Mildred Thompson, deputy director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity, discusses childhood obesity and the campaign to fight it.

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Margaret, today we are going to talk about childhood obesity and
have our listeners know that we work at the Community Health Center but few
know that since 1972 we have been building a world class primary health care
organization that’s committed to special populations focusing on improving
patient outcomes and building healthy communities. In addition to providing care
we are also engaged in research and innovation and this year we are very
focused on childhood obesity.

Margaret Flinter: You know, I think it's been almost 10 years since we did our
first study at the health center on childhood obesity and when I look back we
were lone voices in the world to some extent but it turns out people all over the
country will be getting to recognize just what a problem we had on our hands and
today, the whole country seems to be engaged in understanding it and working to
prevent it. In fact, we were holding our annual symposium, our Weitzman
th
Symposium in just a few weeks on June 10 and we are going to bring together
people from around the country to look at innovations and policy and clinical
practice and in community addressing the obesity epidemic because it's a
complex problem and you just can't address it on one level.

Mark Masselli: And you know The Weitzman Center has been doing this for five
years, bringing people in from all over the United States and around the world, to
talk to us about innovations in health care, and this childhood obesity panel is
going to be very exciting and robust. We have Dr. Ellen Rome from Cleveland
Clinic who will come and present the work that they have been doing and
certainly some of our own initiatives that we have developed at the health center.

Margaret Flinter: That’s right and we are happy to say Dr. Rome will be joined by
the Mayor of Somerville who is coming down with a team from Tufts. Also folks
from the Rudd Center at Yale which has done such groundbreaking work in this
area. But at the community level, we will be adding our own voices to that choir
of people who have done work with _______ and community development
projects working with young women and older women in the Community Health
Centers.

Mark Masselli: And our guest today can add to this important discussion about
childhood obesity and high performing health systems, Mildred Thompson is the
Deputy Director of the Robert Wood Johnson Foundation Center to Prevent
Childhood Obesity and she is here today to help us understand the goals and
challenges we face, we embark on their mission to occur childhood obesity. The
Robert Wood Johnson Foundation has been committed to addressing the obesity
epidemic for three years now and they have pretty ambitious goal to reverse it by

2015. We are happy Mildred can join us today to speak about this very important
subject.

Margaret Flinter: And no matter what the story, you can hear all of our shows on
our website Chcradio.com. Subscribe to iTunes to get our show regularly
downloaded or if you want to hang on to our every word and read a transcript of
one of our shows, come visit us at Chcradio.com.

Mark Masselli: And as always, if you have feedback, email us at Chcradio.com,
we would love to hear from you. Before we speak with Mildred Thompson, let’s
check in with our producer Loren Bonner with the Headline News.

Loren Bonner: I am Loren Bonner with this week’s Headline News. New findings
reflect infant mortality has dropped around the world especially in several
developing countries and improvements in care are linked to the good news. A
new study in the journal The Lancet from researchers at the Institute for Health
Metrics and Evaluation at the University of Washington found that the number of
children younger than five who die this year will fall significantly. Christopher
Murray is Director of the Institute for Health Metrics and Evaluation and Senior
Author of the study.

Christopher Murray: The number of children under age five around the world
who are dying drops quite a bit. It's gone down from nearly 12 million deaths in
1990 to 7.7 million deaths today.

Loren Bonner: The improvement is being attributed to scaled-up efforts in recent
years to combat things like malaria and mother to child transmission of HIV.
Mickey Chopra, the Chief of Health at UNICEF, says the countries that have
made the most progress in reducing child death rates are those where politicians
have made children’s programs a top priority.

Mickey Chopra: Spending more money but also in pushing community based
primary care interventions foremost and preventive interventions as well such as
vaccines and fluid and nutrition.

Loren Bonner: Chopra says that these simple but effective interventions show
real progress even when economic growth and poverty levels around the world
are not declining as fast. The data is less encouraging for the United States
however. As the rest of the world makes strides reducing child mortality, the US
nd
is lagging behind. Today the US ranks 42 globally, behind much of Europe as
well as Cuba and Chile. Researchers found high child mortality rates not only
among Latino and Black populations in the US, but also among higher income
Whites, a group that traditionally has better access to medical care. Researchers
also report substantially higher levels of preventable deaths from diseases like
diabetes and pneumonia. Maternal mortality is also higher in the US than in
most other industrialized countries. US deaths from obstetrical causes within

one year of giving birth rose 7.6 per 10,000 patients to 13.3 per 10,000 between
1996 and 2006. The reasons why are still unclear. Some attributed to the
changes and how statistics are now calculated. Other suspects are medical
approach hasn’t adapted to the shifting profile of the American mother, a woman
who today is more likely to be over 30 and obese. Others blame the high
rd
number of cesarean sections which account for 1/3 of all births to these
alarming statistics.

This week Conversations on Health Care focuses on the issue of childhood
obesity. Everyone from individuals to government and business realize that they
have a part to play to help solve this crisis. IBM is the latest to come forth. The
company is hoping to use its powerful data capabilities to give decision maker
support for identifying the most significant factors influencing obesity. IBM says it
will start utilizing computer models to analyze available data on known factors.
Things such as consumer behavior the location of grocery stores and fitness
facilities and even community transportation options to determine how these
factors interact and therefore what policy is best suited for a particular situation.
Since IBM has the technological capability the company says they see this as an
opportunity to work with different groups who have the data so that they can help
everyone from doctors to politicians make scientific decisions about childhood
obesity. It's an effort to understand and to quantify how every piece of our
environment can contribute to obesity because the problem is more complicated
than trying to push health food and more exercise onto people. Certainly this
connection between obesity and processed foods or lack of exercise is widely
acknowledged but in many cases it's a guessing game as to whether a bigger
impact would be made to incentivizing a new health food retailer to move into
town or expanding bus routes in areas with higher concentration of dual income
families. The advanced simulations of such factors and systems IBM is working
on could help predict which programs to curb obesity would be most successful
and where. Paul Maglio, an IBM researcher says lots of different organizations
already have models or ways of understanding different pieces of what is a very
complex system. IBM is unique and that it can bring all of those systems
together for the first time.

Mark Masselli: Our hope for the future is to be able to make planning decisions,
investment decisions based on an understanding of how the complex world
actually works and how the interactions of systems in that complex world actually
works as opposed to just thinking about those systems in isolation.

Margaret Flinter: IBM intends to partner with a range of individuals and
organizations on the project down the line from industry leaders to medical
clinicians by the end of this year. Its goal is to have one working model around
obesity and over the next few years IBM intends to create a replicable platform
so that decision makers can plug in their own models and make predications
about what policies around childhood obesity will work most effectively. Let's turn
now to our interview with Mildred Thompson from the Robert Wood Johnson

Foundation Center to Prevent Childhood Obesity to discuss why the foundation
has made reversing childhood obesity its top priority and the ways in which it's
been committed to the challenge.

Mark Masselli: This is Conversations on Health Care. Today we are speaking
with Mildred Thompson, Deputy Director of the Robert Wood Johnson
Foundation Center to Prevent Childhood Obesity, welcome Mildred. You know
the Obama administration has a strong plan in place to fight childhood obesity
through the First Ladies Let's Move campaign and your foundation was involved
in the report solving the problem of childhood obesity within a generation put out
by the White House Task Force on Childhood Obesity. Let’s do the 70
recommendations aligned with the foundation’s own policies and principles, but
one point where they differ is that your goal to reverse the epidemic comes 15
years sooner than the White House in 2015. What’s the basis for your more
aggressive goals and do you see some cause for optimizing in any of your early
results?

Mildred Thompson: There isn’t a major distinction. I think that we are all wanting
to see the health of our nation’s children improve. It’s just the measures that we
are using have some of them require a longer period of time but Robert Wood
Johnson Foundation is aggressive in trying to address this issue because really
they believe that everyday that passes means that our children are at risk for a
range of illnesses that some of which can be prevented, if we were to change
some of the environmental factors. So the sooner we can increase awareness
about the problems the sooner we can begin to improve the environment so that
parents and families can make better choices because they have better choices
available to them. And the optimism that I see is that this issue has never had a
more broader range of awareness in input and so at the highest level we have an
issue that we care of about and now it’s being embraced also by the
administration. At the same time there are stakes across the country that’s taken
on this issue at a local level, at a regional level and at a statewide level so there
is nothing like having a range of people speaking your same message about not
only the message about something needs to be done but that we need to do it
but looking at the environment and the place they focus. So to have that kind of
broad awareness about an issue is really the best way for us to kind of have the
impact that we are looking.

Margaret Flinter: And Mildred well before we heard about the administration’s
efforts this year, the foundation has been committed to addressing the obesity
epidemic, remembering back to the announcement in April 2007 that you would
invest at least $500 million over a five-year period to reverse the epidemic, and
certainly we have respected the foundation President Dr. Lavizzo-Mourey’s
commitment to making this a top priority. So you have funded such a wide
variety of initiatives and there is no simple answers to complex problems we
know that, but any one or two initiatives that things or promise of being a real
game changers, things that really seem to make a difference.

Mildred Thompson: Well, I think there are several things. #1 is the foundation
has funded leading researchers who is really making the case, who is showing
the evidence that this isn’t just an emotional factor. We are not trying to address
obesity to have a cosmetics for people to look better. It is about addressing the
implications of health and when you have the evidence that supports why these
changes need to be in place that’s really also critical but the foundation has
funded about 18 organizations under the umbrella of this obesity center that’s
doing a range of work around actions and advocacy and research that combined
we need all of that. We have got to have the research to support and build the
evidence. At the same time we have got to be excellent on the ground to change
those local policies and there is got to be a communication. So the other piece
that I would congratulate them about is this communication fees. This
awareness of shedding a light on why African American, Latino children face the
kind of risk associated with overweight and obesity at a much greater proportion
than other children. So we can’t allow this epidemic to continue and I think I
wouldn’t want to highlight one particular program because we need all of them.
We need the research, we need to excel on the ground and we got to have the
environmental change and this includes awareness and to communicate our
message to broad audiences.

Margaret Flinter: And research certainly takes time if it’s done well and I am
guessing then that we don’t have any of the results of the formal research
projects in yet. Would that be a fair statement?

Mildred Thompson: Well there is some research that’s in, that there is a research
that several organizations are doing research that’s really cutting edge, there is
Bridging the Gap is the group that’s been funded by the foundation to do
research. The Yale Rudd Center is doing some amazing research around sugar-
sweetened beverages and how it’s impacting the health of our children.

Mark Masselli: You know you have a great background for the job that you hold.
You were the director of the City of Oakland’s Healthy Start program and had
your own training in early childhood development, so you have a great grasp on
the importance of promoting and applying healthy practices for pregnant moms
and developing children and the White House report devotes that entire first
section to the significance of giving children a healthy start, things like promoting
prenatal counseling and breastfeeding, prioritizing research and factors that lead
to obesity. Can you explain why these initiatives in gestation and early childhood
are so crucial for the obesity prevention effort?

Mildred Thompson: You can't begin earlier so people believe that when a woman
is pregnant that’s the opportunity but really I believe that it's before she gets
pregnant because if she enters pregnancy in a compromised state of heath than
she is going to have a slightly harder time with this pregnancy according to the
data that we are aware of. So it’s important that a woman is healthy when she

enters the state of pregnancy. And so what we are trying to shed a light on is
that in order for her to be healthy to deliver a healthy baby the community has got
to support her in being healthy, that means there has got to be grocery stores
that give her the range of healthy food, there has got to be exercise, there has
got to be an emphasis on health and health promotion. Yes, there are some
communities who have been able to get money to fund to Healthy Start
Programs in their different areas and all of those efforts need to be in place
because you are using federal funds, you are having local public health
departments involved, you are having state health departments involved, and
really it requires a broad sector and engagement to have the kind of changes that
we are looking for.

Margaret Flinter: Mildred, we can't talk about children of course without talking
about the role of schools in children’s health. Recently we spoke with Colorado
Governor Bill Ritter who has a distinction of being governor of the leanest state in
the country but he made the point that they are very concerned there about the
_______ and that schools really represent an underutilized element of
infrastructure in this work on obesity. Certainly many of your initiatives have had
a focus on the schools, what evidence do you see that change in policy in
schools to promote better nutrition and physical activity can be an effective
strategy and does that benefit extend to other family members in addition to just
the children?

Mildred Thompson: Oh absolutely, absolutely. The school environment, it’s one
area that we are focusing on because that’s the place where children spend a
large majority of their time, not only when you factor in also the after school
environment. So we have to have healthy environment and that includes
everything from looking at the food that’s available in the schools and changing
some of those school food choices. And at least taking the vending machines
and sodas out of school and having healthy water available, getting the water
fountain in place. That also means having physical activity available, having a
requirement and a mandate for play for younger children at recess and play as
well as, some unstructured as well as structured physical activity and using
nontraditional, using dance and other forms of physical activity that’s going to
appeal to a range of children in their ethnic diversity. It also means making sure
that the schools have the kind of resources that they need to improve the school
environment and to make sure that schools understand that there is a link
between having healthy children and having high performing students.

Mark Masselli: Today we are speaking with Mildred Thompson, Deputy Director
of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity.
Another important area and effort is the initiative to give residents and low-
income neighborhoods more access to healthier food, it's a real challenge though
because many grocery stores don’t want to invest in the poor neighborhoods,
maybe don’t have the financial backing to put up grocery stores. Are there any

incentives for law makers to push more health food financing, is the foundation
working in this area as well?

Mildred Thompson: Yes, the foundation has been among a group of partners
who have been heavily investing in getting grocery stores in low-income
communities through efforts such as the Fresh Food Financing Initiative, that was
a model that existed in Philadelphia which showed that having these healthy
foods available in grocery stores, you know resulted in a variety of different
benefits. It wasn’t just the health, it was also the economic benefit. It was
around community development in getting jobs in place. And what we are really
excited about is that the Obama administration is trying to take that model and
bring it up to scale to have a national Fresh Food Financing Initiative in place and
several states have embraced that. So grocery store is just one example. Every
place isn’t going to have a grocery store. There are also incentives to have the
local corner stores serve healthier produce and having incentives to support
those business people to have the kind of refrigeration that’s needed. There are
also efforts around having Farmers Markets be more available and having them
accept WIC Coupons and the Food Stamp Coupons, so we have got to change a
range of Food Retail Environment to improve health.

Margaret Flinter: Mildred that’s very interesting and really focuses on going down
the positive road of making better food choices available to people. I think one of
the changes we have seen in this effort is that which is not so much anymore
about blaming the victim, blaming the person who is overweight or obese but
really looking at root causes and it seems to me that there is more of a national
dialogue beginning now on some of those root causes that maybe haven’t been
so public, the things that the researchers now call obesogens, chemicals that
may disrupt how we metabolize food and may contribute to it. And we have seen
a new collaboration between some of the corporations that produce the snacks
and the sugary drinks that people have implicated. Is your center involved in
those discussions with the industry that produces some of the foods that we have
been trying to move people away from and how is that initiative going?

Mildred Thompson: Well there is one of these things that we are doing is that we
are trying to figure out how to really effectively engage the business community
more effectively into this conversation, so that and the obesity center has created
a series of webinars that we have been doing to highlight these issues in one of
th
the webinars that will take place on June 9 , will be involving this group that now
being forms to Healthy Weight Commitment that’s a group of industry to hear
from them on the kind of strategies that they must undertake in order to change
the environment. So we have to make the case so that it's a win-win situation.
Yes, we want to engage them, yes, we want to hold them accountable, but we
want to see them do some of this voluntarily that in order for them to be really
good neighbors and business partners they have got to make it quite a fair
business case to improve the nutritional value of their foods, and to really listen
to the evidence and it happens to determine how they should make some

changes happen. So, yes we are engaging with them, we are trying to reach out
a hand and to be supportive but we are also going to push them when we need
to push.

Mark Masselli: Thinking about pushing people and new ideas, we would like to
ask all of our guest what innovations in health care do you see going around the
country with a world that excite you in? What should our listeners at
Conversations be keeping an eye out on?

Mildred Thompson: The preventive conversation because if we can provide
some of these diseases and illnesses that we don’t have to pay so much down
the road. That’s the one message that I want to begin to address is that we have
got to pay attention to the particular disparities that exist among the communities
of color in this communities that we live in and we have got to begin to take a
look at the region, how a southern region can have some of the worst health
outcome. So there is all of these things that we need to do to prevent some of
the roads that we are going down.

Margaret Flinter: We have been speaking with Mildred Thompson, Deputy
Director of the Robert Wood Johnson Foundation Center to Prevent Childhood
Obesity. Mildred, thank you so much for joining us today.

Mark Masselli: Each week, Conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives.

Margaret Flinter: In past weeks we have brought you stories on medical
applications for cell phones and video simulations for health care providers. This
week’s bright idea focuses on a new use of mobile health technology. Using text
messages to increase new mothers access to pertinent information, about having
a healthy pregnancy and raising a healthy child. The text for baby campaign was
launched by the White House in February and with the support of many partners
the program has already served over 36,000 expected mothers, and passed on
over a million text messages. Expect a mother, sign-up for these three weekly
text messages time to their due date. By receiving the messages several times a
week the program helps women remember to make crucial appointments, to take
certain safety precautions, such as wearing a seatbelt. These texts also convey
important news such as problems with pediatric medications. Text for baby also
makes a difference in the long run by helping mothers know what is normal and
what is cause for concern during different stages of pregnancy or early childhood
development. Mothers can receive information on specific topics whenever they
want by texting the word BABY to the number 511411. And text for baby has a
Spanish language version in which the users text BEBE. The program has many
enthusiasts who started outreach coalitions to spread the world. One such
coalition in Philadelphia celebrated Easter earlier this month and its diverse
members include the Philadelphia Health Commission, the Maternity Care
Coalition and Clear Channel Radio. Texts for baby’s creators have high hopes

for its continued growth and success. Over 90% of adult Americans carry cell
phones so this program reaches busy mothers right where they are, helping them
and soon their babies to lead healthier lives one text at a time. Now that’s a
bright idea.

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcasted from the Campus of Wesleyan
University at WESU, streaming live at Wesufm.org and brought to by the
Community Health Centre.