Projects on Exercise for Combating Obesity

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Table of Contents

Introduction
Conclusions and Recommendations
References
Appendix A

Introduction

Subject: Funded projects related to the role of exercise in combating obesity.

On June 10, 2022, we had a meeting where we discussed the possibility of developing a new intervention program for preventing and fighting obesity through physical exercise. Following your request, I am sending you the results of the search I performed on the Grants Explorer website. I included the screenshots of strategies I utilized and the summary of the funded projects related to this problem to provide the foundation for our future research to design a better plan for obese individuals. Lastly, I recommend including two approaches to project management: programmatic and policy, systems, and environment (PSE).

Rationale

The primary rationale of our project was to comprehend the existing methodologies implemented by the scientists in this field and identify the most effective approach.

Methodology

Obesity became a global pandemic several decades ago when the fast-food industry started to rise on the market. Therefore, exploration of the past and ongoing funded projects related to this issue was explored on the RWJF Grants Explorer website. Figure 1 represents the search criteria that were utilized to identify research that was done in this field. The keywords were exercise and obesity, and the period was selected from 1972 to 2022. Since the amount of money awarded was an insignificant factor, in this case, the default criterion of any amount was selected. It was essential to choose both active and closed projects to understand the overall long-term trend of research related to the role of exercise in this chronic condition that affects various aspects of human health. In the advanced search area, such items as disease prevention and health promotion, social determinants of health, childhood obesity, health leadership, and health systems were selected.

Figure 1. Search Strategy on RWJF Grants Explorer

The advanced search restricted the number of projects to 33, which focused on various questions. Notably, many of the grant projects in the results section were associated with the pediatrics field because childhood obesity is a particularly significant issue in the United States. Funding for the studies ranged from less than $10,000 to about $24 million (Figure 2). Furthermore, Tables 1A-4A list grant projects studying the effect of exercise on obesity. Specifically, these projects focused on improving childrens and adolescents eating habits and physical training.

Figure 2. The Amount of Money Allocated to the Projects from 1997 to 2015

Statements of Findings

The two main approaches used in the selected projects were programmatic and PSE. The former implies grouping similar projects into one to save time and money and it is highlighted yellow in the table in Appendix A (Carroll and Woodward, 2020). For example, the 2004 project by Monadnock Family Services involved dance classes for people with mental illnesses and individuals with weight issues (Table 1A). The latter, which is highlighted in green, are the strategies implemented to increase the possibilities of healthier choices in a community (RHIhub, 2018). The project conducted by Young Audiences of New Jersey strived to help children be more involved in various physical activities by opening dance and music classes in schools (Table 1A). Morristown Memorial Health Foundation organized an adolescent training program to prevent obesity (Table 1A). The New Jersey KidFit program was funded to provide age-appropriate assistance and training to 10,000 children aged 5-13 (Table 1A). These four projects focused on introducing an intervention in the form of sports classes and activities.

The following four funded projects were more educational in nature. Saint Peters University Hospital organized the project for children of age 8-11 to educate them about healthy food choices and exercise they can do to maintain a healthy weight (Table 2A). Furthermore, the National Academies of Sciences project focused on printing and promoting the book about the causes, consequences, and prevention of childhood obesity (Table 2A). Willow School program strived to teach K-8 students about exercising and healthy eating to prevent obesity (Table 2A). Lastly, the project by American Heart Association introduced an educational program in schools across 13 states to teach students and staff about the importance of physical activity (Table 2A).

There were three nutritional projects striving to improve diet in schools and communities (Table 3A). These programs, conducted by Connecticut Childrens Medical Center, Stanford Institute for Economic Policy Research, and City of Garfield Health Department, separately strived to improve meals in schools and various neighborhoods. Moreover, six mixed studies incorporating nutrition and exercise were found (Table 4A). These six projects goals were to provide training and practical solutions for schoolchildren, their families, and teachers about healthy eating and exercise.

Conclusions and Recommendations

The review of the past and currently funded projects related to the role of exercise in fighting the problem of obesity showed that most were combined studies. These projects involved groups of people with different issues or incorporated other strategies like improving nutrition. Thus, to make our intervention program effective and financially reasonable, we should consider combining physical training and dieting for entire families with this problem. In terms of the PSE approach, the grouping of projects similar to the one proposed in this memorandum can be utilized to combine some of these projects to make them more efficient and less costly.

References

Carroll, S., & Woodward, C. (2020). How programmatic project management improves outcomes for cost, risk, and business performance. Aurecon. Web.

RHIhub. (2018). Policy, systems, and environmental change.

Appendix A

Table 1A.Grant Projects Related to the Role of Exercise in Obesity

Title	Organization	Abstract
Exercise Programs
New Jersey KidFit health and wellness program	New Jersey After 3 Inc.	The Foundations program, New Jersey Health Initiatives, was designed to support projects in New Jersey that develop new approaches to resolving the states healthcare needs, focusing on the Foundations goal areas. This grant supports the implementation of New Jersey KidFit, a high-impact health and wellness program, in a growing network of after-school programs throughout the state. New Jersey After 3 (NJA3) will develop activity guidelines that draw upon research-based promising practices in childhood obesity prevention. Program elements will incorporate regularly scheduled, fun, engaging, age-appropriate fitness and strength-building activities for children, including individual and team sports or aerobic exercises such as dance or martial arts; and participation in clubs organized around complementary nutritional, health, and wellness themes. Activities will target school personnel, families, and other values transmitters through workshops, newsletters, and/or by having them serve as program staff. KidFit will be implemented in 50 NJA3 after-school sites serving over 10,000 children ages 5-13.
Publication on the use of physical activity to prevent and treat obesity and its comorbidities	American College of Sports Medicine Foundation, Incorporated	The American College of Sports Medicine (ACSM) will convene a group of approximately 30 scientific experts for a two and one-half-day conference. The focus of the conference is aimed at developing a consensus document concerning the role of physical activity in the prevention and treatment of obesity and its co-morbidities and identifying the most important research issues to be addressed. This grant supports the publication of the complete conference proceedings as a special supplement to the ACSM Medicine and Science in Sports and Exercise journal. The ACSM will convene the conference to (1) summarize scientific literature pertaining to the role of physical activity in the prevention and treatment of obesity; (2) summarize the evidence for the role of regular physical activity in preventing obesity and treating the co-morbidities commonly seen in the obese; (3) develop a consensus statement on the role of physical activity in the prevention and treatment of obesity in relation to other modalities such as diet, pharmacotherapy and bariatric surgery; (4) develop a series of recommendations concerning the most pressing research questions to be addressed with respect to the role of physical activity; (5) publish a document summarizing the proceedings of the consensus conference; and (6) plan a session for the 1999 ACSM annual meeting.
Improving the health of adults with severe mental illness through involvement in community wellness programs	Monadnock Family Services	The Foundations Local Initiative Funding Partners Program is a matching grants program designed to establish partnerships between the Foundation and local grantmakers in support of innovative, community-based projects that improve health and health care for underserved and vulnerable populations. Even with appropriate therapy and psychotropic drugs, individuals with severe and persistent mental illnesses often have reduced longevity and quality of life due to smoking, obesity, hypertension, diabetes, and cardiovascular disease. This grant provides support for a program that will enroll adults with mental illness in community wellness activities, such as YMCA exercise and dance classes, Weight Watchers, and smoking cessation. In Shape will now grow from a successful pilot program in Keene, New Hampshire, to offer these services to more than 300 individuals in the surrounding 35 towns. The funding partners are Endowment for Health; Hoffman Family Foundation; Cogswell Benevolent Trust; Monadnock Community Foundation; and New Hampshire Charitable Foundation.
Measuring the features and amenities of physical activity resources and the variety and pricing of food around public housing	University of South Carolina Research Foundation	The Foundations Active Living Research program was designed to support investigator-initiated research to identify and assess structural, environmental, and policy changes with the potential to increase population levels of physical activity. This grant provides supplemental funds for a study originally funded by the National Cancer Institute (NCI) focusing on obesity and the built environment that examines the feasibility of obtaining adolescent self-defined neighborhood boundaries via a mapping exercise, tests the practicability of having adolescents complete travel diaries to document their travel and utilization behavior, and elicits factors that are important to adolescents in determining utilization, route preference and neighborhood boundaries. The supplemental grant will increase the use of objective data from a built environment assessment tool, the Physical Activity Resource Assessment instrument, and a nutrition environment assessment tool, the Nutrition Environment Measurement Study, to answer the question, how does quality (objectively measured) and availability of specific amenities or food variety affect physical activity and eating behavior in adolescents?
Feasibility study for expanding In SHAPE a wellness activity program for adults with mental illness	Comprehensive Health Education Foundation	Even with appropriate therapy and psychotropic drugs, individuals with severe mental illness often have reduced longevity and quality of life due to smoking, obesity, hypertension, diabetes, and cardiovascular disease. Monadnock Family Services has been working to reverse that trend with In SHAPE, a pilot program funded through RWJFs Local Initiative Funding Partners program involving 300 participants in 35 towns in and around Keene, New Hampshire. In SHAPE enrolls adults with mental illness in community wellness activities, such as exercise and dance classes and weight loss and smoking cessation programs. A recent study of the program shows significantly positive results in participants well-being and savings in Medicaid costs. The program has garnered strong interest from other communities and from the mental health field. This grant supports the Comprehensive Health Education Foundation (CHEF) to provide guidance and support to Monadnock Family Services in assessing the potential for the expansion of In SHAPE to other communities through replication or adaptation. Project deliverables include a summary of Monadnock Family Services organizational capacity to conduct expansion activities; a definition of the core elements of the In SHAPE program; a summary of the most promising approaches for expansion, as well as projected costs and benefits; and a strategic/business plan for implementation of the selected expansion model. The project is in line with a key component of the Foundations Vulnerable Populations Portfolios strategy: to support the spread of innovative program models to improve the health of the most vulnerable people.
Testing the long-term impact of a healthy lifestyle summer program	University of Houston Houston Park	The Foundations program, Salud America! The RWJF Research Network to Prevent Obesity Among Latino Children was designed to stimulate and support investigator-initiated research and build a field of researchers focused on preventing obesity among Latino children. This project will assess and compare the efficacy of two exercise programs in reducing adiposity indicators and in increasing daily minutes of moderate-to-vigorous physical activity (MVPA) in Latino mothers and their 9- to 14-year-old daughters in Houston. The first program, BOUNCE, provides one weekly exercise session, and the second program, ReBOUNCE, is an after-school aerobic program providing three exercise sessions per week. After participating in BOUNCE, 50 Latino mother and daughter pairs will be randomly assigned to continue in BOUNCE (control condition) or switch to ReBOUNCE (experimental condition). The programs are hosted at a local school, a community center, and adjacent parks. The project hypothesizes that the ReBOUNCE program will be more effe
Establishing a walking project to promote healthy lifestyles among children	Saint Peters University Hospital	Obesity has become a major public health problem. The increasing child and adolescent illnesses burden is especially alarming. This grant supports Saint Peters University Hospital in initiating a program called Promoting Healthy Lifestyles Among Children in New Brunswick. The primary goal is to encourage lifestyle changes in children and give them the tools for lifelong success in weight management by teaching them about good nutrition and physical activity behaviors. Children, ages eight to eleven, will get alternate half-hour sessions on healthy eating and fun physical activity over an eight-week period of time. Child physical parameters of body weight, blood pressure, heart rate, timed mile walk and sub-maximal exercise test, and a questionnaire about physical activity and eating habits will be conducted at the project start, end, and after six months. This project will be considered successful if 160 children are enrolled, improve their eating habits, reach appropriate weight for their ages, complete the program, and parents are educated about the importance of good nutrition and exercise for their children.

Table 2A. Educational Grant Projects

Educational Projects
Promoting healthy lifestyles among Native Americans	Nanticoke Lenni-Lenape Indians Inc.	The Foundations program, New Jersey Health Initiatives, was designed to support projects in New Jersey that develop new approaches to resolving the states healthcare needs, focusing on the Foundations goal areas. The purpose of this project, addressing obesity and diabetes prevention through the unity of the Nanticoke Lenni-Lenape Indians (NLLI) tribal community and traditions, is to target youth of the NLLI Tribe residing in Cumberland, Salem, and Gloucester counties. A summer youth camp will be designed and offered over two seasons to teach healthy traditions by changing the eating and exercise styles of participants and improving the overall lifestyles of the tribal community. Additional monthly youth activities will reinforce the program goals of preventing obesity and diabetes in American Indian children. Tools utilized in the youth camps will be introduced into tribal events, ensuring a community-wide focus on these issues.
Expanding a Web-based nutrition and fitness program for adolescents	Morristown Memorial Health Foundation Inc.	The Foundations program, New Jersey Health Initiatives, was designed to support projects in New Jersey that develop new approaches to resolving the states healthcare needs, focusing on the Foundations goal areas. This grant supports the implementation of Project TeenFit, which expands Morristown Memorial Hospitals health Web site for adolescents, TeenHealthFX.com, into a comprehensive obesity prevention program. Project features include a new, innovative nutrition and fitness Web site for adolescents, a program to introduce the site to seventh graders in six Morris County middle schools, and training on preventing adolescent obesity to parents, community leaders, and educators. Project TeenFit is a Web-based nutrition and fitness program that will allow adolescents to access information and participate online anonymously. The site will include a body mass index calculator, healthy recipes, tips on nutritional eating and exercise, quizzes and games, well-being and lifestyle topics, portion distortion, grocery shopping for the family, choosing good menus, costs of healthy vs. unhealthy foods, self-assessment questionnaires, and resources for further assistance. Site content will be medically accurate, age-appropriate, and ethnically diverse.
Educating congressional policy-makers on womens health priorities, particularly for low-income women and women of color, 2012-2015	Womens Policy Inc. dba Womens Congressional Policy Institute	Through this project, the Robert Wood Johnson Foundation (RWJF) will engage in nonlobbying, educational efforts and nonpartisan research and analysis to ensure that policymakers on Capitol Hill understand womens key health priorities. Specifically, policymakers need to understand the root causes, implications and trade-offs of policy options as identified in consultation with the bipartisan leadership of the Congressional Caucus for Womens Issues, key congressional staff members, the Foundation and key partners among non-governmental organizations. Key priorities over the coming three years could include health promotion and wellness during all life stages; racial and ethnic health disparities; and the potential of better health, reduced obesity, and prevention of violenceall as they relate to girls, women and their families, particularly low-income women and women of color. The bipartisan leadership of the Congressional Caucus for Womens Issues and its Health Task Force will co-sponsor all events. As deliverables for 2012, it is planned to conduct two large briefings open to a broad audience (to include members when Congress is in session); two or three meetings for congressional members only, and two meetings with only the Congressional Caucus for Womens Issues staff. Similar activities are planned for 2013 and 2014, but this grant is intended to provide flexibility in its programming to allow maximum impact. At no time will any portion of this grant be used for lobbying purposes. Similarly, Womens Policy, Inc., will exercise caution in planning activities that involve any members who are running for re-election to ensure that RWJF-funded activities do not actually endorse or appear to endorse any candidate for public office or provide support or assistance to any election campaign or political party.
Developing and publishing a book on preventing obesity in children and youth	National Academies of Sciences, Engineering, and Medicine	Obesity is implicated in approximately 300,000 deaths per year, and is now poised to surpass smoking as the most preventable cause of death in the U.S. For children, the epidemic is especially ominouspeople who become obese as children face the prospect of a life shortened and marred by medical problems, as well as the high likelihood of transmitting their vulnerability to weight gain and diabetes to their offspring. Parents and concerned consumers need to know what researchers have learned about preventing and treating obesity, and how to choose strategies that are most likely to work. This grant provides partial support for the production of a book by Susan Okie, M.D., in collaboration with the Institute of Medicine, currently titled, Protecting Children from Obesity. The book aims to present a broad, practical, and popular look at all the factors contributing to childhood obesity and specific strategies for protecting children, targeting those engaged in trying to improve childrens exercise and eating habits. This project will be considered successful if all project activities are completed and the manuscript is successfully completed and disseminated. Project activities will include: a review/survey of relevant child obesity literature; research on key issues of science, health, and public policy regarding childhood obesity; preparation of all written materials; book design and composition, production, and printing; and marketing and promotion.
Employing an open-innovation approach to develop a new model for academic publishing	University of California, San Diego	The purpose of this project is for the American Journal of Preventive Medicine to use an open-innovation model to test a variety of novel publishing, peer-review and engagement activities in an effort to develop a new model of academic publishing. If successful, the model will create new pathways for information that will enable academic journals to gather, synthesize, evaluate and disseminate practical information about interventions to practicing health professionals much more quickly than the current model permits. The current model, which treats traditional clinical trials as the gold standard for testing the safety and efficacy of interventions, has long been seen by health and health care observers as slowing down the process of discovery and practice innovation. The project will focus on research into new approaches to control childhood obesity. The deliverables will include tests of e-publishing the methods and results of small pilot studies, uncontrolled testing, exercises and case studies in user-centered design; crowd-sourced peer reviews; innovation challenges; development of the necessary editorial, data-collection and production structures; publishing 8 to 10 reports on new approaches to controlling childhood obesity; collection and publication of user feedback on the various tools and apps being tested; evaluation of the overall effort, based on a set of developed metrics (including numbers of submissions/postings, turnaround time, and reader assessment of the value of postings to clinical practice); and a report that articulates the new model for other academic publishers.
Educating elementary school children about healthy lifestyle habits through a puppet show format	MicheLee Puppets Inc.	The Robert Wood Johnson Foundation, Local Funding Partnerships program, is a matching grants program designed to establish partnerships between the Foundation and local grantmakers in support of innovative, community-based projects that improve health and health care for underserved and vulnerable populations. Building on 20 years of experience creating Muppet-style live puppet performances in schools, the EXTREME Health Challenge uses an interactive game show format to promote healthy nutrition and exercise for children grades K-5 in Florida schools. The script follows the mandated Sunshine State Curriculum, and teachers receive grade-appropriate classroom lesson plans that can be used before and after performances. This grant provides continued support for an auditorium-based show which will reach more than 200,000 children over the life of the grant. As it travels to approximately 360 schools throughout the state, it will reinforce other childhood obesity prevention activities, including those already funded through the Local Initiative Funding Partners Program. Funding partners include the Darden Restaurants Foundation; Edyth Bush Charitable Foundation; Florida Hospital; Sun Trust Bank; Winter Park Health Foundation; Community Foundation of Central Florida; The Chatlos Foundation, Inc.; Pinellas Co. Food Service; STEPS to a Healthier Pinellas; and Walt Disney World Company.
Establishing a center for health, fitness and nutrition education	Willow School	As countless studies have shown, the precipitous rise in childhood obesity has been accompanied by a correspondingly sharp increase in the incidence and prevalence of medical conditions in children that had been quite rare in the past. Aside from the crucial role played by genetics and various family environment factors, creating new habits of mind and behavior that promote and produce good health requires a comprehensive approach; one embracedat the very leastboth in the home and at school. The Willow Schoolan independent, coeducational, K-8 day schoolwill launch a program designed both to teach young children about the importance of sustaining their physical health and to make available to them the various means by which they can achieve this goal. The Center for Health, Fitness, and Nutrition Education (Center) will bring together, under a common rubric, several of the pursuits essential to leading healthy lives: physical education; hands-on instruction in organic gardening and food preparation; and the study of healthy eating, exercise, and play habits. This grant provides funding to help leverage other support to finance the construction of a new facility for the Center. This commitment from RWJF will help the Center raise the funds to hire the necessary staff to design the Centers programs and curriculum.
Expanding the Healthy Schools Program in states with the highest prevalence of obesity, 2007-2011	American Heart Association Inc.	During the past four decades, obesity rates have soared among children of all age groups, increasing nearly fivefold among those ages 6 to 11. Creating healthy school environments is an essential component of the Foundations strategy to prevent childhood obesity. Because 97 percent of youth in the United States attend schools, spending six to eight hours a day on school campuses, its essential that school policies and environments enable and encourage children to eat well and be active. The Alliance for a Healthier Generations Healthy Schools Program represents the Foundations largest investment in school-based efforts under its major initiative to reverse the epidemic of childhood obesity in the United States by 2015. The Healthy Schools Program was launched with Foundation support in 2006 to help schools develop healthy environments and to recognize those schools that succeed in doing so, and aims to: establish healthy school environments as an education priority; provide healthy food options for students during the regular and extended school day; increase opportunities for students to exercise and be physically active; and develop programs for teachers and staff to become healthy role models. For each objective, the program has developed policy, program and practice standards based on the best available evidence for affecting youth physical activity and eating behaviors. These standards serve as the basis for support to schools and for the recognition program. Support to schools is provided through onsite and virtual technical assistance. As of May 2007, 230 pilot schools in 13 states are receiving hands-on technical assistance, and more than 900 schools are enrolled in the virtual support program. Through these combined efforts, the program is already reaching nearly 750,000 students. To reverse the childhood obesity epidemic by 2015, RWJF needs wide-scale efforts with the potential to increase healthy eating and active living for millions of kids. This grant supports the expansion or introduction of the Healthy Schools Program in up to 17 states with the highest prevalence of obesity. It will enable the program to provide hands-on assistance to at least 6,400 additional schools that serve vulnerable populations and to offer online and phone support to all interested schools.
Providing performances of the Jump with Jill rock n roll nutrition concert to schoolchildren in NJ counties with the highest obesity rates	Young Audiences of New Jersey, Inc	Although the Robert Wood Johnson Foundation became a national philanthropy in 1972 and has operated on a national scale since then, it also has continued funding a limited number of local institutions and projects in the New Brunswick area and throughout New Jersey. It does so in part to honor the legacy of its founder, and in part to recognize the special responsibilities to the communities and the state in which it is located. This one-time grant will help Young Audiences (YA) expand the Jump with Jill program to serve more New Jersey school children in counties with the highest obesity rates, according to County Health Rankings: Cumberland, Salem, Atlantic, Hudson, Essex, Camden, Passaic, Cape May, Gloucester, and Union. Created by a registered dietitian and musician Jill Jayne, this proven-to-be-effective program uses the arts to educate elementary school students about health, nutrition, and exercise. YA will serve approximately 20,000 kindergarten and elementary school students throughout these counties. The live school performances are designed to translate nutrition education into music, dance moves, and a hip wardrobe to get students engaged, moving, and learning about healthy habits. Tailored for two age groups (grades K-2 and 3-5), Jump with Jill energizes and empowers students, giving them the knowledge to make healthy choices. The program-related books and other materials are aligned with the NJ Department of Educations MyPlate standards, and the Health Education Curriculum Analysis Tool standards.
Implementing People on the Move 2009 in Baldwin Park, Calif.	California Center for Public Health Advocacy	The Foundations program, Healthy Kids, Healthy Communities: Supporting Community Action to Prevent Childhood Obesity, was designed to catalyze and support policy and environmental change projects to promote childrens physical activity and healthy eating, especially in lower-income and racial/ethnic communities at greatest risk. The purpose of this particular project is to decrease unhealthy food marketing and advertising, increase access to healthy foods in corner stores near schools and improve greenways and walkability to the downtown as it undergoes development. Deliverables include developing a corner store strategy and citywide policy, building on the 2007 Resident Advocacy Promoting Health in Baldwin Parks Downtown Development Project by implementing policies and plans to improve greenways and walkability to increase opportunities for exercise and healthy food access.
Increasing capacity at the local level for social intervention to prevent childhood obesity (Year 1)	Third Sector New England	The Foundations program, Communities Creating Healthy Environments: Improving Access to Healthy Foods and Safe Places to Play in Communities of Color, was designed to build state and national momentum to reverse the epidemic of childhood obesity through strategic investment in those communities most affected. This grant will support Design Studio for Social Intervention (DS4SI) in furthering efforts of the Robert Wood Johnson Foundation to address childhood obesity through strategic investments in local advocacy and community-building. Specifically, DS4SI will develop materials and resources that will build the capacity of grantees of the Communities Creating Healthy Environments (CCHE) national program to develop effective, replicable policy initiatives to address childhood obesity, especially in communities most affected by the epidemic. Deliverables will include: (1) developing specific materials and exercises regarding culture, spectacle, game theory and other aspects of social intervention; (2) participating in strategic communications and other strategy discussions related to CCHE; and (3) facilitating discussions and providing training at technical assistance meetings, as well as at regional and national CCHE convenings. The grantee will not use RWJF funds to support lobbying activities or any communication to legislators reflecting a view on specific legislation.
Increasing capacity at the local level for social intervention to prevent childhood obesity (Year 2)	Third Sector New England	The Foundations program, Communities Creating Healthy Environments: Improving Access to Healthy Foods and Safe Places to Play in Communities of Color, was designed to build state and national momentum to reverse the epidemic of childhood obesity through strategic investment in those communities most affected.T his grant supports Design Studio for Social Intervention (DS4SI) in furthering efforts of the Robert Wood Johnson Foundation to address childhood obesity through strategic investments in local advocacy and community-building. Specifically, DS4SI will develop materials and resources that will build the capacity of grantees of the Communities Creating Healthy Environments (CCHE) national program to develop effective, replicable policy initiatives to address childhood obesity, especially in communities most affected by the epidemic. Deliverables will include: (1) developing specific materials and exercises regarding culture, spectacle, game theory and other aspects of social intervention; (2) participating in strategic communications and other strategy discussions related to CCHE; and (3) facilitating discussions and providing training at technical assistance meetings, as well as at regional and national CCHE convenings. The grantee will not use RWJF funds to support lobbying activities or any communication to legislators reflecting a view on specific legislation.
Engaging grant makers to develop coordinated and strategic action to address childhood obesity and foster a Culture of Health in Appalachia	Greater Kanawha Valley Foundation	This grant supports the active engagement of funders within the Appalachian region to develop shared approaches for advancing childhood obesity prevention through strategies for policy and environmental change. In isolation, grantmakers have limited capacity and resources to solve the serious and complex problems at the systemic level that impede the health and well-being of the people they seek serve. This is particularly true for funders in the Appalachian region. Despite meaningful individualized work, many of these grant makers lack a shared analysis of their regions health challenges. This problem is compounded by limited collective thinking on how to leverage and share resources on a systematic level; a low tolerance for investing long-term in specific areas; and differences in geography, culture, organizational practices, and priorities. The Appalachia Funders Network (Network) will lead an eight-month, collective-thinking process to identify and create a long-term strategic plan to address childhood obesity that focuses on policy and environmental change. The plan will delineate the specific geographic focus, as well as identify the funders committed to partner in this work. The Greater Kanawha Valley Foundation serves as the fiscal sponsor for this grant and will exercise oversight over the programmatic and financial aspects of the project. No RWJF funds will be used for lobbying.
Supporting the 2014 Urban Soccer Symposium	U.S. Soccer Foundation	This grant supports the U.S. Soccer Foundations Urban Soccer Symposium, a four-day event that provides community leaders with the opportunity to participate in interactive workshops designed to support and strengthen their current and evolving programs, using organized sports games (such as soccer) for social change. With obesity and overweight disproportionately higher in minority and low-income populations, the Soccer Foundation created the Symposium as a way to encourage increasing physical activity and improving the overall health of youths from these populations. This years symposium, May 1 through 4, in Washington, will host approximately 200 participants who typically work in communities with high minority populations and that are considered low-income. This years event will focus on asset-mapping exercises; strategies for instilling physical activity habits in youths; approaches for increasing free play for youths; and ways of maximizing impact through program models and building sustainable community partnerships. In addition, the participants will gain insights into the promising practice of positioning sports as the hub for wraparound youth and family services. Deliverables for this effort will include a summary report of the conference proceedings and details on ways in which participants have committed to using this information to promote physical activity through soccer within communities with high rates of physical inactivity and childhood obesity. The Soccer Foundation will not use Robert Wood Johnson Foundation funds for lobbying.
Developing and implementing the infrastructure for a national Web-based geographic information system for childhood obesity prevention (Phase 3)	University of Missouri-Columbia College of Agriculture, Food and Natural Resources, CARES	This grant provides continued funding for the Center for Applied Research and Environmental Systems at the University of Missouri to enhance the Childhood Obesity Geographic Information System (COGIS) by: (1) improving the GIS mapping interface, security protocols, and onboarding process; (2) developing the ability to create stories with interactive maps, images, documents, and video that are embedded and linked directly in the story itself (hypercontextualized narratives) and to connect to other websites and databases (interoperability); (3) providing targeted technical assistance and data-uploading services to users; and (4) analyzing spatial data. Many of the COGIS 2.0 functionalities will also be publicly available. Deliverables will include two training videos; an exercise on how to create a starter map, save a report, upload content, and create output; starter maps organized around the Robert Wood Johnson Foundation Childhood Obesity teams six policy priorities; a minimum of six training webinars; ongoing user support; surveys to assess user experience; the ability to create hyper contextualized narratives; and quarterly reports and a final report.
Increasing capacity at the local level for social intervention to prevent childhood obesity (Year 3)	Third Sector New England	The Foundations program, Communities Creating Healthy Environments: Improving Access to Healthy Foods and Safe Places to Play in Communities of Color, was designed to build state and national momentum to reverse the epidemic of childhood obesity through strategic investment in those communities most affected. This grant provides support for Design Studio for Social Intervention (DS4SI) in furthering efforts of the Foundation to address childhood obesity through strategic investments in local advocacy and community-building. Specifically, DS4SI will develop materials and resources that will build the capacity of grantees of the Communities Creating Healthy Environments (CCHE) national program to develop effective, replicable policy initiatives to address childhood obesity, especially in communities most affected by the epidemic. Deliverables will include: (1) developing specific materials and exercises regarding culture, spectacle, game theory and other aspects of social intervention; (2) participating in strategic communications and other strategy discussions related to CCHE; and (3) facilitating discussions and providing training at technical assistance meetings, as well as at regional and national CCHE convenings. The grantee will not use Foundation funds to support lobbying activities or any communication to legislators reflecting a view on specific legislation.
Womens Health Fair	Young Womens Christian Association of Princeton, New Jersey (YWCA)	This grant provides partial support for a womens health fair to be held in Trenton and to be targeted on four vulnerable populations: Latina/Hispanics, African/Americans, the elderly, and the disabled. The Breast Cancer Resource Center (BCRC), Princeton YWCA will sponsor the event. The fair will not only feature measures for the early detection of breast cancer (breast exams by volunteer physicians, instruction in self-exams, coupons for free mammograms), it will also include educational stations on a wide array of other subjects relative to womens healthamong them nutrition, prenatal care, exercise, hypertension, stress management, HIV, and obesity. Staff from area hospitals and special care centers (substance abuse) will be present to provide information on available health resources. Also, translators will be available to help non-English-speaking visitors attending the fair. BCRC will work with local churches and community leaders to ensure maximum attendance. This will include not only the promotion of the fair but also the provision of transportation, food, and baby-sitting.

Table 3A.Grant Projects Related to the Role of Nutrition in Obesity

Healthy Nutrition
Examining the effects of in-store marketing on the purchase of excess, non-nutrient calories and on childhood obesity	Stanford Institute for Economic Policy Research (SIEPR)	The Foundations program, Healthy Eating Research: Building Evidence to Prevent Childhood Obesity, was designed to support investigator-initiated research to identify and assess environmental and policy influences with the greatest potential to improve healthy eating and weight patterns among the nations children. The impact of family food purchasing on child obesity is understudied, and little is known about the roles that consumer shopping behavior and local prices for goods with different nutritional content play in determining obesity prevalence. This project will use unique; nationally representative scanned UPC data collected by Nielsen over a 12-year period on consumer grocery purchases and health to examine the role prices and local purchase environments (such as store density) play in determining the nutritional content of goods purchased and the resulting effects on obesity. Investigators will conduct a health behavior survey of families with children from the Nielsen Homescan panel, collecting additional measurements on individual-level health outcomes, food consumed outside the home, as well as exercise and other behaviors. A descriptive analysis will be conducted to examine how nutritional bundles from grocery purchases, prices paid for food items, food purchases outside the home, exercise behaviors and obesity status co-vary with each other and how these relationships change with household socioeconomic status. The causal effects of local food purchasing environments and food prices on the nutrient intake of households will be identified. To the extent that higher prices or the lack of accessible grocery stores play a role in reducing the nutritional quality of household purchases, these analyses will provide evidence on the scope of possible economic interventions. Deliverables include a series of academic papers to be published in applied economics and public health peer-reviewed journals.
Robert Wood Johnson Foundation Community Health Leaders	City of Garfield Health Department	The Robert Wood Johnson Foundation Community Health Leaders program was designed to provide recognition for the contributions community health leaders make to achieving RWJFs mission and goals and to enhance the capacity of these individuals to have a more permanent and widespread impact on health care problems. The RWJF Community Health Leaders Program annually honors 10 individuals who have made significant contributions to improving the health and health care of their communities. Each Community Health Leader receives an award in the amount of $125,000. Twenty thousand dollars goes directly to the leader to recognize past accomplishments and $105,000 goes to an organization designated by the leader to support the continuation of and enhancement of the leaders work. Darleen Reveille, RN, is the Senior Public Health Nurse at the City of Garfield Health Department in New Jersey. Darleen was selected as a 2012 Community Health Leader for her creativity and work in developing the F.U.N. (Fitness, Unity & Nutrition) Partnership to combat obesity by promoting community gardening, healthy nutrition, and summer camp activities for youth. Darleen will use RWJF support to create Food for Thought: Healthy Living. The project will include 20 local community partners in a collaboration designed to engage 300 seventh-grade students in a garden-to-table curriculum, along with activities including gardening, food safety, nutrition, and physical activity. Harvested produce will be distributed among the participating families, the school nutrition service, and a student-run farmers market. Brief questionnaires will be administered to participating children and their families to measure how community gardening and physical activity changed their knowledge, attitudes, and/or behaviors around nutrition and exercise.
Kid Healthy Program: Increasing daily exercise and the consumption of healthy food	Connecticut Childrens Medical Center	The Injury Free Coalition for Kids of Hartford, at Connecticut Childrens Medical Center, will implement and evaluate a community-based childhood obesity prevention program called Kid Healthy. The purpose of this project is to increase daily consumption of healthy foods (and decrease consumption of unhealthy foods) and increase daily exercise (and decrease sedentary activity). These objectives will be accomplished through: (1) educational sessions promoting Kid Healthy food choices and activity levels to children ages 6 and 7 and their caregivers; (2) engaging local groceries and restaurants to create an awards program for children who make healthy food choices; (3) promoting Kid Healthy choices in school menus and vending machines; and (4) building parent and community support for the program with a grassroots public awareness campaign.

Table 4A. Projects of a Mixed Nature (Nutrition and Exercise)

Mixed Nutrition and Exercise Programs
Building a movement of community residents for educational justice and a healthy community in East Los Angeles	Community Partners	The Foundations program, Communities Creating Healthy Environments: Improving Access to Healthy Foods and Safe Places to Play in Communities of Color, was designed to build state and national momentum to reverse the epidemic of childhood obesity through strategic investment in those communities most affected. The purpose of this project is to advocate for changes in school policies that increase access to healthy food, recreation and exercise for students in East Los Angeles. Deliverables include: increasing youth physical activity during and after school, the establishment of Health Empowerment Zones in at least four East Los Angeles schools, survey of organizations youth members on food and recreation choices, and the passing of school policies that improve the food and recreation environment for East Los Angeles students
Creating a bicycle-friendly community with access to healthy, affordable foods through community gardens in Baldwin County, Ga.	Georgia College & State University Foundation, Inc.	The Foundations program, Healthy Kids, Healthy Communities: Supporting Community Action to Prevent Childhood Obesity, was designed to catalyze and support policy and environmental change projects to promote childrens physical activity and healthy eating, especially in lower-income and racial/ethnic communities at greatest risk. The purpose of this project is to plan and implement several community vegetable gardens that are located in, or are in close proximity to, low and moderate income neighborhoods. The vision is to transform Milledgeville and the surrounding county into a Bicycle Friendly Community where active transportation is utilized for activities of daily living in addition to exercise and recreation. Deliverables include: working with after-school programs to implement the Smart Choices program, conducting an extensive self-study that addresses the 5 Es (engineering, education, encouragement, enforcement, evaluation and planning), and creating a 9.36-mile pedestrian/bicycle path that will travel along Fishing Creek from the Oconee River Greenway on the eastern edge of the community to the Industrial Park and Recreation Complex on the west side of town.
Aligning Forces for Quality: The Regional Market Project	Healthy Memphis Common Table	The Foundations initiative, Aligning Forces for Quality: The Regional Market Place, was designed to help communities across the country align health care forces to improve the quality of health care.Healthy Memphis Common Tables Million Calorie M.A.T.C.H AF4Q MATCH initiative is a collaboration among many partners to address the diet and exercise habits of the citizens of the City of Memphis and Shelby County, Tennessee, to address a local obesity epidemic. The policies advanced by the project are aimed at transforming the food and physical activity environments in multiple organizations and community venues. Targeted organizations include local municipalities (policy changes targeted to effect all public buildings), major employers, nonprofits, and churches. Deliverables will include the creation of policies that require healthy options in food and beverage machines, limiting desserts at meetings to fruit or smaller portions, requiring caterers to provide calorie counts on food, encouraging physical activity during the work day, and reorienting public spaces to encourage physical activity.
Aligning Forces for Quality: The Regional Market Project	P2 Collaborative of Western New York Inc.	The Foundations initiative, Aligning Forces for Quality: The Regional Market Place, was designed to help communities across the country align health care forces to improve the quality of health care. Under this grant, this initiative is managed by the P2 Collaborative of Western New York (WNY) in collaboration with community partners to provide school-aged children, their families, and the entire community with activities that will establish a foundation for making healthy choices about fitness and nutrition at an early age to minimize the trend towards obesity and weight-related illnesses. The project team will engage youth in schools to promote healthy eating and exercise inside and out of school, and convene and facilitate information sharing among service providers and policy makers to inform on grant activities and to share learnings. Deliverables include WNY implementation of the Fit and Fun program to encourage physical activity and healthy eating in schools. Additionally, project partners will work with school administrators to implement two policy changes that may include student access to fresh drinking water, promoting healthier food options, and improving the health of vending machine options.
Expanding the Healthy Schools Program in states with the highest prevalence of obesity, 2011-2014	Alliance for a Healthier Generation, Inc.	The goals for this grant are to increase the total number of schools engaged in the Alliance for a Healthier Generations Healthy Schools Program (HSP) by 15,000, with 1,500 receiving intensive on-site assistance, and to increase the number of schools achieving HSPs National Recognition Award by 50 percent. HSP supports schools with technical assistance, tools and resources to enable them to establish a healthy school environment as an educational priority; to provide healthier food options for students during the regular and extended school day; to increase opportunities for students to exercise and play before, during and after school; and to develop programs for teachers and staff to become healthy role models. Additionally, HSP recognizes schools that succeed in these goals through its awards program. Currently working with more than 10,000 schools, HSP will continue to focus its efforts on those states and school communities most impacted by the childhood obesity epidemic.
Supporting HealthCorps use of peer mentoring to curb childhood obesity at four U.S. high schools	HealthCorps	This grant provides support for four full-time HealthCorps coordinators to serve in four diverse high schools across the country to engage students in a nutrition, fitness and mental-resilience curriculum in the classroom, as well as in relevant service-learning projects outside the classroom. Each HealthCorps coordinator will make a two-year, full-time commitment to their assigned school. Approximately 600 students will participate at each school, thereby impacting up to 2,400 students. These students will engage in service-learning projects that will impact up to an additional 7,200 community members. The project will provide students with the information needed to make healthy choices about diet and exercise, as well as with experiential opportunities.

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