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Williamston, North Carolina is a small town along the banks of the Roanoke River, built back in 1779. Like many parts of rural America, Williamston has struggled economically over the years, but it’s now known as a haven for hunting, fishing, and camping around the lush Roanoke National Wildlife Refuge. No doubt Williamston residents were surprised to find that they were also known for living in the county with the shortest average life spans in North Carolina. A 2006 study conducted at Harvard found that residents of Williamston had disproportionately high rates of diabetes and cardiovascular disease, due primarily to obesity.
“The report said people in our county [Martin] had a rate of diabetes 87 percent above the state average,” explains Tim Hardison, an exercise physiologist who was a 7th grade science teacher in Williamston at that time. “People talked about the study, but I didn’t see anyone doing anything about it, so I decided to start with my students.”
Hardison began by teaching his class a very simple lesson. He showed them how to calculate their body mass index (BMI). Once they understood the formula, Hardison recalls, each student wanted to know, “Is my number good?” “I was shocked to find that 58 percent of that class was overweight or obese, but I could not imagine telling these kids they were obese without giving them the tools to do something about it.” Rather than trying to force the kids into diet and exercise programs, Hardison decided to make healthy life lessons part of their everyday curriculum and let them use the knowledge to help themselves.
The program he created—Motivating Adolescents with Technology to Choose Health (MATCH)—now engages 1,000 students a year in a 16-week curriculum that makes lessons about healthy eating, exercise and health risks (such as smoking, hypertension and heart disease) part of their school day. MATCH was developed and expanded with funding from the Blue Cross/Blue Shield of North Carolina Foundation. Hardison now works at East Carolina University and runs MATCH full time, while working to enhance the program with Suzanne Lazorick, MD, a 2009-2012 Robert Wood Johnson Foundation (RWJF) Physician Faculty Scholar and assistant professor of pediatrics and public health at the University.
Creating a Model to Move Forward
After the first year, Hardison saw that the BMI in many of his students had actually decreased after they participated in MATCH. To verify and improve results and collect more solid data, Hardison turned to Lazorick. “I teach prevention and population health,” Lazorick says, “but even though I focus on childhood obesity in clinic settings, I was interested in the bigger picture—working outside the clinic to help kids prevent obesity where interventions were likely to have their main impact.”
Using her RWJF Physician Faculty Scholar award to pay for her research time, Lazorick worked with Hardison on several aspects of the MATCH program. “First, we needed to refine the program so it could be taught by others and add measures for nutrition and physical activity. The first study was not controlled, so there was also a need to look more closely at the results. Our overall goal is to have an impact on childhood obesity, but this program is unique because it’s an educational model—a standard curriculum that also improves BMI. It will hopefully have a long-term impact on how the kids take care of themselves,” Lazorick says.
Motivating Kids To Get Healthy
While it is critical for MATCH directors to use sophisticated methods to collect data and present their case to funders, Hardison believes in the power of curious 12-year-olds. “I don’t really target parents, even though nearly 80 percent of MATCH participants’ parents are struggling with weight issues of their own,” Hardison says. “If you want to change a household, just give a 7th grader a little knowledge. They’re going to want to talk about it.”
Shondella Lawrence, a 12-year-old graduate of MATCH, is a perfect example. Softspoken, but proud of her accomplishments, Lawrence says, “MATCH taught me about what tobacco and cigarettes can do to your body, how to manage my weight, and how a person can get heart disease.” Lawrence says she has lost eight pounds since starting MATCH and made personal decisions about her health. “I’ve cut down on watching TV so that I can exercise more. Now I walk, play basketball with my family and drink lots of water.”
By simply educating kids, giving them tools to change, and motivating them through modest rewards like earning brightly colored wrist bands for their walking skills, Hardison and Lazorick continue to see great results. “About 70 percent of our overweight kids have improved their weight status in that their BMI has come closer to the mean,” says Hardison.
“Using the primary outcome of BMI Z-score that assesses if overweight students’ BMI moves closer to the mean, results from the first two years were published in the October 2011 issue of Childhood Obesity. Out of 198 kids, 104 were overweight at the start. Of these, 72 percent and 66 percent respectively decreased their BMI Z-score each year,” Lazorick says. “Some kids lost from 5 to 25 pounds during the first year of MATCH and 75 percent of them were successful in maintaining improvement when measured again at the beginning of the 10th grade year. Such a sustained improvement has not been shown by other school-based interventions and encourages us to continue to figure out ways to expand.”
Teachers also benefit. “I knew I could not burden teachers with a separate health curriculum, so I made the lessons part of math class (calculating calories and BMI), language arts (writing about smoking risks, heart disease, and health), and focused on evaluating and educating kids, then motivating them to participate in healthy activities,” Hardison says.
As they move forward, Lazorick says, “the mentoring and advice I received from RWJF Physician Faculty Scholar program colleagues around the nation really helped me work with this educational model of how to impact health. We have just been funded for the next three years to expand to 12 schools, from the seven we have been in the last two years, and we are applying for other grants to conduct research to find out what behaviors the kids changed, what role the home environment plays and to understand if and how the intervention increases motivation.”
“We want to streamline the program to make it easier for teachers and figure out what lessons work best,” Hardison adds.
The Robert Wood Johnson Foundation Physician Faculty Scholars program provides research opportunities for junior physician faculty members through mentoring, protected time, networking and the opportunity to gain valuable research experience. The program produces academic leaders who are creative and well-positioned to improve the nation’s health and health care.