Community involvement and a shared belief that obesity is a preventable disease developed over a lifetime prompted HealthPartners, a seven-hospital integrated system in Minnesota, to launch a community initiative to prevent childhood obesity.

The idea started in 2011 when community representatives advising Lakeview Health Foundation’s board picked the issue as a problem its Stillwater, Minn., community could rally around and solve. The initiative began in three communities served by Lakeview Hospital in 2013 and grew to seven communities associated with additional HealthPartners hospitals by children healthy

The childhood obesity arm of the effort involves two similar programs, PowerUp and BearPower, which focus on improving nutrition, increasing physical activity, reducing screen time and discouraging consumption of sugar-sweetened beverages. Another program, yumPower, is a healthy eating campaign for people of all ages in the Minneapolis-St. Paul metropolitan area.

A major emphasis is changing the food environment so that eating healthy is easier for families, says Marna Canterbury, the Lakeview foundation’s director of community health.

For example, the PowerUp team has worked with food pantries — known locally as food shelves — to find new sources of fresh fruits and vegetables. Those sources include grocery stores pitching in produce near the end of shelf-life, community gardens, farmers and even home gardeners. “If we want the highest-risk kiddos in our community to be able to eat well, we need to know they have a steady supply of fruits, vegetables and good food, regardless of whether their families rely on a food shelf,” Canterbury says.

Supporting article: Obesity as a Chronic Disease, Not a Character Flaw

The pantries also redesigned their layouts to display fresh produce and whole-grain foods prominently and attractively. Eighty percent of people served by the food shelves have children, and a survey showed that their customers count on them for almost all their fruits and vegetables, Canterbury says.

Another part of the effort features elementary school “challenges” in which kids learn about nutrition, track how many fruits and vegetables they eat, taste vegetables, and take a “veggie vote.” In 2015, the program reached 22,000 kids in 60 schools. “The best way to encourage children to change their food behavior is to allow them to try something new in a really safe way,” Canterbury says.

On the initiative’s provider side, pediatricians, nurse practitioners and physician assistants ask families about their food consumption. If buying fresh produce is a challenge for families, the provider gives them a fruit and vegetable “prescription” — a $10 voucher that can be used to buy fresh produce at local grocers.

Plans are in the works for a similar project promoting exercise, Canterbury says. Families with economic barriers will get a prescription for physical activity in the form of a vastly reduced membership to their local YMCA.

The program has had many other successes. It worked with the Stillwater Public School District to change its wellness policy so that sweets are no longer used as a reward and recess denial is no longer used as punishment. School sporting event concessions now feature healthy options. Many schools hold open gyms in communities that don’t have a place where families can exercise in winter.

Businesses are embracing the initiative. When Great Harvest Bread Co. opened a bakery two years ago, it opted not to offer sugar-sweetened beverages. “It’s one relationship at a time building that momentum,” Canterbury says.

The initiative isn’t old enough to have made a measurable impact at the population level, but HealthPartners is tracking clinics’ body mass index data with an eye on the long term. In the meantime, it relies on surveys of its partners and families to measure success. A 2016 survey found that 93 percent or more of community members say the initiative is very important or important to their community, Canterbury says.

In addition to a staff investment, the effort costs HealthPartners about $350,000 annually, mostly for outreach, she says. Its partners chip in, too. For example, the grocery chain Cub Foods funds the fresh produce prescription, and the YMCA donates part of the reduced membership.

“This is not work that we as a hospital can do alone,” Canterbury says. “This is work that we do outside of our offices, building relationships with local restaurants, schools — anybody who wants to be part of this.”