SAMPLE - POLICY MEMO by Faith Ilesanmi

TO: Governor of the State of Texas

FROM: State Department of Public Health
SUBJECT: Obesity Prevention Program - Dealing with Childhood obesity in Texas
DATE: 04/19/2017
The Department of Public Health oversees public health issues being faced in the State
of Texas. The Obesity Prevention Program is an intervention program overseen by the
Department of Public Health in the state to reduce obesity and to improve well-being. It was
developed in October 2013 from the Nutrition, Physical Activity and Obesity Prevention
(NPAOP) and Worksite Wellness Programs (Texas Department of State Health Services, 2016).
Objective: With the health consequences of obesity, the Obesity Prevention Program seeks to
increase physical activity, increase dietary intake of fruits and vegetables and limit sugar intake,
thus preventing obesity. Hence, based on this program, this memo proposes policies to adopt and
implement the School Wellness Integration Targeting Child Health (SWITCH) approach to
preventing childhood obesity.
Background
The Center for Disease Control and Infectious Disease has defined childhood obesity as
a Body Mass Index (BMI) of ≥95th percentile with regards to age and sex, while overweight has
been defined as a BMI of ≥85th to <95th percentile with regards to age and sex (Statistics, 2002).
Childhood obesity is a global public health issue and in the US, it is a prevailing issue
(Glickman, et al., 2012). According to the World Health Organization (WHO), under-five
obesity rates increased in 144 countries from 4.2% to 6.7% between 1990 and 2010 with a
possible rise to 9.1% in 2020 (Lakshman, Elks, & Ong, 2012: de Onis, Blossner, & Borghi,
2010). In the US, rates of childhood obesity have increased significantly over the last four
decades (Ogden, & Carroll, 2010).
Based on the National Health and Nutrition Examination Survey done in the US between
1999-2004, it was observed that 8.3% of under-5 children were obese (Lakshman, et al., 2012;
Mei, et al., 2008). Cunningham, Kramer, & Narayan, (2014) also observed that in a prospective
cohort study done in the US over 9 years that 12.4% of children between a mean age of 5 and 6
years were obese and 14.9% of them were overweight. According to the Institute of Medicine
(US), Texas currently ranks sixth among states in rates of childhood obesity (Institute of
Medicine (US), 2009) while the Trust for America’s Health and Robert Wood Johnson
Foundation, (2017) observed that 19.1% of children aged 10 to 17years in Texas were obese with
Texas ranking 10th among the 51 states and 14.9% of children aged 2 to 4 years were obese with
a ranking of 19th out of 51 states.
With childhood obesity, the major problem is “an imbalance between energy intake and
energy expenditure” (Lakshman, et al., 2012). Several factors have led to this upward trend in
childhood obesity in the US. These include reduced participation in physical activity, increase in
the intake of high calorie foods and soda drinks, and sedentary habits like TV viewing
(Lakshman, et al., 2012). In a study done by Dennison, Rockwell, & Baker, (1997) to assess the
effects of fruit juice consumption on childhood growth in New York, they found that of the 168
children studied, those who consumed more than 12fl Oz/day of fruit juice were more
predisposed to becoming obese unlike those who consumed less juice. Ludwig et al. (2001)
noted that a daily consumption of sugary beverages was linked with a greater BMI was among
548 US children aged 12 years studied over 19 months. Moreover, Taveras, et al., (2005), found
that increased intake of fried foods away from home was linked with an increase in BMI. In

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addition, Proctor et al. (2003) noticed that childhood obesity was associated with television
viewing.
With the National Health and Nutrition Examination Surveys data taken between 2001
and 2004 from 4 year olds to 11 year olds, Anderson, Economos, & Must, (2008) noted that
more than 6 in 10 kids were in front on the TV or computer for over 2hrs daily which is more
than the number of hours the American Academy of Pediatrics suggest (2 hours). (American
Academy of Pediatrics, 2001). Also, Krahnstoever Davidson, Marshall, & Birch, (2006)
observed that children who were in front of the TV for more than 2 hours daily had a higher risk
of being obese with growth.
Gortmarker, et al., (1996) also noted that almost 5 more children who spent greater than 5
hours watching TV daily were overweight than those who followed the American Academy of
Pediatrics recommendations. Also, Crespo, et al., (2001) assessed the relationship between
television watching, energy intake, physical activity, and childhood obesity in the US and they
noticed that children who watched the TV for over 4 hours daily had a higher prevalence of
obesity. Furthermore, within Texas, Hoelscher et al., (2004) observed that in a sample of 6630
children schooling in public schools in Texas, 22.4% of 4th graders, 19.2% of 8th graders and
15.5% of 11th graders were overweight.
The health implications of childhood obesity in adulthood could be debilitating
(Lakshman, et al., 2012). Serdula, et al., (1993) did a literature review to evaluate the association
between childhood obesity and adult obesity between 1970 and 1992 and they discovered that
approximately one-third of preschool obese children and 50% of obese school-age kids grew up
to become obese adults. Based on the long-term health consequences and quality of life issues
linked with childhood obesity which include type 2 diabetes, hypertension, obstructive sleep
apnea, asthma, polycystic ovary syndrome, early onset of puberty, irregular menstrual cycle,
fractures, poor self-image, depression, social stigmatization, school absenteeism, bullying,
anxiety and poor academic performance, families, health workers, and policy providers need to
provide prompt interventions for childhood obesity (Reilly, 2003; Griffiths, Parsons, & Hill,
2010; Gortmarker, et al., 1993; Lakshman, et al., 2012).
Since several actors play a role in managing childhood obesity, the objective of this
memo is to give an assessment of childhood obesity rates in Texas based on previous research
conducted to propose recommendations for reducing these increasing trends of obesity among
children in Texas. The recommendation in this proposal is to adopt and implement the SWITCH
program which is a family, school and community-based intervention for modifying some
behavioral factors for childhood obesity which include physical activity, television
viewing/screen time, and nutrition (Eisenmann, et al., 2008) with a view to implement this
program in various schools across Texas.
SWITCH
The SWITCH approach which is evidence-based targets parental oversight of their
children’s habits through their schools. SWITCH is a family, school and community based
intervention that seeks to adjust behaviors which could predispose to childhood obesity like
nutrition, television viewing, and related to childhood obesity. SWITCH was implemented as a
multilevel project to enhance the reach of the program as a result of involving all key players in
the intervention. The implementation aimed to decrease TV viewing, increase participation in
physical activity and increase fruits and vegetable intake in kids in a bid to reduce childhood
obesity (Eisenmann, et al., 2008).
The SWITCH program has four phases. The first phase with three aspects, Do, View and

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Chew. In the first phase, children and their parents assessed their behaviors and their attitudes
towards modifying these behaviors to fit into the Do, View and Chew model (Eisenmann, et al.,
2008). In the second phase, rewards for participation were allocated to increase self-efficacy.
Children and their families monitored their daily participation in physical activity, daily intake of
fruits and vegetables and their daily screen time. Teachers in schools rewarded the kids based on
their progress. The third phase involved improving family dietary habits while the fourth phase
involved maintaining the behavioral change and reinforcement (Eisenmann, et al., 2008).
Since SWITCH targets personal, behavioral, and environmental factors, it develops
children’s self-efficacy, changes their perceptions and attitudes and that of their families and it
increases community awareness about obesity. In addition, SWITCH endeavors to utilize
parental and family influence in child modelling (Eisenmann, et al., 2008).
Policy Recommendation
Programs targeting obesity should take into account the individual, family, institutions,
policies and global forces (Bradshaw et al., 2007). Different studies have observed body weight
changes in children based on intervention programs. For instance, Gentile, et al., (2009) did an
intervention over 7 months using the SWITCH approach. After the intervention, a third of the
children had reduced TV viewing, 23% spent less time on video games, 49% ate more fruits,
39% of children ate more vegetables while 62% of children became physically active (Gentile, et
al., 2009). Also, Welk et al., (2015) observed the effectiveness of an online SWITCH program
on 211 children in ten high schools. They used trackers to monitor their discipline in attaining
their goals with their parents help with the daily Do (≥60 minutes of moderate-to-vigorous
physical activity), View (≤2 hours of screen time), and Chew (≥5 servings of fruits and
vegetables) behaviors serving as the baseline. They observed that most parents were contented
with the SWITCH program (Welk et al., 2015).
From this analysis, it was observed that the SWICTH approach would be effective in
reducing childhood obesity in Texas. Hence, we recommend SWITCH as a guideline for
childhood obesity prevention.
Therefore,
The Health program goals based on the SWITCH approach include:
• To reduce the Body Mass Index to < 85th percentile for age and sex among 40% of
overweight and obese children attending high school in Texas over 5 years ( Statistics, 2002).
Behavioral goals
At the end of 5 years of intervention, children attending high schools in Texas should:
• Increase engagement in physical activity for at least 30 minutes in 5 days, weekly by 75%.
(American Heart Association, 2017)
Environmental goals
At the end of 5 years of intervention:
• 70% of teachers will support children’s participation in physical activity (Eisenmann, et al.,
2008).
• 75% of parents will support children’s participation in physical activity (Eisenmann, et al.,
2008).
Hence, the following recommendations are suggested:
• The state government will set aside money in the budget to support the future funding
needs of the program.
• The School Health Advisory Committee will recommend and support the delivery of the
SWITCH program in high schools in Texas.

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 • School Principals will review the materials developed for the program, and decide if the
program meets their needs, will evaluate alternative programs targeting increasing
children’s participation in physical activity and reducing childhood obesity, will decide to
use the SWITCH program after evaluating other alternative programs and sign a
memorandum of understanding.
• School principals and parents will adopt and support the delivery of the program.
• The schools with the support of the parents, principals, physical education teachers, and
nutritionists will implement the SWITCH program.
• This implementation would involve physical activity training sessions for school staff,
physical activity discussions during parent-teacher association meetings, creating posters
that encourage physical activity, healthy eating and reduced screen time in classrooms,
discussing physical activity with children in the classroom once weekly, sending text
messages and emails to parents to give them updates about physical activity, adding
physical activity discussions to schools’ monthly newsletters.
• The School Health Advisory Committee, principals, physical education teachers, and
other necessary staff will maintain the delivery of the program in high schools in Texas.
• Principals will ensure strict adherence and compliance with the program schedule.
• Principals will collaborate with one another to monitor progress in individual schools
• Program directors will partner with organizations that can fund physical activity
programs in the school.
• Program directors would maintain contact with the local government authorities, school
boards, school health advisory committee, permanent secretary and other program
supporters to keep them abreast of the program’s progress.
• Principals will encourage the ministry of education to add physical activity trainings to
the school’s curriculum.
• Children will have increased their Fruit &Vegetable consumption to at least 5 servings of
Fruits &Vegetables per day.
• Children will talk with their parents about the need to increase the intake of fruits and
vegetables and low-fat diets
• Children will encourage their parents to buy fresh fruits and vegetables.
• Children choose to eat 5 servings of fruits and vegetables daily.
• Children will decide to participate in physical activity and performance exercises in
school and at home.
• Children will decide to reduce screen time to less than 2 hours per day.
• Children will inform their parents about buying the materials they need to engage in
physical activity
• Parents would involve their children in physical sports.
• Parents would teach their children about what they need to participate in physical sports.
• Parents will provide the materials their children need to participate in dance exercises,
running, basketball, table tennis or soccer games frequently with their children,
participate in dance exercises, running, basketball, table tennis or soccer games
frequently with their children
I believe the SWITCH program would play a major role in reducing childhood obesity trends in
Texas and its environs.
Thank you

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