Reflections on Childhood Obesity in Mississippi

An Interview with Dr. Gerri Cannon-Smith, Co-Leader of the Phase 1 Mississippi Be Our Voice team

July 19, 2012

By Julie Eisen

Dr. Gerri Cannon-Smith
Gerri Cannon-Smith,MD, the co-leader of the Phase 1 Mississippi Be Our Voice team, comments on the state of childhood obesity in Mississippi.
According to a new report from the Center for Mississippi Health Policy, the state has seen a significant decline in the combined rate of overweight and obesity among elementary age students in Mississippi public schools. The rate dropped from 43.0 percent in 2005 to 37.3 percent in 2011. In a state that is consistently reported to have the highest obesity rates in the country, this is momentous news.

NICHQ has directly contributed to Mississippi’s obesity reversal efforts through Be Our Voice, a national project to mobilize and train healthcare professionals to become advocates for local policy changes in the fight against childhood obesity. Starting in May 2009, Phase 1 of the project focused on Mississippi and six other states.

What follows are excerpts from an interview with one of the Mississippi team leaders, Gerri Cannon-Smith,MD, in which she comments on the state of childhood obesity in Mississippi, responds to the new report, and reflects on the Be Our Voice project.

As a physician who is active in childhood obesity work in Mississippi, can you give us your perspective on the childhood obesity epidemic?
As a pediatrician, my mantra has been that “Every child should reach his/her optimum potential.” The obesity epidemic has threatened that goal. In previous decades, obesity was not considered a chronic condition in children, and consequently office approaches and reimbursements have lagged behind this epidemic. Our challenge currently is to not only incorporate evidence-based strategies into our practices and electronic health records, but to also enlist the support of family, school, peer groups, and community. This is not a problem that can be solved without “all hands on deck.”

What are the unique challenges that face Mississippi when it comes to childhood obesity?
In terms of the backdrop, Mississippi has been listed seven years running as the heaviest state in the nation. Childhood obesity is just one component of our childhood obesity problem. Mississippi is a rural state, and we have a high poverty rate. Despite the fact that we are rural state, we still have a lot of food deserts, and some people do not have access to fresh fruits and vegetables on a regular basis. In a rural area, there also tends to be a lack of resources, particularly in terms of recreational facilities. There are some rural communities that may have a Boys and Girls Club, but not every city will have a YMCA or a health club, particularly in the more rural areas of the state.

Also, in Mississippi we are known for our hospitality, which translates into meals for every celebration – usually high-calorie laden meals with these celebrations. There are a lot things in our traditions. Mississippians have strong feelings related to individual choice, which makes it a little difficult sometimes for people to look at problems in terms of a community issue, rather than an individual issue.

Recently there was a report released indicating rates of overweight and obesity in elementary school age children in the Mississippi public schools dropped from 43 percent in 2005 to 37.3 percent. What was the local reaction to the report?
It has been encouraging. For years we have been hearing that Mississippi is the heaviest state, so to actually see that we are making some progress and that the trend is starting to plateau has really been encouraging for a lot of groups. The intransigence of obesity in all segments of the population during the past decade makes any progress heartening. It is especially important that progress is evident in children and adolescents as it decreases the risk of current and future complications.

I think now there is a sense that we feel that what we are doing is not in vain. It energizes people to continue to work, because despite the fact that childhood obesity is beginning to level off, there are still some challenges. As the report indicates, there are still persistent and widening disparities between African American and white students; overweight and obesity rates are increasing in African American females; and there is overall misconception and denial of healthy weight status. I think people are continuing to stay energized around those areas.

What factors do you think have contributed to this reported decrease in overweight and obesity among elementary school age children?
In addition to the Healthy Students Act of 2007, there have been other statewide and community initiatives, which have been instrumental in achieving this goal. Initiatives have ranged from preschool to senior initiatives, have included ecological levels from individual and family to policy (school, childcare, workplace) levels, and have included raising awareness and skill building. This has been accomplished through media campaigns; work in faith-based, community, and workplace settings; legislative activity; bootcamp and weight management programs; and, of course, obesity advocacy training.

Also, firmly entrenched cultural traditions are gradually changing with the engagement of champions from schools, pulpits, elected official offices, clinical offices, public health groups, insurance, recreational, and community groups and associations.

Moving into your work with NICHQ, can you reflect on Be Our Voice and what you have specifically worked on in Mississippi?
The Mississippi American Academy of Pediatrics (AAP) Chapter’s Be Our Voice project is designed to prepare health professionals to better advocate for obesity prevention policy and initiatives. Participants were given information about obesity in the state and their local communities and related environmental issues, and they were trained to effectively advocate in a variety of media and legislative settings in the time available, whether it be one hour or years.

Our program was a little different from some of the other Be Our Voice programs, in that we already had a significant school policy change, through the Healthy Students Act of 2007, and had a pending child care regulation policy change. The steering committee decided that our role should be to promote full implementation of the policy, which varies from school district to school district, and to provide skill building and networking opportunities for advocates already engaged in local, district, or statewide initiatives.

A unique component of the project was the attempt to mobilize pediatric and internal medicine pediatric residents as advocates for their local schools. All participants were provided with local School Wellness Council contact information, but many have opted to direct their efforts toward community-, state-, and faith-based initiatives, which include community gardening, joint-use agreements, breast feeding promotion, promotion of healthy life styles, safe routes to schools, individual school programs, competitive weight loss initiatives, and professional trainings. Additionally, some of our advocates have been allowed to develop or implement programs within school districts to ensure full implementation of nutrition and physical activity goals of the Healthy Students Act.

Do you believe your work on Be Our Voice may have contributed to the decreased rates of overweight and obesity among elementary school age children? If so, how?
I think so. We definitely can’t underestimate the effect of the Healthy Students Act, but I think Be Our Voice is one of the many efforts that have had an effect on the progress. I don’t think you can really have progress in the schools unless there are accompanying changes in the community that surrounds those schools.

One example that comes to mind is that one of our steering committee members, a school nurse, was told by a local grocer that their customers were asking the stores to provide healthier fruits and vegetables that they had not provided previously. She believes this is because the school had changed their nutrition program, partly as a result of lessons learned from Be Our Voice.

What is your team most proud of in the project?
There were four areas that I thought were our major contributions. One is to increase the advocacy skills of new and previously engaged advocates. We were able to customize the trainings for our area by having local speakers. For instance, we wanted to talk about engaging with the schools, so we brought in a principal who won a national award for school engagement; we had our Medicaid public relations specialist come in to talk about engaging with legislators; and we had local television anchors and publicists and newspaper editors come in and talk about getting your story out. Our participants found it very useful.

Two is increasing awareness of and participation in school-related initiatives among the health professional communities. A couple of our advocates who were health education instructors started working with the public schools in their local areas. Each school district decides what they do in terms of the health curriculum, and the Be Our Voice advocates have been able to partner with several middle schools to provide that nutrition and physical activity curriculum.

Three is providing opportunities for networking among individuals and groups with similar areas of interest related to obesity prevention. We were able to help build partners beyond geographic convenience. At our initial training we asked people to self-select their area of interest, so by doing that we already had ready-made teams. After, there were people who linked themselves geographically, but primarily people linked themselves by interests, so several of them have continued to work together along those areas of interest.

And four is providing resources for individual and groups for program planning and grant making. I have been told by several of our advocates that our toolkit was very useful for them in applying for grant funding for some of the projects they were interested in.

Phase 1 of the project formally ended in August 2011. How do you plan to continue the momentum for the future?
In general, we want to help people stay abreast of what childhood obesity initiatives are going on in the areas. For example, we recently had a series with our public television station with the host of the public radio show, Southern Remedy, and they had a mass campaign. There was a series of programs dealing with childhood obesity, and as a result, they had more media exposure. Several of our advocates are a part of that program and that campaign. We really believe in networking, because there are so many people that are already actively involved in obesity prevention work, and we don’t want to be seen as a competitive force. We want to just push those initiatives that are currently effective. We are also supporting and promoting new and innovative projects through mini-grants and collaborative efforts.

Dr. Gerri Cannon-Smith is an Associate Professor of Behavioral and Environmental Health at Jackson State University and a consulting clinician for G.A. Carmichael Family Health Center. Currently, she serves on the executive committee of the Mississippi chapter of the American Academy of Pediatrics.