Jamie Jeffrey, a pediatrician at Women and Children's Hospital, a division of Charleston, ( W. Va.) Area Medical Center, likes the everyday stuff of pediatrics. She swears she could talk all day about potty training and temper tantrums.

But by the early 2000s, Jeffrey was seeing so many overweight and obese children that treating chronic diseases like hypertension, Ttype 2 diabetes and sleep apnea became a regular part of her practice. "This was just something that hit me in the face," she says. Sixteen to 19 percent of children in West Virginia were overweight or obese, according to the Centers for Disease Control and Prevention. Jeffrey suspected that the obesity rate for her mostly urban, mostly Medicaid patients was much higher.

She decided to do her own research at the Children's Medicine Center, where she is director, charting the body mass index of her patients' body mass index. The results: 44 percent of kidschildren ages 2 to 14 were either overweight or obese. That prompted her to start a weight -management program that emphasizes family involvement and setting small goals each week. Each family has a team guiding them that includes a doctor, dietitian and nurse educator.

Many kids in the program are so overweight, they're off the children's body mass index chart, literally. "They're BMIs 42 and 43, and the chart only goes to 35," Jeffrey laments.

She realized that the problem wasn't just about family dynamics. How could kidschildren make better food choices if their after-school program served high-fructose juice instead of fresh fruit? Or cut down on video games and play outside more if they lived in a high-crime area or one with no green space nearby?

"I was asking my patients to do things that were too hard for them," she recalls. "It's not because they lacked motivation. They were trying so hard, but they were not being successful."

In 2008, Jeffrey approached the parent hospital, Charleston Area Medical CenterCAMC, about applying for a Healthy Kids, Healthy Communities grant from the Robert Wood Johnson Foundation. She also pitched the idea to the Kanawha (County) Coalition for Community Health Improvement, an organization founded by CAMC and other local hospitals to evaluate health risks and improve local health conditions. "Hearing from Dr. Jeffrey, we thought, 'Wow, this is something the coalition needs to apply for,' " says Judy Crabtree, the coalition's executive director. "I truly believe it wouldn't hadve happened without her driving it."

The coalition brought in 17 partner organizations that already were working on obesity efforts already, including the health department and the local United Way chapter, and organizations like Charleston's parks and recreation department.

In 2009, the program, called Keys for4 Healthy Kids, received a grant of $360,000 over four years. Each year, community partners have raised an additional $150,000.

Keys 4 Healthy Kids has two priorities: Increase access to healthy, affordable food and increase opportunities for physical activity.

The healthy food effort began with training at five child- care centers to improve lunches and snacks, and introduce activities to get the youngsters up and moving. Staffers are taught nutritional lessons and practical ones, too, like negotiating contracts with grocery stores to buy fresh fruit in bulk to save money.

The program launched 11 community gardens and 26 container or raised-bed gardens in classrooms. "Kids who wouldn't try anything new at lunch, now that they've planted it and saw it grow, they're going to eat it," says Jeffrey.

A mapping project identifies "physical activity deserts." One of the worst was a playground that closed after problems with teens. A youth council worked with the parks and recreation committee to make the park safer, and a promotional company to installed age-appropriate playground equipment at half the cost.

Jeffrey sees progress at places like a preschool, where cans of fruit cocktail collect dust because the kidschildren refuse to eat it.

"Something they had eaten and loved before now tastes slimy." she says. "That's very powerful because it shows if we give them the fresh fruit and vegetables — not force it, just offer it — not only will they eat it, they'll like it better."