South University Management of Childhood Obesity Johns Hopkins Nursing EBP Research Paper I have uploaded the 3 articles and the Research Evidence- Based f

South University Management of Childhood Obesity Johns Hopkins Nursing EBP Research Paper I have uploaded the 3 articles and the Research Evidence- Based form Appendix E Research appraisal, were each article individually has to be analyzed and placed on the Appendix E form. Curr Obes Rep (2017) 6:108–115
DOI 10.1007/s13679-017-0253-z
Partnership for a Healthier America: Creating Change
Through Private Sector Partnerships
Caitlin Simon 1 & S. Lawrence Kocot 2 & William H. Dietz 3
Published online: 24 April 2017
# The Author(s) 2017. This article is an open access publication
Purpose of Review This review provides background on the
formation of the Partnership for a Healthier America (PHA),
that was created in conjunction with the Let’s Move! initiative,
and an overview of its work to date.
Recent Findings To encourage industry to offer and promote
healthier options, PHA partners with the private sector.
Principles that guide PHA partnerships include ensuring that
partnerships represent meaningful change, partners sign a
legally binding contract and progress is monitored and
publicly reported.
Summary Since 2010, PHA has established private sector
partnerships in an effort to transform the marketplace to
ensure that every child has the chance to grow up at a healthy
weight. Many agreements between PHA and its industry
partners align with the White House Task Force Report on
Childhood Obesity. The reach and impact of over 200
partnerships attest to the success of this initiative.
Keywords Nutrition . Physical activity . Childhood obesity .
Business . Partnership for a Healthier America . Let’s Move!
This article is part of the Topical Collection on Obesity Prevention
* Caitlin Simon
In the late 1990s and early 2000s, voluntary agreements
emerged as a promising strategy to engage companies around
health issues. Private-public partnerships were forming to
solve some of the most critical global public health issues,
and both the World Bank and World Health Organization
promoted these approaches. When the Clinton Foundation
and the American Heart Association founded the Alliance
for a Healthier Generation (AHG) in 2005, two of their four
fundamental “pillars” were voluntary agreement approaches
with food and beverage companies and with health insurers.
In 2009, First Lady Michelle Obama was considering a
major initiative to battle childhood obesity. The Let’s Move!
initiative would include a broad set of activities; one strategy
included work with industry. In late 2009, discussions
between a number of organizations, including the Robert
Wood Johnson Foundation (RWJF), AHG and the White
House, led to the identification of a need for a national
organization that could drive voluntary changes by business
to address childhood obesity with public-private partnerships,
and hold companies accountable to implement those changes.
Additionally, these discussions acknowledged that ending our
nation’s childhood obesity crisis required a long-term “generational” strategy and therefore needed an organization that
would exist beyond the timeframe of the Administration to
continue efforts initiated by Mrs. Obama. To meet these needs,
the Partnership for a Healthier America (PHA) was created.
Partnership for a Healthier America, 2001 Pennsylvania Avenue NW,
9th Floor, Washington, DC 20006, USA
Creation of PHA and Early Work
Center for Healthcare Regulatory Insight, KPMG, LLP,
Washington, DC, USA
Sumner M. Redstone Center, Milken Institute School of Public
Health, Washington, DC, USA
As shown in Table 1, The Let’s Move! initiative was formally
launched on February 9, 2010. This launch by the First Lady
also included the announcement of a new independent foundation, The Partnership for a Healthier America, to “accelerate
Curr Obes Rep (2017) 6:108–115
Table 1
Partnership for a Healthier America’s Key Dates
Year Activities
2010 February: Let’s Move! and PHA launched
March: 1st PHA Board Meeting
May: Publication of the White House Taskforce Report on Childhood Obesity; HWCF commitment
2011 January: 1st full-time PHA staff hired
June: Let’s Move Childcare launched and Bright Horizons (PHA’s 1st Childcare) commitment
July: 1st food access commitment
November: PHA’s 1st Building a Healthier Future Summit
2012 September: Healthier Hospital Food Initiative launched with 17 hospital systems
2013 February: Let’s Move Active Schools launch
March: PHA’s 2nd Building a Healthier Future Summit; release of PHA’s first progress report (for 2012)
September: Drink UP launch
2014 March: PHA’s 3rd Building a Healthier Future Summit; release of PHA’s 2013 Progress Report; announcement of PHA’s 1st convenience store
November: Healthier Campus Initiative launched with 20 campus partners
2015 February: PHA’s 4th Building a Healthier Future Summit; Announcement of PHA’s first active design commitment; FNV announcement
May: Release of PHA’s 2014 Progress Report
June: FNV launches in lead markets
2016 May: PHA’s 5th Building a Healthier Future Summit; release of PHA’s 2015 Progress Report
existing efforts addressing childhood obesity and facilitate
new commitments towards the national goal of solving
childhood obesity within a generation” [1]. President
Barack Obama kicked off the launch by signing a
Presidential Memorandum creating a White House Task
Force on Childhood Obesity, with a mandate to develop
a national action plan within 90 days to maximize federal
resources and set concrete benchmarks towards the first
lady’s national goal.
PHA was incorporated on January 13, 2010, and its board
of directors was seated on March 23, 2010. In addition, on that
date, the board appointed a Founders Committee to serve in an
advisory capacity to the Board of Directors. Members of the
Committee included the leaders of The California
Endowment, Kaiser Permanente, Nemours, Robert Wood
Johnson Foundation and W.K. Kellogg Foundation. These
foundations and organizations had already worked together
for several years to address the challenge of obesity.
On April 1, 2010, the First Lady participated in a conference
call with the press to announce that she had agreed to be the
honorary chair of the Partnership, and that Mayor Cory Booker
and Senator Bill Frist would serve as honorary co-chairs. On
April 8, 2010, the Board met to approve the appointment of
Larry Kocot as interim president and CEO of PHA, the application for Section 501 (c)(3) status and consider a draft strategic
plan and commitment process for PHA.
PHA’s board and Founders Committee provided significant
expertise on issues related to childhood obesity, and the
organization was well positioned to play an independent,
non-partisan convener role in facilitating commitments across
the private sector. PHA’s first commitment was with the
Healthy Weight Commitment Foundation (HWCF),
which at the time consisted of 16 of the largest food
and beverage companies in the USA. The commitment
was the product of discussions between industry, the
White House, RWJF and PHA, and was formalized with
PHA on May 17, 2010. The HWCF committed to reduce the caloric content of their products by 1.5 trillion
calories by 2015. To validate the HWCF commitment,
RWJF funded an independent external evaluation that
ultimately found that the HWCF exceeded their commitment and reduced 6.4 trillion calories from their products [2]. Moreover, families with children purchased 66
fewer calories per day per person from HWCF brands, a
meaningful amount in children’s diets [3].
The commitment process adopted by the board helped
establish the operating principles for PHA, including that (1)
PHA would work independently, but in support of the Let’s
Move! initiative; (2) the process to develop and sign
commitments with the private sector would reflect meaningful
changes in support of honoring good behavior and changing
behavior; and (3) PHA would evaluate and publicly report the
progress of those commitments.
On May 11, while the HWCF agreement was being
negotiated, the White House released the White House
Task Force Report on Childhood Obesity. The Taskforce
Report outlined key issue areas, including early childhood, empowering parents and caregivers, healthy food
in schools, access to healthy, affordable food, and increasing physical activity. Additionally, the report outlined opportunities to create change, including where the private
sector could make a difference. Although PHA’s work
Curr Obes Rep (2017) 6:108–115
went beyond the focus areas outlined in the White House
Taskforce Report for Childhood Obesity, PHA used the
report to establish priorities for potential commitments.
Early commitments including the HWCF, early childhood
education, WalMart Stores Inc.’s (Walmart) agreement to
reformulate foods, and Walmart’s and other retailers’
commitments to build new stores to improve food access,
and several commitments that were made later reflect
recommendations from the report (Table 2).
Table 2
Since 2010, PHA has partnered with over 200 companies
to increase the supply of healthier options and launched two
marketing campaigns to build demand for those options:
“Drink Up” to encourage water consumption and “FNV” to
encourage the consumption of fruits and vegetables. PHA’s
effort to transform the marketplace, as a part of a broader
movement to ensure that every child has the chance to grow
up at a healthy weight, has become a key component in a
multi-sector effort to return child obesity rates to 1970 levels.
PHA partnerships aligned with the White House Taskforce on Childhood Obesity Report to the President
Goal or target
Examples of interventions
Early Childhood
Kaiser Foundation Hospitals Inc. commitment to achieve Baby-Friendly USA designation and/or
participate in The Joint Commission’s perinatal bundle.
Early care and education
Bright Horizons, Learning Care Group, KinderCare, and New Horizon Academy commit to
provide healthful foods and beverages and to promote physical activity.
Empowering parents
Making nutrition
Walmart’s commitment included the “Great For You” food labeling initiative and icon that designates
and caregivers
information useful
items that meet nutrition criteria informed by the 2010 Dietary Guidelines for Americans.
Darden Restaurants Inc., Hyatt Corporation, Subway, Sodexo, and Westin Hotels all committed to
improving the nutrition of their children’s meals.
Food marketing
Sesame and Produce Marketing Associations committed to collaborate to help promote fresh fruits
and vegetable consumption to kids.
Drink Up marketing campaign promotes water consumption and FNV marketing campaign
promotes fruit and vegetable consumption.
Health care services
700+ hospitals—representing about 10% of all hospitals in the USA—have joined PHA’s Hospital
Healthier Food Initiative, providing healthier options for hospital employees and visitors.
Healthy food in schools Food-related factors in
Sodexo committed to implement Smarter Lunchroom tactics and serving an additional 17 million
the school environment
free breakfasts in primary and secondary schools.
The Mushroom Council committed to pilot recipes for mushroom blend burgers in schools, and in
collaboration with Sodexo, 250 school districts across the country will be switching from
all-beef burgers for K–12 students to a mushroom-beef blend burger.
The Y-USA, Boys & Girls Clubs of America (BGCA) and the National Recreation and Park
Association (NRPA) committed to meet nutrition guidelines based on the National AfterSchool
Association’s Standards for Healthy Eating and Physical Activity (HEPA) in out-of-school time
Access to healthy
Physical access to
PHA’s 7 retail partners, including Walmart, collectively built or renovated 800 locations in areas
affordable food
healthy food
with low food access, increasing the accessibility of healthier food for more than 8.1 million
people across the country.
PHA partners include over 1100 convenience store locations across the country, 73% of which are
located in food deserts, are expanding healthier food options in their stores.
Through PHA’s Healthier Campus Initiative, 44 college and university partners collectively provide
healthier food options for more than one million students, faculty and staff across 26 states.
Food pricing
During the course of its commitment, Walmart saved customers more than $6 billion on fresh
produce and had over 470 healthier products that it ensured were priced less than or equal to the
less healthy alternative.
Product formulation
Sixteen major food companies—including Walmart, Sodexo, Subway, Dannon, and Mars Food—
have joined in the effort to transform the marketplace, creating healthier options and reducing
over 6 trillion calories in the US food supply.
Increasing physical
Expanded day and
The Y-USA, BGCA and NRPA committed to meet physical activity standards based on the
afterschool activities
National AfterSchool Association’s Standards for HEPA in Out-of-School Time Programs.
The “Built Environment” Kaiser Foundation Health Plan committed to support Fire Up Your Feet, a youth physical activity
program that encourages active transportation to and from school.
Four housing developers committed to incorporate active design strategies into their buildings,
creating healthier environments for 4650 units of affordable housing across the country
Community recreation
U.S. Tennis Association committed to create at least 5000 kid-sized tennis courts.
Curr Obes Rep (2017) 6:108–115
PHA’s Partnership Principles
Market transformation occurs when public health and
business sectors work together on agreements that are in the
interests of public health and the business interests of the
company. This perspective is consistent with CDC’s
Guidelines for Public-Private Partnerships [4•] as well as
Kraak and Story’s review [5•] of similar partnerships related
to the food environment. Both note the importance of an
agreement that includes clear goals that benefit both parties
and holds partners accountable for outputs or outcomes. The
agreement with the HWCF established several key operating
principles that have been expanded as PHA’s work has grown.
The first principle is that companies should stay in their
lane, i.e., a company’s commitment should relate to its core
business. For example, a food or beverage company should
commit to reduce calories in its products rather than invest in a
physical activity intervention.
Partners should make evidence based, meaningful
commitments that address nutrition and physical activity. To
ensure that commitments are meaningful, PHA develops
commitments with input from a variety of stakeholders. For
example, public health experts ensure that commitments are
informed by current science. At the same time, leaders in the
sector help inform PHA about the current landscape and challenges. The most successful commitments balance the ideal
with what is feasible. While PHA seeks meaningful commitments, commitments that do not advance the business interests
of the company making the commitment are not typically
sustainable. Sometimes, the consequence is that commitments
may not be transformative (e.g., a company agrees to end
production and sales of a sugar beverage), but rather incremental and meaningful (e.g. a company reformulates a sugar
drink to reduce calories by 30%). Additionally, PHA
considers the potential for initial commitments to create
sector-wide changes. For example, PHA’s work with Kwik
Trip, Inc. (Kwik Trip), a convenience store chain, led to
additional commitments from other convenience store chains
and some of the largest distributors in the sector. A subcommittee of PHA’s Board reviews and approves each commitment, and assesses the impact of the commitment.
PHA considers how each commitment specifically
addresses disparities related to obesity. Disparities became
an early PHA focus. However, as PHA grew and the work
evolved, consideration of the effect of the commitment on
disparities became an element of the approval process. For
some larger companies, the impact of a commitment on disparities is often likely but difficult to measure. Nevertheless,
PHA tries to ensure that the populations that need change the
most will benefit.
PHA commitments require a signed agreement for each
commitment. PHA distinguishes itself by insisting that
partners do more than publicly declare the actions they plan
to take. Companies are held accountable through agreed upon
metrics, signed contracts, and transparent reporting on
progress. At the outset, it is made clear that partners will be
held accountable for meeting their commitment, despite leadership changes or economic uncertainty, through a signed
agreement that specifies metrics and the timeframe. Progress
is assessed through verification of the commitments through
unbiased, independent third-party evaluators that monitor and
publicly report on the progress as part of PHA’s Annual
Progress Report.
PHA Partnerships 2010–2016
The wide range of partners and commitments makes it difficult to quantify the full reach and health impact of all of PHA’s
commitments. In addition, we are unable to routinely cite sales
data, which would reflect impact, because they are proprietary.
Nonetheless, estimates of the reach and outcomes of a number
of the commitments of PHA’s partners are summarized below.
These estimates reflect the number of individuals or organizations affected by the commitment at the time the commitment
was made.
Seven early childcare companies and out-of-school time
providers committed to collectively create healthier
environments for more than 6 million children.
Seven retailers collectively built or renovated 800
locations in areas with low food access, increasing the
accessibility of healthier food for more than 8.1 million
people across the country.
Sixteen major food companies—including Walmart,
Sodexo Operations, LLC (Sodexo), Subway ®, The
Dannon Company, Inc. (Dannon), and Mars Food US,
LLC (Mars)—joined an effort to transform the marketplace, creating healthier options and reducing over 6
trillion calories in the US food supply.
700+ hospitals—representing about 10% of all hospitals in
the USA—joined PHA’s Hospital Healthier Food Initiative,
providing healthier options for hospital employees, visitors,
and millions of patients.
Forty-four diverse colleges and universities across 30
states joined PHA’s Healthier Campus Initiative to create
healthier campuses for over 1.2 million students, faculty
and staff.
Five major brands—Nike USA, Inc. (Nike), Reebok
International LTD., Mercedes-Benz USA, LLC, Dick’s
Sporting Goods, Inc., and The North Face, Inc.—committed
to invest more than $115.5 million in activities to increase
physical activity in US children.
Four housing developers committed to incorporate
active design strategies into their buildings, creating
healthier environments for 4000 units of housing
across the country.
Curr Obes Rep (2017) 6:108–115
Over 1100 convenience stores across the country are
expanding healthier food options in their stores, 73% of
which are located in food deserts.
Company-Level Commitments
PHA partner commitments often result from one-on-one
negotiations between PHA and the respective partner.
These commitments can represent a core business change,
such as reformulation of products or menu changes, or an
investment in healthier choices, such as physical activity
programming. Examples include Walmart, Nike, Produce
Marketing Association (PMA), Sesame Workshop (Sesame),
and Dannon.
In January 2012, Walmart, the world’s largest retailer,
committed to work with suppliers to reformulate certain packaged food items by reducing sodium by 25% and added sugars
by 10%, removing all remaining industrially produced trans
fats, assuring that healthier choices are not more expensive
than their less healthy counterparts, and developing criteria
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