This document provides information about childhood obesity rates globally and in the United States, with a focus on rates in North Carolina and Pitt County. Some key points: - Childhood obesity is considered one of the most serious public health challenges worldwide, with 42 million children under 5 estimated to be obese globally. - In the US, over 1/3 of children and youth are overweight or obese. North Carolina has the 5th highest rate of obese youth ages 10-17 at 19.3%. - In Pitt County, NC, over half the population is overweight or obese. The county has many fast food restaurants and sedentary lifestyles contribute to high obesity rates. The document proposes

1. HLTH 4200 Worksite Paper
By Justin Cude, Cami Lee, Maria Hartung, Constantine Unanka, and Trey Pennington

2. Section I
On an international scale, childhood obesity is considered to be one of the most serious
public health challenges of the 21st century [2]. Steadily on the rise as of 2013, obesity among
children below the age of five is estimated to be as high as 42 million globally, majority of them
(31 million) said to be living in developing countries [2].According to the Harvard School of Public
Health, obesity can harm nearly every system within a child's physiology, including the heart and
lungs, muscles and bones, kidneys and digestive tract along with the hormones that control blood
sugar and puberty. Also associated with obesity among the childhood population includes,
unfortunately, the heavy social and emotional stresses added by one’s peers and/or self. What
makes the problem of childhood obesity even worse is the fact that youth who are overweight or
obese have substantially higher risks of remaining overweight or obese leading into adulthood [1].
In a 2012 published study, one which focused in on and collected data from numerous studies held
between 1999 and 2011, authors Sameera Karnik and Amar Kanekar go into great detail explaining
multiple factors which influence childhood obesity and more importantly what can be done to
combat this epidemic. According to this pair of authors, “childhood obesity is due to the imbalance
between caloric intake of the child and the calories utilized for growth, development, metabolism,
and physical activities. Normally the amount of calories a child consumes through food or
beverages, if not used for energy activities, leads to obesity.” They go on further to explain that,
“Factors causing childhood obesity are genetic, behavioral, and environmental,” and “that obesity
can be multifactorial in children.” However the authors concluded by stating that childhood
obesity can be tackled at the population level by education, prevention and sustainable
interventions related to healthy nutrition practices and physical activity promotion[6].

3. Childhood obesity is becoming more prominent in America. According to NCCP(National
Center for Children in Poverty), childhood obesity was found to be most prevalent in the
Southeastern region of the United States with eight of the ten states recording the highest rates of
childhood obesity among the rest of the nation[10]. Nationally, more than one-third of children and
youth are overweight and more than 17 percent are obese [4]. Overall 33.5% of children ages 10-
17 years old are considered overweight or obese within the state of North Carolina. In fact, North
Carolina is ranked fifth worst nationally in regards to childhood obesity shown by the graph below
[5].
States with Highest Rates of Obese 10-17 year olds
Ranking States Percentages of Obese 10-17yr olds
1 D.C 22.8%
2 West Virginia 20.9%
3 Kentucky 20.6%
4 Tennessee 20.0%
5 North Carolina 19.3%
6 Texas 19.1%
7 South Carolina 18.9%
8 Mississippi 17.8%
9 Louisiana 17.2%
10 New Mexico 16.8%
In 2008, among N.C. children ages 10-17, 17.6 percent were overweight, and 15.2
percent were obese (a combined 32.8 percent were overweight or obese), compared to 61.3
percent who were at a healthy weight [4]. These results are shown in the graph below.

4. *BMI category based on percentile (underweight = below 5th
percentile, healthy weight = 5th
percentile to less than the85th
percentile, overweight = equal to or greater than the 85th
percentile but less than the95th
percentile, obese = equal to or greater
than the95th
percentile) for age. Datasource: North Carolina Child Health Assessment and Monitoring Program (CHAMP)
Survey Data (2008): State Center for Health Statistics, Raleigh NC.
In 2010, males had a higher rate of obesity than their counterpart females except for African
Americans. Percentages were collected for races of the following: Hispanic, Mexican American,
White, and African American. Hispanic males had an obesity rate of 25.5% while the females
stood at 17.5%. Mexican American males had an obesity rate of 26.7% compared to the females
at 17.4%. White American males had an obesity rate of 16.7% while the females were at 14.5%.
Finally, African American males had an obesity rate of 19.8% compared to 29.2% of the females
[10]. More specifically, Pitt County, located in Greenville, North Carolina, is home to 168,148
citizens. Of those citizens, half of them are overweight or obese [3].More than 1 in 3 kids are obese
or overweight, and 72% of adults are affected as well [8]. Obesity is often the product of factors
such as sedentary lifestyles, fatty foods, and family history. Research shows that families ate more
meals prepared away from home than in the past, resulting in consumption of more total calories
per sitting. In 2007, 49.9% of children were found to watch more than two hours of television per

5. day adding to the less than 44% of North Carolina’s high school students that were physically
active. In fact, around 20 percent of children did not meet the 60 minutes per day recommendation
for physical activity [7]. Below is a graph that includes percentages of children ages 6-17 who met
the 60 minute recommendation of physical activity.
Data Source: North Carolina Child Health Assessment and Monitoring Program (CHAMP) Survey Data (2007): State Center for
Health Statistics, Raleigh NC.
In Pitt County alone, 25% of adults eat fast food 4+ times a week, 16.8% adults meet the
fruit and vegetable requirements, 42% meet exercise requirements, and 20.5% claim to have been
sedentary for the past month [3]. Pitt County was the #1 city with most fast food restaurants in
2006, and currently has 100 fast food restaurants (not sit-down service) surrounding the area.
Obesity is a problem because it is affecting not only adults, but children as well since the parents
are setting examples for them.
Pitt Fit is a program that promotes health education as well as health promotion to
overweight and obese adolescents between the ages of 12-17 years old. By creating a safe, fun

6. environment for adolescents to exercise, Pitt Fit also hopes to target and change the lifestyles as
well. Project Mentor, a program based at East Carolina University that focuses on overweight and
obese adolescents, has had positive outcomes from the program throughout the years [7]. By
facilitating physical activity and fun, we hope to influence adolescents and educate them about
lifestyle changes. With a hands-on program that works one-on-one with kids, valuable benefits
such as self-esteem, self-confidence, and education can make a world of difference. Funding this
program can help with that. We truly believe Pitt Fit will be successful as well since it holds the
same values and ideals as Project Mentor.

7. Bibliography
[1] "Child Obesity: Too Many Kids Are Too Heavy, Too Young." Obesity Prevention Source.
Harvard School of Public Health, n.d. Web. 12 Nov. 2014.
<http://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends/global-obesity-
trends-in-children/>.
[2] "Childhood Overweight and Obesity." WHO. World Health Organization, 2014. Web. 12 Nov.
2014. <http://www.who.int/dietphysicalactivity/childhood/en/>.
[3] "Community Profile: Pitt County, North Carolina." Centers for Disease Control and
Prevention. Centers for Disease Control and Prevention, 25 Oct. 2013. Web. 8 Oct. 2014.
<http://www.cdc.gov/nccdphp/dch/programs/CommunitiesPuttingPreventiontoWork/com
munities/profiles/obesity-nc_pitt-county.htm>.
[4] “Data Resource Center for Child and Adolescent Health.” National Survey of Children’s
Health. Child and Adolescent Health Measurement Initiative Data Resource Center. 2007.
Web. 6 Nov. 2014. <http://www.childhealthdata.org/>
[5] “F as in Fat: How Obesity Policies Are Failing in America.” Trust for America’s Health.
National Survey of Children’s Health. 2009. Web. 15 Oct 2014.
<www.healthyamericans.org>

8. [6] Karnik, Sameera, and Amar Kanekar. "Abstract." National Center for Biotechnology
Information. U.S. National Library of Medicine, 2 July 2005. Web. 14 Nov. 2014.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278864/>.
[7] Muse, Kathy. "MINDSET MENTORS: ECU Students Learn While Training Teens to Embrace
Healthy Lifestyles." ECU Project Mentor. ECU News Services, 13 Oct. 2014. Web. 20
Oct. 2014. <http://www.ecu.edu/news/projectmentor.cfm>.
[8] “North Carolina State Center for Health Statistics”. Child Health Assessment and Monitoring
Program. North Carolina Department of Health and Human Services, 13 Nov. 2013. Web.
14 Oct. 2014. <http://www.schs.state.nc.us/units/stat/champ/>
[9] Oughton, Hali. "Pitt County Is 'Fit Community' with Obesity Problem." Pirate News Network
RSS. N.p., 11 June 2012. Web. 08 Oct. 2014.
<http://www.piratenewsnetwork.net/2012/06/11/fit-pitt/>.
[10] Wile Schwarz, Susan. "Adolescent Obesity in the United States." NCCP. Facts for
Policymakers, n.d., November 2010. Web. 16 Oct. 2014.
<http://www.nccp.org/publications/pub_977>

9. Section II
As an assessment mechanism, existing records would be most appropriate for Pitt Fit.
Doctors with records of overweight and obese patients are able to determine what is best for their
clientele. Recommendations of our program can be made to the parents, and through that, future
one-on-one meetings can be made with the parents to give them more information.
Another assessment mechanism that may prove to be useful for Pitt Fit would be the delphi
technique. Environments such as schools can be used by sending a form full of information home
with the child. If the parents are interested in the program, they can fill out their information to be
contacted with at a later date. If the parents feel uncomfortable about giving their information, or
if they are uninterested in the program, they have the option to remain anonymous.
Through both existing records and the delphi technique, interest data can be collected. The
delphi technique is used in an array of fields to study program planning, needs assessment, policy
determination and resource utilization specific to a real-world issue [11]. In regards to Pit Fit there
will be a panel of experts who determine how well the program will succeed. Experts will use
opinion and research based data to come to a consensus opinion on the given issue. Pit Fit will
utilize a health fitness specialist, nutritionist, and a pediatrician as panel members. This technique
will address future developments such as what could be or what should be, rather than what is
happening right now in order to determine overall success of the program.
Besides the health specialists in charge of the program, parents are also invited to determine
what is best for the children as far as the program goes. Parents are one of the most important
determining factors in their children’s success since they spend the most time with them.
Therefore, it is encouraged that they be involved. Teachers, especially physical education teachers,

10. in their schools should also be allowed to give their input since they are also working with the
children every week at school.
The goal of Pitt Fit is to promote healthy lifestyle habits in young teens and adolescents
between the ages of 12-17 years old, and to reduce the amount of obesity in the residents of Pitt
County. Through educating the parents of these adolescents, we hope to establish a good at home
environment that will aid in the prevention of health related risks.
GOAL: TO REDUCE TO AMOUNT OF OBESITY IN THE RESIDENTS OF PITT COUNTY
PROGRAM OBJECTIVES
1) By 2016, we would like to increase aerobic exercise amongst 12-17 year old kids in Pitt
County by 15%.
OUTCOME (what): increase aerobic exercise
TARGET POP (who): 12-17 year old kids
CONDITIONS (when): 2016
CRITERION (how much): 15%
2) Through our year-long aerobic exercise program at Pitt Fit, overweight and obese teens
will be able to reduce their risks of weight-related diseases as well as participate in a follow-
up every year for 2 consecutive years to determine their success and compare it to their
pre-program level of fitness.
OUTCOME (what): reduce risks of weight-related diseases as well as participate in a
follow-up
TARGET POP (who): overweight/obese teens
CONDITIONS (when): 2yrs
CRITERION (how much): duration of program

11. BEHAVIORAL OBJECTIVES
1) To encourage 30% of kids in Pitt Fit to adhere to continue on in the program until they age
out, and to continue with the lifestyle later on in life. There will be a follow-up with each
individual both 1 year and 2 years after the program's completion.
OUTCOME (what): At least 30% of kids adhere to lifestyle change
TARGET POP (who): Kids in Program
CONDITIONS (when): Until they age out of program
CRITERION (how much): Programs Duration and 1 and 2 year follow-ups
ENVIRONMENTAL OBJECTIVES
1) There will be a parents-child workout day once every month to both educate the parent on
their influential role in their child’s life, and to also get them involved in the activities.
OUTCOME (what): Educate and Involve in program
TARGET POP (who): Parents
CONDITIONS (when): Offered once a month
CRITERION (how much): Every month their kid is a part of the program
ADMINISTRATIVE OBJECTIVES
1) During the next 12 months, 30 adolescents will be participating in Pitt Fitt.
OUTCOME (what): Adolescents participating in work out
TARGET POP (who): 30 adolescents
CONDITIONS (when): Over the next year
CRITERION (how much): 3 days out of the week.

12. LEARNING OBJECTIVES
1) After participating in Pit Fit, those participating will be able to identify and make better
choices about daily exercise and eating habits.
OUTCOME (what): identify and make better choices about exercise and eating habits
TARGET POP (who): those participating
CONDITIONS (when): after completing the program
CRITERION (how much): daily
2) During one Pit Fit Session, participants will express their views on healthy eating habits
OUTCOME (what): express views on healthy eating habits
TARGET POP (who): those participating
CONDITIONS (when): during a session
CRITERION (how much): all

13. Section III
The PRECEDE model fits well with Pitt Fit because it focuses on outcomes rather than
input. It covers both the diagnosis as well as the assessment of the program. The social diagnosis
deals with the problems of the community and priorities of the people such as the overweight and
obesity epidemic. Epidemiological diagnosis identifies health goals and problems of the society.
This targets the unhealthy diet and lack of exercise of the community, as well as lack of willpower
to change their lifestyle. Educational and organizational diagnosis deals with three factors: the
predisposing factors, reinforcing factors, and enabling factors. The predisposing factors include
society’s beliefs, knowledge, attitude, and life experiences. The goal is to determine why society
has allowed itself to live an unhealthy lifestyle full of health risks, and what can be done to change
that. Reinforcing factors include social support, motivation, and influence. Through support of
their family, health education of specialists, and health promotion of Pit Fitt, goals can be met by
the mentees, motivating them to continue with the program. Enabling factors deal more with the
physical and mental ability to take part in the program. It also takes into consideration the available
resources, accessibility to the resources, and affordability for the resources. Next is the
administrative and policy diagnosis which does the assessment and development of the program
before implementing it. We obviously want to perfect the program as much as possible before
introducing it.
At the end of the program, process evaluation, impact evaluation, and outcome evaluation
take place. Process evaluation assesses the equipment, facilities, supplies, and personnel to
determine their impact on the program. Impact evaluation assesses the beliefs, knowledge, attitude,
intentions, and values of the participants to see whether or not there were any changes in behavior.
Pitt Fit hopes to influence the participants’ knowledge about various exercises and health

14. education, as well as transition their attitude to a positive outlook healthy living. Lastly, the
outcome evaluation assesses the productivity, health care cost, absenteeism, and behaviors. This
summary will help determine what can be done more efficiently, what aspects needs to be
improved, and how this program can be the best it can be.

15. Section IV
Program development:
What are you going to do to target the identified theoretical constructs? The PRECEDE model
focuses on predisposing factors such as the beliefs, knowledge, attitude, and life experiences of
the community. The goal of limiting the predisposing factors is to determine the causes for
unhealthy lifestyle leading to potential health risks, and create preventative outcomes. In order to
target the predisposing factors identified in section III, activities such as running, walking, weight-
lifting, sports, and machines would be incorporated into the program. Not only does it include
activities that the community has participated in before, but it also encourages new activities for
the community to engage in to increase their knowledge.
Technology:
- Myfitplan
- Music (to listen to with exercise)
- Fitbit and pedometer
Facilities needed:
- Gym
- Wellness center
- Field
Services offered:
- 1-on-1 with mentor
- Education on various health factors
- Group Activities
Contracts needed:

16. - Doctor notes
- Permission from parents
Marketing of programs:
- Facebook
- Doctor’s offices
- Schools
Timelines:
- 1yr program
- 2yr follow-up
Activities:
- Indoor activities
- Weights
- Machines
- Track for running/walking
- Outdoor activities:
- Sports
- Field activities
- Outdoor games
- Moderate & Intense activities
- Depends on risk classification
- Communication:
- Positive reinforcement
- Increase knowledge/awareness

17. - Incentives and disincentives:
- Look good/feel good
- Don’t like to sweat/feel gross
- Tired/sore
- Commitment need

18. Section V
Evaluation Plan
Independent Variables:
- Interventions
Dependent variables:
- Body Mass Index (BMI)
- Skinfolds
- Weight via scale
- Absenteeism
Confounding variables:
- Weather
- Schedules
- Absenteeism
Simple:
- VO2max
- Blood pressure
Complex:
- Absenteeism
- Productivity
Objective:
- Bruce maximal treadmill test
- DEXA
- Pedometers/Fitbit

19. Subjective:
- Absenteeism (lack of effort/motivation)
- Enjoyment
- Potential Outcomes
Participation:
- Regularity of Participation
- Absenteeism
- Adherence
Measuring program success can benefit Pitt Fit by giving insight about what needs to be
changed, removed, and what needs to be developed more. Measurements such as participation in
physical activity, knowledge and increased awareness of health, overall reduced health risks, and
recruitment/retention would show a success in the program. By inviting friends to join Pitt Fit, the
youth can encourage others to be active. Those who grow out of the program but still want to be
involved, could become a “mentor” for others, encouraging them to make lifestyle changes while
also keeping track of their own lifestyles.