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Changing the Curve

Erika D. Peterman

November 2, 2015

When John Armstrong, M.D., first took the helm as Florida Surgeon General and Secretary of Health in 2012, he requested an environmental scan of the state's biggest health threats.

"It was very clear that the top challenge we're facing in Florida is the challenge of weight," Dr. Armstrong said.

The numbers confirm that the Sunshine State is in a battle with obesity. Only 35 percent of Floridians are at a healthy weight. If the current trend continues, almost 60 percent of Florida residents will be obese by 2030 and six out of 10 children borntoday will be obese by the time they graduate from high school. The impact in dollars and cents is overwhelming. Over the next 20 years, obesity is expected to cost Florida $34 billion as it contributes to millions of cases of chronic disease, including type 2 diabetes, heart disease and cancer.

"We know that weight-challenged individuals live sicker and they die younger," Dr. Armstrong said. "We also know that the cost of managing just the consequences are staggering for the health care delivery system." In Jan. 2013, the State Department of Health (DOH) launched a program designed to turn the tide. The Healthiest Weight Florida initiative, a public-private collaboration involving other state agencies, non-profits, businesses and communities, seeks to help Floridians of all ages make better choices about what they eat and to become more active. Community partnerships are key. This year, DOH recognized 65 communities as "Healthy Weight Community Champions" for their work in implementing best practices to create environments where it's easier to make healthy choices - everything from new sidewalk construction to encourage walking, healthy food choice requirements in county food service contracts to city-wide health and wellness initiatives.

"This is not a top-down approach," Dr. Armstrong said. "(Communities) are actually in a position to do something about it on their terms. We have done a variety of initiatives within this program to stimulate local action."

In just one example of a state partnership, DOH teamed up with the Florida Department of Environmental Protection for its Nature Play "Prescription" Program, in which 10,000 passes to state parks were given to children who are either weight challenged or at risk for weight challenges. The idea is to promote outdoor activity.

Another component is "I Promise," which consists of virtual and physical message boards where individuals can post specific, measurable goals such as drinking more water, getting five servings of fruit and vegetables daily or taking the stairs every day. In addition to using the website, people can post their goals on actual message boards in every county health department offi ce across the state.

"My own promise is to walk 15,000 steps a day," Dr. Armstrong said. "I have a wrist device that helps me measure those steps."

DOH has set twin goals of becoming the healthiest weight state in the nation (Colorado currently holds the title) and bending the weight curve in Florida by fi ve percent in fi ve years. Th e slope of that curve has already begun to change, as Florida has gone from being in the top 20 healthiest weight states to the top 15.

One thing that sets Healthiest Weight Florida apart from other initiatives is that it accentuates the positive.

"It's not a 'don't be fat' goal. It's not a lose-weight goal. It's a be-healthy goal," Dr. Armstrong said. "People do better with aspirational goals. It's been proven time and time again. Unfortunately, the national conversation is all about fat and it's all about obesity."

Last year, DOH collaborated with the FMA to launch the "Healthiest Weight: A Life Course Approach" CME course at Annual Meeting in Orlando, and it is available for free in the FMA's online CME catalog. Dr. Armstrong said that physicians are key in the state's healthy weight efforts.

"Physicians are essential for not only helping individual patients and their families; they're essential as leaders in the community to get the conversation going," he said.

A common conversation

The Florida Department of Agriculture and Consumer Services is also doing its part through the "Living Healthy in Florida" campaign, which was launched about a year ago to "create a common conversation around health and nutrition in Florida," said Robin Safley, who is Director of Food, Nutrition and Wellness for the Department. While many agencies talk about health in terms of specifi c issues such as healthy weight or chronic diseases, "When you peel back the onion, you realize the foundational conversation rotates around the same pillars: eating nutritious food, balanced lifestyles, exercise," said Safley. Living Healthy in Florida encourages people to make nutritious food choices by eating more of the fresh fruits and vegetables that are grown right here in Florida. A Florida produce calendar educates consumers about fruits and vegetables that are in season and provides fact sheets and recipes revolving around each. In videos, a chef demonstrates how to cook with Florida produce. There are activities to help children learn about healthy living, tips to build a healthy diet and more.

"What better way to communicate how to live and eat better than to market the very fruits and vegetables they can find in their neighborhoods?" Safley said.

Another component, Florida's Roadmap to Living Healthy, uses an interactive, online map to help government agencies and other organizations identify the state's "food deserts," or areas without ready access to quality retail grocery stores, where Floridians are eligible for food stamp benefits and the death rates from diet-related illnesses. Safley said Department Commissioner Adam Putnam is "committed to ensuring that all people have access to fresh fruits and vegetables throughout their environments" as well as doing everything he can to help shift the cost curve associated with obesity.

One of the Department's newest partnerships is with Moffitt Cancer Center. The two will collaborate to highlight the "superfood" fruits and vegetables that can help prevent cancer. The Department is also working with the FMA to create a toolkit for physicians that will help them discuss food and health with their patients.

"Fundamentally, this is about helping Florida's kids, adults and families make more informed choices ... and, if you will, live long and prosper," Dr. Armstrong said regarding DOH's efforts. "It's a very personal initiative."


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