There’s more to the problem of childhood obesity than just eating too much, and there’s more to the solution than just saying, “Eat less.”

That’s why a team of West Virginia University researchers has spent a year mapping community-level factors.

The Choose to Change, funded by a $4.7-million grant from the U.S. Department of Agriculture, has completed extensive community assessments of Kanawha and Monongalia counties, looking at the communities through a variety of lenses.

“A mixed-method approach to our research study helps to quantify and more accurately describe the current nutrition and physical activity environments for families of young children in these two counties,” said Elaine Bowen, a health promotion specialist with WVU Extension. “Prior to this, the environmental factors were not adequately studied and understood. It was essential that our study interventions are informed and guided by facts instead of researcher assumptions and opinions.”

Community nutrition and physical activity environments may contribute to obesity by influencing food choices and physical activity levels. To evaluate these environments some team members conducted the Nutrition Environment Measures Survey, assessing the availability, price and quality of healthier foods in more than 1,000 food outlets, such as stores and restaurants, in the two counties.

Others constructed a Geographic Information Systems database to explore the environment as it relates to physical activity. And others conducted focus groups of parents, educators, and other community members to get a more personal lay of the land and understand a range of perspectives on the obesity epidemic.

According to Bowen, the methodologies used help identify barriers and opportunities for future family, school, and community interventions.

“Community engagement involves consultation, meaningful involvement, true collaboration, and shared leadership,” Bowen said. “Studies show that by increasing communication, involvement, and trust, projects such as Choose to Change can have greater impact.”

It’s the kind of comprehensive approach that’s uniquely suited to a major land-grant institution like WVU.

“This project is an example of how the University carries out its land-grant mission of promoting access to higher education and applying research to meet the needs of West Virginians,” Bowen said. “Every college, as well as the Extension Service, is part of this mission. With this project, many university units and faculty within units are collaborating.”

Disciplines represented on the Choose to Change team include human nutrition and foods, exercise physiology, community nutrition, economics, curriculum and instruction, physical education, child psychology, computer sciences and public health. Each team member is responsible for various project components.

Finding nutritions, affordable food
A combination of technology and legwork went into the NEMS survey.

“We purchased a database of all the food outlets, but we then had to visit each location to verify it existed and was operating,” said Kristin McCartney, Choose to Change coordinator for Monongalia County. “We also added locations that were missing to come up with the final list of outlets.”

Researchers used a GIS device to get the GPS code of each location to be used to create food maps. They provided extensive training to all participants rating the outlets in order to be able to evaluate and report in a standard fashion.

“With the restaurant survey, much of the information could be filled out by visiting a restaurant’s web site,” McCartney said, “However those locations still required a visit to answer marketing questions.”

According to Susan Partington, Ph.D., project director and principal investigator, survey results indicated a high density and thus greater access to food outlets in urban areas and low access in rural areas.

“Audit scores were highest for large supermarkets due to greater availability and lower cost of healthy choices and higher quality and greater variety of fresh produce,” said Partington, associate professor of human nutrition and foods in the Davis College of Agriculture, Natural Resources and Design. “These results will be used to determine if the community nutrition environment is a contributor to obesity by influencing the food choices and eating behaviors of participant families.”

Mapping healthy alternatives
Mark Middleton, a graduate research assistant in WVU’s Regional Research Institute and a doctoral candidate in agricultural and resources economics in the Davis College led the GIS component of the assessment.

“I have mapped out all the restaurants, grocery stores, shopping areas, schools and so on,” said Middleton, who earned his M.S. in applied sociology from the Eberly College of Arts and Sciences. “From a given address we are able to determine the distance to each of these features. By combining the distance with the NEMS score we create a healthy eating score for a house.”

Middletown and RRI colleagues are also doing a sidewalk study by developing a walking-score method that can be used in more rural areas. A walking score is a system that gives the walkability of the immediate area surrounding any housing unit. Greater walkability may be related to higher levels of physical activity.

“The system developed works fine for New York or D.C. but tends not to work in rural areas,” Middleton said. “We are looking to add amenities that encourage walking in rural areas. We are also interested in adding slope of the street to this scoring system. Walkability in mountains is dependent on the slope of the streets.”

Results in both counties showed a prevalence of low walkability, few amenities, and no sidewalks. Unpleasant, unsafe outdoor spaces may discourage activity. Limited access due to distance may also contribute to “unhealthy behaviors” and obesity.

Getting personal
Lesley Cottrell, Ph.D., vice chair of research for the WVU School of Medicine Department of Pediatrics and co-investigator of the West Virginia Prevention Research Center, worked with Emily Murphy, Ph.D., Extension childhood obesity prevention specialist, in conducting eight focus groups with 32 parents,32 school staff and 31 key community informants.

Many focus group participants perceived the prevalence of obesity among preschool children as very low, compared to what it actually is. The West Virginia CARDIAC Project reports that about 30 percent of kindergarten children are overweight or obese. Parents reported factors including genetics, the high cost of healthy foods, and few physical activity options as major obstacles in preventing obesity.

The second year of the project is concentrating on a school-based intervention for families of Pre-kindergarten children and community engagement. Community kick-off events were held in April, where Monongalia County and Kanawha County participants were briefed on the project plans and community assessment results. They were polled about what they will do to prevent childhood obesity in their community.

Community Advisory Boards are being formed in each county to review the community assessment results and create an action plan. The project is currently recruiting families of Monongalia County and Kanawha County preschool children to participate in the research. For more information, please visit



CONTACT: David Welsh; Davis College of Agriculture, Natural Resources and Design

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