This summary provides an overview of a recommendation to address childhood obesity in South King County, Washington. 1) The recommendation proposes expanding the "offer" method used in the Summer Meals program, which allows children to choose their own meal components and is more nutritious than pre-packaged meals. 2) It also suggests incorporating weekly nutrition workshops to educate children on making healthy choices and developing lifelong nutrition habits. 3) Outreach materials like flyers would be distributed to involve families and encourage word-of-mouth participation in the program. Collaboration with various organizations would be needed for implementation.

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Addressing Childhood Obesity in South King County: A Recommendation for United Way of
King County
Alma Akras
University of Washington
Public Health Undergraduate Capstone
June 2016

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I. Summary and Synthesis of Childhood Obesity
Introduction
Childhood obesity is the prevailing nutritional disorder in America’s youth, with an
estimate of 1 in 5 children being obese nationally and locally in King County.1,2 Obese children
are 5 times more likely to be obese as adults compared to non-obese children.1 Not only is
childhood obesity a current concern, it creates an array of burdens for the future.1
Ironically, children of low-income families are 7 times more likely to be obese than
underweight.3 This paradox in a developed nation where excess body fat is associated with
lower-incomes can partially be attributed to the nation’s value of consuming cheap, processed
foods laden with added sugars, fat, sodium, and detrimental food additives.4 Additionally,
children of low-income households have an increased risk of becoming obese because of
increased food insecurity.4 Low-income communities are susceptible to living in food deserts
where healthy foods are difficult to access and afford. Food deserts primarily consist of fast-food
chains and convenience stores selling cheap, processed foods, rather than grocery stores that sell
healthy, fresh food options.4,5 Moreover, individual decision making of nutritional choices
contributes to the childhood obesity epidemic in America. Individual nutrition choices are often
formed through health education.6 Unfortunately, low-income individuals are less likely to
receive an adequate education compared to higher-income individuals, subsequently making
low-income individuals more likely to make unhealthy dietary choices.7, 8
Population
Within King County’s youth population, nearly half are of color; this is important to note
because obesity rates are highest among children of color.9,2 Specifically, south King County’s
youth faces a disproportional risk of obesity because of the region’s higher poverty rate and

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significantly lower education levels in comparison to King County overall.10 South King County
has the lowest median household income and the highest prevalence of food deserts within the
county, making healthy eating a common challenge for families.9 Lastly, children are
approximately 40% of south King County’s population, thus childhood obesity is a public health
concern requiring attention.10
Impacts of Childhood Obesity
Childhood obesity is a preliminary indicator of a child’s risk for future health outcomes.
For instance, obese children are more likely to develop Type 2 Diabetes, cardiovascular
complications, lower self-esteem, etc.11-13 Importantly, prevention and reversal of obesity is
critical to promote children’s health and development into adulthood.11,12,14 From a financial
standpoint, health care costs become a major burden on families with obese children.15 Obese
girls growing into obese women have increased rates of unemployment, or obese women who
are employed usually have significantly lower wages than normal weight women.16,17
Consequently, obese children growing into obese adults are 1.76 times more likely to be
compensated in unemployment wages and receive welfare, creating a massive financial strain on
the United States’ fiscal services and taxpayer’s money.18 Preventing childhood obesity, rather
than treating obesity’s effects, has the greatest impact for avoiding mental and physical health
threats that can have a lasting effect in adulthood.11,14,17
Stakeholder Input and Current Efforts to Address Childhood Obesity
A stakeholder in the issue, Emily Vyhnanek, is the family stability program coordinator
at United Way of King County. Emily emphasizes the importance of expanding outreach for
existing programs that address childhood obesity. For instance, the Summer Meals program is a
segment of the Fuel Your Future campaign alleviating food insecurity by providing meals in the

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summer months to children and adolescents who qualify for free and reduced lunches at school.
Importantly, Emily addresses the challenge of improving nutrition quality in the Summer Meals
program. Currently, there are two ways children can receive a lunch; either by picking their own
components of their lunch (a vegetable, a fruit, a protein, etc.) to create their meal, which is
called the ‘offer’ method and is used in the Des Moines area food bank. Whereas the majority of
south King County uses the ‘serve’ method, which provides children a pre-combined meal that
often loses nutrition through extra processing. Emily would like to see the ‘offer’ method
expand, especially since parents have noted that the meals are not as nutritious as desired.
On a national scale, Michelle Obama’s “Let’s Move!” campaign addresses America’s
childhood obesity epidemic through lifestyle changes. Michelle Obama places a primary
emphasis on children becoming more physically active.19 Similarly, the director of the Salvation
Army food bank in south King County, Martha Barrett, is an advocate for children to become
more physically active in their communities, rather than being confined inside their homes.
Martha also passionately explains the food bank’s partnerships with grocery stores, which have
enabled the food bank to shift from primarily stocking processed foods to now storing many
whole, unprocessed foods. For instance, dried lentils, whole grains, and fresh produce are
available at the food bank, and clients have expressed gratitude for this shift.
II. Recommendation
I recommend the UWKC’s Summer Meals program to expand the ‘offer’ method in south
King County, as well as incorporate nutrition workshops and enhance program outreach.
1. The ‘offer’ Method

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The ‘offer’ method is a tactic to improve the diet quality in children of low-income
communities where at least 50% of children are eligible for free and reduced lunches, like south
King County. The ‘offer’ method provides food that is less processed and has a higher nutritional
content. Expanding the ‘offer’ method with nutrition workshops allows children to individually
make healthier choices at sites to create a nourishing meal. Importantly, the ‘offer’ method
permits children to create a meal that aligns closer to their family’s cultural food norms, which is
relevant considering the abundant diversity present in south King County.9
2. Nutrition Workshops
To complement the ‘offer’ method, I recommend incorporating weekly nutritional
workshops for children at the Summer Meals sites. My intent is to advise, educate, and inspire
kids to have a stake in their food selections to make sustainable nutrition choices and create a
demand for improved food quality. Workshops would be designed using the 2015 Dietary
Guidelines for Americans (DGA) as a framework, putting research and expert nutrition
suggestions from the DGA Committee to work in communities. For instance, the 2015 Dietary
Guidelines emphasize decreasing added sugar consumption.22 An approach to teach children
what added sugar is and how it is hidden in processed foods can be demonstrated through an
awareness workshop that enables children to taste the raw form of chocolate, “a cacao nib”, and
to compare its taste and form to the common processed chocolates they are familiar with, like
Hershey’s, Reese’s, Kit-Kat, etc. The purpose of this activity is for children to understand how
heavily manipulated processed foods are with added sugar to become the sweet, indulgent
chocolate candy bars they consume. The workshops are an approach for children to become
mindful consumers in a society where large food industries market unhealthy foods specifically
to them.

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3. Outreach
Family involvement is crucial for creating sustainability and effectiveness for the
proposed nutrition education.20 Flyers containing each workshop’s key points can be dispersed to
parents/guardians for the purpose of integrating this knowledge at home. Additionally, an
overview budgeting pamphlet can be given to parents/guardians on how to make the nutrition
knowledge financially feasible, especially because many of these families are enrolled in the
Supplemental Nutrition Assistance Program (SNAP) or visit food banks.27 SNAP provides many
resources to guide families on food budgeting, which will be a helpful resource to create the
pamphlets. Another purpose of these flyers and pamphlets is to encourage outreach through word
of mouth to have families spread awareness of the program. Emily Vyhnanek stressed the need
to create more awareness of the Summer Meals program, especially through word of mouth,
which she noted to be the most common route of communication bringing the public to utilize
services.
Collaboration
To carry out this recommendation at Summer Meal sites, collaboration with United Way
of King County will be necessary, specifically the Summer Meals program coordinator, Lydia
Landrey. Speaking with managers of Summer Meals sites on how and why they should adopt the
‘offer’ method for their Summer Meal site will be crucial to expand the “offer” method. An
example meal is to make your own whole-grain wrap with options like fresh vegetables,
hummus, egg salad, tuna, beans, fresh herbs etc. A workshop to complement this meal would be
to communicate the 2015 Dietary Guideline of reducing saturated fat and sodium by
incorporating spices and herbs to substitute for the flavors provided by saturated fat and salt.22
The workshop would involve children planting herbs of their choice in a pot, which they can take

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home, care for, and have the family use in their meals to naturally enhance flavors of simple
dishes.
Finances
To address funding for the materials not included in the currently funded Summer Meals
program, additional funds may be received from United Way of King County, private grants, and
SNAP. Notably, my recommendation directly aligns with the federally funded ‘SNAP-Ed’
program, which provides guidance for communities and families on obesity prevention
strategies, which could be a potential partnership that could provide funds.23 In 2017,
Washington will be allocated an estimate of $9,598,456 for SNAP-Ed programs through federal
funding, which is a prospective source to fund my recommendation.24
Metrics
The success of my recommendation can be measured using focus groups and feedback
surveys from children and their family members. Also, at the beginning of the summer, a
nutrition questionnaire for children and their family members will be disbursed to grasp their
baseline nutrition knowledge. At the end of the summer, the same nutrition questionnaire will be
disseminated to track the effectiveness of the nutrition education on children and their families.
Additionally, the Center for Training and Research Translation (Center TRT) provides guidance
for applying evidence-based research to public health practice in nutrition for obesity
prevention.25 Center TRT provides logistical support for implementing this recommendation and
evaluating its significance for sustaining it as a long-term childhood obesity intervention.25
Justification

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My multi-faceted recommendation of expanding the Summer Meals’ ‘offer’ method with
incorporated nutrition workshops and program outreach is derived from research-based tactics.
For instance, research demonstrated the effectiveness of using pre-existing establishments,
community engagement, nutrition education, and a focus on preventing/reversing obesity to
mitigate health and financial burdens.20, 21 Importantly, I have specifically chosen to improve the
Summer Meals program because it addresses food insecurity, which is a prominent cause of
childhood obesity.4
From a long-term perspective, my recommendation is guided with the hope of low-
income families creating an increased demand for nutritious foods in their communities, which
would incentivize grocery stores to expand to food deserts and supply the demand. Especially
grocery stores that accept SNAP benefits, which would enable low-income families enrolled in
SNAP to have the financial feasibility of purchasing healthy foods, and the grocery stores would
receive the equivalent profit as they would from a customer not paying with SNAP benefits.26
From a personal standpoint, I created this recommendation because I sympathize for
children who are inevitably burdened with an increased risk of obtaining a preventable disease.
My family has a history of cardiovascular disease, which places me at an increased risk. My risk
has encouraged me to understand and create approaches using nutrition to avert obtaining a
preventable chronic disease. My recommendation encompasses my value of emphasizing the role
of nutrition in averting illness. Importantly, my passion and creativity in food and nutrition
propels me to implement my recommendation in partnership with United Way of King County.
By tailoring to the needs of at-risk children, early prevention and/or reversal of obesity can be
achieved to improve overall health and quality of life for susceptible children.

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References
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States. Obesity Research. DOI: 10.1002/j.1550-8528.1998.tb00322.x

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16. Caliendo, M., Lee, M. (2013). Fat Chance! Obesity and the transition from unemployment to
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24. SNAP-Ed. FY 2017 SNAP-Ed Allocation Estimates. Retrieved from:
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