Age Range: 8 to 13
The Shapedown program is offered by hospitals throughout the country, including several in New Jersey. RWJH has offered the program for over 10 years as part of its community health department; the 2004 grant permitted the program to greatly expand. Candidates are identified through health screenings in school. The criteria for participation are a Body Mass Index (BMI) in the 85th percentile plus two additional risk factors, or simply a BMI in the 95th percentile. Students with these risk factors and their families are invited to take part in the Shapedown program for free and are given additional nutrition counseling. The 10-week program meets one evening a week for two hours and includes activities for the whole family. All participants are required to obtain both physician and parental consent prior to participating in the program. RWJH screens applicants to ascertain whether they and their families are able to make the necessary commitment to the program.
A grant from the Bristol-Meyers Squibb Company has allowed RWJ H to offer the program at no cost to Mercer County youth identified as at risk for Type II diabetes. Children outside Mercer County are welcome to participate but must pay the program fee of $350. RWJH sought the grant recognizing that most insurance plans do not cover treatment or intervention for children diagnosed as overweight and offer only limited coverage for children diagnosed with Type II diabetes. Rates of Type II diabetes have risen dramatically in children over the last 10 years and can often be prevented through healthy eating and regular physical activity. Although more families are able to attend because it is offered at no cost, this can also be present an obstacle as some families may not feel tied to the program without a financial commitment. Future offerings at Hamilton may require families to pay a deposit that is refunded upon completion of the program.
The RWJ Hamilton Shapedown program uses the program book developed by the University of California, but staff has adapted the program by incorporating a healthy cooking segment and a 20-minute workout session into each class meeting. The program’s mission statement is “to be fit, healthy and at peace.” Participants learn about nutrition, exercise and family communication strategies through a variety of activities including letter writing, role playing, guest lectures on bullying, nutrition demonstrations, recipe handouts and art activities. While participants are not divided into groups by age, RWJ Hamilton staff work hard to tailor each session to the class, adapting lessons on the spot if needed. For example, recipes may reflect the ethnicity of participants.
Results
Participants are measured on several criteria at both the first and last program session. These measurements include height, weight, BMI, resting and active heart rates, waist and hip measurements, and number of pushups and sit-ups. The goal is to see improvements by the end of 10 weeks. Of the 24 participants in the fall 2005 session, there was an 18.5 percent decrease in both systolic and diastolic blood pressures combined. The group overall also performed 300 percent more push-ups and sit-ups. Reunion sessions are held four to five months after program completion. Participants are able to monitor individual progress in changing habits through food journals and logs measuring TV, fast food, and soda consumption. Parents are also encouraged to keep journals throughout the program and offer fun incentives and rewards. Successful participants have had actively involved and supportive families. Of the 48 families who have participated to date, 43 completed the full 10-week session.
A study published in 2004 in the Journal of the American Dietetic Association (JADA) found similar results. Of the participants who completed the Shapedown program at San Jose State University, weight, waist and hip measurements, active heart rate, triceps skin fold thickness, and BMI were significantly decreased over the two-month program. Participants were also found to have increased self-awareness about dietary habits and their knowledge of healthy eating and exercise habits. However, the program had a lower completion rate than participants in the RWJ Hamilton program. Of the 30 adolescents in the studied program, only 19 completed the program. Another study published in 1993 also found the program to be successful in improving body image and self-esteem in obese adolescents who had been diagnosed with insulin dependent diabetes mellitus.
Lessons Learned
Family support, involvement, and commitment are critical to success in the program and to sustaining long-term lifestyle change. Staff stresses the importance of involving both parents in the program, as many activities involve strategies to improve family dynamics and communication skills. Both parents are encouraged to come to all sessions but may rotate weeks. Through frequent phone calls and weekly postcards, staff hopes to make a personal connection with participants that will inspire them to complete the program. Families are asked to sign a contract to signify their commitment. Of course, obstacles to class attendance may arise, such as lack of transportation or other family obligations.
Involvement of Mercer County area nurses and school support has been crucial. Participants are identified though in-school health screenings; 1,600 students have been identified as at-risk for type II diabetes. Public, private and charter schools are introduced to the program through school assemblies, health fairs, PTA meetings, and letters from the RWJH Shapedown staff. Although some schools have resisted getting involved in the program, the program staff has been very happy with participation and program results thus far. As part of their school outreach, the staff gives one-time presentations in schools on nutrition. Activities for younger students may include Nutrition Jeopardy! Presentations for middle school students incorporate information on alcohol and tobacco use. Local family physicians have also been critical in identifying potential participants for the Shapedown program. Parental permission is obtained before children are screened for risk factors.
While the program at RWJ Hamilton has been successful, staff has ideas for improvement and expansion:
Implementation Guide
Strengths
Innovative Ideas
Resources
www.shapedown.com
Offers information on starting a program and the required training sessions. Also sells program workbooks and manuals
www.rwjuhh.edu/health/family.asp
Information on program from Robert Wood Johnson Hospital
Contacts
Robert Wood Johnson University Hospital Hamilton
One Hamilton Health Place
Hamilton, NJ 08690
Phone: (609) 586-7900
RWJ Hamilton Center for Health and Wellness, Hamilton
Phone: (609) 890-4440
RWJ Hamilton Diabetes and Overweight Screening and Support
Program for Children and Teens in Mercer County
Phone: (609) 584-2893
