RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Coca-Cola Crisis: The relationship between soda consumption and BMI in a Marion County clinic Project Date: 10/12/2009 During a time where childhood and adult obesity is reaching epidemic proportions, the American Society of Family Physicians announced a highly controversial merger with Coca-Cola to promote consumption of its products as part of a healthy life style. This raised a highly charged debate as to whether or not family physicians could ethically support soft drink consumption in the face of numerous studies linking soft drink or soda consumption to increasing BMI. In Marion County, obesity rates are even higher than Oregon in general. This study sought to create a snap shot of the current obesity trends within a specific Marion County clinic and assess the association between soda consumption and BMI. Additionally, the study sought to assess the motivational factors that contribute to soda consumption. Soda consumption was assessed through surveys that were self reported and correlated to the most recently recorded clinic BMI. Over 200 patients were surveyed with only 74 responders. Of those responding, only 18 self identified as soda consumers. When assessed, it was found that there was a statistically significant positive association between soda consumption and BMI with an average BMI for soda consumers of 33.4 with a 95% CI (29.86-36.99) compared to 29.4 in the control group with a p-value of 0.012. This positive association supports numerous studies that have addressed a caloric as well as hormonal association between BMI and soda consumption. This relationship calls into question the ethics of supporting a healthy lifestyle that includes soda consumption that is associated with obesity and its myriad of co-morbidities. Childhood Obesity: A review of literature to support development of a community intervention Project Date: 10/12/2009 besity is one of the leading health concerns in the developed world. Being overweight and obese as an adult has consequences of type II diabetes, cardiovascular disease, hyperlipidemia, and exacerbates other health conditions such as arthritis. Obesity is growing not only in the adult population but also the pediatric population. More than 16% of children are obese or overweight currently, a 4-fold increase in the last 30 years. These numbers are larger in underserved and minority populations. The Community Health Improvement Partnership (CHIP) in Madras, OR has initiated a number of programs in the schools and community to fight obesity. There is interest in focusing on pregnant women and parents of young children to change behavior before it becomes habit. Background research was needed to identify which groups to target and how to have to most meaningful impact at a reasonable cost for the community. A review of the literature showed 1) the early in life the intervention, the more successful, 2) Interventions should aim at decreasing sedentary activity and unhealthy food choices 3) Anticipatory guidance and reinforcement of breast feeding, delaying introduction of solids and parental nutrition knowledge building are effective tools in preventing obesity. Interest and Barriers to a new Nutrition Curriculum in Grants Pass Elementary Schools Project Date: 10/12/2009 Obesity and the related health events have become an epidemic throughout America. Health related habits are learned at a young age and reinforced throughout childhood. There are currently multiple movements to introduce more nutrition and health education to schools in an attempt to curb this epidemic. Specifically, in Grants Pass elementary schools a group wants to implement a nutrition and health curriculum however little was known about the status of the health education system and potential barriers. The goal of this project was to assess the interest and potential barriers to implementing the “Be a Fit Kid” nutrition and health curriculum in Grants Pass elementary schools. Interest was strong among the 5 physical education teachers interviewed. Each pointed out potential barriers to consider with implementation of the curriculum. Results of these interviews were used as a foundation for writing a grant to fund the program. Physical activity group visit at the McClaine Street Clinic in Silverton, Oregon Project Date: 10/12/2009 Currently, in the United States, obesity is a growing problem with many related health concerns, the small town of Silverton, OR is not exempt from this problem and many of those who reside there are overweight. One of the health concerns related to obesity is Type II DM, this project attempted to identify some of those who are at risk of developing or who already have Type II DM, and get them involved in some type of physical activity. This was done through a group patient visit with a didactic session on exercise, followed by a 1 mile walk for physical activity, and ending with individual meetings to discuss their personal action plan for physical activity. Participants were selected based not only on their Type II DM risk factors but also if they were sedentary. Public Perceptions Regarding Adult Obesity and Treatment Options in Gold Beach, OR Project Date: 9/7/2009 Obesity is a nationwide problem associated with many well-known effects on physical and emotional health. Gold Beach is a small, coastal community in the southern portion of Curry County, OR. It is not currently known what options exist regarding obesity in this rural area, and what local public perceptions are regarding both the problem of obesity and the treatment options available. This qualitative project was designed to explore regional views on obesity and therapies available both from patients and physicians in the area. These were conducted via personal interviews with many members of the community. In addition, a literature search was performed to explore evidence-based data available on other treatment options that have been explored. Results showed many areas of frustration with diet and exercise, as well as success with mainly surgical therapies. Interestingly, many behavioral and group therapies had not been tried in this smaller community. Based on the perceptions gathered from patients in Gold Beach, failures and successes reported, and the literature search performed, recommendations to help physicians and patients achieve weight loss outside of medical and surgical management were created. Ontario Greenhouse Project: Phase 5 Project Date: 6/29/2009 Obesity is a nationwide epidemic, and primary prevention is aimed at combating childhood obesity. Malheur County in Oregon has some of the highest risk children in the state. The Ontario greenhouse project has been in the planning process for the past year with Dr. Sandra Dunbrasky, the community pediatrician, and rotating medical students from Oregon Health Science University. The project’s goals are to implement a greenhouse at a local elementary school in order to get students involved in hands-on learning about raising, harvesting, and consuming the CDC recommended daily amount of fruits and vegetables in the hopes that obesity will be successfully prevented. The current phase of the project centers on securing funds to get the program implemented by fall of 2010. Grant proposals were submitted to various national agencies due to the shortage of local donor support in the rural setting. Ontario Greenhouse Project: Phase 4. Synthesis, Relocation, Curriculum, Design Ideas Project Date: 3/16/2009 As medical students and simply as residents of America, we have all been made aware of the nation’s increasing problems with obesity. The prevalence of adult and childhood obesity are now at the point of being called epidemics. Unfortunately, the state of Oregon and especially the children of Malheur County are leading this growing trend. Greater than 25% of the kids in Malheur County are considered obese by their screening BMIs. The Ontario Greenhouse Project is an attempt to combat this rising obesity by teaching kids about healthy food, engaging them in the growing and harvesting experience, and ultimately aiming to change the way children think about and choose the food that they eat. Ontario is the largest town in Malheur County and the hopes are that if this project is successful, more school greenhouses and gardens could be adopted throughout the county and state. The first three phases of the project consisted of 1) research into why this idea is needed, how feasible it is to accomplish, and how we could estimate the success of the project after completion; 2) research into similar programs on the West Coast and an estimate of cost; 3) gathering public support by making teacher and parent-oriented presentations, contacting local media to assess their interest in promoting this cause. By the time phase 4 of the project was initiated, the school that had agreed to be the demo school for this greenhouse announced that their principal would be leaving by the end of this school year. Phase 4 then aimed to approach another school with the idea, thus needing to summarize and condense the work already done into an efficient presentation, and to add some more specifics as far as proposed timeline, materials and recommendations for design, and ideas for curriculum in the greenhouse and in the classroom based on other programs and their successes and challenges. A presentation was made to the principal of Pioneer Elementary in Ontario and now the plan for the near future is to present the project to the superintendant and the school board over the next few months. Phase III of the Ontario Greenhouse Project: Gathering Public Support Project Date: 2/9/2009 The problem of obesity within the United States has reached what some have labeled as "epidemic" proportions. Over the last 30 years, the percentage of obese adults within the US had doubled, and the percentage of obese children has nearly tripled. Obesity is the result of ingesting more calories than one expends through physical activity. Hence, reshaping the food choices children make on a daily basis can have a lasting impact on both their weight and their health. The Ontario Greenhouse project strives to do exactly that. The project is a multi-phase endeavor to build a school greenhouse in which the entire student body can participate in growing fruit and vegetables that can be served in the school's cafeteria. This hands-on experience would be supplemented by classroom-based nutrition education and instructional sessions in the greenhouse run by farmers and Master Gardeners from the surrounding area. The goal of the current phase, Phase III, was to gather public support by creating teacher- and parent-oriented power-point presentations to introduce the project to administrators, teachers and parents within the district. In addition several local media outlets were contacted and asked to help garner public support by mentioning the project to consumers. Finally, a wide variety of local community members, as well as leaders in the school garden movement, were contacted and asked to participate on an advisory committee for the project. By involving the community in the nutritional education of children, the project aspires to change the way children and their families approach healthy eating, and thereby improve the overall health and well-being of Ontario's citizens. Keeping Kids Physically Active in Madras, Oregon Project Date: 12/29/2008 Childhood obesity has become a major health problem throughout the United States over the last several decades. When battling this epidemic, there is often a two-pronged approach involving nutrition and physical activity. In Jefferson County, only half of youth met the recommendations for physical activity suggested by the Center for Disease Control. In addition, Jefferson County does not have the resources for a parks and recreation division to help organize and publicize available youth sports programs. This project focused on the opportunities for children to participate in organized physical activities in Madras, Oregon. The aim of this project was to provide a resource for patients that provides information about guidelines for physical activity for children and the youth sports programs that are available in the community of Madras. Burns Biggest Loser Part 2: Finding Reliable Healthy Weight Loss Information In a Small Rural Community Project Date: 12/29/2008 Over 66% of Americans are overweight or obese. In urban areas, there are a variety of weight loss classes, clubs, and programs available to the individual motivated to lose weight. Paradoxically, in rural areas like Burns, Oregon the prevalence of overweight and obesity is greater than the national average, yet the weight loss resources are scarce. If a resident of Burns, Oregon wants healthy weight loss information there are few local resources, none of which offer free weight loss education, guidance, and monitoring. One option for such an individual is MyPyramid.gov, a free interactive web site that offers personalized diet and physical activity assessment, and encourages healthy self-monitoring behaviors. Eating Well on a Budget Project Date: 10/13/2008 Obesity is an epidemic in this country, affecting young people more and more. It is an epidemic that is seen in all social classes, but disproportionately affects people of lower socioeconomic status. The Coos Bay area is generally of lower income than the state as a whole. Several barriers to healthful shopping were identified throughout the project. While overweight and obese children were identified at the clinic, and all children had inquiry into their diets at each well child check, there lacked a comprehensive handout for patients who have trouble creating a menu to keep to their shopping budgets, while providing nutritious meals. This project was designed with the goal of creating an educational handout that would have nutritional information as well as a menu and recipes to demonstrate how a family of four might eat healthy meals for one month while sticking to a $400 budget, (this number based on DHS data showing that, on average, a person receiving food stamps is allotted approximately $100/month). Through working with a local chef, this pamphlet was created with the goal of being handed out in clinic, with the possibility of future distribution at local DHS offices. Childhood obesity in a rural setting Project Date: 10/13/2008 The prevalence of childhood obesity among US children has increased between 2-4 folds in the last 40 years. The state or Oregon has not been an exception from this nationwide epidemic and in fact one in four eighth-graders in Oregon are now overweight or at risk of becoming overweight. Studies have been conducted looking at the causes and origins of this potential disaster. However, few of these studies have been done in a rural setting. An array of environmental and social changes that severely challenge a family’s ability to make healthy choices for their children have contributed to this epidemic, including barriers to safe and accessible physical activity and fresh, nutritious foods, coupled with an increase in sedentary pastimes such as television and computers, known as "screen time", and more frequent use of automotive vehicles rather than walking and biking for transportation. This article is intended as a very preliminary beginning at studying childhood obesity in a rural setting with the ultimate goal of providing additional insight into this problem as well as potential possible solutions. Reducing Obesity in Veneta, Oregon: Is TOPS (Take Off Pounds Sensibly) Part of the Solution? Project Date: 10/13/2008 Obesity is a major health issue for Americans including residents of Veneta, Oregon. A survey of the electronic medical record used at Dr. John Allcott’s Veneta clinic revealed 495 patients with a Body Mass Index (BMI) over 30 (medically obese) out of his 1483 active patients. While observing Dr. Allcott it became apparent that he refers many of his obese patients to a group program for weight management called TOPS (Take Off Pounds Sensibly). In order to learn about TOPS, assess its effectiveness for Dr. Allcott’s obese patients, and determine whether it could be part of a refined obesity initiative patients were interviewed, a local meeting was attended, the TOPS website was explored, and the medical literature was searched. A review of weight loss programs including Weight Watchers and TOPS concluded that TOPS helps some people and is inexpensive, but given the lack of scientific studies demonstrating its effectiveness the decision to join should be left up to the individual. Personal success stories were compelling, but other patients identified barriers that turned them away from TOPS. Survey of the electronic medical record revealed that out of the 110 (22 male, 88 female) patients who were referred to TOPS, 24 had insufficient chart data to analyze, 39 (45%) decreased their BMI overall, 41 (48%) increased their BMI overall, and 6 (7%) had unchanged BMIs. Limitations exist in determining which patients were truly attending TOPS meetings and given that nearly half saw an increase in BMI and half saw a decrease in BMI, the objective evidence is unconvincing. However, given the many compelling success stories heard it was determined that TOPS should be a key component of the menu of options for weight loss. The final product was the development of a system for addressing weight management with obese patients in the Veneta clinic which includes identifying patients with BMIs > 30, a screening question asked by the medical assistant, and recommendations by the physician. This system has been implemented in the Veneta clinic and will hopefully help reduce obesity, its comorbidities, and its unnecessary cost. Childhood Obesity Knowledge in 9th Graders at Klamath Union High School Project Date: 10/13/2008 Since the 1960's, childhood obesity has increased in the United States foru fold from 4% to 16.3% in 2006. In Klamath County, the current rate is even higher at 24.4% in 2007 making childhood obesity a serious epidemic. This is also 5% higher rate than the rest of Oregon. The Klamath Basin United Way 'Trends and Solutions of Klamath County 2006' survey noted obesity as the #8 health concern among children. In addition, a panel of experts surveyed listed obesity/eating disorders as the #1 problem not addressed in the community. Even more surprising, obesity/eating disorder education was listed as the #1 service needing the most improvement. I sought out on my project to prove the United Way study was correct with the assessment that obesity education needs improvement. In order to do so, I taught three classes on obesity to 82 ninth graders at Klamath Union High School. I gave them a survey to fill out before and after the class about their knowledge on obesity. The results showed that less than fifty percent of the students had knowledge in many of the different complications of obesity. Of those, hypercholesterolemia and sleep apnea were two complications that they learned the most about. Pediatric Obesity: Documentation and Intervention Project Date: 9/8/2008 Pediatric obesity is a rising epidemic that poses new challenges for clinicians to manage. The goal of this study is to design a clinic documentation tool that can be used to collect data and help focus possible interventions and subsequent progress in a Klamath Falls, Oregon pediatric clinic for patients with a BMI percentile greater than 85%. The design was gathering clinical information on how to manage obese patients, both from the literature and interviews with providers. Observations were made at Klamath Pediatric clinic on how documentation tools were implemented in the clinical outpatient workflow. This data was then synthesized into a document that could be implanted to help manage obese pediatric patients. The document consisted of a single piece of paper in which the front is filled out by the patient's family before the provider has seen the patient, and the back side is filled out by the provider during the office visit. The final product is a tool to manage overweight and obese pediatric patients by assessing obesity risk factors, probe possible interventions, and set goals. Development of Two Innovative Programs in Lebanon, Oregon: Build Lebanon Trails and Planting Seeds of Change Project Date: 9/8/2008 Obesity, and the myriad negative health consequences that accompany it, continues to rise throughout the US, Oregon, and especially eastern Linn County where greater than 66% of the population is overweight or obese. Medical costs for obesity-related health problems in Oregon's adults totaled an estimated $781 million in 2003 - a number that will rise much higher as the current population ages. While some changes have already been implemented to combat unhealthy weight, further work is needed. The Community Health Improvement Partnership (CHIP) program has aided in the development of two innovative programs in Lebanon, OR - Build Lebanon Trails (BLT) and Planting Seeds of Change (PSOC)- that approach this end from different angles. In meeting with the CHIP coordinator and leaders of BLT and PSOC, I found that both programs were recently created and have many obstacles to surmount before they can reach their full potential. During my time in Lebanon I worked with both to help them overcome some of these barriers and aid the programs in progressing to their final goals. Obesity in Scappoose, Oregon: Developing a patient handout about the benefits of a Mediterranean Diet Project Date: 9/8/2008 Obesity and weight-related diseases (hypertension, diabetes mellitus, and hypercholesterolemia) are major medical problems in the United States. This study was initiated to design an educational handout to assist patients in making beneficial nutritional changes to combat these diseases. The study consisted of an observational period to assess patients’ needs, difficulties, and constraints during this process, as well a period of research and development to create a pamphlet to best address these requirements. During the latter phase, strong research was found proving that the Mediterranean Diet was beneficial in addressing these diseases. The final period of the study consisted of a distribution phase to share the new material with the patients and gauge the impact of the handout. More research needs to be done regarding how the pamphlet influenced the patients, and would reveal specific strengths and weaknesses. Phase 2 of Ontario Greenhouse Project: Learning from other successful programs, estimating initial cost, and initiating community involvement Project Date: 9/8/2008 The children of Malheur County are greatly affected by obesity with a current rate of obesity that is 13% greater than the rest of Oregon. Obesity among children can be partially explained by the fact that children of Malheur County are eating fruits and vegetables far below the USDA recommendations. The goal of this project is to work towards introducing a greenhouse program at an Ontario school that will involve the student body in growing fruits and vegetables. Hopefully, such a program would curve the students’ food preferences towards more fruits and vegetables and help reduce obesity among the children. This will be a multiphase project, of which this is the second phase. The aims of this phase include: (1) learn from other greenhouse programs (2) estimate the cost of starting the program, and (3) initiate community involvement. These aims will be accomplished through review of available literature, interviews with members of the Ontario community, and contacting people from other greenhouse programs in Oregon. One can get many ideas and resources from other programs. The estimated original cost may range from $5-20K depending on the size and complexity of the greenhouse. Community involvement may be at an individual level, business level, and may include the local hospital and Malheur County Experiment Station. Burns's Biggest Loser: A real world program of education, increased physical activity and healthy food choices to lose weight. Project Date: 9/8/2008 There is an epidemic of obesity across the United States including small communities like Burns, Oregon. One method to counteract obesity includes increasing activity and decreasing food intake. Members of the community of Burns desired a program to lose weight that incorporated health diet advice and physical activity suggestions. They also wanted a program that was fun, motivating and offered social support in their efforts to lose weight. Thus, a program to lose weight was developed that centered around making healthy food choices with portion control, increasing daily physical activity using a team competition approach. Additionally, the participants were offered education on the risks of obesity and methods to recognize and counteract barriers to physical activity as well as education in goal setting. This comprehensive program was implemented and the participants were followed for the first week which resulted in an average weight loss of just less than two pounds per participant. Phase I of the Ontario Greenhouse Project: Assessing the need for and Feasibility of a School-based Nutrition Education Program in Ontario, Oregon Project Date: 8/4/2008 The prevalence of childhood obesity in the United States has continued to increase over the last three decades to its current rate of 17%. The problem is particularly felt in Malheur County on Oregon’s eastern border, where greater than 1 in 4 children are obese. The Rural Clerkship preceptor in Ontario (Malheur’s largest town) has proposed a Greenhouse Project to address this problem, starting with a local elementary school. The aims of this phase of the project are three-fold: (1) to assess the need for such a school-based intervention, (2) to assess the feasibility of the Greenhouse Project, and (3) to estimate the successfulness of such an intervention. These aims were accomplished through review of the available literature and interviews with pertinent members of Ontario’s community, including members of an Ontario elementary school identified as a likely pilot site for the greenhouse. It also appears that the project is much needed, due to a lack of nutrition education in the targeted elementary school, as well as the aforementioned severity of the countywide childhood obesity problem. Additionally, the Greenhouse Project has potential to be a successful program; a few major concerns regarding the burden of this project on the school district were brought to light and suggestions are made herein as to how they can be addressed. It is hoped that this project can be carried through to completion with the help of other medical students that will be coming to Ontario for their Rural Clerkships in the future. Planting Seeds of Change: Improving the Health of the Community - an Edible Endeavor Project Date: 8/4/2008 Childhood obesity is an enormous issue facing the health care system, schools, and the community at large. This study examined a community initiative, Planting Seeds of Change, whose mission is to increase healthy eating habits and reduce childhood obesity through a garden based educational endeavor. The project entails the formation of a school based garden which grows produce used in the school lunches and serves as a classroom without walls for the children of Seven Oaks Middle School. This study hoped to gather the pertinent information about the formation, maintenance, and future aims of the project so as to consolidate this information into a working summary to be shared with others. The study also examined the statistics of childhood obesity and literature which detailed community and/or school based efforts to combat obesity. Research was conducted via interviews, observation, and literature searches. The final result was a detailed PowerPoint presentation discussing Planting Seeds of Change and the literature supporting such a community based initiative, which will be utilized at several state and nationwide meetings and conferences. Portion Size? Serving size; Teaching Healthy Living Choices in Scappoosereatment of Chronic Pain Project Date: 6/30/2008 Obesity is a growing epidemic in the United States of America. This along with low health literacy, especially in rural areas, leads to increased obesity in these areas. Rural areas also suffer from physician shortages making the time spent with patients more and more valuable. The goal of this project was to make the most of time spent at the doctor’s office to educate obese patients about portion control. The design was a PowerPoint presentation about how food portions and therefore caloric content has changed over the past 20 years. This presentation also included information about exercise requirements to burn these extra calories. In order to maximize the time spent at the doctor’s office, the presentation was set up to run on the computer in each exam room while the patient waited for the doctor at OHSU’s Family Medicine Clinic in Scappoose, Oregon and was shown to 15 obese patients. Educating and Empowering Patients and Physicians to Reduce Diabetes-Associated Morbidity in Eugene, Oregon Project Date: 4/28/2008 Diabetes is an epidemic in the United States. Successful management of A1C, LDL, weight, and blood pressure reduces diabetes associated mortality and morbidity. Patients and physicians have ever-increasing expectations to reach established target goals, many times without complete success. Reaching targets requires a partnership between the patient and physician; patient responsibility, motivation, and investment in their personal health care can have tremendous impact in outcomes. Educational and motivational barriers can be overcome through the use of a patient-specific visual risk assessment profile that demonstrates the direct influence patient actions today have on future risk of complications including heart attack, stroke, kidney failure, foot problems, and eye problems. The American Diabetes Association’s online Personal Health Decisions (ADA’s PHD) risk profile can be used by physicians and patients together in order to successfully move toward established targets, reducing morbidity. Specifically, integration of the PHD into the existing PeaceHealth Diabetes Wellness Assessment Program (DWAP) could increase successful management of physician and patient management of diabetic targets within the PeaceHealth system in Eugene, Oregon. The Oregon Wellness Policy and Input from Local Providers in the North Santiam School District Project Date: 4/28/2008 Purpose: The prevalence of childhood obesity has increased over the past several decades. Wellness Policies have been developed at both the national and state levels to combat this epidemic by providing healthy food in schools, promoting nutrition education and encouraging physical activity. This project attempted to gain a solid understanding of the Oregon Wellness policy requirements and ascertain what input the North Santiam School District, which encompasses the town of Stayton, receives from local health care providers. This information was compared to nearby districts including the similar Cascade and the much larger Salem-Keizer School Districts. Design and Methods: This was an observational study. Methods included in-depth interviews with food service directors in the North Santiam, Cascade and Salem-Keizer School Districts along with the cooks at the private St. Mary’s Elementary in Stayton (Appendix B). A thorough Ovid Pub Med search of the terms “nutrition” and “school” was also conducted and papers read for background information. Results: The Oregon Wellness Policy is an evolving set of guidelines for schools relating to all food, including entrees, al la carte items and beverages served on school property during an extended school day (Appendix A). Involvement from local health care providers, in all districts interviewed, was minimal. No district had a physician currently serving on their Wellness Committee. Future: This study was intended to identify areas for future research, including: surveying clinicians’ knowledge regarding the Oregon Wellness Policy and identifying barriers to their involvement with local school wellness committees. Action should then be taken to educate local providers on areas where they could participate in school nutrition. Childhood Obesity in John Day: Building on Previous Work and Increasing Community Awareness Project Date: 3/17/2008 Obesity is a growing problem in the United States and its rise has been well documented and publicized as are the long-term health consequences of obesity. During the fall of 2007, during her Rural Community Health Clerkship at the Strawberry Wilderness Community Clinic in John Day, OR, Logan Thomas investigated the prevalence of obesity in elementary schoolchildren in John Day by analyzing height, weight, and sex information and calculating the BMI for all children at Humbolt Elementary School in Canyon City, OR. She found that 32% of children aged 6-11 years in John Day were overweight or at risk of becoming overweight, compared to 19% nationally. She presented this data to school district administrators and helped facilitate discussions of options for future action to address the problem of childhood obesity in their community. In these discussions, the consensus reached by school administrators was that initial efforts should be focused on educating the community. Interest was expressed in developing a handout for parent-teacher conferences to educate parents about the prevalence of childhood obesity in John Day and to give parents some hints and ideas on ways they can help improve their children’s health. I sought to gauge whether there was continued interest in such a handout and coordinate my efforts with those community members already actively working in the issue of childhood obesity. I developed handout for parent-teacher conferences that revisited Logan Thomas’ data and provided tips for parents to help improve their children’s health. It is currently being reviewed by the Grant County School District #3 Superintendent. I also developed a more extensive webpage that included the same information plus additional tips for healthy eating that is posted on the Strawberry Wilderness Community Clinic Website. Childhood Obesity in Coos Bay, Oregon Project Date: 3/17/2008 Childhood obesity has become a significant health problem in the United States. The kids in Coos County, Oregon have not escaped this trend. With more unemployment and a smaller proportion of residents with a high school diploma, the children of Coos Bay are in fact at a higher risk of becoming overweight, and all the co-morbidities associated with that, than the rest of Oregon. How can the pediatricians of Coos Bay help combat this problem in the context of a busy clinic? Are there other resources available within the community to help? This project attempted to create a patient handout addressing these questions. To do this, research was done through the internet and medical journals. Community organizations like the public health department, the Boys and Girls Club, WIC and the school district were consulted. Furthermore, advice was elicited from local dietitians, social workers, nutritionists, physicians and other health care providers. In the end, a patient handout was created synthesizing the most relevant information for parents. They were taught how to recognize childhood obesity, the health consequences of this problem, suggestions for healthy living and contact information for programs that reinforced these healthy living tips. Furthermore, information was included for physicians who wish to refer their patient on to further counseling. Primary Care in the Digital Age: Developing the next step of quality care delivery using computer resources in Lebanon, Oregon Project Date: 3/17/2008 Rural primary care in the United States faces a set of challenges in the upcoming years, chief among these is the lack of enough primary care providers to support a growing population, as it ages and manifests complications of chronic illnesses related to obesity. Rural areas face the added difficulty of recruiting new doctors, with a net effect of leaving fewer PCPs to care for more patients in rural areas relative to urban areas. This project explores patient and physician perspectives on using the electronic health record and on-line resources to expand and streamline the care given to the Lebanon community within the Samaritan Health System. Using a 10 question online survey administered to patients over a two-week span and discussions with IT, administration, and physicians, I attempted to quantify patient desire and ability to engage more actively in their health maintenance. I also identified several possible future steps towards streamlining the delivery of care and engaged providers to learn the barriers and opportunities to test and integrate such measures. The overall conclusions drawn from these brief surveys were 1) the community may not yet be ready for or interested in deep online participation in their care; 2) several barrier exist both at the technical (software) and administrative levels to quick and agile trials of possible streamlining measures, and 3) despite these two facts, the opportunity exists at little to no initial cost to begin implementing future electronic functions that may likely ease the transition to future clinical advances. Adult Obesity in a Rural Clinic: Prevalence, Comparison and Weight Reduction Strategies Project Date: 2/11/2008 The prevalence of obesity in the US has doubled in the past two decades so that now, almost two out of three adults are either overweight or obese[1]. This epidemic of excess body fat is a major public health concern since it leads to a higher risk of premature death, type II diabetes, hypertension, dyslipidemia, coronary heart disease and other serious diseases and health concerns. The state of Oregon is not immune to this epidemic, by no means. Although less obese than the U.S. average, more than 1/2 of the state’s population is either overweight or obese[2]. Upon investigating the prevalence of overweight/obese at a rural health clinic in Scappoose, OR, however, it was determined that the prevalence there was much worse than either the overall state or nation values - over 50% of clinic patients were obese and more than 3 out of 4 patients were either classified as overweight or obese. In order to begin to reverse these numbers, it was determined that a need existed to put together a concise resource, available to the clinic staff and patient population, to help increase awareness of all the resources for weight reduction strategies that can be safely used to achieve and maintain a body weight that optimizes health. Writing Exercise Prescriptions For the Primary Care Physician. Project Date: 12/31/2007 The epidemic of overweight and obesity in America is on the rise. Many public health organizations, including the National Institutes of Health and the U.S. Department of Health and Human Services Office of the Surgeon General, have called upon physicians in the primary care arena to assess and treat this growing problem. Numerous scientific studies have revealed the benefit of physical activity on not only preventing and treating obesity, but also on the prevention of other diseases; indeed exercise has been associated with a decreased risk of overall mortality. The use of a written exercise prescription, as opposed to verbal advice, is a significantly superior method of galvanizing sedentary individuals to start and follow a regular exercise schedule. Here, an exercise algorithm was developed and built-in to the EMR at AppleGate Internal Medicine Clinic to facilitate discussion about exercise between physicians and patients, and to generate a written exercise prescription based upon individual patient needs, limitations, and desires. Development of the Jefferson County School Wellness Policy Project Date: 12/31/2007 During the past 20 years, there has been a dramatic increase in the prevalence of obesity in the United States, with more and more children becoming overweight and/or obese. It is thought that as much as 14% of 2 - 5 year old children and 19% of 6 - 11 year old children in the U.S. are overweight. This is becoming a growing health concern as there is a clear increase in morbidity and mortality associated with being overweight and obese due to increased risks of coronary heart disease and type 2 diabetes. Although obesity-associated morbidities occur most frequently in adults, overweight children and adolescents are more likely to become overweight or obese adults. Conversely, health-conscious and active children are more likely to maintain these habits into adulthood. The Jefferson County school district has received federal funding for a Community Health Improvement Project (CHIP) aimed at reversing the growing trend of childhood obesity in Central Oregon. To complete the first objective of the CHIP, a Wellness Policy was developed to be presented to the 509J school district for approval. This Wellness Policy is aimed to motivate and assist students aged kindergarten through twelfth grade to maintain and improve their health and prevent disease by shaping the children’s attitudes toward physical fitness, nutrition, and health. It focuses on improving district-wide school policy in four main areas: health and nutrition education, physical activity and physical education, nutritional standards, and policy review. Childhood Obesity Prevalence in John Day: A Project of Data Collection and Dissemination. Project Date: 10/15/2007 With more data and continued discussion of health effects, the obesity epidemic has become perhaps the largest health problem facing the American population today. Despite its prevalence and its proven health consequences, many communities continue to believe that obesity is not an issue. This belief is not easily altered. This study was designed to collect height and weight data from all children attending Humbolt Elementary School, calculated BMIs for each child, and then graph them on the CDC growth charts to determine the number of overweight and at risk of being overweight children in each age and gender category. On average, 32% of children in John Day are either overweight or at risk of being overweight. Research into national data, rural data, and rural Oregon data was done to provide context for the data collected in John Day, and this was presented together to the school district administration. After the presentation, a discussion of possible ways in which schools can enact change and various options for funding these changes was discussed with the school district administration. The end result of the project led to an increased awareness of the extent of the obesity issue in John Day and an increased interest in enacting change within the community to address this issue. Analysis of average body weights in selected pediatric populations between 1997 and 2007 in John Day, OR Project Date: 10/15/2007 The number of children in the United States who are overweight, or at risk of becoming overweight has reached epidemic proportions. Annual obesity-related costs in 6-17 year-olds exceed $127 million per year and project to far exceed this value in the future as these children mature into adults as obesity is a key risk factor for the development of many adverse health conditions including: hypertension, dyslipidemia, Type 2 diabetes, cardiovascular disease, sleep apnea and orthopedic pathologies. Increased consumption of foods high in calories and fat combined with decreased amounts of physical activity are environmental factors identified as key contributors to this obesity epidemic. As these environmental factors have become more prevalent in rural communities, the effect upon the body weight of children in these communities is a concern. The goal of this project was to evaluate changes in the average body weights of 5-6 year-old children, 9-10 year-old children and 13-14 year-old children in 1997, 2002 and 2007. The results of this study show that the weights of 5-6 year-old children in John Day, OR have significantly increased over the past 10 years and that the weights of both 9-10 and 13-14 year-old children are trending upwards. These results of this study were discussed with the medical community with the goal that increased awareness of this trend will lead to improved screening and implementation of preventative measures. Caregiver Perspectives on Childhood Obesity in the Warm Springs Community Project Date: 9/10/2007 Background: Much like other Native Americans across the United States, the Native Americans of Warm Springs, OR have high rates of obesity, regardless of sex or age. Caregivers have the opportunity to exert significant influence over the factors that contribute to obesity among their children. Methods: The BMI profiles of 600 Native American children in Warm Springs from age 5 through 14 were determined from electronic medical records. A survey tool was then developed and used to survey 19 caregiver-child pairs in the community. The survey recorded the height and weight of the child, and asked qualitative questions of the caregiver regarding the child’s weight, factors contributing to weight and general health. Results: Electronic medical records showed that 56.8% of children ages 5 through 14 were either at risk or overweight. On the caregiver survey, only 50% of caregivers of children who were at risk or overweight actually believed that their child was either “slightly overweight” or “very overweight.” For children who were at risk or overweight, 30% of caregivers agreed with the statement: “Some people are born to be fat and some thin; there is not much you can do to change this.” While the vast majority of caregivers believed that what a child eats (95%) and how much a child exercises (95%) are “very important” to their present and future health, only about two thirds of all caregivers believed that how much time a child spends in front of a TV (69%) and how much a child weighs (63%) are “very important” to their present and future health. About a third (37%) of all caregivers were “not at all concerned” that their child would get heart disease in the future. A Closer Look at the Nutritional Habits of Scappoose High School Students Project Date: 4/30/2007 Obesity has become increasingly prevalent among school-aged children and adolescents in the United States. With obesity becoming increasingly more widespread in the U.S., especially amongst the rural population, it is probable that adolescents in their high school years will reflect this same trend. This study examines the attitudes towards nutrition of Scappoose High School students who do and do not participate in an athletic activity in Scappoose, Oregon. A survey was formulated which gathered information on their opinions on the cafeteria foods as well as on the impact of athletic or physical activity on nutritional choices. At the present, nutritional education for the general Scappoose high-school population is limited to a part of the Health class curriculum. At the clinic, nutritional habits are checked when adolescents come in for a sports physical exam. Otherwise, there was no established presentation of the nutritional values of the food offered by the school or the benefits of physical activity on their health. The results of this survey will be given to the athletic director and health class instructor to aid in their understanding of their students views on nutrition. No More Excuses Project Date: 3/19/2007 Type II Diabetes and Obesity are increasing in incidence at an alarming rate. It has been well established that diet and exercise is the treatment of choice for obesity and type II diabetes. This study attempted to identify the effectiveness of treating and managing type II diabetics with diet and exercise. The design was to document each diabetic patient seen over a 5-week period, the date they were diagnosed with diabetes, their BMI and HbA1C at diagnosis and their current BMI and HbA1C as well as the medications used to treat their diabetes. When able, patients were questioned as to reasons why they chose to not exercise. These values were put into a chart from which came the results: How many patients have managed to successfully treat his or her diabetes with diet and exercise alone. Finally, a pamphlet was made to help aid providers in educating patients on the benefits of increasing physical activity through little effort on behalf of the patient. Striving for Healthier Children: A Closer Look at the Scappoose School District’s Local Wellness Policy Project Date: 3/19/2007 The prevalence of obesity and its associated diseases in the U.S. has been increasing over the last decades at an alarming rate. The OHSU clinic in Scappoose was noted to have a particularly high prevalence of obesity amongst its adult patient population. Obesity rates in the U.S. of young children have doubled and that of adolescents have tripled over the past twenty years. Prevention is the most effective tool in reversing the obesity epidemic, as well as increasing overall health, and generally the earlier the intervention, the more potentially effective it is. One particularly important site for prevention measures are the public schools, since children often receive most of their nutrition, exercise, and lifelong nutritional and physical education at school. Three years ago, the federal government signed into law an act that requires each local education agency or school district participating in the National School Lunch Program and/or School Breakfast Program to develop a local wellness policy that promotes the health of students and addresses the growing problem of childhood obesity. This project focuses on analyzing and discussing the Scappoose school district Local Wellness Policy along with some of the major obstacles to its implementation. Eastern Oregon Medical Associates Weighs In: Assessment of the prevalence of overweight and obese patients in a rural community health clinic and provider education about screening, prevention, and treatment of obesity. Project Date: 2/12/2007 The obesity epidemic in the United States is well known to primary care providers. Obesity is a contributing factor to patients acquiring diabetes, hypertension, coronary artery disease, arthritis, certain cancers, and other diseases. Lowering an overweight or obese patient’s weight by just 10% can decreased their cardiac risk factors and can increase their quality of life.1 Primary care clinics are the cornerstone of prevention, screening, and treatment of obesity but according to providers at Eastern Oregon Medical Associates (EOMA), advice on healthy eating and exercise often falls on deaf ears. Physicians at this rural health clinic feel that they have an overwhelming number of overweight and obese patients but are unaware of the most effective ways of counseling these patients about weight loss. They were also eager to learn of any new treatment options. This project aimed to determine just what the rates of overweight and obese adult patients were in the clinic and to educate the providers on the most recent research and recommendations on screening, prevention, and treatment. EOMA uses an electronic medical record system that automatically calculates BMI with each patient visit. To determine the prevalence of overweight and obesity, data was collected for all patients 15 years and older who had a BMI of greater than 24 by using the EMR system’s search function. Data was categorized by overweight (BMI>24 but <30) and obese (BMI>/=30) and then further categorized into gender and age. It was found that EOMA has a prevalence of 12.6% overweight patients and 13.5% obese patients; much lower than the national prevalence. Research using several different methods (Medline database search, Cochrane database search, and use of NIH and CDC data) was used to find the most current information and recommendations on screening, prevention, and treatment of obesity. This information was compiled into a report that included the clinic data and was presented to all providers at EOMA. Environmental Factors which Contribute to Obesity in Rural Communities: A Case Study of Coos Bay, Oregon Project Date: 10/16/2006 Studies suggest that the obesity epidemic disproportionately affects rural areas. However, it is difficult for people to change habits which contribute to obesity. Although patient education and counseling is an important step in changing behavior, even those patients who are aware of their condition and the necessary changes that need to be made to improve their health are unable to accomplish weight loss. Past efforts at changing behavior in Coos Bay have focused on counseling in the clinic setting, and are often ineffective due to time constraints and inability to exert influence over behavior outside of the clinic setting. Educational materials made available to rural physicians are un- or under-utilized. However, there are other methods for changing behavior. Studies show that the environment affects physical activity levels and obesity levels in a community. Environmental factors of rural communities like Coos Bay present unique challenges to successful weight loss when compared to larger cities like Portland. The main goal of this project was to study environmental factors of Coos Bay which may contribute to high rates of obesity and differ from those of more urban environments. This has important implications for the health of rural communities, and suggests that the health of a community can be substantially improved in an equitable manner by environmental modification. Diabetes Mellitus and Obesity in Eugene, OR: An Assessment of the Epidemic and Development of Treatment Recommendations. Project Date: 9/11/2006 Diabetes is a growing epidemic worldwide. In the U.S. diabetes is the sixth leading cause of death and affects 18.2 million Americans currently, with an estimated 5.2 million who have not yet been diagnosed. Importantly, overweight and obesity are the main modifiable risk factors for type 2 diabetes. The goal of this community project was: 1) to assess the nature of the problem of diabetes and its relationship to obesity at Barger Family Medicine Clinic, 2) to develop a guideline based on an extensive literature review in the management of diabetes and obesity and 3) to develop a hand-out and nutritional food guide for patients with diabetes. Weight loss interventions in Astoria, OR: development of a patient resource guide to connect patients with weight loss resources in the community. Project Date: 8/7/2006 With over 60% of Americans classified as overweight or obese, a significant portion of our population continues to share an elevated risk for obesity related conditions such as diabetes, hypertension, coronary artery disease, arthritis and sleep apnea. Through this project, I hoped to identify ways in which physicians could support their patients who are trying to lose weight. Exploring this question involved observing how my preceptor in Astoria discussed weight loss with her patients. I then created a list of simple, cost effective ways a family physician could support weight loss among a patient population. An interview was conducted with my preceptor and her practice partner to learn how willing they would be to implement various weight loss interventions. I spent one morning at Curves, a chain fitness center that offers circuit training and is attended mostly by women. Willing participants were interviewed regarding weight loss and how doctors could support weight loss efforts. Interviewees were also asked to evaluate how helpful it would be if their doctors implemented various specific weight loss interventions. Of the many interventions suggested, patients and doctors were most excited about the availability of a booklet that presented information on local resources for weight management. Therefore, the project culminated in the creation of "Health Knocks: A Resource Guide to Weight Management in Astoria, OR". This tool will help physicians to connect patients with weight loss resources n the community. Are We Still a Fast Food…County? – A Look into Dining Options and Overconsumption in Madras, Oregon Project Date: 2/13/2006 Obesity continues to be a major public health concern and has become a prime target for health promotion and disease prevention efforts over the years. Previously, a rural health community research project was conducted to investigate the prevalence of obesity and metabolic syndrome in Madras, Or with results indicating rates comparable to, if not higher than those of Jefferson County and the country. I based my research off these findings and qualitatively studied how the lack of healthful dining options and societal barriers contribute to poor dietary choices and overconsumption in people in Madras. Methods for this study included utilizing the Jefferson County surveillance data with emphasis on ethnic and socioeconomic disparities to establish a background understanding of the population. Various fast food and dining locations were then visited, and managers and working staff interviewed to obtain subjective perspective on the dietary preferences of members in the community. Findings from this research included consumer interests in heartier portions, meatier options with condiments, special value meals, and cheaper, highly advertised items, regardless of their nutritional value. Furthermore, literature reviews demonstrated correlations between culture and socioeconomic status with rates of obesity, specifically a higher percentage of Hispanics and lower income households with poorer dietary habits. Based on these findings, a brochure on weight loss and management was designed in both English and Spanish to increase community awareness in a culturally sensitive and population-specific manner. Emphasis was placed on preventive measures, proper diet, exercise and healthy lifestyle choices to minimize risk factors for obesity and its related comorbidities. The Problem of Obesity in Coos Bay, OR Project Date: 10/17/2005 This Community Project studies the prevalence and impact of obesity among internal medicine patients of the Bay Area Clinic (BAC) in Coos Bay, OR, and provides a convenient source of patient education in the form of a brochure. The first 50 internal medicine patients seen by my preceptor were evaluated and were categorized according to their BMI. Patients were categorized as “healthy weight” (BMI = 19-25), “overweight” (BMI = 25-30), or “obese” (BMI > 30). Of the 50 patients evaluated, 26% were of a healthy weight, 36% were overweight, and 38% were obese. Because of the high prevalence of obesity in this patient population, as well as the lack of convenient patient education materials on the topic, an informative/educational brochure was created with the goals of: 1.) informing patients of the health risks associated with obesity, 2.) providing patients with a list of useful diet and exercise resources, and 3.) providing patients with tips on weight loss. Obesity Associated Type II Diabetes Mellitus In Scappoose, OR, Adolescents: Awareness May Lead Early Diagnosis and/or Prevention Project Date: 10/17/2005 As in adults, the numbers of overweight and obese children and adolescents have tripled over the past thirty years. As a result, the incidence of type-II diabetes, conventionally known as “adult onset diabetes”, in childhood has risen 10 fold. Obesity and its related co-morbidities represent a major proportion of family practice office visits. Indeed, during my time in the Scappoose clinic the majority of the adolescents seen were either overweight or obese. The aim of this study was to determine, using provider interviews and information available for the prevalence of obesity at Scappoose High School, OR, if adolescents are at high risk of developing type II diabetes (DMII), and if so, what are the rates of diagnosis and factors which may limit the process. Adolescents of Scappoose, OR, in accordance to national trends, were found to be at risk of developing DMII but have low rates of diagnosis, raising a concern for the awareness of overweight and obese adolescent patients and their parents. Finally, using the information learned from the study a new patient handout was made, aimed at increasing patient/parent awareness of obesity and DMII, to improve prevention, detection, and long-term outcomes. Employee Wellness At The Corvallis Clinic Project Date: 3/21/2005 Philomath Family Medicine is part of the Corvallis Clinic which employs 570 people in 3 clinics. Over the past year, several employees have mentioned their interest in company-sponsored fitness programs and activities. Many people working at the Corvallis Clinic feel that obesity is a major problem among employees in their organization. While informal walking groups and weight loss support groups exist, there is no explicit program in place to help employees maintain their health. This project was created to explore the possibility of creating a wellness program for Corvallis Clinic employees. This project focused on three things: 1) Assessing a local wellness program already in place at Samaritan Health Services (not affiliated with the Corvallis Clinic) 2) Gathering information on interest, ideas, and feasibility of a wellness program for the Corvallis Clinic 3) Making recommendations for a wellness program at the Corvallis Clinic Weight Loss Support Group Project Date: 3/21/2005 Obesity has become one of the most problematic medical conditions currently faced in the United States as well as Oregon. Obesity raises the risk of morbidity from several life threatening conditions, however that risk may be reduced with weight loss. The purpose of this study is to improve the effectiveness of treating obesity in the setting of the Rinehart Clinic in Wheeler, Oregon. Observation of a family practitioner and patient interviews were the primary sources of patient information about dieting effectiveness and patient resources. A diet plan which included educational materials was readily available in the clinic, but no further information or support source was identified in this community. Evidence exists that social support dramatically increases the amount of weight loss as well as the ability to keep weight off. Therefore, a weekly weight loss support group was established as a social support network for patients trying to lose weight. Physical Activity in Children and Adolescents in Ontario, OR Project Date: 1/3/2005 Obesity has become a major health concern in the United States over the past several decades. When attacking this overwhelming problem, two areas are often targeted in order to keep obesity at bay: nutrition and physical activity. Despite their equal importance in a healthy lifestyle, physical activity is often overlooked in favor of nutrition, hence the popularity of fad diets and the current anti-carbohydrate campaign. Unfortunately, these trends are often short-lived and allow for little long-term success. For significant and more permanent change, patient education is an absolute necessity. At the Treasure Valley Pediatric Clinic in Ontario, Oregon, the primary method of patient education came in the form of a handout, whether the health issue was constipation, acne, or nutrition. Glaringly absent from this selection of handouts was any information regarding physical activity and exercise. The aim of this project was to evaluate the level of physical activity in the community, particularly with children and adolescents, and then create a patient handout that would provide education regarding ways to improve current fitness levels. Ultimately, the level of physical activity was found to be inadequate among children and adolescents in Ontario, Oregon; therefore, a kid-friendly brochure was produced and distributed at the pediatric clinic with the hope that early education could lead to a lifetime of healthy habits. Fighting Childhood Obesity with Physical Education Project Date: 9/13/2004 Obesity is a growing problem in all age groups, but particularly alarming are the growing numbers of overweight children. The rural community of Burns, Oregon has not escaped this dilemma. Many attempts to address this problem have been made, but the community has yet to incorporate an important resource: physical education. Recent studies have shown that by enhancing physical education class, especially at the elementary level, dramatic differences can be made in a child’s weight. The purpose of this project is to evaluate the current PE and nutrition programs at Slater Elementary School in Burns, and make suggestions for increasing their effectiveness. This will be done by suggesting means to increase funding and support, and through making a parent handout on easy ways to keep their child’s diet healthy. Prevalence of Eating Disorders in a Klamath Falls Pediatric Clinic Project Date: 8/9/2004 Eating disorders represent a significant cause of morbidity and mortality and typically present in adolescents and college-aged young women. Pediatricians have a unique opportunity to detect and treat these disorders.6 At the Klamath Pediatric Clinic it was noted that a large proportion of the visits were for mental health, however none of these were for the treatment of eating disorders. The purpose of this study was to specifically screen for eating disorders to determine if the prevalence was low or if the disorders were not being identified. A screening questionnaire was developed and given to patients at the clinic aged 10 and over, over a two week period. None of these patients screened positive for anorexia or bulimia, however the prevalence of obesity appeared to be fairly high. In addition, a brochure was developed to use as an informational and screening handout for concerned patients and an initial assessment form was made to use for a patient presenting with an eating disorder. I also visited the mental health treatment center for the area, which had the ability to provide outpatient treatment for eating disorders. General Guidelines for Preventing Childhood Obesity, and a Closer Look at Progressive Resistance Training as a Therapy for Diabetic (Type II) Patients with Co-morbid Obesity Project Date: 7/5/2004 Obesity in adolescents and children is a growing trend across the US. It is not an isolated phenomenon but is a co-morbid condition and even a causal factor for many other pathologic processes. Among the Native Americans, there is an extremely high prevalence of obesity and diabetes mellitus II. In Burns, there are efforts to make obesity more visible on the health awareness billboard. This will be a continuation of the project started by Alison Bahr, a former medical student in Burns. This project will provide two handouts. One handout will outline the guidelines for the prevention of childhood obesity, and will be made available for the Logician digital system at the clinic. The other handout will discuss options in physical activity as an adjunctive treatment of obese diabetic patients, and will be submitted to the Burns Times-Herald for public awareness. Television and Childhood Obesity: Spreading the Message in Harney County Project Date: 5/10/2004 Childhood obesity is a problem across the country with health implications for the present and future. Recent studies have shown that reduced time in front of the television for children and adolescents may help prevent obesity. While community groups and programs exist in Burns to promote youth fitness, no one has specifically outlined the role television viewing has on childhood obesity. The purpose of this project is to educate patients and the community about reducing time in front of the television and its potentially significant impact on childhood obesity prevention. This will be done through an article publication in the Burns Times-Herald and a public service announcement on local radio stations, KQHZ and KZZR, all in association with the physicians at High Desert Medical Center. In addition, a patient handout will be made available in clinic to help parents develop good television viewing habits with their children. Childhood Obesity: How Does Lebanon Compare to the Nation? Project Date: 5/10/2004 Background: Obesity is becoming a major public health problem that needs to be addressed in the clinical setting. The National Health and Nutrition Examination Studies (NHANES) have monitored the prevalence of overweight children in the United States for the past three decades. The most recent NHANES study shows about 15% of children ages 6-19 are overweight. Problem: The prevalence of overweight children in the Lebanon, Oregon community is unknown. Non-systematic observation would suggest the prevalence of overweight children to be greater than the national statistic. To determine the prevalence of overweight children in the Mid-Valley Family Practice Group (Lebanon, Oregon), a cross-sectional study was conducted. Methods: The sample population was derived from children who presented to the Mid-Valley Family Practice Group (Lebanon, Oregon) for well child exams during 1999 and 2000. A total of 77 charts were reviewed for height, weight, and age. Children with a body mass index (BMI) of ³ 95th percentile for age and gender were identified as being overweight. Results: In the study population, 20% of children ages 6-11, and 35% of children ages 12-19 were overweight. Conclusion: Childhood obesity is a real health problem both nationally and in the Lebanon community. Clinicians should be aware of this growing number of overweight children, monitor BMI on a yearly basis, emphasize prevention in non-overweight children, and recognize when intervention for weight loss is indicated. Attitudes and Behaviors Regarding Nutrition and Exercise At Scappoose High School Project Date: 3/29/2004 The rates of obesity have been steadily increasing in rural and urban communities across the United States in recent years. Obesity rates among children and adolescents are growing even more rapidly than those seen for adults. There are many factors associated with the development of obesity; genetics, diet, physical activity and mental health to name a few. In an effort to address these issues, the USDA developed the Dietary Guidelines For Americans in 2002. By directing the implementation of the Dietary Guidelines For Americans towards the youth in America, we may be able to more effectively ensure the development and maintenance of healthy lifestyles. In order to better understand the health attitudes, beliefs and habits of adolescents in Scappoose, Oregon a survey was developed and conducted at Scappoose High School that addressed these issues. Obesity and clinical interventions in John Day, Oregon: Develpment of a patient handout. Project Date: 3/29/2004 Obesity is a growing problem in the US and in Oregon leading to several chronic health problems. This study evaluates clinical interventions and community resources for patients wanting to loose weight in John Day, Oregon. A family physician was observed providing recommendations on diet and physical activity changes intended to result in weight loss. Due to time constraints in a busy practice, several times the conversation had to be limited. The clinic routinely weighed patients but calculation of a patient's body mass index was rarely calculated. The office lacked printed material to raise awareness of how weight affects health or health or diet and exercise suggestions for weight loss to offer patients. A survey of community resources was completed including interviews with a county health nurse and nutritionist. There were limited community resources and no information about them in the clinic. Two patient handouts were developed and made available to patients. The handouts were used as an aide to provide information and tools for patients to refer to at home. School Vending Machines and Obesity in Ontario, Oregon Project Date: 3/29/2004 Obesity is an epidemic among adolescents in America. Overweight children are at risk for many diseases as children and later as adults. There are myriad factors that have contributed to the current epidemic. These factors have been termed a “toxic environment.” I evaluated the food environment at Ontario High School to address what factors at school contribute to a toxic environment. My study found that 40.9% of students at Ontario High School were overweight or at risk to become overweight. This is well above the national rate of 30.4%. A survey assessed reasons for meal termination and the number of snacks purchased from school vending machines. Overweight adolescents were more likely to stop eating because of external cues than healthy weight adolescents. Overweight students drank nearly 2.5 times more soda pop than those of healthy weight. Using this data, a letter was sent to Ontario High School’s principal and school board members strongly encouraging the elimination of soft drink vending machines from school. Evaluation and Management of overweight children in Cave Junction, OR: development of a patient/student handout to outline behavior modification strategies for patients and students at the local schools. Project Date: 3/29/2004 Obesity is on the rise in the world, in the U.S. and in Oregon. Obesity and its complications and co-morbidities are poised to overtake tobacco as the leading “actual” cause of death in the U.S. And our children are right in the middle of the epidemic with the rate of overweight in Oregon’s teens tripling in the past 20 years. Objective: The aim of this study was to ascertain where the children in Cave Junction, OR fit in the larger picture of obesity. How many of the children in a rural Family Medicine practice are overweight and “at-risk” for overweight? Also, what interventions are available and what will be effective at helping these children maintain appropriate weights? Methods: The charts of the 208 children aged 2-20 years old that are seen at Cave Junction Family Medicine clinic were reviewed for heights, weights, gender and age of the children. Body Mass Indexes (BMIs) were then calculated using the CDC’s BMI-for-age and sex charts. Results: Of the 208 children found in the clinic’s database, only 113 of them had heights recorded. Two children (2%) were “underweight” (<5th percentile BMI for age and sex.) Seven children (7%) were “at risk for underweight” (5-10th percentiles). Fifty-eight children (51%) were “normal weight” (10-85th percentiles). Twenty-two children (19%) were “at risk for overweight” (85-95th percentiles.) And twenty-four children (21%) were “overweight” (<95th percentile.) The only BMIs in the charts were from transferred records. Conclusion: The children in Cave Junction are more overweight than the average child in the U.S. (21% in CJ vs. approx 15% in the U.S.) Also, BMIs are not currently being tracked in that clinic and there is good reason to do so. The Influence of Soft Drinks in the Ontario, Oregon School District Project Date: 1/5/2004 Childhood obesity is an epidemic in the United States with numerous medical, social, and occupational consequences. Obesity is a complex problem, influenced by genetics, home and school environments, and social pressures. Soft drinks have been one target of obesity opponents: soft drink consumption has been linked to obesity in several studies. One battlefield for soft drink influence has been in public schools across the country. My goal was to explore the consumption of soft drinks and the effects of advertising in the school system of Ontario, a rural community of roughly 10,000 people in Eastern Oregon. To accomplish this end, I spoke with the district food service coordinators, high school principal, and school district superintendent, as well as representatives from PepsiCo. Through these interviews, I sought to uncover each person’s opinions about the causes of childhood obesity, the influences of soft drink advertising, and the role of schools in implementing nutrition programs. Lastly, I hoped to raise awareness of childhood obesity and its health consequences, as well as the negative effects of soft drink consumption in schools through an informational pamphlet. Evaluation of Childhood Obesity in a Rural Pediatric Clinic Project Date: 11/10/2003 The incidence of childhood and adolescent obesity is rapidly increasing in the United States. Related to this is a substantial increase in the incidence of type 2 diabetes in children. The short term and long term effects this will have on both the individual and the health care system are drastic. Modifiable risk factors for obesity include sedentary lifestyle and poor eating habits. This project looks at helath behaviors among patients of a rural pediatric clinic. Grade school and high school aged patients at Klamath Pediatric CLinic were given a survey covering several healthy lifestyle issues such as exercise regiments, eating practices, and amount of time spent watching television. Those who were given the survey were also measured for BOdy Mass Index (BMI). Finally, the educational tools provided by the clinic regarding obesity and healthy eating and exercise behaviors were assessed. The findings suggest that the health behabiors that correlate with obesity in the population studied were short duration of exercise (p<0.01) and less than 3 exercise sessions per week (p<0.025). Other behaviors such as eating habits and watching television did not correlate with obesity in this population. Based on this study, it is recommended that the community work to improve child participation in physical activities. Prevalence of Overweight Among Philomath Children, Fall 2003 Project Date: 9/29/2003 Obesity is an increasing problem in the country’s adult and youth populations. Among adults in the United States, the prevalence of obesity increased from 13% to 27% between the years 1976-1980 and 1999. The problem is as substantial in the youth population. The prevalence of overweight among children aged 6-11 has increased from 4% to 15.3% between the 1960s and 1999-2000. This community project studied the data of 370 school children in Philomath, OR from grades kindergarten through 6th. Each child’s Body Mass Index (BMI) was calculated to assess the prevalence of overweight and at risk in Philomath’s youth population. It was found that only 66% of Philomath’s youth are normal weight, 16% are considered at risk, and 18% are overweight (data categorized using the CDC’s growth charts for children). The overweight problem needs to be addressed, most likely by parents and by schools. A less sedentary lifestyle as well as nutritious and moderate food consumption should be promoted. Eating to lose fat in Coos County, OR Project Date: 7/7/2003 A low carbohydrate or Atkins diet has received much attention in the press recently, and has gained popularity among those battling excess weight. Coos Bay and North Bend, OR are no exception to the wave of popularity. They are also no stranger to the epidemic of obesity in this country, with a prevalence of obesity in Coos County of about 20%. The diet promotes weight loss through very low carbohydrate eating and fairly liberal consumption of protein and natural fats, without calorie restriction. It is thought to work by inducing lipolysis (and thus “burning fat”) as a result of so few carbohydrates to burn for fuel. Lipolysis leads to a state of ketosis which may be responsible for appetite suppression and loss of calories in the urine as ketones. At the Bay Clinic in Coos Bay, numerous patients were immediately identified who had tried this diet. In an effort to assess why the diet is so popular, how well it is working for people and the impact it has had on the community, a survey, several interviews and a current literature review were conducted. The results of the survey showed a relatively easy to follow diet plan and overall participant satisfaction. Most people had lost a significant amount of weight in 3-6 months. Most of these people had tried low fat diets before without lasting success. Numerous restaurants, health clubs and a nutrition consultant in town support the low carbohydrate approach to eating. There are a couple of stores in town that carry specifically low carbohydrate products. Finally, three recent studies have evaluated a low carbohydrate diet compared to a low fat diet to show more weight loss, longer adherence, and an absence of negative impact on lipid profiles for the low carbohydrate diet. From these data a patient and healthcare provider information sheet was designed to describe the diet, how it is done, answer some common questions and provide a list of resources for information on recent studies and relevant websites. Obesity Project Date: 12/30/2002 Obesity is a growing epidemic in the U.S. today. Currently obesity related diseases claim 300,000 lives yearly. If this trend continues, obesity will overtake smoking as the number one preventable killer of United States citizens. Obesity costs our health care system more than 330 billion dollars annually, which is approximately 12% of the national health care budget. It is an enormous problem. At the present there are no effective “quick fix” therapies for obesity. Drug therapy has been un-affective and gastric bypass is an option for very few. Good old-fashioned dietary control through lifestyle change and physical activity seem to be the most effective and long-lasting way to prevent and treat obesity. Because treatment is so difficult, the war on obesity begins with prevention. Children who are obese become adults who are obese. Obese six-year-olds become obese adults 50% of the time, while adult obesity rates from obese teens rise as high as 70-80%. Are we succeeding at preventing this obesity epidemic? Data suggests that primary care doctors are poor at screening for and treating the complications of obesity. Childhood obesity has nearly doubled since the 60’s and we are still not actively treating this epidemic. I set out to define the gravity of this problem in the West Salem Clinic. Both low-income and Hispanic populations are the populations with the greatest increase in childhood obesity in the last 15 years. The West Salem Clinic treats mostly low-income families and the majority of the patients are Hispanic. Providers at the clinic have noticed the problem for years and I set out to define the prevalence of childhood obesity in the West Salem Clinic and compare it to the U.S. population. After defining the prevalence of this at-risk population, I developed a detection and screening process to identify and treat obese and overweight children. I provided the providers of the clinic with a checklist of evidence-based guidelines for identifying the complications associated with childhood obesity. This detailed checklist includes prevalence data to convince providers of the importance of screening. I also made up a short checklist to be inserted in the chart if any child is ever identified as overweight on the BMI growth chart. Overweight is defined as a BMI >85 percentile for age and sex while obesity is >95 percentile. This checklist contains solid evidence-based screening tests that should be done on every overweight or obese child. Identifying and treating the medical complications associated with childhood obesity is responsible but the obesity itself must be treated to truly take care of your patients. Most physicians encourage diet and exercise but most folks are unresponsive to these vague suggestions. Diet and exercise is accomplished through lifestyle change. Lifestyle change is very difficult and it must be encouraged and followed in a gradual step-wise fashion to prevent failure and assure lo The Skinny on Losing Weight: Obesity and Treatment Recommendations for Adults at Philomath Family Medicine Clinic Project Date: 3/25/2002 According to the most recent national surveys, overweight and obesity have become an epidemic in the US. The health risks associated with obesity are enormous including hypertension, diabetes, dyslipidemia, non-alcoholic steatohepatitis and sleep apnea. An information survey of patients at Philomath Family Medicine clinic showed that overweight and obesity are significant problems. 61% of adults between the ages of 18 and 63 are either overweight or obese: one third are overweight while 28% are obese (BMI>30). The combined prevalence of overweight and obesity (BMI>25) is 62% in women and 60% in men. This is consistent with recent US national population surveys from the CDC. Although a majority of those who are at least overweight reported having a discussion of the dangers of obesity with their doctors, only a handful received guidelines on how to effectively and safely lose the weight. The goal of this community project is several fold: 1) to assess the nature of the problem with obesity at Philomath Family Medicine clinic, 2) to formulate recommendations for managing and treating obesity and 3) to develop a patient education handout on healthy approaches to losing weight. Weight Loss Success: A Local Guide to Resources. Project Date: 5/6/2002 Obesity has become a serious health issue in the United States. The population of Philomath and Corvallis, both located in the mid-Willamette Valley in Oregon, is no exception. In response to the lack of awareness of local resources for sufferers of weight loss issues, a local guide was created to increase the general population?s knowledge of this critical issue, as well as assist individuals mentally and medically. A brochure was constructed to warn them of the dangers of obesity, to inform individuals of the benefits of weight loss, and to inspire and spark an interest in the many exercise and nutritional programs available in the area. Back to subject search page or search by preceptor site