De Heer addresses childhood obesity

In summer, elementary and middle school students seem to have unlimited time for outdoor exercise and exploration––long, sunny days free from classes or cold weather to keep them indoors.

But through three years of research, Hendrik “Dirk” de Heer found that weight gain among the highest risk students is highest in the summer months when there are no fitness programs available through schools and many families cannot afford expensive summer programs.

An associate professor in the NAU Department of Health Sciences, de Heer decided to address the “obesity gap” facing minority students through a Southwest Health Equity Research Collaborative (SHERC) Pilot Project Program grant titled “Addressing Health Disparities in Childhood Obesity, One Summer at a Time.”

The SHERC grant, supported by funding through the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH #U54MD012388), provides researchers up to $30,000 in funding per year per project. The purpose of the Pilot Project Program is to provide preliminary seed funding to support and to mentor junior investigators to increase their competitiveness for National Institutes of Health and other external health and health equity-related research funding.

De Heer, Regina Eddie, assistant professor in the College of Nursing, and Taylor Lane, doctoral student in Interdisciplinary Health Program, found that interventions are most needed in the summer among populations that are at highest risk, especially 7 to 11 year olds, yet in Arizona the need is not being met. Statewide, they discovered that only 22% of children participate in summer activities, even though more than 60% of families are interested in summer programs.

In Flagstaff, the researchers found that children at the highest risk for obesity and its consequences were in the schools with many children with limited socio-economic means.

Developing the pilot project

Through his pilot project, de Heer partnered with a program called Fit Kids of Arizona, which is a pediatric obesity treatment and prevention program that is part of Northern Arizona Healthcare. Together, de Heer and the Fit Kids staff led by Sherry Walka and Hiliary Howdeshell developed a summer fitness incentive program modeled after a Centers for Disease Control and Prevention Summer Scorecard intervention program.

This program partners with local businesses that have exercise facilities (for example, a pool, climbing gym, ice skating rink etc.) to provide children with free or reduced price access to these facilities to encourage them to try new activities.

In the summer of 2018 and 2019, the researchers recruited 220 FUSD students, ages 7 to 11, many of whom had limited financial means to participate in summer programs. To follow the students’ progress, De Heer measured the students’ body mass index at the start of the program and at the program’s completion. The students were given lanyards with scorecards that businesses stamped when the student participated in their program or exercised at their facility.

“Our Fit Kids partner, Hiliary Howdeshell, has been working with local businesses through the Fit Kids program for years and she has great contacts with our local business and community,” de Heer said. “They were very supportive.”

De Heer said that half of the punch card items included free activities, such as going to a local park and playing for an hour. Once their cards were filled, the students could turn them in for prizes or other incentives.

De Heer said there were several challenges executing the summer program––one was having students keep track of their lanyards and free passes. He said that parents’ time and access to transportation made some of the activities logistically challenging.

“Even though kids were given free passes, they still had to have a parent take them to the activity,” de Heer said.

Though their final measurements have been delayed due to the COVID-19 closings, their initial results have been positive.

Challenges of fighting obesity and encouraging healthy lifestyles

De Heer said that the goal of his research was to determine the most effective ways to support high-risk children and teach the students fun ways to integrate health and fitness into their everyday lives so they would continue their healthy lifestyles.

He said the goal was to create a project outside of school, where days are packed with the academic curriculum and there is little time for an exercise and nutrition program that would teach students how to stay healthy and active throughout their lives.

“It is sometimes hard to attain funding for prevention,” de Heer said. “But the students who need it the most are going to suffer until we start integrating more exercise and nutrition education in our daily lives during the times they need it the most. You can’t simply wait for children to have a serious condition.”

Future projects

De Heer said that the team recently joined the Pediatric Obesity Weight Evaluation Registry (POWER), so they can propose future research projects and collaborate with similar programs around the country.

“My dream is to provide every single kid that wants it a free health program during the highest risk time period of the year, the summer,” he said. “It would benefit them and society for the rest of their lives.”

Meanwhile, he said joining the POWER registry will allow him to apply for larger grants and collaborate at a national level.

“Childhood obesity presents a challenge in virtually every community in the U.S., and we need to collaborate across the nation to figure out what works best in helping the most vulnerable kids in the most efficient way,” de Heer said. “The SHERC pilot project was a great first step towards this goal.”