An Ounce of Prevention

An Ounce of Prevention – Legally Speaking; Will Your Employment Policies Hold Up In Court?

By: HOLLI W. HAYNIE

The foundation of one's health is built within the home. Healthcare providers can only go so far, and often people receiving care are already sick or on their way. As people have continued to develop habits of eating more and doing less, the ideals of healthy living have steadily slipped away into an undeniable epidemic of obesity. The conditions brought on by obesity are an increasing burden not just on the healthcare system, but in business and the home. Consider this, the estimated cost of overweight and obesity in the United States – about $122.9 billion according to ObesityinAmerica.org – is comparable to the economic costs of cigarette smoking. Obesity and obesity-related ailments result in at least $62.7 million in lost workdays each year.

While there is no single solution to this dilemma, many people agree a crucial place to start is with children. If an ounce of prevention is worth a pound of cure, learning healthy eating habits in early childhood is a means to ensuring better habits for the future. That is the purpose of the Porter-Leath Spoonfuls program, designed to provide nutritious meals to young children, typically in lower income families, who are being cared for in home daycare facilities.

Common Table Update

Researchers Find Hope for a Healthier Memphis:
In recent years, the Mid-South has been plagued by an epidemic of obesity coupled with diabetes, the most important cause of premature death and unnecessary suffering for its citizenry. Fortunately, investigators at the University of Tennessee Health Science Center (UTHSC) have discovered reason for hope. Their research concludes that while rates of obesity and diabetes continue to climb, more Mid-South citizens are making the healthy lifestyle changes needed to reverse the epidemic. Although Shelby County obesity and diabetes levels remain higher than national averages, obesity rates are now increasing slower than both the national and state rates.

The Healthy Memphis Common Table (HMCT) kicked off its Obesity and Diabetes Initiative in late 2003 with the goal of reversing the increases in these twin epidemics by 2008. The many HMCT Partners are spearheading numerous projects in businesses, churches, hospitals, clinics and neighborhoods throughout Memphis and the Mid-South to promote health habits and reverse trends in obesity and diabetes. Meanwhile, Memphis physicians are working with the HMCT Aligning Forces for Quality Initiative to improve diabetes care in the Mid-South.

To track the progress of these efforts, UTHSC coordinated a survey for citizens in the Memphis area to determine their health habits, which contribute to either wellness or to poor health outcomes such as obesity/diabetes. The telephone survey of more than 700 Mid-Southerners revealed that more adults are exercising at least one day a week, eating fruits and vegetables and are cutting back on fatty foods than in the past. The 2007 survey demonstrates that Shelby County residents now eat more vegetables than people in other parts of Tennessee or in the U.S. as a whole, and they exercise more than people in the rest of Tennessee. The full progress report for the Obesity and Diabetes Initiative is available online at http://www.healthymemphis.org/data_center/reports/.

According to Jim Bailey, MD, principal investigator for the Healthy Memphis Data Center, and professor of medicine for UT Health Science Center College of Medicine, "Behaviors that lead to obesity and diabetes are difficult to change, but Memphians are taking the first steps." Dr. Bailey added, "Now we need to recommit ourselves to making community-wide changes to prevent and treat these diseases by promoting physical activity, creating healthy environments, promoting healthier diets and achieving sustained weight loss."

More than ever, Memphians are aware of the causes and cures for obesity and diabetes. Most encouraging is that local residents are making healthy behavior changes. By setting concrete targets and monitoring the quality of care their patients receive, Memphis providers are also steadily improving the quality of diabetes care in the Mid-South area.

For more information contact: Dr. Jim Bailey or Cindy Martin (901-448-2475)

^1. Eddy DM et al. The Potential Effects of HEDIS Performance Measures on the Quality of Care. Health Affairs, 2008.

Aligning Forces For Quality Initiative: Working with physicians, hospitals, businesses, and consumers to improve healthcare for the people of Memphis.

"The goal of this program is to improve the diet of children up to 12 years old and we seek to educate providers on childhood nutritional needs while ensuring the compliance and integrity of the program," explained program director, Shedron Davis. "What we try to do is assist in combating obesity at an early age with good nutrition. The only way the children can be trained is if the adults are provided with the nutritional information."

Porter-Leath is a United Way of the Mid-South partner agency. The program is a spin-off of the USDA's Child and Adult Care Food Program to Family Day Home Providers, with funding provided by the Tennessee Department of Human Services (DHS). The USDA (United States Department of Agriculture) has specific nutritional recommendations for children. Homes which provide childcare to enrolled children aged birth to 12 are eligible to serve meals that meet the health, safety and nutritional needs of the children and in turn they receive reimbursement for the cost of the meals. Currently Spoonfuls, which serves West Tennessee, is serving 83 family day homes, providing nutritious meals and snacks to more than 800 children each day.

Family day home providers have to be licensed through DHS, which is where many providers are referred to the Spoonfuls program. Davis also works to recruit through health fairs, career days, and particularly word-of-mouth. Eligible providers are trained by Davis and staff on the proper nutrition for various age groups, as well as sanitary and safety measures. They are taught how to prepare the food and are given USDA guidelines on appropriate portion sizes for each age. For instance, it is encouraged to use fresh fruits and vegetables, rather than processed items, and milk is served with every meal. They use cycle menus which provide grocery lists and preparation instructions. Davis said they are encouraged to be creative. They are also given guides on what foods are eligible for reimbursement. Each year the per-meal reimbursement rate increases.

It no doubt has its perks, but there are stringent rules with which to adhere, maintained Davis. Follow-up is built in throughout the year, with providers undergoing quarterly monitoring reviews. Providers are monitored for every aspect of healthy habit building, from food prep to hand washing to appropriate exercise. The program also goes an extra step by offering workshops throughout the year on nutrition, health, safety and recordkeeping accuracy.

"It's a structured program where children are able to learn and gain educational skills that will prepare them for Head Start or preschool," explained Davis. "The early intervention education has the ability to change the direction of behavior habits and eating habits of an individual. It will increase their skills and knowledge about their health."

The program has been excellently received by providers, added Davis. External, sealed survey data aggregated from the Urban Child Institute shows the program has been 99 percent effective. During the past year, Spoonfuls has served 1,258 children and 376,000 meals have been provided.

"Everyone enjoyed (the program) and is recommending other people to the program," Davis said. "We're continuously serving new providers, with 23 new providers last year."

Healthy Habits Developed Early

When parents drop off their children at Cassandra Perkins family daycare in Tipton County, they know exactly what the kids will be eating each day. Evidence of nutritional awareness is seen throughout the house in the form of posters, articles and handouts. Perkins has provided home daycare for 22 years under the name Cassandra's Family Daycare Home. She's been in the Spoonfuls program for 10 years and she said it brings her great satisfaction to see children eating healthy.

"When kids eat balanced meals, they are glowing and growing," she praised. "I believe when kids are eating healthy, they're learning even better."

The program trains providers like Perkins not only in the ways of food preparation and menu planning, but offers suggestions on how to incorporate nutrition education into daily routines. For instance, Perkins explained, she may talk to the children about how carrots give her strong eyes or how milk builds strong bones, which offers the opportunity to practice colors, numbers and food knowledge.

"If this program was not available, I wouldn't be as in tune with nutrition. The meals may not be as balanced," maintained Perkins. "I'm blessed that I came on board when I did. The parents are pleased. When children leave the home to go into public school, the habits continue. They like the healthy food."

In addition to good nutrition, Perkins and the children she cares for eat all their meals family style. Monday through Friday, they have all their meals at the table, which promotes proper table manners and hygiene. She said parents often tell her how their children request healthy items during meals and know a lot more about food and food preparation. And they're often pleasantly surprised to see their children setting the table or serving their own food.

Parents are invited over for various functions and are provided suggested snack lists – no candy, soda or junk food – as she always looks for the healthiest option. Perkins said she always keeps up with the latest news about obesity, nutrition and exercise to post on her walls and to pass out to parents. "Parents tell me their children get a great start here."

Since she's been in the program, Perkins has become a program mentor, helping new providers learn the ropes. In addition she has won numerous recognition awards from Porter-Leath for her exemplary service. She's also on the Tipton County pre-K advisory committee.

As for her dedication to the program, Perkins said, "It's about taking care of our children. They are our future. We have to teach them well and feed them well."

To learn more about the Spoonfuls program or to give a donation, visit: www.porterleath.org