Fighting Diabetes Across America: New Jersey Dietitians are a Vital Force in Obesity PreventionFriday, November 08, 2013
The New Jersey Dietetic Association (NJDA) is actively involved in the state’s ShapingNJ partnership, which aims to help people within the state fight against obesity and chronic disease.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
Fighting Diabetes Across America is one in an occasional series talking about how various healthcare programs, advocacy, empowerment, and entrepreneurship are being done to help in the battle against the disease.
In this piece, DiabetesCare.net talks to Denise Langevin, RD, about the state’s ShapingNJ partnership.
With its beginnings starting over five years ago, ShapingNJ, has been a state partnership overseen within the New Jersey Department of Health Office of Nutrition and Fitness and originally funded by a five year Cooperative Agreement with the Center for Disease Control (CDC). Over 200 organizations—both companies and not-for-profit organizations—have been recruited as partners.
The mission for the partnership was to implement policy and environmental change strategies for citizens of New Jersey to help them fight obesity and chronic diseases such as type 2 diabetes.
Denise Langevin, past president, New Jersey Dietetic Association (NJDA), and representative to ShapingNJ says previous obesity prevention efforts had focused mainly on behavioral change at the individual level, but access to and education about nutritious foods and physical activity needed to reach people where they live, work, learn, and play. ShapingNJ has been focusing on policy and environmental changes that will assure that making the healthy choice is the easy choice.
NJDA has been an integral part of ShapingNJ over the years, beginning with planning and implementing the partnerships’ various work programs. Members volunteered their time to lend their expertise to the work groups, gathered data, evaluated research, identified settings to be targeted and helped develop strategies for each setting.
After the initial data gathering phase, the partnership is divided up into five workgroup areas with a focus on the following settings: childcare centers; schools; communities; worksites and businesses; and healthcare.
While the program addresses everyone, there has been a special emphasis on childhood obesity. There is a toolkit for school administrators or nurses to use, and childcare centers` personnel are being trained on nutrition and exercise for the young children who use these centers.
ShapingNJ has been evolving, and it will soon fall under the Chronic Disease group within New Jersey’s Health Department. The partnership finished its five-year grant earlier this year, but work will will be sustained through continued partnerships with various not-for-profit organizations, companies, and state government.
As the partnership is continuing to morph and evolve, DiabetesCare.net spoke to Langevin (pictured, lower left) about its beginnings, how it serves the state’s citizens, and its direction moving forward.
DiabetesCare.net: Can you provide an overview of the ShapingNJ partnership?
Langevin: It was developed to bring together a lot of diverse groups who had a common mission in some way or another to help make New Jersey healthier, specifically preventing obesity and chronic diseases like type 2 diabetes as priorities.
DiabetesCare.net: How would you characterize NJDA’s role in the ShapingNJ program?
Langevin: NJDA wanted to be involved from the beginning. We feel we are the nutrition professionals in the state, and obviously a program aiming to work on a major issue that nutritionists are so much a part of, we felt we had to be at the table and part of that work.
What came out of those initial discussions was that there were so many ways to fight this obesity problem, and so we can address it together.
Our NJDA members have always been involved in obesity prevention and treatment on a behavioral level. What ShapingNJ has done has put that in a bigger perspective and layered that with other elements like environmental and policy change to make it easier for people to make those behavioral changes.
DiabetesCare.net: Since the partnership began back in 2008, do you have any statistics or anecdotes you can share in terms of how many people are involved or who has been affected by the program?
Langevin: I believe we have had over 200 partners that were signed on over the past year to the partnership. When we started out, we had 50 or 60 partners and so this expansion is a big achievement in and of itself.
Each of these partners have worked in different areas. I was the official representative of NJDA, and I was involved with the school setting workgroup in developing tools for schools to use including a model wellness policy and guidelines for wellness councils to improve and encompass nutrition and physical activity. Of course there were a lot of other NJDA members who participated in the ShapingNJ Partnership, often representing their work settings, and many of them worked on other aspects of the ShapingNJ strategies.
One of the very successful outcomes of the ShapingNJ initiative came out the Childcare Workgroup. Partners working in that group submitted recommendations to update regulations for New Jersey child care centers so that they could be more in line with current best standards for nutrition, physical activity, TV screen time limitations and breastfeeding support.
NJDA wrote a letter supporting these recommendations and provided comments on the proposed regulations when they were published. Although not all of the recommended changes were included in the final regulations, many of the recommendations that NJDA supported regarding nutrition standards, physical activity, screen time, and breastfeeding support were incorporated.
Another great outcome of the ShapingNJ work was to increase the baby-friendly initiative in hospitals. The goal of this initiative is to increase exclusive breastfeeding rates in New Jersey, thereby preventing obesity and improving health outcomes. The two major objectives of the initiative are: Implementing the World Health Organization’s “Ten Steps to Successful Breastfeeding” in NJ delivery hospitals and implementing office based trainings for pediatric, family. and OB providers and their staff about best breastfeeding practices. Ten hospitals were provided with mini-grants to help them implement the “Ten Steps.” No hospital in New Jersey had the baby-friendly designation before and there are four now. Three came out of the training program that ShapingNJ had in place and there are others in the pipeline.
In addition, in the past year, through the ShapingNJ initiative, NJ Department of Health awarded grants to 18 nonprofit organizations and local health departments in high-risk communities to address strategies to decrease obesity. Funded nonprofit organizations worked alongside local partners to create and implement projects that would change the policies and environment of their communities and were required to have two foci: nutrition and physical activity. Projects primarily addressed food and nutrition through nutrition education and school or community gardens and physical activity through projects aimed at physical education for children and walking.
DiabetesCare.net: Programs and toolkits are being used for schools. How have they been implemented?
Langevin: The toolkits and resources developed by our School Setting Workgroup have been targeted to school administrators, the school nurse association, and the school food service association--of which many are dietitians.
Some of these organizations have been getting information to their members so that they can bring these resources to local school districts. It doesn’t have to be the principal who chooses to be involved in wellness initiatives, but it has to be someone who is going to champion a program, and really push it and create a whole culture within the school.
Obviously, you have to have administrative buy-in, but sometimes the spark for an initiative can come from different levels. We have seen cases where it comes from the school nurse. In other instances, the food service director has been a real champion in his district. One principal who was reluctant at first, eventually became involved and started living the program himself. In the process, he lost 30-40 pounds.
DiabetesCare.net: Do you have any concerns about the funding changing now that the initial five-year grant is up?
Langevin: They are questions everyone has. The state is looking for industry and foundation support. For example, one of our partners is Campbell’s Soup who has helped with schools and community programs. The Robert Wood Johnson Foundation and others also have been actively working with ShapingNJ. Much of our work and discussion in the last year of the grant revolved around sustainability of the initiatives that were begun through ShapingNJ. Efforts will continue to seek new grants and to bring on other funders.
DiabetesCare.net: How does ShapingNJ work in the childcare centers?
Langevin: As an outcome of the work done in the childcare setting to update childcare regulations, ShapingNJ has teamed up with Nemours to develop a training program for childcare center staff. A team consisting of both dietitians and childcare providers are providing training for the childcare center personnel about the regulations and the best practices in how to improve nutrition and activity for children in these centers. The training will include nutrition standards, physical activity, and screen time standards for spending time in front of the tv and computer, and setting policies for parents who want to continue breast feeding.
DiabetesCare.net: Obviously there is a link between obesity and type 2 diabetes. Do you think ShapingNJ is having a positive effect on trying to reduce this form of diabetes?
Langevin: Absolutely. ShapingNJ aims at preventing obesity in all age groups. While a lot of what we have done has been aimed at childhood obesity, the changes have been in all sectors—the workplace, the community, are two examples, so people are becoming more aware and understanding these healthier behaviors and environmental and policy changes help make access to good nutrition and physical activity easier.
By targeting school and community settings, it is hoped that the obesity levels will come down and eventually decrease the type 2 diabetes prevalence, especially in younger people.
The latest statistics show obesity is starting to level off in several age groups, so we believe partnerships and programs like ShapingNJ are helping.
For anyone interested in learning more about ShapingNJ, interested readers can go here.