 1986 to 1990 in a nationally representative cohort of 746 youths aged 10 to 15 years in 1990 whose mothers were 25 to 32 years old. Overweight was defined as a body mass index higher than the 85th percentile for age and gender. Results: We observed a strong dose-response relationship between the prevalence of overweight in 1990 and hours of television viewed. The odds of being overweight were 4.6 (95% confidence interval, 2.2 to 9.6) times greater for youth watching more than 5 hours of television per day compared with those watching for 0 to 2 hours. When adjustments were made for previous overweight (in 1986), baseline maternal overweight, socioeconomic status, household structure, ethnicity, and maternal and child aptitude test scores, results were similar (odds ratio, 5.3; 95% confidence interval, 2.3 to 12.1). We also found significant relations between television viewing and increased incidence and decreased remission of overweight during this 4-year period, adjusted for baseline
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covariates. The adjusted odds of incidence were 8.3 (95% confidence interval, 2.6 to 26.5) times greater for youth watching more than 5 hours of television per day compared with those watching for 0 to 2 hours. Estimates of attributable risk indicate that more 60% of overweight incidence in this population can be linked to excess television viewing time. Conclusion: Television viewing affects overweight among youth, and reductions in viewing time could help prevent this increasingly common chronic health condition.

12. Tamara S. Hannon, Goutham Rao, Silva A. Arslanian. (2004). Childhood Obesity and Type 2 Diabetes Mellitus. Northern Michigan University. Retrieved from, http://pediatrics.aappublications.org/content/116/2/473.short

Abstract: Until recently, the majority of cases of diabetes mellitus among children and adolescents were immune-mediated type 1a diabetes. Obesity has led to a dramatic increase in the incidence of type 2 diabetes (T2DM) among children and adolescents over the past 2 decades. Obesity is strongly associated with insulin resistance, which, when coupled with relative insulin deficiency, leads to the development of overt T2DM. Children and adolescents with T2DM may experience the microvascular and macrovascular complications of this disease at younger ages than individuals who develop diabetes in adulthood, including atherosclerotic cardiovascular disease, stroke, myocardial infarction, and sudden death; renal insufficiency and chronic renal failure; limb-threatening neuropathy and vasculopathy; and retinopathy leading to blindness. Health care professionals are advised to perform the appropriate screening in children at risk for T2DM, diagnose the condition as early as possible, and provide rigorous management of the disease. Does the piece identify the need to change healthy lifestyles in obese families? No, it does not identify the need to change healthy lifestyles in obese families. Does the piece theoretically define healthy lifestyles? No, it does not.
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Does the piece tell us how to measure healthy lifestyles? No, it does not. Does the piece give us a model program or educational program that has shown to change healthy lifestyles? No, it does not.

13. Tom Baranowski, James Mendlein, Ken Resnicow, Erica Frank, Karen Weber Cullen, aJanice Baranowski. (2000). Physical Activity and Nutrition in Children and Youth: an Overview of Obesity Prevention. Science Direct, Volume 31, Issue 2. Retrieve from: http://www.sciencedirect.com/science/article/pii/S0091743500906868 Abstract: Obesity, especially among children, has become epidemic. Even with major advances in genetics, behavior is likely to continue to play a central role in the development of adiposity and obesity. Interventions to help children and adolescents change their dietary or physical activity behaviors may be justified on four grounds: (1) immediate social and health benefits may be obtained; (2) critical periods in childhood may require certain behaviors to lead to healthy outcomes in adulthood; (3) chronic diseases and their elevated risk factors detected in youth may track into the adult years; and (4) the behaviors established in childhood may track into the adult years. Immediate benefits for children (ground 1) and the high tracking of obesity from childhood to the adult years (relates especially to grounds 3 and 4) are the strongest reasons for helping children acquire and retain healthy habits. The nine other papers in this supplemental issue address measurement and intervention issues, with special emphasis on obesity prevention. Reviews of the measurement literature were conducted for diet, nutritional status, physical activity, physical fitness, process evaluation, and environmental factors. Reviews of the intervention literature were conducted for health care providers, schools, and larger community settings. Effective programs for children can and should be designed, implemented, and evaluated. 14. T., Baur, Lobstein, L. and Uauy, R. (2004), Obesity in children and young people: a crisis in public health. Obesity Reviews, 5: 485. Retrieved from: http://onlinelibrary.wiley.com/doi: 10.1111/j.1467-789X.2004.00133.x

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15. Wardle & Steptoe. (2002). Socioeconomic differences in attitudes and beliefs about healthy lifestyles. BMJ, Retrieved from http://jech.bmj.com/content/57/6/440.short Abstract: The factors underlying socioeconomic status differences in smoking, leisure time physical activity, and dietary choice are poorly understood. This study investigated attitudes and beliefs that might underlie behavioral choices, including health locus of control, future salience, subjective life expectancy, and health consciousness, in a nationally representative sample. Socioeconomic differences in healthy lifestyles are associated with differences in attitudes to health that may themselves arise through variations in life opportunities and exposure to material hardship and ill health over the life course. Does the piece identify the need to change healthy lifestyles in obese families? Yes, this piece does show the need to promote healthy lifestyles in obese families through education. The article states that attitudes and beliefs that might underlie behavioral choices, including health locus of control, future salience, subjective life expectancy, and health consciousness. By having families understand that unhealthy choices could be caused by their attitudes could help change these behaviors. Does the piece theoretically define healthy lifestyles? No, this article did not theoretically define healthy lifestyles in obese families through education. Does the piece tell us how to measure healthy lifestyles? No, this article does not measure healthy lifestyles. Does the piece give us a model program or educational program that has shown to change healthy lifestyles? Yes, this article provides the reader with data on a survey that was done.

Williams & Wilkins. (2002). Peer Relations of Youth with Pediatric Conditions and Health Risks: Promoting Social Support and Healthy Lifestyles. Journal of Developmental & Behavioral Pediatrics, pp 271-280. Retrieved from, http://journals.lww.com/jrnldbp/Abstract/2002/08000/Peer_Relations_of_Yo uth_with_Pediatric_Conditions.13.aspx
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Abstract: Peer relations and close friendships play important roles in youngsters emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends influence on treatment adherence, and (3) peers and friends impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., brains, jocks) that are linked with healthpromoting behaviors may prove beneficial to youngsters disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters peers and friends into the medical management of youth with chronic pediatric conditions. Does the piece identify the need to change healthy lifestyles in obese families? Yes, the piece shows the need to promote healthy lifestyles in obese families. The article states, This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends influence on treatment adherence, and (3) peers and friends impact on healthpromoting and health-risk behaviors. This is educating families on what could influence their children. Does the piece theoretically define healthy lifestyles? No, the piece does not theoretically define healthy lifestyles. Does the piece tell us how to measure healthy lifestyles? No, the piece does not measure healthy lifestyles.
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Does the piece give us a model program or educational program that has shown to change healthy lifestyles? No, the piece does not give us a model program that has shown to promote healthy lifestyles in obese families through education.

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Section 3: Synthesis of the Literature ASSESSING GENERAL NEED (LITERATURE REVIEW) To Promote Healthy Lifestyles in Obese Families Through Education. 7. What is the need to promote healthy lifestyles in obese families through education? The following evidence found within the literature shows a need to promote healthy lifestyles in obese families through education. To prevent obesity and diabetes there are grounds for recommending the combination of increasing daily physical activity level to a PAL-value of at least 1.8 and reducing dietary fat content to 20-25 energy% in sedentary subjects, and to 25-35% in more physically active individuals (Astrup, 2001). Integrating all the activities of a multi-component prevention intervention, and delivering and sustaining it in different environments, continues to be a major challenge for health professionals as well as for parents, educators, and children themselves. Still, encouraging progress has been made in several areas, and the increased awareness of the problem of childhood obesity by all concerned will continue to foster our efforts in this area (Caballero, 2004). Reversing these trends requires changes in individual behavior and the elimination of societal barriers to healthy lifestyle choices. Basic treatment of overweight and obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management rather than short-term extreme weight reduction (JM, 2001). To prevent clinically significant obesity and later metabolic disease in predisposed youth, all sectors of society must work together to support strategies to change public opinion and behavior across the life span (Southern, 2004). Both parents and children indicated that encouragement and small victories to sustain involvement in getting more fit were critical to success. The findings also suggest that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals (Borra, 2003). Television viewing affects overweight among youth, and reductions in viewing time could help prevent this increasingly common chronic health condition (Gortmaker, 1996). This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on 1. The role of peers and close friends as a source of support 2. Friends influence on treatment adherence and 3. Peers and friends impact on health-promoting and health-risk behaviors (Wilkins, 2002). Attitudes and beliefs that might underlie behavioral choices,
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including health locus of control, future salience, subjective life expectancy, and health consciousness, create hardship and ill health over the life course (Steptoe, 2002). 8. Theoretical Definition of DV: Healthy Lifestyles: What is the way we will theoretically define Healthy Lifestyles? Health is a state of complete physical, mental and social wellbeing, not just the absence of disease. Healthy living is steps, actions, and strategies one puts in place to achieve optimum health. These steps include: Physical (for the body), Emotional Wellness (for the mind), and Spiritual Wellness (Lewis, 2014). Healthy lifestyle is a valuable resource for reducing the incidence and impact of health problems, for recovery, for coping with life stressors, and for improving quality of life (Lewis, 2014).

8a. How can you model the theoretical definition for Healthy Lifestyles?

Healthy Lifestyles

Physical (For The Body)

Emotional Wellness (For The Mind)

Spiritual Wellness (For The Soul)

Good Nutrition, Eating right, getting physically fit, adequate rest

Self- supportive attitudes, positive thoughts, positive selfimage

Inner calmness, creativity, trust in your inner knowing, Forgiveness, love, compassion, laugh, happiness, joyful relationships

-Harvard Foodplate -60 min of activity 3-5 a week -8 hrs of sleep each night

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9. Assessing Specific Need (Finding a valid test to measure healthy lifestyles in obese families through education). Name:___________________________________ Age: ________ Gender: __Male __Female Current Weight: ________________________________ Do you consider yourself: __underweight __overweight __just right The Healthy Lifestyles Questionnaire is based off of..Using the following scale from 1-5, please rate yourself based on your physical activity level, nutritional habits, emotional status, and social wellbeing. Write the number that reflects each question the most. 1= I completely disagree with the statement 2= I disagree with the statement 3= I feel neutral toward the statement 4= I agree with the statement 5= I completely agree with the statement

Exercise Level Check Your Current Level of Exercise: o Level 1_ None o Level 2 Light Exercise: 1-3 times per week, easy pace, stretching, walking, etc. o Level 3 Moderate Exercise: 2-3 times per week, moderate pace, some weights, etc. o Level 4 Heavy Exercise: 3-5 times per week, vigorous pace, weights, fast running, etc.

Eating: o I never skip breakfast___ o I eat three well balanced meals/day___ o I never eat on the run___ o I never snack___ o I snack on healthy food___

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Sleep: o I get 8 hours of sleep a night o I have a lot of energy during the day__ o I do not suffer from fatigue__ I I I I I have self-support__ have a positive attitude__ am focused__ have positive thoughts and viewpoints__ have a positive self-image__

o o o o o

Spiritually: o I am forgive__ o I am happy__ o I have joyful relationships with my immediate family__ o I have a positive relationships with others__ o I am a loving person__ o I have inner calmness__ o I trust myself__ 9a. Test Validity: Please argue that your test has logical or content validity, that it actually measures your dv (all content areas) per the theoretical definition of the dv Our Healthy Living Questionnaire is valid to measure healthy lifestyles in obese families because it covers all of the components of our theoretical definition of healthy lifestyles. In our Healthy Living Questionnaire, we asked questions based on all of these components of the theoretical definition to determine their status; therefore, we claim content validity. The questionnaire is based on a 1-5 point scale. The higher a person scores, the healthier their lifestyle is. The questionnaire also gives the health professional an idea of what the individuals lifestyles are. 9b. Please say how you would develop test-retest reliability (test consistency) for your test. To determine test-reliability, we will administer the Healthy Lifestyles Questionnaire and Assessment to a different set of people at the YMCA in Escanaba. We will use the test in Escanaba on Monday and Wednesday; if they have same scores, this we will establish reliability before we use it in our program.

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9c. Pretend you gave your test in a pretest situation for the tp. Please identify at least 4 measurable objectives. Participants will go from 40/104 on the pre-test will score to a score of 90/104 by the end of the 6 week program Participants will go from 20/44 on the Nutrition section of the pre-test to 40/44 by the end of the 6 week program. Participants will go from 10/25 on the Emotional section of the pre-test to 20/25 by the end of the 6 week program Participants will go from 20/35 on the Spiritual section of the pre-test to 30/35 by the end of the 6 week program Participants will drop time on their pre-assessment (1 mile walk for time) by the end of the 6 week program

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HL 367 Section 3 (Continued): Synthesis of Literature 10. Based on the literature review, which program model from will you use? Identify the model and then identify the steps in the model. Then, right next to it, show how you will adapt the model for your content or time needs. Please go into very specific detail about what your program is, WHAT YOU WILL COVER, and how you will implement it. THIS IS THE PROGRAM YOU WILL USE TO TRY TO CHANGE YOUR DV IT IS IMPORTANT THAT YOU FLESH IT OUT IN DETAIL. MAKE SURE YOU FOLLOW THE MODEL COMPLETELY. See the example below from GET FIT WITH THE GRIZZLIES. Mission of Program: To promote healthy lifestyles in obese families through education Fitness for Families: YMCA Marquette 6 week/ 12 lesson (60 minutes per session, two session per week) focusing on nutrition and physical activity for families (kids ages 5-12 years old). This program will be organized by the YMCA in Marquette, Michigan. At the end of the program, the Families will participate in annual Walk/Run 5k on April 12th, 2014. Families and athletes of all ages from across the UP and northern Wisconsin participate in this fun event to raise money for the Strong Kids Campaign. NMU students and YMCA staff worked to develop program and the marketing staff procure money to fund the program. Parent & Child Fitness Program: CorePlus PT All inclusive with membership program. 45 minute, 1-5 days a week program (come at your own leisure) focusing on involving the while family in fitness. It is designed to increase overall conditioning, improve coordination and balance, increase endurance, and improve confidence. The program consists of exercises using jump ropes, hurdles, ladders, cones, hula hoops, and more all designed to increase your heart rate, energize your system and bring the fun back to getting fit! The program also consists of stress management courses. Whether it is the fear of going to a new school or transitioning from elementary to middle school, stress effects kids of all ages. Our workshops provide effective stress management

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strategies, and tools to reduce stress, improve concentration and create balance Nutritional Aspects in Program: Fitness for Families works directly with a nutritionist to provide the nutrition component of our programs. Fitness for Families works with children, adult caregivers and parents to inform and educate improving nutrition. Children: Goal is for the children to understand what eating healthy is and find healthy food choices they like. Education on healthy food choices Hands on taste testing Alternative snacks that are healthy Nutritional Aspects in Program: CorePlus Performance Training works directly with a nutritionist to provide the nutrition component of our programs. CorePlus PT works with children, adult caregivers and parents to inform and educate improving nutrition. Children: Goal is for the children to understand what eating healthy is and find healthy food choices they like. Education on healthy food choices Hands on taste testing Alternative snacks that are healthy

Adults: Goal is for the various adults who interact with the children to understand the benefits of eating well, provide healthy alternatives and be aware of healthy fundraising and party options.

Healthy snack choices Healthy fundraisers In-school parties

Parents: Goal is for the parents to understand the benefits of having their children eat well, be aware of healthy snack choices, and ways to eat healthy while still maintaining a reasonable budget

Adults: Goal is for the various adults who interact with the children to understand the benefits of eating well, provide healthy alternatives and be aware of healthy fundraising and party options.

Healthy snack choices Healthy fundraisers In-school parties

Education on healthy food choices Healthy snack choices Ways to minimize cost

Parents: Goal is for the parents to understand the benefits of having their children eat well, be aware of healthy snack choices, and ways to eat healthy while still maintaining a reasonable budget

Education on healthy food choices

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Healthy snack choices Ways to minimize cost

Training the Teachers: Les Mills certified fitness instructors, along with a certified nutritionist will run program. This program requires all physical educators to attend a two day training program. During this training period, instructors will learn the Fit for Families program itinerary, how to teach each activity, and the importance of the nutritional aspects. Will train instructors to administer pre/post tests on nutrition and physical activity knowledge using a set protocol. Set up a booth in the YMCA with information about the program and its processes. Also, post advertising flyers in elementary and middle schools in the Marquette area. FITNESS FOR FAMILIES PROGRAM Week 1/Lesson 1 Collect pre-test data on knowledge of nutrition and physical activity. Give out log books with work sheets to families that allow them to record their nutrition and physical activity habits on a weekly basis. Also, leave weight log that should be taken in the morning on Monday & Friday of each week. Include parents by giving a chart of healthy choices to eat for breakfast, lunch, and dinner. Encourage parents to get rid of snack food and replace with healthier options. Encourage parents to eat with their children. Info about physical activity given in the log book, such as additional activities to do with the family outside of class meetings. Instructors collect log books weekly for data and to view progress
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Qualified instructors to instruct classes.

FITNESS FOR FAMILIES PROGRAM Week 1/Lesson 2 1 Mile Walking Assessment: show the importance of walking frequently instead of sitting. This activity should be timed in order to track progress. Nutritional Lesson: give the family a nutritional goal to meet by next meeting. The importance of Breakfasts What to eat, and what Not to eat Give samples and recipes

Week 2/Lesson 3 Bike outing along bike path Stress the importance of bike safetysmall presentation at the beginning of meeting If participants do not own a bike, families can stay and cycle in the studio. Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Daytime Snacks & Evening Cravings What to eat, and what Not to eat: show comparison Week 3/Lesson 5 Water safety presentation: stress the importance of water safety and the dangers of Lake Superior. Swimming lesson: give a basic swimming lesson to adults and children. Have the parents assist with their childs lesson if they feel uncomfortable. Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Lunch For the kids at school What to eat and what Not to eat Give examples and basic recipes to try with the family Week 4/Lesson 7 Karate Lesson Stress the importance of safety Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Eating pre- exercise What to eat and what Not to eat Give examples and basic recipes to try with the family

Week 2/Lesson 4 Hike up Sugarloaf Stress the importance of hiking safety Mental (emotional) Lesson: Stress levels presentation Where to get help if needed? Hand out stress balls

Week 3/ Lesson 6 Swim lesson refresher: practice basic skills Water Aerobic Pool Activity Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Lunch (continued) For the adults What to eat and what Not to eat Give examples and basic recipes to try with the family Week 4/Lesson 8 Racquetball Activity Explain rules Play game Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Eating post- exercise What to eat and what Not to eat Give examples and basic recipes to try with the family

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Week 5/Lesson 9 Basketball Activity Explain rules Play game Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Dinner The importance of eating together as a family What to eat and what Not to eat Give examples and basic recipes to try with the family

Week 6/Lesson 11 Yoga Activity Spiritual (soul) Lesson: The importance of not smoking presentation o Show the importance of not smoking under pressure or while stressed The importance of not drinking presentation o Show the importance of not drinking under pressure while stressed Annual 5k walk/run Families walk together during this event All families get T-shirt an water bottle

Week 5/Lesson 10 Gym activity with hula-hoops, cones, jump ropes, and more! Circuit training and stations Physical Lesson: Sleep & Energy Level Presentation o The importance of adequate sleep and how it effects out energy level o How much sleep do we need? o What effects our sleep? o Give sleep log to track over the weekend Week 6/ Lesson 12 One mile walk together for time Collect Post test data on test of nutrition and physical activity knowledge worksheet. Collect log books. Nutritional Lesson: give the family a nutritional goal to meet by next meeting. Times of the day to eat The importance of not skipping meals and eating more frequently in smaller amounts

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11. What apps are out there that would help you with your programming? Id them, explain them, show a pic of them if possible, and link to them. Any fitness, and nutrition app will help with our programming. For example, fooducate app is effective in directing and motivating individuals to find healthier, good quality foods. We could implement the strategies from this app into our programming as an effective way to promote healthy lifestyles.

Another App that we found is Nutrition quiz. Nutrition Quiz provides fun quizzes that list common myths when it comes to fitness, nutrition, diet and health. This would be great for children to educate them in different fruits and vegetables.

The last app we could use is the calorie count app. The calorie count app can be used to keep track of all the calories consumed that day. You can also type in your weight, age, height and it will calculate how many calories you should consume each day. This would be a great app to do with your family. You can even try and make it into a fun game!

12. First do NO harm and then do good. What safety considerations for your program are there? Explain. Include forms, liability waiver, PARQ, etc. if appropriate.
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We have decided to include a liability form that we found that has descriptions and safety procedures for any type of program at the YMCA. Retrieved from: http://www.ymcasv.org/pdfs/form_liabilitywaiver.pdf 13. Social Cognitive Theory Light says people are more likely to engage the prescribed program behaviors if they know what to do (change the dv), know how to do it (enact your program), want to do it (are motivated), believe they can do it (have good selfefficacy), and have a supportive environment. How would you determine that: Our tp knows what to do? We will ask our tp if they know what to do to participate in our program. We will explain our program and make sure there aware that they will develop a healthy lifestyle by the last session. Our tp knows how to do it? We will explain the structure of our program, meeting for 6 weeks, twice a week, for an hour each. It will take place at the YMCA in Marquette, MI. Our tp wants to do it (is motivated)? We will give them incentive to want to be physically active and have an increased awareness. We can apply the information to their family and friends so they can help and give them support. Our tp believes it can do it (is self-efficacious)? We will empower them to want to learn and increase their awareness. We will use positive reinforcement to motivate them. Our tp has a supportive environment? Fitness for Families staff, family, & friends will help develop a healthy lifestyle for the individual

Section 4: EVALUATION Design/Mission Fit 12. What evaluation design will you use? The evaluation design that we used is the One-group pre-test & post- test design.

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(One-group Pre-test/Post-test Design) O X O

PreTest: Healthy Lifestyles Questionaire & Assessment (1 mile walk test) (Wellness Watchers, 2002)

Intervention: Fitness For Families program (CorePlus, 2010)

PostTest: Healthy Lifestyle Survey & Assessment (1 mile walk test) (Wellness Watchers, 2002)

13. What threats and to internal validity accompany the evaluation design you selected in #10? We like to believe that our program caused the change in the obese families, and not something else. However, because we do not have a control group it opens up the opportunity for threats history, maturation and mortality. 14. What is your mission fit question and what is the evidence that you met your mission? Mission Fit Question: Did we promote healthy lifestyles in obese families? We will know that our program was successful at promoting healthy lifestyles in obese families through education, if the participants show an improvement on their Healthy Lifestyles Questionnaire, and also their 1 mile walk test assessment in the post test situation. By looking at the questionnaire and assessment, we will be able to see participants improvement and measure their progress to determine if they met their goal. If participants increase post-test scores and the test actually measures healthy lifestyles, then we will promote healthy lifestyles in obese families.

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Section 5: Marketing and Communication 15. How can you use social media or traditional media to market your program (make your target population aware that it exists and make them want to come to the program)? Develop at least one marketing tool related to your program and show it/ and link to it. Please place your agency logo on the material. We created a website partnered with the YMCA to promote our mission and program. We created a fun website for families to visit. Our website includes examples of activities we do throughout the program as well as a detailed weekly agenda throughout the program. Our website will help with marketing our program throughout the Marquette community. The website can be viewed by clicking http://hl367fitforfamilies.weebly.com 16. How can you use social/traditional media to communicate with the members of your program about the program? By creating a website, we are able to communicate with our families, community and staff about our program and expectations that are implied to participate in the program. On our site, you will find the "What's Going On" tab, which serves as our communication tool. The Whats Going On tab takes the website viewers to an interactive blog that details what is going on in the program each week. The website can be viewed by clicking http://hl367fitforfamilies.weebly.com

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Section 6: Granting Agency 17. Identify a granting agency to help you fund your program. Provide the agencies mission. What is the grant and how is it compatible with our mission? Agency: The St. Joseph Community Health Foundation Mission: We invest in and collaborate with other community agencies to improve the physical, mental, and spiritual health of the poor and underserved. Amount: $19,445 Compatible with our mission: The St. Joseph Community Health Foundation mission is beneficial to our dyad mission because it will allow the Obesity Wellness Network and YMCAs Diabetes Prevention program to reach out and help at-risk individuals in our community adopt healthier lifestyles. http://sjchf.org/index.php?option=com_content&view=article&id=58& Itemid=65

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Section 7: Webliography 1. Arne Astrup. (2001). Healthy lifestyles in Europe: prevention of obesity and type II diabetes by diet and physical activity. Retrieved from: http://journals.cambridge.org/action/displayAbstract?fromPage=online &aid=1357356 2. B Caballero. (2004). Obesity Prevention in Children: Opportunities and Challenges. International Journal of Obesity, S90-S95. Retrieved from: http://www.nature.com/ijo/journal/v28/n3s/full/0802797a.html 3. C. Luley, A. Blaik, S. Aronica, J. Dierkes, S. Kropf, and S. Westphal. (2010). Evaluatin of Three New Strategies to Fight Obesity in Families. Journal of Nutrition and Metabolism, Volume 2010, 10 pages. Retrieved from: http://www.hindawi.com/journals/jnme/2010/751905/abs/ 4. Elsevier. (2002). Childhood obesity: public-health crisis, common sense cure. The Lancet, 473-482. Retrieved from, http://www.sciencedirect.com/science/article/pii/S0140673602096782

5. Epstein. (November 21, 1990). Ten-Year Follow-up of Behavioral, Family-Based Treatment for Obese Children. The Journal of the American Medical Association, Vol. 264, No. 19. Retrieved from: http://jama.jamanetwork.com/article.aspx?articleid=383979 6. Fooducate. (n.d.). Lose weight with fooducate! lose weight, track your progress, and eat real food. Retrieved from http://www.fooducate.com/ 7. Harvard school of public health. (n.d.). Food pyramids and plates: What should you really eat?. Retrieved from http://www.hsph.harvard.edu/nutritionsource/pyramid-full-story/ 8. Kolata. (January, 29th 2014). Obesity Is Found to Gain Its Hold in Earliest Years. The New York Times.
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http://www.nytimes.com/2014/01/30/science/obesity-takes-holdearly-in-life-study-finds.html?ref=health&_r=1 9. Lewis, L. (2014). What is a healthy lifestyle?. Retrieved from http://www.healthylifestylesliving.com/health/healthy-lifestyle/whatis-a-healthy-lifestyle/ 10. Lyznicki JM. (2001). Obesity: assessment and management in primary care. American Family Physician. Retrieved from, http://europepmc.org/abstract/MED/11417771/reload=0;jsessionid=A BgEKoUsk9HduYVrU50y.0 11. Melinda Southern. (2004). Obesity Prevention in Children: Physical Activity and Nutrition. Science Direct, Volume 20, issue 7-8. Retrieved from: http://www.sciencedirect.com/science/article/pii/S089990070400098X 12. Oberle, K. (2013). Coreplus performance training. Retrieved from http://www.corepluspt.com/index.php?page=about-us 13. St Joseph Community Health Foundation. (n.d.). Retrieved from http://sjchf.org/ 14. Steven L. Gortmaker. (1996). Television Viewing as a Cause of Increasing Obesity Among Children in the United States, 1986-1990. Jama Pediatrics, Vol 150, No.4. Retrieved by: http://archpedi.jamanetwork.com/article.aspx?articleid=517896 15. Susan T Borra. (2003). Developing health messages: Qualitative studies with children, parents, and teachers help identify communications opportunities for healthful lifestyles and the prevention of obesity. Journal of the American Dietetic Association, pp 721-728. Retrieved from,

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http://www.sciencedirect.com/science/article/pii/S000282230300292X 16. Tamara S. Hannon, Goutham Rao, Silva A. Arslanian. (2004). Childhood Obesity and Type 2 Diabetes Mellitus. Northern Michigan University. Retrieved from, http://pediatrics.aappublications.org/content/116/2/473.short 17. Tom Baranowski, James Mendlein, Ken Resnicow, Erica Frank, Karen Weber Cullen, aJanice Baranowski. (2000). Physical Activity and Nutrition in Children and Youth: an Overview of Obesity Prevention. Science Direct, Volume 31, Issue 2. Retrieve from: http://www.sciencedirect.com/science/article/pii/S0091743500906868 18. Wardle & Steptoe. (2002). Socioeconomic differences in attitudes and beliefs about healthy lifestyles. BMJ, Retrieved from: http://jech.bmj.com/content/57/6/440.short

19. Wellness Watchers Internation. (2002). Healthy living quiestionnaire. Retrieved from http://www.boonsborowellness.com/Documents/healthy_lifestyle.pdf 20. Williams & Wilkins. (2002). Peer Relations of Youth with Pediatric Conditions and Health Risks: Promoting Social Support and Healthy Lifestyles. Journal of Developmental & Behavioral Pediatrics, pp 271280. Retrieved from, http://journals.lww.com/jrnldbp/Abstract/2002/08000/Peer_Relations_ of_Youth_with_Pediatric_Conditions.13.aspx 21. YMCA. (n.d.). Ymca mission. Retrieved from http://www.wcfymca.org/index.php?option=com_content&view=article &id=57&Itemid=83 22. YMCA of San Diego County. (n.d.). Careers. Retrieved from http://ch.tbe.taleo.net/CH15/ats/careers/searchResults.jsp?org=YMCA SANDIEGO&cws=1 23. https://caloriecount.about.com/apps

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24. https://itunes.apple.com/us/app/nutrition-quiz-600+facts/id668562312?mt=8

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Section 8: Reflection Michele Kolin: After taking the course HL367, I can say that we have grown professionally in our field. We can assess a general need, identify measurable objectives, find an evidence-based program, implement it, and then evaluate it to see if our objectives, therefore our mission, were met. This course has taught me how to use new technology. This course taught me the fundamentals of self-directed learning. We were briefly instructed how to do a section, then we did it within our dyad pairs. It was difficult to meet the standards of each assignment; however, I believe we did so effectively to the best of our ability. This course taught me how to solve problems on my own and use the literature to guide me. The critical thinking aspect was the hardest part for me. I consider myself a good critical thinker, but it was difficult to determine valid research and compare it to others. It was difficult basing our program off of valid material and measuring what makes the material valid. Collaborative learning was simple. Working with my partner to create this program was easy because we have similar interests within our fields. The project itself was not easy, but working with a partner for alternative perspectives and ideas made it fun. We get along and have similar schedules which allowed us to work together to achieve our goals. Kayla Stanley: Reflecting back on HL 367 I can assuredly say that this project has increased my knowledge of program planning and evaluation. For the past few weeks I have learned to assess the need, identify measurable objectives, plan an evidence-based program, implement, and evaluate to see if we have met our mission. After spending weeks researching our mission, developing tests, creating models, and even creating a professional website Michele and I can finally say weve accomplished our project! We set out with the mission to promote healthy lifestyles in obese families through education. This mission is one that we were both very passionate about, so the outcomes were endless. I learned how to work in dyad pairs, and learned how to work at a fast self-directed pace. Michele and I worked consistently every week outside of class to accomplish our goals, and our schedules worked perfectly. To be completely honest this project was a bit overwhelming at times, and the amount of time and effort you had to put in this project was a lot. We learned how to manage our time, and to get our work done ahead of time so we wouldnt feel like we were waiting till the last minute. The work load advised throughout the project was relevant and I feel like I was working like a
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professional throughout the entire thing. After completing a website for this project, I understand that this is a tool to educate the community. I realize now that technology is something we need to keep up to date with because we will be using it a lot. This project let me be creative and create a program to our interests that I could carry with me into my future careers. The exposure to program planning and evaluation and Pattys instructions have aided my growth as a professional in my field: community health education. Im walking away from this class with the ability to take an issue, create a mission for that issue and apply the program planning and evaluation model to any need. This project allowed us to think critically and use our resources to plan an evidence based program. Although, we would not have achieved our hard work and motivation without our supporters; Patty and fellow classmates. This assisted in achieving our goal! Thanks for this opportunity.

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Section 9: Powerpoint

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