Behavioral Modification Program to Control Obesity among School Children in Knott County, Kentucky

Childhood obesity is one of the major public health concerns in the United States (US). Obese children have a greater likelihood of developing cardiovascular disease risk factors such as high blood pressure and cholesterol, and impaired blood glucose[7].The prevalence of obesity among children 2 to 5 years of age in Kentucky was 15.7% (US average 8.4%) and 17.6% (US average 17%) among adolescents in Kentucky being higher than the national averages [8,3]. A major goal of the Behavioral Modification Program is to promote healthy behaviors among elementary school children to control obesity by modifying eating, physical activity and screen time behavior. The proposed program is adapted from an evidence based multi-level intervention (school, family and community) program, the SWITCH, what you do, view, and chew. The SWITCH was developed and tested by the randomized control trial in Cedar Rapids, Iowa in 2005. The Kentucky River District Health Department (KRDHD) is implementing the adapted behavioral modification program in three elementary schools of Knott County, among potentially eligible 356 students from grade 3 to 5 from 2017 to 2020. Knott Co. is situated at the eastern region of the Kentucky and it has the highest rate of adult obesity (41%) in the state [11]. The prevalence of early childhood obesity in Knott County is 15.5%, which is almost double in compare to national average (8.4%) [15]. The KRDHD is a regional public health department. It has 7 counties under its jurisdiction. There are six staff members of the KRDHD are directly involved in the proposed program along with Mrs. Samjhana Shakya, a project director. The KRDHD is collaborating with six partners including the University of Kentucky, the Knott County Cooperation Extension, and other local organizations to implement the program. The participants of the program will set a goal/goals related to eating, physical activity and screen time each week and perform guided activities to achieve the goal which continues for 8 months (October to May of an academic year). Parent and teachers will support the participants to meet their goals. Similarly, there are community based intervention components (PSA, bill boards, community presentation, and educational booth) to create a supportive environment and raise the community awareness. Major outcomes of the proposed program are a) increased fruit and vegetable consumption b) increased physical activity, c) reduced screen time, and d) reduced Body Mass Index among participants. These outcomes will be assessed by baseline survey, end line survey and 6 month follow up survey among participants (students), parent, and teacher. Community impact will be assessed by baseline and end line community survey. The long term impact of the program will be the more involved and aware community, family and schools in Knott County to promote healthy behavior and supportive environment to control childhood obesity. The proposed program is promising to be sustainable in future because of the strong collaboration with local stakeholders, an active community participation, and enhanced capacity building (training, adapted materials, data) through this program. We anticipate to extend this program to the rest of the counties under jurisdiction of the KRDHD in near future after grant period