MAPPS Overview

The Healthy Lifestyles Initiative methodology is based off of national work from NICHQ-Collaborate for Healthy Weight. This methodology crosses 3 sectors (Government, Community, and Healthcare) in various settings (schools, early childhood, workplace, health departments, churches and PCP offices) to reach children and families where they live, study, work and play. It is centered on creating customized MAPPS for Change plan.

MAPPS for Change is a planning tool to help partners identify and outline actions they will take as being part of the Healthy Lifestyle Initiative.

A MAPPS for Change plan includes 5 key elements:

• M – Consistent use of message (12345 Fit-Tastic!).
• A – Consistent assessment of weight status and lifestyle behaviors.
• P – Customized healthy lifestyle plan for all.
• P – Policies & practices to create environments that enable healthy eating and active living.
• S – Statistics & story telling about message reach, assessment/plans completed and policy/environmental changes made.

Using these 5 elements, organizations in our community can engage at a level that best matches their needs, resources and capabilities. Partners create a MAPPS for Change plan that is customized and will guide their actions to incorporate the Healthy Lifestyle Initiative into their organization.

Message

Target behaviors seen in the 12345 Fit-tastic! message come from the Expert Committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. (Barlow 2007) for clinicians to advise patients and their families to adopt and to maintain the following eating, physical activity and sedentary behaviors:

1. Obtain moderate to vigorous physical activity for at least 60 minutes each day.
2. Limit television and other screen time (the American Academy of Pediatrics recommends no television viewing before 2 years of age and thereafter no more than 2 hours of television viewing per day). Consistent Evidence
3. Eat a diet rich in calcium. Consistent Evidence
4. Limit consumption of sugar-sweetened beverages. Consistent Evidence
5. Encourage consumption of diets with recommended quantities of fruits and vegetables. Mixed Evidence

**Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007; 120 (suppl 4): S164-S192.**

Assessment

In moving towards change, we cannot improve what we cannot measure, therefore getting an accurate picture of each individual’s weight status is an important first step toward conversations that empower individuals to take action to improve their own health. The Expert Committee recommends that physicians and allied health care providers perform, at a minimum, a yearly assessment of weight status in all children, and that this assessment include calculation of height, weight (measured appropriately), and body mass index (BMI) for ages and plotting of those measure on standard growth charts. It is also recommended that qualitative assessment of dietary patterns, levels of physical activity and sedentary behaviors should be performed in all pediatric patients at a minimum, at each well child visit for anticipatory guidance.

What is included in the Healthy Lifestyles Assessment?

Measurements: The assessment starts with obtaining an accurate height/weight. Those measurements are used to calculate BMI/BMI%tile to determine weight status.

BMI Calculator: http://www.cdc.gov/healthyweight/assessing/bmi/

Weight Status: According to the Center for Disease Control (CDC), these are the weight status categories:

Children & Teens
Weight Status Category – Percentile Range
Underweight – Less than the 5th percentile
Healthy weight – 5th percentile to less than the 85th percentile
Overweight – 85th to less than the 95th percentile
Obese – Equal to or greater than the 95th percentile

Adults
Weight Status Category – BMI
Underweight – Below 18.5
Healthy weight – 18.5 – 24.9
Overweight – 25.0 – 29.9
Obese – 30.0 and Above

Lifestyle Questions: Think about how you live your life. Then, answer these questions. When you’ve finished the assessment, find out how you can make your lifestyle healthier and happier!

1. Physical Activity: On a typical day, how many minutes do you (does your child) spend in active play/ exercise (breathing harder or sweating)?
2. Screen Time: On a typical day, how many hours are you (is your child) in front of a screen (TV, computer, video game, cell phone)?
3. Milk and yogurt: On a typical day, how many times do you (does your child) drink milk?
   1. What type of milk does your child drink?
4. Water and beverages: On a typical day, how many times do you (does your child) drink plain water?
   1. What other beverages do you (does your child) drink in a typical day?
   2. On a typical day, how many times do you (does your child) drink sodas, fruitades or sports drinks?
5. Fruits and Vegetables: On a typical day, how many times do you (does your child) usually eat fruits or vegetables?

Plan

Starting the conversation can and will be challenging to help someone to take action to improve their health. By shifting the conversation towards healthy lifestyle behaviors, we hope to empower patient and families towards behavior change.

Use of Motivational Interviewing (MI): The Healthy Lifestyles Initiative encourages the use of MI when starting the conversation. MI is a directive style of communication that provides patients with the opportunity to create change in behaviors by dialoging in a non-judgmental atmosphere. This atmosphere invites patients to consider making changes in his/her behaviors and elicits intrinsic motivation for change (as opposed to providers telling patients what they must change). (Miller & Rollnick, 2002)

Numerous studies have shown that allowing patients the opportunity to advocate for their own change is predictive of their future behavior change. Studies have also demonstrated that integrating MI into clinical encounters improved outcomes. People are more likely to “comply” with appointments, lab draws, medication adherence, and treatment plans when MI is integrated into practice.

Policy

In this comprehensive framework “MAPPS for Change,” we also invite partners of the Healthy Lifestyles Initiative to think about their role in policy and environmental change. By implementing policies that promote healthy environments and behaviors, we can change and make the “healthy choice” the “easy/ default choice.” In doing this we can collectively build social support for healthy eating and active living and adopt a culture of wellness. Below are some key changes we hope to achieve through policy:

• Improve public safety.
• Create or enhance access to places for physical activity.
• Limit advertising of minimal nutritive foods near schools and child care centers.
• Use standardized assessment tools to evaluate the community for opportunities to improve environment.
• Use point-of-decision prompts for healthy behaviors (ex: hang up 12345 Fit-tastic! posters by stairs)
• Promote menu labeling.

Other policy initiatives: We acknowledge and encourage partners to enroll in larger policy initiatives to fulfill this part of their MAPPS for change. Some of these are:

• Partnership for a Healthier America
• Healthy Vending
• Baby-Friendly USA

Statistics

Statistics is the science of learning from data. Data offers essential insight in determining what is working and what alternatives need to be presented. In order to comprehensively align as partners, sharing a common evaluation framework is needed. By tracking progress and aligning data, time and resources will be focused adequately and help all involved have success.

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