CAVANAUGH: This is KPBS Midday Edition. I'm Maureen Cavanaugh. The San Diego state graduate school of public health has been doing research into what creates conditions for childhood obesity. And what might be done to reverse that trend. Now the school has been awarded $6 million. The largest grant it's ever received to test that research and add to it. The study will take place in Imperial County which has a 39% rate of childhood obesity. Joining me is my guest; doctor Guadalupe Ayala, a professor in SDSU's school of public health, and the grant's lead investigator. Hello. AYALA: Good afternoon, Maureen. CAVANAUGH: Congratulations, first of all. AYALA: Thank you, I'm very excited about this opportunity. CAVANAUGH: Imperial Valley would seem a perfect place to try to if figure out childhood obesity. It has the highest rate, I understand of any county in California. What health issues are raised with so many over weight kids? AYALA: That's a great question. One of the reasons why we decided to work in Imperial County is partly because of the high obesity rates, and because of the wonderful partnerships that we have. Primarily because we are looking at some statistics that in 10 to 20 years we could have a prevalence rate of diabetes of 50% in kids. One of two kids could have diabetes if we tonight reverse this trend. CAVANAUGH: What are some of the factors that you already identified that head to childhood obesity specifically in Imperial County? AYALA: What we see similar to other communities across the United States, and those that are both predominantly Latino, Hispanic, as well as others of different racial and ethnic minority groups, we see high unemployment rates which translates to high poverty rates, which then is associated with food and security, which then leads people to often consume les healthy foods. That's sort of a series of mechanisms that leads to this greater risk of childhood obesity. But really childhood obesity, there isn't any one factor that's responsible for this. We know there's research looking at genetic influences all the way up to built environment influences that folks here at San Diego state have been investigating for a while. CAVANAUGH: The way the environment is structured, whether it allows for people to walk and exercise? AYALA: Exactly. Right. So we about the built environment in terms of access to affordable and accessible places to be physical he active, we also think about grocery stores and restaurants that may have healthy options. And soy there's a sort of a push-pull in research in terms of there are individuals that often want to ascribe lack of motivation for leading a healthy lifestyle, and that's of course part of the equation. But there's also the part of the equation that looks at the built environment about having access to those healthy options. There's the physical environment, but there's also the social environment. And so we now see in many communities, in imperial county as well as others, that we are developing social norms around it being acceptable to be heavier, to eat these unhealthy foods. So what we're really trying to do with this project is reverse that trend. CAVANAUGH: As I understand it, you want to get in this and really change a lot of things about the way kids eat, and their access to physical activity. Let me go through a couple of things that you might want to change when this project gets going. What kind of changes would you hike to make in schools? AYALA: Great question. In the schools, what we're hoping to do, and this project itself is a partnership with imperial county public health at the present time, which is a wonderful organization as well as a federally qualified health center. In writing the proposal, what we really discovered in the schools that there isn't access to healthy water. So one of the things that the schools have been doing across the country is decreasing access to sugar sweetened beverages, which we know is one of the factors associated with childhood obesity. What hasn't happened is increasing access to healthier options. Water and low fat milk. One thing we want to try in those schools is something that's been done in other it is across the country, is introducing water jets. It's a low cost way to provide easy, potable, attractive water to kids. It doesn't require bottles, which is another concern from an environmental perspective. CAVANAUGH: And you want to get in there and work with some restaurants about portion size. I find that really interesting. How are you going to do that? AYALA: Absolutely. Well, what we are hoping to do is -- and this is based on some pilot work we did on a previous project with doctor John elder was the lead investigator. We worked with restaurants to create healthy menu options. We know a lot of times restaurants have child menu items typical fair, chicken nuggets, hotdogs, even a Mexican restaurant or a Chinese restaurant will order additional products to appeal to kids. And what we're trying to get them T do is either modify some existing healthy items but reduce the portion sizes that are more consistent for a child. But also offer healthy side dishes so instead of French fries, offer a side of salad or some cut up fruit. Also not have the unlimited fill your beverage because we know that any one beverage can introduce a lot of calories into the kids' diet. MAUREEN CAVANAUGH: You say that you have worked in imperial county before and that you've developed good partnerships. It sounds like you're going to be needing them if you want to make changes like that. Upon how willing are local leaders and business people do you think to work with you? AYALA: So far we have an amazing planning team. So we have individuals that represent the parks and recreation department, the schools, daycare centers, City Council men. So through our partnerships on two previous projects, one funded by the American cancer society that was a family based healthy eating intervention, which we're finding some significant changes in the families, we also have a diabetes prevention control study. And we're finding that as a result of those two initiatives, we're finding that the community residents are very motivated to participate in these sorts of programs because they often lack some of those resources. And so they see that we're out there and interested in really doing what we can in partnership with them. CAVANAUGH: I'm wondering, a big factor in this is families. How are you going to be working with families? Let's say the kids have better options at restaurants and they have access to healthy drinking options in school. What about when they get home? AYALA: You hit it right on the nose. This whole study, this demonstration study is really about reaching all the context or all the sectors that the kids touch. And so the idea is that if we don't work in conjunction with families, just as if we don't work in conjunction with restaurants or park and recreation departments, these efforts are not going to be sustained. One of the models that we've been using, and it was developed years ago, hundreds of years ago in Central America and Africa and India, is a community health worker model. So the idea is you identify individuals, leaders in the community who are interested in making those changes, involve them, train them, then they go out and spread this message. So we're going to be using that model in the Latino community, it's called the -- so we'll be using this model to train individuals to work one-on-one with those families. They're the ones who can get families to open their door and connect with. I may have the knowledge and skills to do it, but I'm not them. I'm not a member of that community. So really working with the community residents to be to convey that information in the most culturally relevant way. CAVANAUGH: That's what's going to happen to the results of this study? AYALA: We're really hoping that as a result of the collaborations, this is funded by CDC, there are some other research sites involved in this effort. University of Texas health sciences center, and the Massachusetts department of public health. The idea is that as a result of our combined efforts, by 2014, we're supposed to produce a report to Congress that will then determine where the funding priorities are going to any for childhood obesity. So our charge is really to come up with some best practices that are going to be sustainable in the communities in which they're being developed, but also disseminated, something that we can take to other communities that are similar to the ones that are being tested so that it's not just reaching one community but hopefully at some point we'll reach the entire nation. MAUREEN CAVANAUGH: A model for other parts of the nation. I've been speaking with doctor Guadalupe Ayala, and the grant's head investigator. I want to thank you for coming in and speaking with us. AYALA: Thank you very much for this time. Appreciate it.
We'll have more on the SDSU grant on Wednesday's show.
The focus will be on Imperial County. It has a childhood obesity rate of 39 percent, the highest in California. The statewide average is 28 percent.
Graduate School of Public Health Professor Guadalupe Ayala, the grant's lead investigator, says researchers will be working with schools, grocery stores, restaurants and hundreds of families to promote healthy eating habits and exercise.
"It's a demonstration study," she said. "The idea is to take the best practices we've developed at the institute to try to affect changes in multiple settings that kids interact with."
For example, Ayala hopes to have restaurants introduce healthy options and get schools to increase physical activity.
"It's a holistic approach to trying to reduce the prevalence of childhood obesity," said Ayala.
One idea in the plan is to give students more healthy food options. Many schools in Imperial County lack working water fountains, which in the past have led students to turn to sugary drinks. Schools have banned high-calorie soft drinks, but they haven't provided students with alternatives.
Ayala said they plan to replace old drinking fountains with water jets, which are inexpensive and have had a great impact on other parts of the country.
"We also have a clinical focus. Clinicas de Salud del Pueblo will be working with them to try to increase access to treatment associated with childhood obesity," she said.
Imperial County's Public Health Department will also be involved in the efforts.
Imperial County also has high unemployment and poverty, which Ayala said are some of the factors contributing to the its high obesity rate.
