San Diego Team Changing Behaviors One Square Mile at a Time

December 14, 2011
By Darry Madden

The San Diego Healthy Weight Collaborative is centering its work on a very small physical area of Chula Vista, California. A city just south of San Diego and a few miles from the Mexican border, Chula Vista has an obesity rate of 40 percent.

The efforts focus on a local elementary school, primary care clinic, childcare center, and liquor store that are all within walking distance from one another. Many of the families who live in the area frequent all four establishments. The team’s goal is to change policy and messaging in all four locations in an effort to see real and lasting change in this concentrated area. If this strategy is successful, the team plans to spread the model to other pockets of Chula Vista and San Diego County.

Branding in English and Spanish
First, the team is adapting the ‘5-2-1-0’ messaging for its bilingual target population (‘5-2-1-0’ indicates five or more fruits and vegetables per day, less than two hours per day of recreational screen time, one or more hours of physical activity and zero sugar-sweetened beverages) . Hispanic colleagues say that this messaging just doesn’t resonate in Spanish, so the team is considering other options for its Spanish speaking audience. The team plans to use this message on posters, handouts, and brochures at all four locations.

New Prescription Pad
For the primary care clinic, the team is developing a “Prescription Pad” based on the 5-2-1-0 messaging. The idea is that the healthcare provider will check off whichever of the 5-2-1-0 messages the patient and provider agree are in need of improvement. “The patient signs the prescription and takes it home as a reminder,” said team member Michelle Zive, principal investigator with Communities Putting Prevention to Work and Network for a Healthy California.

Overhaul of the Wellness Policy
The changes at the school include a major overhaul of the wellness policy. This involves some significant shifts toward stronger language. For example, phrases like “suggest” and “encourage” are being replaced with “restrict” and “eliminate.” So where once it was suggested that celebrations not include cupcakes, cupcakes are now restricted. “Initially, parents were startled, even appalled,” said Zive. In response, parents and staff at the school are being surveyed in the interest of refining the policy to make it more palatable for them.

Customized Healthy Weight Plan
In addition, the team hopes to complete a BMI assessment and create a healthy weight plan for each of the 800 children at the elementary school. The team is considering the possibility of having this plan be co-created with the student and parent, the idea being that they’ll be more likely to follow a plan that they have a hand in creating.

Bringing Healthy Food to the Community
Four area liquor stores, including one across the street from the elementary school, are being retrofitted with the necessary equipment to sell fresh, and whenever possible, local produce. While this project is funded by a separate grant, the Cilantro to Stores project, as it’s called, is very much a part of the San Diego team’s vision. Western Chula Vista, the older half of the city, is a food desert, with a liberal sprinkling of fast food and liquor stores that sometimes also sell processed food to the community.

The grant provides the stores with refrigeration and support, and dictates some of the particulars, like where in the store the fresh fruits and vegetables are to be displayed.

“Where you live in a community has an effect on your access to healthier foods,” said Cheryl Moder, a team member representing the county’s obesity initiative. “We know that it’s not just that someone is eating too much, but rather eating unhealthy foods.”

Alignment Is Key
The team believes that aligning all of these efforts across multiple locations within this concentrated area is the key to a sustainable strategy to promoting and achieving healthy weight in their community. “It’s not one thing or another,” says Moder. “It’s doing everything that matters.”