Case Study: Shape Up Somerville

Shape Up Somerville started as a community-based participatory research (CBPR) trial in 2003 with funding from the Centers for Disease Control and Prevention.¹ The goal was to create a multi-level approach to prevention of obesity among elementary children in 1^st through 3^rd grade.²  In Somerville, “44% of the city’s 1^st through 3^rd graders were overweight or at-risk of being overweight.”² The city of Somerville partnered with Tufts University, the Somerville School Committee, and a variety of community-based organizations to engage the community and influence the multiple sectors that would have an impact on obesity prevention.³ A broad range of strategies were used to develop and implement projects that would coordinate efforts to create environmental changes within the community, specifically targeting elementary aged children.³

Formative research, including: focus groups, one-on-one interviews, and community meetings, were conducted to gather data for the community initiative.¹  Building relationships was crucial to the success of Shape Up Somerville.  Tufts University met with community leaders and conducted key informant interviews to gain support and trust within the community.¹ Additional support for the intervention was garnered from elected and appointed officials in the community, as well as numerous organizations.  To aid in the design of the intervention, focus groups were held with parents, children, and teachers.¹ Other forms of community outreach included: monthly parent and community newsletters, community events, local media utilization, meetings with the Parent Teacher Association, and the use of public forums for specifically parents.⁴

Projects and programs that Shape Up Somerville developed included:

• Shape Up Approved Restaurants that display healthy options on their menus.³
• Improved school nutrition program which increased the amounts of healthy food choices and decreased the amount of unhealthy options to students.³
• HEAT Club In-School Curriculum, which stands for Health Eating, Acting time.  90 teachers were trained to teach this curriculum.⁴
• Safe Routes to School to increase walkability in the community.  This included walkability checklists from parents, pedestrian trainings, and data collection to inform future policies and city planning.⁴
• Training clinicians and school nurses to address overweight issues among children.³
• Improvement of current parks and create new parks.³

These are a few examples of some of the original projects that Shape Up Somerville pursued, however more projects continue to develop and be implement as the community collaborative continues.  As Shape Up Somerville grew, it began to take on a Collective Impact approach, which enabled it to manage the intricate web of various organizations, individuals, and programs across the community.  Collective Impact includes five conditions, which were utilized by Shape Up Somerville to increase the efficacy of the community collaborative. 

Five Conditions of Collective Impact

• Common Agenda: It was critical that all stakeholders involved shared the same desired outcomes for the community.³
• Shared Measurement: Discussions among the community and partners took place to decide upon three key measures for Shape Up Somerville; weight, BMI z-score, and “increases in energy expenditures (EE) beyond increases in EE and energy.”³
• Mutually Reinforcing Activities: Projects and strategies were coordinated to produce a greater effect on the outcomes.³
• Continuous Communication: This took place via regular meetings and websites.  The community was constantly informed through media such as newsletters, newspaper columns, TV, and radio.³
• Backbone Support: The city of Somerville provided the backbone support for Shape Up Somerville and its projects.  A team of individuals was created to support and ensure the functioning of the initiative.

Shape Up Somerville did face some challenges while working to achieve its various goals.  While attempting to alter the school nutrition program, barriers such as budget issues, allocating resources and union contracts arose.  Also, some resistance came from parents and school staff initially, but was resolved shortly after implementation.¹  When the first changes were made, the sales of a la carte items at schools dropped, but over time, the sales and school lunch participation has increased.²  Somerville’s food service director notices that improvements and notes that “without access to sugary and high-fat treats and with messages about healthy eating coming from everywhere, students began to opt for our meals with fruits and vegetables.  Now we never hear complaints—these changes have become the new normal.”² 

Additional challenges were faced in regards to recruiting restaurants to be Shape Up Approved.  It was impossible to conduct focus groups with the restaurants and difficult to make contact with owners and managers to discuss the initiative and convince them to offer healthy options.⁵  This was mainly because there was no restaurant association or any sort of leadership organization that could have been contacted to enable contact with the restaurants that would have been convenient and considered trustworthy.⁵  This challenge was overcome by unplanned visits to restaurants and conducting on-the-spot interviews with owners and managers of restaurants that were identified during parent focus groups as popular locations.⁵

      From initial evaluation measures, Somerville children had decreased the amount of beverages sweetened with sugar by an average of at least 12-ounces per week when compared to controls in other cities.⁶  Also, sports participation and physical activity increased 0.2 per year.⁶  This data was from the first two years of Shape Up Somerville and likely there has been greater improvements over the course of the initiative since its inception in 2003.  BMI scores also displayed positive association from 2003 to 2004, in which children in Somerville on average reduced “approximately one pound of excess weight gain over eight months for a 9-year-old child.”²  More evaluation of the Shape Up Somerville is necessary to fully understand the impact it has had on the community, however evaluating an initiative such as Shape Up Somerville can be difficult due to the diverse amount of projects it envelopes, as well as additional outside factors within the community that would have an impact on the outcomes.

Today, Shape Up Somerville community initiative continues to develop and is considered a model program in the Let’s Move Campaign by Michelle Obama.⁷  Somerville is also a part of the Massachusetts Department of Public Health’s Mass in Motion Program and has been funded and recognized by the Robert Wood Johnson Foundation as a leader in the national program Healthy Kids, Healthy Communities.⁷  Key factors to the initiatives success are its ability to be flexible, encompassment of multiple levels of a community to enact change, and its ability to be sustainable.  Using the five conditions of Collective Impact has helped it continue to be an impactful, engaging community program with a great number of partners and stakeholders.  Shape Up Somerville is a prime example of how the community, government, and organizations can band together to initiate environmental changes to achieve better health outcomes for its population.   

References

1.      Economos CD, Curtatone JA. Shaping up Somerville: A community initiative in Massachusetts. Prev Med. 2010;50:S97-S98.

2.      Cluggish S, Kinder G. Shape Up Somerville: District Tackles Childhood Obesity. The Education Digest. 2008;73:32.

3.      FSG.  Collective Impact Case Study: Shape Up Somerville.  Boston, MA.  http://www.fsg.org/Portals/0/Uploads/Documents/PDF/CI_Case_Study_Shape_Up_Somerville.pdf.  Accessed September 16, 2014.

4.      Shape Up Somerville.  Tufts University Web site.  http://www.nutrition.tufts.edu/index.php?q=research/shapeup-somerville. Accessed September 16, 2014.

5.      Economos CD, Folta SC, Goldberg J, et al. A community-based restaurant initiative to increase availability of healthy menu options in Somerville, Massachusetts: Shape Up Somerville. Preventing chronic disease. 2009;6:A102.

6.       Folta SC, Kuder JF, Goldberg JP, et al. Changes in diet and physical activity resulting from the Shape Up Somerville community intervention. BMC pediatrics. 2013;13:157-157.

7.      Shape Up Somerville.  A Decade of Shape Up Somerville: Assessing Child Obesity Measures 2002-2011.  Somerville, MA.  http://www.ci.somerville.ma.us/sites/default/files/SUS-BMI-ReportFINAL-4-12-2013_0_0.pdf.  Accessed September 14, 2014.