Students in Boston participate in the Billion Mile Race, part of the Active Schools Acceleration Project spearheaded by ChildObesity180. (Photograph by Ian MacLellan for ChildObesity180)
Nelda Jasso is keenly aware of the toll that obesity takes on children. As a physical education teacher at Baker Middle School in Corpus Christi, Texas, she sees it in her students every day.
“You can tell they are bothered by it,” says Jasso. “They don’t want to run; they’ll walk. And they dress in baggy clothes.”
Then Jasso came across an initiative called the Billion Mile Race. The program, open to any US school, challenges 5- to 12-year-olds to join school-based walking and running clubs free of charge and, collectively, reach one billion miles. Schools can set targets, post their miles on the campaign’s website, and watch the ticker climb upward. As of July 2017, students had notched more than 65 million miles, the equivalent of 274 trips to the moon.
Jasso’s school already had a weekly program called Mile Monday, on which all the school’s students each walk or run a mile before P.E. classes. But Jasso saw in the Billion Mile Race an opportunity to help them become even more active by pursuing an inspiring goal. “Our school has enrollment of 1,000-plus, so I figured if we did this once a week, we’d get 1,000 miles—and throughout the year, they’d add up,” she says.
The Billion Mile Race is part of the Active Schools Acceleration Project (ASAP), which aims to increase physical activity in America’s schools. With funding from the New Balance Foundation, which focuses on preventing childhood obesity, it is among several initiatives spearheaded by an innovative public-private partnership called ChildObesity180.
Created by Christina Economos, a childhood nutrition expert, Peter Dolan, a former pharmaceutical company executive and now ChildObesity180’s chair, and Miriam Nelson, a professor at Tufts University, it aims to incubate new approaches to tackling child obesity and scale them. Their ultimate goal is to reach 80 percent of US children between the ages of 5 and 12.
Cross-sector Leadership
The child obesity epidemic originated in the 1970s, when everything from increased portion sizes to sodas and junk food to reduced school exercise programs drove alarming increases in the number of severely overweight children.
By the late 1990s, research revealed the scale of the problem, as obesity rates tripled and pediatricians saw children suffering from older adult conditions such as heart disease and type 2 diabetes. “Because it was gradual, it did not initially get a high level of public health concern,” says James Marks, executive vice president of the Robert Wood Johnson Foundation, a funder of ChildObesity180.
In recent years, progress has been made, with rates of child obesity stabilizing. Yet 17 percent of American children are still obese. “And of children 1 through 5, about 22 percent are overweight or have obesity, so we have an epidemic on our hands,” says Mary Story, Duke Global Health Institute’s associate director for academic programs and a leading expert in child-obesity prevention.
Child obesity is challenging, she explains, because such a complex range of social, nutritional, and economic factors drive the epidemic. “There’s just not one thing that we could be doing that’s a solution,” Story says.
For Dolan, the issue was personal. “One of my sons was meaningfully overweight in high school, and I saw what a big difference that change made for him,” Dolan says. So, when he was looking for a new challenge after retiring, child obesity was a natural choice.
In 2009, Dolan met Economos, a professor at the Friedman School of Nutrition Science and Policy and Medical School at Tufts University, where he chairs the Board of Trustees, and was impressed by her work.
Between 2003 and 2005, Economos led Shape Up Somerville, an initiative designed to prevent weight gain in early elementary schoolchildren by engaging schools, healthcare providers, local restaurants, and others. Two other Massachusetts communities with similar socio-demographics participated, acting as control groups. All 30 public elementary schools in the three communities participated. After two school years, the children in Somerville gained less weight and were less likely to be obese or overweight than those in the control communities.
To Dolan—whose business background included a role as chairman and CEO of pharmaceuticals company Bristol-Myers Squibb—the cross-sectoral approach of Shape Up Somerville made sense. He believed that business could bring financial rigor and market knowledge to problems such as obesity. “There’s growing recognition that industry can be part of the solution,” he says.
To Economos, who wanted to replicate nationally what she had learned in Somerville, Dolan was a natural partner. “He was an international business leader who had a different mind-set, which was that innovation can help grow programs to scale rapidly,” she says. “That’s not how people in public health typically think—so that was interesting.”
Soon after meeting, Economos and Dolan created ChildObesity180 and enlisted a set of charter members who had interest and expertise in tackling child obesity. “The thought was that if we brought together champions from different sectors, used the best available evidence, and scaled it up rapidly, we could reach millions of kids,” Economos explains.
It was important that charter members be senior executives at the CEO level or equivalent, says David Bliss, a consultant who worked with ChildObesity180 from its early days. “What we didn’t want was a group of people who could only go so far, then had to call headquarters for guidance,” Bliss says. “People at the senior level don’t have to go back to home base to check if they can say something.”
Charter members were required to attend all sessions in person and make personal commitments rather than signing up their organization. “They were not putting their company on the table and making promises for them,” Economos says. “They were individual leaders who were interested in the topic, could make a difference, and then hopefully influence their sector.”
The next step was to build trust among members. This was critical, given lingering tensions between business and other sectors. “If you’re an academic or a nonprofit and it’s known that you’re sitting with industry, have you sold out?” Bliss asks. “And if you’re in industry, are you going to say something that could show up in a news flash that afternoon?”
To alleviate such concerns, Bliss conducted confidential interviews with all members and created a document collating (unattributed) their opinions and insights. This built understanding and also enabled the group to move rapidly.
Since then, regular face-to-face meetings have reinforced group trust. “As much as technology has advanced our ability to communicate, there are some big things you can’t do unless you’re in the same room,” Economos says.
Decisions Informed by Data
To identify strategies to pursue, the team initially turned to the work done by organizations such as the National Academy of Medicine (formerly the Institute of Medicine), an NGO, and the White House Task Force on Childhood Obesity, launched by the Obama administration in 2010 to develop a strategy to fight childhood obesity. These organizations produced a series of reports highlighting the most promising strategies across the country.
To narrow down the roughly 100 initiatives covered by the reports to six to eight strategies that the team could scale up, it reviewed each, scoring them according to a set of 10 criteria. These included the time an initiative took to achieve results, the strength of evidence it had produced, and its potential for engaging a range of sectors. A priority was to tackle areas not already receiving attention, such as out-of-school programs and the restaurant industry.
This emphasis on data and assessment continues to inform ChildObesity180’s decisions. It researches and publishes peer-reviewed studies, and conducts randomized controlled trials. Local and national surveys evaluate the availability of snacks, beverages, and physical activity as well as children’s perceptions of weight, nutrition, and physical activity, and parents’ knowledge of calorie recommendations for children.
Critically, if the evidence does not add up, the team thinks again. This was the case for the Breakfast Initiative, designed to give more low-income children breakfast at school. The initiative not only ran into funding hurdles but also was unable to confirm the role of school breakfast in weight regulation. “There really wasn’t any good evidence out there,” Economos says. ChildObesity180 decided to end it.
The emphasis on data and evaluation can prompt difficult decisions, but it also helps ChildObesity180 assess which programs have the greatest impact. This was the case with the ASAP initiative. To find the most effective national child-obesity-prevention intervention, a crowd-sourcing competition was launched to solicit schools’ ideas for getting students to be more active. Hundreds of proposals were narrowed down to three: a school-based walk-run program, a before-school physical-activity program, and a classroom-based program that gets students moving in breaks throughout the school day.
These three options were then tested in 1,000 schools, each of which received a small grant and could choose which of the three to implement. Most opted for the walk-run program. “We wanted the market to speak,” Economos explains. “At the end of that year, based on research and participation rates, hands down walk-run was the top.” The next step was to expand that program from 600 schools to 50,000 and, later, to launch the Billion Mile Race.
As with all its initiatives, it then sought implementation partners—such as Let’s Move! Active Schools, a collaborative of health, education, and private sector organizations—capable of expanding the program nationally. By December 2016, ChildObesity180 had reached more than nine million children nationwide—something Dolan says could not have been done without such partnerships.
“We’re handing them off to a scale-up partner,” he says. “And the good news is we’ve done all the hard work.”
Correction: The original version of this article, published in the Fall 2017 issue of SSIR, neglected to mention that Tufts University Professor Miriam Nelson helped create ChildObesity180. That omission has been corrected in this version of the article.
Read more stories by Sarah Murray.