Taking on childhood obesity in a big city: Consortium to Lower Obesity in Chicago Children (CLOCC)

https://doi.org/10.1016/j.ppedcard.2008.05.004Get rights and content

Abstract

A growing body of research on childhood obesity points to the increased risk of chronic disease from early childhood through adulthood, including coronary heart disease. There is growing consensus on the need to address childhood obesity at multiple levels (individual, family, community, societal). The Consortium to Lower Obesity in Chicago Children is a data-driven, multi-level, multi-sector, Chicago-wide initiative aimed at preventing childhood obesity. This report outlines how CLOCC was formed, how it is organized and conducts its work, its evaluation activities emerging results. Lessons learned and recommendations for other chronic disease prevention consortia are provided.

Introduction

The scale of the current childhood obesity epidemic is by now familiar to health professionals and the general public, as are its potential effects. A growing body of research points to increased risk of chronic disease from early childhood through adulthood, including coronary heart disease [1], [2], [3], [4]. There is growing consensus on the need to address obesity and to do so using an ecological model (i.e., with simultaneous work at the individual, family, institutional, community and societal levels) [5]. However, there is much less consensus on how this model can be employed, due in large part to the sparse current body of knowledge on what works for childhood obesity prevention or management [6], [7].

To establish this consensus, research is needed to expand the body of evidence that can guide interventions. Available information must be applied in creative prevention and management trials at all ecological levels and in all societal sectors, including homes, schools, primary and specialty care practices, community centers, businesses, government agencies, and industry [8]. Such multi-level initiatives must be carefully evaluated, to assure that our knowledge base will allow us to invest the limited resources available in what is most likely to work. The results of these trials and evaluations then must be disseminated to diverse actors and organizations who can integrate effective methods into existing policy, programs, and practice. Effective multi-level networks will be instrumental in catalyzing the development and dissemination of knowledge, and to policy and advocacy efforts that will help to increase funding, improve environments, and change institutions in ways that are favorable to obesity prevention.

The Consortium to Lower Obesity in Chicago Children (CLOCC, www.clocc.net), founded in December 2002, is such a network. CLOCC is a data-driven, multi-level, multi-sector, Chicago-wide initiative aimed at preventing childhood obesity. To date, CLOCC has engaged over 1700 individual partners from over 700 organizations in all sectors of Chicago life and beyond. CLOCC has been recognized as a model childhood obesity prevention effort by the American Medical Association, the Centers for Disease Control and Prevention, the Institute of Medicine, and The United States Surgeon General for its innovative approach and broad reach [9], [10], [11], [12]. The Consortium is being tapped for technical assistance by emerging coalitions across the country. This report outlines how CLOCC was formed, how it is organized and conducts its work, its evaluation activities and emerging results. Lessons learned and recommendations for other chronic disease prevention consortia are provided.

Section snippets

CLOCC's formation

In the spring of 2002, the Otho S.A. Sprague Memorial Institute, a Chicago-based family foundation focused on health and healthcare, proactively funded a planning process to determine the viability of a consortium to address childhood obesity in Chicago. The planning process was led by the third author, Katherine Kaufer Christoffel, who has long worked in Chicago on issues at the border between clinical medicine and public health. The planning process was based on four key premises: 1) the

Structure and operations

CLOCC sits in the Center for Obesity Management and Prevention (COMP), in the Mary Ann and J. Milburn Smith Child Health Research Program of the Children's Memorial Research Center (CMRC, www.childrensmrc.org/comp). CMRC is the research arm of the Children's Memorial Hospital (www.childrensmemorial.org), a freestanding children's hospital that is affiliated with the Feinberg School of Medicine at Northwestern University. COMP coordinates the community, clinical, research, and educational

Efforts related to data surveillance

Effective public health work requires current information on condition prevalence. CLOCC immediately identified and addressed a gap in data to describe patterns of obesity in Chicago children, particularly those in the focus age range of 3–5 years. Working with the Chicago Public Schools and the Archdiocese of Chicago, CLOCC collected BMI data from children's school health exam forms in 28 public and Catholic schools. The data showed that 23% of children in Chicago had BMIs above the 95th

Efforts related to policy development

The release of CLOCC's 1st Annual Report – which included the BMI data described above – raised public awareness and thrust the Consortium into policy discussions at the state level. In the following months, dozens of bills related to childhood obesity were introduced in the IL General Assembly, and CLOCC was often asked to provide analysis. Soon, CLOCC saw the need to develop a legislative agenda of its own. Two working groups identified BMI surveillance as a top priority, and jointly hired a

Efforts related to clinical care

CLOCC's clinical initiatives emerge from the work of the Clinical Practices Working Group. Clinicians in the working group seek to share existing resources and develop new ones to enhance clinical efforts in childhood obesity prevention and management. Efforts to date have focused on 1) identification of local resources and advertisement of resources tested at local primary care sites (http://www.childrensmrc.org/pprg/resources), 2) discussions on coding of childhood overweight conditions (//www.clocc.net/resources.htm

Public education

Early in its history, CLOCC saw a need for broad-based public education to raise awareness about childhood obesity and provide positive guidance to Chicago families for protecting their children from the epidemic. Development of a communication campaign became a top priority. With marketing expertise and support from corporate partners, CLOCC Directors hired a public relations firm and worked with them to develop the shape and creative components of a campaign. CLOCC trademarked the campaign

Community-based initiatives

In order to facilitate the behaviors recommended in the 5-4-3-2-1 Go! message, resources and strategies need to be directed at the local, neighborhood level. Chicago is divided geographically into 77 official neighborhoods. CLOCC identified 10 of these as having obvious need (often with good baseline data) as well as pre-existing relationships with CLOCC partners and some capacity to organize around childhood obesity prevention efforts. CLOCC refers to these as “vanguard communities.” Community

CLOCC seed and implementation grants

From its inception, CLOCC has provided seed funding to research projects related to its mission and goals. Proposals that focus on formative research and program evaluation are reviewed and funds (typically ~ $10,000–$20,000 per project) are awarded twice a year. Past funded projects include an inventory of physical education program needs in Chicago schools and piloting of a preschool intervention for Latino children and families. All funded projects are listed on the CLOCC website, and

Funding history

CLOCC's first full year of operation was sustained solely by resources from one local foundation that awarded a 3-year $550,000 grant (the Otho S.A. Sprague Memorial Institute) and the indirect support supplied by Children's Memorial Hospital. Currently, 90% of CLOCC's $1.9 M annual budget is raised from local and national philanthropies. A few grants have been multi-year, but most are for just one year. At the time of this writing, 10 foundations are engaged. Less than 10% of the overall

CLOCC evaluation activities and plans

With CLOCC's growth and reach has come the need to understand the Consortium's effects. CLOCC received initial funding from the Chicago Community Trust to perform a qualitative evaluation of its resource development, capacity building, involvement of community agencies, and fostering of new programs. Results indicated that Consortium partners were pleased with CLOCC's direction and derived great benefit from participation in its many activities. Currently available data from partners confirm

Dealing with opportunities and obstacles

CLOCC has become a resource for obesity prevention in Chicago and beyond. Local and national recognition have resulted in numerous requests to serve on advisory groups, participate in events and meetings, provide consultation on projects, mentor students, and more. CLOCC's growing staff has been critical to the Consortium's ability to respond. Yet, a growing staff also presents a growing fundraising burden. One alternative has been to forward requests on to Consortium partners — creating

Lessons learned from CLOCC's experience to date

  • 1.

    A strong office and leadership are needed for such a broad effort that relies heavily on volunteerism and aims to support and mobilize the many organizations that help the Consortium to achieve its mission.

  • 2.

    Working groups are most effective when leaders come from organizations highly engaged in community-based work and when group goals are related to the missions of those organizations taking the lead.

  • 3.

    Empirical data help to create a solid foundation on which to build, but may not be readily

Acknowledgements

The authors thank CLOCC's able staff and many partners for their contributions to CLOCC's work, including this manuscript.

References (25)

  • W.H. Dietz

    Critical periods in childhood for the development of obesity

    Am J Clin Nutr

    (May 1994)
  • S.M. Lorch et al.

    Myocardial velocity, strain, and strain rate abnormalities in healthy obese children

    JCMS

    (2007)
  • H. Zhu et al.

    Relationships of cardiovascular phenotypes with healthy weight, at risk of overweight, and overweight in US youths

    Pediatrics

    (Jan 2008)
  • J.L. Baker et al.

    Childhood body-mass index and the risk of coronary heart disease in adulthood

    NEJM

    (Dec 2007)
  • K. Bibbins-Domingo et al.

    Adolescent overweight and future adult coronary heart disease

    NEJM

    (Dec 2007)
  • K.K. Davison et al.

    Childhood overweight: a contextual model and recommendations for future research

    Obes Rev

    (Aug 2001)
  • S.E. Barlow et al.

    Management of child and adolescent obesity: summary and recommendations based on reports from pediatricians, pediatric nurse practitioners, and registered dietitians

    Pediatrics

    (Jul 2002)
  • H.J. Binns et al.

    Guidelines help clinicians identify risk factors for overweight in children

    Pediatr Ann

    (Jan 2004)
  • Institute of Medicine

    Preventing childhood obesity: health in the balance

    (October 2004)
  • Centers for Disease Control and Prevention

    Certificate of appreciation: partner in advancing public health award

    (2004)
  • M.M. Longjohn

    Dinner speaker

  • L. Tanner

    Chicago group tackles childhood obesity

    (October 19 2004)
  • View full text