Madeline Lasell

SPH 223: Letter of Intent

Facilitating Fitness in Fifth-Grade (FFIF): A School-Based Obesity Prevention Program

for Fifth Graders in Vallejo, California
Target Audience and Setting
Facilitating Fitness in Fifth-Grade (FFIF) aims to reduce obesity prevalence among fifth-
grade students (aged 10-11 years old) attending school in the Vallejo City Unified School
District of Solano County, California. In California alone, 31.2% of children and adolescents
aged 10-17 are considered overweight or obese.1 Specifically, among fifth-grade schoolchildren,
the Vallejo Unified School District maintains a high obesity rate that surpasses California’s
collective obesity rate. While 40.3% of California fifth-graders are considered overweight or
obese, 51.5% of the Vallejo Unified School District’s fifth-graders are overweight or obese.2
Obesity affects 17% of U.S. children and adolescents, with a concentrated prevalence among
Hispanics (21.9%) and non-Hispanic Blacks (19.5%).3 Likewise, Hispanics and non-Hispanic
Blacks are widely affected by obesity in the city of Vallejo. Within its school district, 60.7% of
fifth-grade Hispanics and 46.9% of fifth-grade Blacks are classified as overweight or obese.4
FFIF aims to initiate health behavior changes during childhood that will have long-lasting
impact in terms of weight status. As the program’s title suggests, fifth-graders are the ideal target
audience for this pilot program. A fifth-grader’s weight status has the tendency to remain stable
from elementary school throughout high school.5 A recent study found that 65% of obese fifth-
graders remained obese up to their tenth-grade year. This same cohort accounted for 83% of all
observed tenth-graders who were considered obese at the study’s conclusion.5 Additionally, most
fifth-graders have not yet experienced puberty, which is known to result in rapid growth and
changes in body mass index (BMI). Targeting pre-pubertal children prevents against rapid
growth changes that may compound baseline weight data for an older adolescent population.
Lastly, each of the 15 Vallejo elementary schools expected to carry out this program only enroll
up to fifth-grade. For these reasons, FIFF will solely be implemented in a fifth-grade cohort.
Proposed Intervention
Facilitating Fitness in Fifth-Grade (FFIF) is comparable to the novel obesity prevention
program implemented by Johnston et. al in 2013.6 During their study, trained health
professionals met with school administrators, cafeteria staffs, and elective teachers three times
per week to integrate nutrition and physical education into various school curriculums.6 They
utilized motivational interviewing (MI) technique to promote intervention adherence and to
Madeline Lasell
SPH 223: Letter of Intent

resolve staff ambivalence.6 This provided staff members with ample support, which resulted in
successful program implementation and slowed weight gain in obese schoolchildren.6
The FFIF program will similarly implement a five-year “professional-facilitated
intervention” that includes curriculum materials, staff training, and ongoing support from
qualified health professionals. During the first year, these health professionals will embed FFIF
curriculum within each elementary school’s existing curriculum by addressing barriers that arise
during the motivational interviewing process. As in Johnston et. al, FFIF curriculum will deliver
specific health messages via: 1) daily teaching moments, 2) weekly integrated lesson plans for
core and elective subjects, 3) bi-monthly classroom activities, and 4) school-wide promotional
activities each semester.6 These strategies are expected to reduce students’ BMI values by
increasing their fruit and vegetable intakes and physical activity levels.
At minimum, FFIF requires five years of implementation to determine whether it can
reduce the prevalence of fifth-grade obesity and maintain long-lasting impact. Health educators
will follow the inaugural fifth-grade cohort until their tenth-grade year to determine whether
BMI reductions seen in fifth-grade are maintained through tenth-grade.
FFIF has the potential to be well-maintained at a low cost, so long as adequately trained
staff adhere to the curriculum. This assumption is based on how well the Johnston et. al
intervention held up throughout the duration of its two-year timeline. The health professionals
assessed program compliance and discovered that only 3 of the 20 teachers in the intervention
group did not meet curriculum standards by failing to provide an integrated lesson once per
week.6 Hence, it is likely that this two-year intervention can be successfully expanded to the
five-year FFIF program.
Given the disproportionate rates of childhood obesity across minority populations,
Johnston et. al implemented their program within ethnically-diverse student populations. They
found no differences in post-intervention zBMI scores across the included minority groups,
indicating that the curriculum reduced zBMI scores for all groups, regardless of ethnicity.6 With
its comparable intervention, FFIF will likely be effective in reducing BMI values across the
diverse Vallejo student population.
Staffing and Costs Incurred
In addition to one year of experience working in child weight management, FFIF health
professionals must have a degree in nutrition, kinesiology, or another health-related discipline.
Madeline Lasell
SPH 223: Letter of Intent

The health professionals must also be trained in motivational interviewing prior to working
directly with Vallejo Unified school staff. FFIF will therefore require both a temporary
psychologist and a temporary registered dietitian to appropriately train health professionals prior
to implementation.
There are 15 elementary schools within the Vallejo Unified School District.7 There must
be one qualified health professional at each school in order to facilitate the curriculum
intervention and host school staff trainings and meetings. To meet this demand, five health
professionals will be responsible for managing the curriculum across the fifteen elementary
schools (i.e. three schools per professional). The FFIF curriculum and accompanying materials
will be developed by the entire team of professionals during the summer prior to implementation.
During weekly meetings with the school staff, each of the health professionals will provide
necessary alterations to the curriculum. All preliminary curriculum materials will need to be
provided to the fifth-grade teachers in each school. A small stipend will also be provided to each
teacher who participates in the implementation of the program.
Monitoring and Evaluation
To assess program efficacy, FFIF health professionals will evaluate BMI status of the
inaugural fifth-grade cohort. Before implementation, student heights and weights will be
obtained to calculate BMI values. Heights and weights will be measured again after the first
semester of implementation and at the conclusion of the students’ fifth-grade year. Annual
follow-up measures will be collected from the cohort throughout the five-year time span to
assess long-term changes in weight. FFIF health professionals will solely follow members of the
cohort who remain within the Vallejo Unified School District.
During the first year of implementation, FIFF health professionals will assess curriculum
adherence through weekly 1-hour observations and via verbal self-reports from staff. These
ongoing assessments will complement the weekly staff meetings used to assess overall
compliance to the program. Health professionals will also perform structure evaluations at the
conclusion of the first and second semesters of implementation. These evaluation measures will
determine the adequacy of personnel training, facilities, equipment, and curriculum materials. It
is expected that any necessary alterations will be made to the program throughout its first year.
Thereafter, the program will be self-sustained and health professionals’ involvement will be less
frequent during the subsequent years of implementation.
Madeline Lasell
SPH 223: Letter of Intent

References
1. The State of Obesity. The State of Obesity in California. The State of Obesity.
https://stateofobesity.org/states/ca/. Published 2017. Accessed March 4, 2018.
2. Kidsdata. Students Who Are Overweight or Obese, by Grade Level. Kidsdata.org.
http://www.kidsdata.org/topic/725/student-weight-
current/table#fmt=1026&loc=341,2,350&tf=84&ch=623,624,625&sortColumnId=0&s
ortType=asc. Published 2015. Accessed March 4, 2018.
3. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of Obesity Among Adults
and Youth: United States 2011-2014. NCHS Data Brief No. 219. 2015.
https://www.cdc.gov/nchs/data/databriefs/db219.pdf. Accessed March 4, 2018.
4. Kidsdata. Students Who Are Overweight or Obese, by Race/Ethnicity and Grade Level.
Kidsdata.org. http://www.kidsdata.org/topic/727/student-weight-race-
current/table#fmt=1028&loc=341,2&tf=84&ch=623,624,625,7,11,726,85,10,72,9,73&s
ortColumnId=0&sortType=asc. Published 2015. Accessed March 4, 2018.
5. Schuster MA, Elliott MN, Bogart LM, Klein DJ, Feng JY, Wallander JL, Cuccaro P,
Tortolero SR. Changes in obesity between fifth and tenth grades: A longitudinal study
in three metropolitan areas. Pediatrics. 2014;134(6):1051-1058.
6. Johnston CA, Moreno JP, El-Mubasher A, Gallagher M, Tyler C, Woehler D. Impact of
a school-based pediatric obesity prevention program facilitated by health professionals.
J Sch Health. 2013;83(3):171-181.
7. Vallejo City Unified School District. School Websites. Vallejo City Unified School
District. http://www.vallejo.k12.ca.us/websites. Published 2017. Accessed March 5,
2018.