The Children’s Hospital of Philadelphia ANNUAL REPORT TO THE AMERICAN BEVERAGE FOUNDATION FOR A HEALTHY AMERICA JUNE 2013 The Children’s Hospital of Philadelphia F O U N D AT I O N Update on The Children’s Hospital of Philadelphia Healthy Weight Program EXECUTIVE SUMMARY The fight against childhood obesity continues to be a struggle for many Americans across the country. Despite progress in recent years, children in Philadelphia remain at great risk of becoming obese due to challenges common among its impoverished populations. CHOP’s Healthy Weight Program (HWP) was launched to enable children and their families in Philadelphia and surrounding areas to live healthier lives. The transformational investment from the American Beverage Foundation for a Healthy America has allowed HWP to break new ground that will accelerate the fight against childhood obesity, both in this region and across the country. The Healthy Weight Program has brought together numerous people to provide input related to clinical care, research, education, and community work in childhood obesity. It incorporates the collective work of general pediatricians, endocrinologists, gastroenterologists, bariatric specialists, behavioral psychologists, researchers in basic science and clinical research, community researchers, health services researchers, and information technology specialists. Our goal is to have an impact on obesity prevention and treatment with a special emphasis on preventing early childhood obesity. In just the second year of our partnership, the Healthy Weight Program has already accomplished its primary clinical volume goal and is expanding at an extraordinary pace. The research studies initiated by HWP are leveraging the intellectual capital of top-notch researchers and CHOP’s first rate institutional research environment; and our partnerships are being leveraged to provide better education to the broader grass roots and academic communities. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N Highlights from the past year include: • Development of a HWP Strategic Plan including initiatives focused on early childhood obesity prevention • Tripling of clinical volumes at the Healthy Weight Clinic — a four-year goal met in just two years • Preliminary results indicating high percentage of children and adolescents attending the new program showing benefit in body mass index (BMI) score • Launch of the Childhood Obesity Clinical Registry using electronic health record data to identify patient characteristics and outcomes • Initiation of a Primary Care Obesity Advisory Board to develop a new “Pediatric Obesity Management Model” for the primary care setting that includes obesity prevention and treatment guidelines suggested by the American Academy of Pediatrics • Seven research studies underway with findings from one study leading to an abstract submission to the Annual Obesity Society Meeting in November 2013 identifying risk factors associated with early childhood obesity • Numerous educational presentations by HWP staff on obesity management • Expansion of trainee program to provide clinical experiences in a weight management program for undergraduate and graduate students as well as physicians in training at CHOP (including residents and fellows at CHOP in the Nutrition Fellowship and the Pediatric Gastroenterology Fellowship Programs) • Collaboration with the City of Philadelphia Department of Health to understand childhood obesity rates in Philadelphia • Development of new community partnerships and initiatives including co-leadership of a community-wide discussion on “HBO Weight of the Nation: Children in Crisis” Our capacity-building initiatives are of particular importance as they reflect our investment in preventative measures and efforts to develop tools that support our approach. We are in the process of developing a new model of care to be utilized throughout the CHOP Care Network that can impact hundreds of thousands of children, and our pediatrician advisory group will play a key role in developing our initiatives in the primary care setting. Despite our early success, we are constantly reminded that the fight against childhood obesity is a long-term effort, and therefore we have prioritized the development of a strategic framework for the program. It is our hope that this framework will strengthen our leadership position and maximize and sustain the impact in years to come. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N STRATEGIC PLAN Strategic planning for the Healthy Weight Program was undertaken to identify strategies and initiatives that would ensure that the program, catalyzed by the partnership with the American Beverage Foundation for a Healthy America, would grow stronger and become a leader in obesity prevention, treatment, and management. We prioritized a focus on early childhood obesity prevention since early obesity tracks into adulthood. In December of 2012, members of the Healthy Weight Steering Committee, with input from CHOP’s Strategic Planning division, finalized a vision and strategic plan for 2013-2020. The vision for the Healthy Weight Program is as follows: The Healthy Weight Program will provide national leadership on reducing childhood obesity through innovative work on prevention, treatment, and identification of early causes. Our efforts will be integrated across the CHOP healthcare system and in collaboration with community partners. The plan includes strategic goals that would strengthen the HWP, thereby maximizing its impact. As part of the planning process, the following strategic goals were developed: • Clinical care that provides the right care at the right place and at the right time utilizing the care network platform and electronic health record • Research advancing our understanding of root causes and effective models for treatment focused in early childhood intervention • Education for future leaders, clinicians, and families within CHOP and the broader community • Community collaboration with organizations to meet local needs and advocacy at local, regional, and national level to influence policy • Sustainability for long-term impact This plan was established to guide the development of all initiatives of the Healthy Weight Program — clinical, research, education, and community-based — and provide a clear direction for our program in years to come. The team has already begun implementation of the strategic plan with many initiatives described in the coming pages. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N CLINICAL PROGRESS Healthy Weight Clinic A flagship goal of the partnership between HWP and the American Beverage Foundation for a Healthy America was an increase in patient visits in the Healthy Weight Clinic, with the ultimate goal of tripling patient volume in four years. This goal was met in two years. Figure A: Healthy Weight Clinic Delivered Visits: FY12 v. FY13 NPV = New Patient Visits , FOL = Follow-up Visits The Healthy Weight Clinic’s focus was to increase the number of follow-up visits, knowing that success comes from frequent visits and engagement with the program. We have substantially reduced the wait time for appointments; currently new visits can be arranged within a week and return visits within two weeks. The increase in follow-up visits is notable, as it demonstrates the ability to retain patients in the program and reflects an improvement in patient engagement — both of which provide our clinicians with a greater opportunity to effect behavioral changes. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N Our clinical model has changed to provide more appointment availability for families and to increase exposure of families to experts in nutrition, physical activity, and behavioral change. A clinical psychologist joined the team and developed a new behavioral health component to prepare families for the health behavior changes and to assist children with psychosocial issues such as poor self-esteem, challenges with body image, and bullying. Figure B: New Healthy Weight Clinic Model Key: MD = Medical Doctor, NP = Nurse Practitioner, RD = Registered Dietitian, PA = Physical Activity Specialist, SW = Social Worker As part of Healthy Weight clinical expansion, the new teaching kitchen and fitness center has enabled the program to add a practical approach to weight management. Patients and their families can participate in new nutrition education and physical activity opportunities, as well as learn skills that they can incorporate in their daily lives. We have implemented cooking demonstrations, tastings, and produce distributions from our new Community Supported Agriculture (CSA) program partnership with West Philly Foods. The Healthy Weight Program provides portions of fresh produce shares to families attending our clinic as well as allowing for community families in need to access fresh produce through subsidized shares. We have broadened families’ understanding of healthy food options by introducing them to new healthy snack ideas and in tandem, teaching them how to prepare them at home. We have developed group sessions that take place in the kitchen and fitness center for children and their parents. These activities have contributed to increased engagement between the HWP and patient families. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N Obesity Registry The ability to track and demonstrate patient outcomes is the impetus for the development of a CHOP Obesity Registry. The registry will be a large database that houses key assessment measurements and outcomes for every child across the extensive CHOP Care Network. The registry will help provide an accurate reflection of the obesity epidemic’s impact at CHOP and be able to work with other national databases to compare outcomes of interventions and trends over time. Since January 2013, the Healthy Weight Program staff has worked with a dedicated HWP Data Analytics team to develop an electronic registry of patient information from the Healthy Weight clinic. After working to define important variables and validating the ability to obtain accurate data from the electronic health record (EHR), the team is generating reports related to our patient population and outcomes (see Figure C below). A large percentage of our patients are Philadelphia residents between 6 and 11 years old, African-American, and female. These data supported our decision to focus our intensive program on this particular age group. Figure C: Socio-demographic characteristics of Healthy Weight Clinic patients for fiscal year 2012-2013 (July 1, 2012- June 30, 2013) 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N We also understand from the Obesity Registry data that we are indeed having an impact. Results showed that 65% had a reduction in BMI Z score, 18% had no change, and 17% had an increase (see Figure D below). Figure D. Treatment response to 3 or more visits for Healthy Weight Clinic patients on BMI z-score, November 1, 2012- June 30, 2013 (new clinic model) While long-term results are more important and will be forthcoming, we are encouraged by 83% of patients having an early impact from the program. Our next step is to capture information about pertinent comorbidities including hypertension, dyslipidemia, pre-diabetes/diabetes, sleep apnea, and asthma. Over the course of summer 2013, the team plans to pilot the addition of several patient reported outcome measures that will be added to the registry, collected electronically on a tablet, and be completed by patients during their regularly scheduled visit. Capacity-building Initiatives in Primary Care In addition to our work in the clinic, the Healthy Weight Program is leading the development of new capacities that will strengthen its mission in the primary care setting. The CHOP Care Network (i.e., its primary care network) consists of 31 primary care practices throughout the region. Data from the electronic health record (EHR) provides encouraging information that the overweight and obesity rates within the CHOP Care Network have not increased over the past 5 years. Significant work remains, however, since approximately 1/3 of children and adolescents throughout the CHOP Care Network (approximately 55,000 children and adolescents) are either overweight or obese. This has confirmed our focus on early childhood obesity prevention and treatment. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N Pediatric Obesity Management Model We have developed an advisory board of pediatricians from the CHOP Care Network to discuss and develop a new model of obesity prevention and treatment that starts in the primary care practice. The patients who require specialized services such as those provided by a multidisciplinary clinic would be referred to the Healthy Weight Clinic. The HWP working group includes six CHOP physicians representing various sites within the Care Network. Quality Improvement Project for Obesity Recognition The CHOP Obesity Advisory Board will also provide advice to help guide a quality improvement initiative for obesity recognition in CHOP primary care practices. This initiative will involve improved recognition of obesity at an early age and determine individualized treatment for the right care at the right place at the right time. We will track improvement changes using the EHR. Initial information about conducting this process is underway. Members from the physician group working on the development of the new model of care may also serve as experts on the quality improvement project to guide decisions regarding what may and may not be helpful to pediatricians in practice. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N RESEARCH UPDATE The investment from the American Beverage Foundation for a Healthy America allowed the launch of seven research studies to date involving obesity prevention and treatment. Most of the studies involve children and families from neighboring high-risk populations and communities where obesity rates are among the highest in the city. The following projects were launched by the Healthy Weight Program last year for a two-year funding cycle, with the second year of funding starting July 2013. The studies will be completed in June 2014. Modeling of Obesity-Related Risk Factors Using CHOP Network Registry The Principal Investigator is using information from the electronic health record to assess current obesity-related rates in the CHOP pediatric network. The CHOP health system, including primary, secondary, and tertiary care along with an integrated electronic health record with years of longitudinal data representing millions of pediatric visits, provides a rare opportunity to develop such a strategy across a large population. The study is using data from these visits for developing models that permit better understanding of causes of childhood obesity. The investigator team has constructed a cohort of more than 200,000 children with available demographic, health care utilization, and anthropometric data. Their initial analyses comprise a subset of 100,000 children with longitudinal follow-up information from primary care practices in the CHOP Care Network. Within this group, the investigators have been assessing associations during infancy and early childhood and the risk of developing obesity. Improving Home Food Preparation Ability Among Families with Young Children: A Peer Mentoring Intervention This study addresses home food preparation, an important but often overlooked part of any obesity intervention. It tests the effectiveness of a community-located, peer-mentored intervention to improve home food preparation practices in families with 0-3 year old children enrolled in Early Head Start in West Philadelphia. Nineteen mothers were enrolled in a randomized controlled trial and five peer mentors were paired with the participants for six weekly cooking intervention sessions. The project will test the intervention’s effect on 1) self-efficacy related to cooking; 2) home food preparation practices; 3) healthfulness of the diet; and 4) parent and child body mass index. Early findings: During interviews conducted after the intervention concluded, participants reported: 1) increased confidence in their ability to cope with challenges (such as a lack of ingredients), be creative in the kitchen, and prepare food at home; 2) peer mentors helped maximize participation and learning by tailoring instruction according to individual participants’ needs; 3) healthfulness of diet and eating habits improved; and 4) classes reminded participants that the necessary act of cooking could be enjoyable. Quantitative data collection and analysis is ongoing. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N Eating Pace Retraining in Early Childhood Obesity Prevention (Re-Pace) The aim of this study is to develop a novel family-based behavioral intervention to help 4-7 year old children at risk for obesity (children who eat rapidly and have an overweight parent/legal guardian) develop a more normal eating rate. The investigators’ prior study found that rapidly eating, 4-year-old children were at significantly greater risk of becoming obese than children who ate at a normal rate. The intervention uses a novel feedback technique with the use of the “Motivator,” a pager-size device worn at the waist during meals which prompts the child to eat at a more normal pace of eating in addition to other educational and behavioral methods. Recruitment for study participation began in January 2013. The investigators hope that the novel Re-Pace intervention will help the children develop a more normal eating rate, and, thus, develop a better sense of satiety and prevent the development of obesity. Recruitment, assessment, and plans for additional cohorts are ongoing. Identification of Compounds Effective in Preventing and/or Treating Obesity Using a Novel Mouse Model of Childhood Hypothalamic Obesity Understanding central regulation of food intake and energy expenditure is an important step in obesity prevention and treatment. It is well known that the area of the brain that regulates feeding and energy balance is the hypothalamus. In this study, investigators are targeting receptors in the brain or peripheral tissue with available drugs or drug combinations in a mouse model of hypothalamic obesity. Early findings: Preliminary results indicate that exenatide (drug) has the potential to arrest hypothalamic obesity in mice by decreasing food intake and increasing activity despite a reduction in metabolic rate. Additional Studies Augmenting the four initial studies, three new research studies were added to the Healthy Weight Program portfolio in 2013. We are excited about a recently launched technology-based interventional project using social media to engage low income mothers in obesity prevention of their newborns. Such novel interventions have the potential to augment or replace face-to-face care. Given the cost associated with face-to-face interventions, technology based interventions can have a broad reach at very low cost. A Peer-Based, Social-Media Enabled Intervention to Promote Healthy Growth in Infancy The Institute of Medicine has prioritized research on the prevention of obesity in childhood. Prior interventions have had limited success in preventing obesity and have been difficult to sustain. This study, leveraging the ability of peers to motivate behavior change and using social media (i.e.,Facebook) as an enabling technology, will develop and then test this novel approach to prevent obesity. Conceptually, the study represents a significant advance by using visual imagery within Facebook as a tool for modeling and self-modeling - an innovative strategy that has proven successful in motivating rapid behavior change. The study aims to develop and evaluate a novel peer-based, social media-enabled intervention delivered primarily through private Facebook groups, that promotes behavior change and fosters behaviors associated with healthy 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N growth to prevent early obesity. By using modeling and peer support with obese, low income, primarily AfricanAmerican mothers in the immediate prenatal and newborn period, this intervention will establish these behaviors long-term, promoting improved growth patterns throughout childhood. Results of focus groups and interviews have already begun to shape the intervention content and delivery style. The study team has filmed and produced several short videos that will be used to deliver interventional educational messages and foster interaction and conversation within peer groups. The next aim of the project, a pilot study to assess the feasibility of an abbreviated, two-month version of the intervention has begun. Community-based Participatory Research (CBPR) Initiative The Healthy Weight Program collaborated with area academic institutions to strengthen its position in the fight against childhood obesity and deepen its relationship with the community at large. The “Community-Based Participatory Research (CBPR) Initiative” harnesses unique strengths of academic-community partnerships and serve innovative ways for the Healthy Weight Program to deepen its impact with the surrounding community. In collaboration with the local institutions (University of Pennsylvania, Temple University, and Drexel University), the HWP organized a Community Driven Research Day on January 24, 2013. The event provided an opportunity for Community Based Organizations (CBOs) to discuss their research needs with researchers from local academic institutions. Through an interactive poster session, 18 CBOs and community groups highlighted their research questions. A total of 118 people, including from those area non-profits, community groups, public sector partners, and researchers and students from local academic institutions, attended the event. Following the event, a competitive pilot grant program to support community-based projects in health literacy, healthy weight, and healthy behaviors was announced by the Community Driven Research Day planning committee. Proposals received were reviewed by a committee comprised of CHOP/Penn faculty members and a community reviewer. Two projects were funded by the Healthy Weight Program from this pilot grant program. The projects will be funded for one year and will start in July 2013. The details of the projects are as follows: Goal Setting around Positive Lifestyle Changes in a Community-Based Program This collaborative study was developed through a partnership between a community-based organization, Investing in Ourselves, and CHOP. Investing in Ourselves (IO) is a community-based organization that promotes positive lifestyle changes. With a comprehensive health focus that mobilizes community members to improve their physical and financial health, IO conducts community outreach to teach healthy cooking, physical fitness, business literacy, saving, basic computer skills, and leadership development. The study will investigate goals around diet and physical activity that have the highest rates of success for children and their families and thereby prevent and treat obesity. The specific objectives of the project are to: • Investigate the strategies employed by a community-based program to increase success rates in attaining proximal goals set around diet and physical activity; • Reach approximately 100 individuals seeking lifestyle changes to improve their health at this communitybased program; 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N • Promote family and peer support networks for individual and group goal setting; and • Establish a mutually beneficial academic-community partnership. Peripartum Obesity and Postpartum Weight Retention Study This project was developed through an academic-community partnership developed and sustained over the past five years between CHOP and the community-based organization, Maternity Care Coalition (MCC). The MCC will collaborate with a CHOP investigator to conduct the project. Maternity Care Coalition’s mission is to improve maternal and child health in high-risk communities, through the collaborative efforts of individuals, families, providers, and communities via advocacy at the local, state, and national levels. Since 1980, MCC has nurtured more than 50,000 families in the Philadelphia region. MCC has a deep commitment to nutrition screening and obesity prevention. The goals of this study are to use the tenets of community-based participatory research to conduct a randomized controlled trial testing a low-cost intervention targeting post-partum weight retention and improved breastfeeding among women. Subsequently, the investigators will disseminate the findings and implement the intervention throughout an urban area. This study is also partially funded by another private foundation. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N EDUCATION As part of its strategic framework, the Healthy Weight Program has identified education as a focus area of its growth strategy, since it remains a first step and essential component in the fight against obesity. Our vision for education in fighting childhood obesity incorporates the education of children, families and professionals. We will look to develop a cadre of ambassadors that can effectively communicate information about obesity prevention throughout the CHOP network to reach the thousands of children and adolescents that CHOP providers see. We have begun with our pediatrician advisory group, and our long-term vision is to develop a physician fellowship training program so we are training the next leaders in pediatric obesity. The expansion of the clinic has enabled us to expand the physician trainee program at CHOP, providing clinical obesity management training opportunities to numerous medical interns, residents and fellows, as well as trainees from other disciplines. This year, we have helped provide clinical experiences to 22 trainees through the Healthy Weight Clinic, which has now become a specific rotation for the Nutrition Fellows at CHOP. We are also getting international requests to train in our clinic. Each summer, HWP offers a competitive summer internship to a qualified undergraduate or graduate student with interests in nutrition, physical activity, or behavioral health in a clinical pediatric weight management setting. With the expansion of our space and team, we were able to offer two intense summer intern slots to nutrition and exercise science undergraduate students. The program also continues to establish its leadership position on childhood obesity through the facilitation of educational opportunities, highlighted by the HWP’s co-leading a discussion with the City of Philadelphia’s Department of Public Health on “HBO Weight of the Nation: Children in Crisis.” Other HWP educational opportunities bringing Penn and CHOP researchers, clinicians, and students together to discuss topics related to childhood obesity include: • Presentation entitled “Pediatric Obesity: Politically Correct and Practical Interventions” to pediatric nurse practitioner students, Thomas Jefferson University (July 2012) • “Childhood Obesity” presentation at the Nutrition Center Seminar Series, The Children’s Hospital of Philadelphia (December 2012) • Co-sponsored lecture on “Weighing in: Skeletal Health after Bariatric Surgery” at joint CHOP- Hospital of University of Pennsylvania Endocrine Rounds (December 2012) • Presentation entitled, “Nutrient-Sensing Signaling Pathways Offer Novel Therapeutic Window in Respiratory Chain Disease” at the Mitochondrial Research Affinity Group Seminar, Philadelphia, PA (January 2013) • The Joint Penn-CHOP Center Symposium on Nutrition, Obesity, and Metabolomics at the Clinical Interface, convening scientists, clinicians, and interested faculty together to discuss current research and other efforts related to obesity at both institutions (February 2013) • Presentation entitled “Trends, Causes, and Medical Complications of Obesity” during Frontiers in Medicine: Gastroenterology, a course for 4th year University of Pennsylvania medical students (February 2013) • Presentation entitled, “Endocrine Complications of Steroid Therapy” at the Fourth Annual Pediatric Endocrinology Clinical Pearls and Review for the Primary Care Practitioner, held at The Children’s Hospital of Philadelphia (February 2013) • Presentation entitled, “Approach to the Child and Family with Obesity” at the Fourth Annual Pediatric Endocrinology Clinical Pearls and Review for the Primary Care Practitioner, held at The Children’s Hospital List continued on next page 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N of Philadelphia (February 2013) • Presentation entitled, “Cardiometabolic Risk Factors and Obesity in Adolescents with Down Syndrome” at the Research Seminar, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania(February 2013) • Presentation entitled “Childhood Obesity: Assessment, Prevention & Management” to University of Pennsylvania undergraduate students as a guest lecturer for Issues in Nutrition, Exercise, and Fitness (April 2013) • Presentation entitled, “Cardiovascular Risk in Obese Adolescents” at the Research Seminar, Children’s National Medical Center, Washington, DC (May 2013) 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N COMMUNITY The HWP serves as an important community resource throughout Philadelphia. In addition to the communitydriven research initiatives listed above, the Program is continually exploring partnerships that address childhood obesity in our shared community. While the Healthy Weight Program continues to support the community through one-time, episodic events, we have developed a model that guides the formation and evaluation of collaborations that deepen our presence and sustain our impact in the community. Figure E: HWP Community Partnership Framework The City of Philadelphia and the Healthy Weight Program are also collaborating to understand the obesity prevalence in children and adolescents throughout the City. The HWP Data Analytics group replicated the analyses the Philadelphia Department of Public Health published in Preventing Chronic Disease in 2012 using data from the School District of Philadelphia related to obesity (covering school years 2006-2007 to 2009-2010). Using data from CHOP’s electronic health records of children in the City of Philadelphia, the HWP performed the same analyses. Among 5 to 18 year old patients seen within the CHOP network and living within a Philadelphia zip code, 21.9% were obese in 2009-2010, while 8.2% were severely obese. The prevalence was similar among a sample of children within the School District of Philadelphia with 20.5% obese and 7.9% severely obese during the 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org F O U N D AT I O N same school year. Recently, the Healthy Weight Program forged a partnership with The Enterprise Center, a Community Development Corporation. The Enterprise Center supports local entrepreneurship in the Walnut Hill neighborhood of West Philadelphia, including through their West Philly Foods Community Supported Agriculture (CSA) program, as well as through the Dorrance H. Hamilton Center for Culinary Enterprises. We are in the process of developing specific projects to partner on, including projects related to food access and knowledge and skills related to preparation of locally grown, fresh foods at home. Presently, the Healthy Weight Program advertised this CSA to CHOP employees. With 18 employees signing up, West Philly Foods added a CHOP pickup location for weekly shares of produce. The Healthy Weight Program purchased four full shares of produce to be used for cooking demos in the Healthy Weight kitchen, to share with families for their use at home, and to use during intensive group sessions. Additionally, the Healthy Weight Program has recently begun participating in the Sustainable Communities Initiative (SCI) of the Philadelphia Local Initiatives Support Corporation (LISC). This Healthy Communities SCI group brings together local organizations and members of the Philadelphia Department of Public Health to support projects that address the City’s goals of decreasing obesity, hypertension, and diabetes. Both the SCI and the Enterprise Center are well-established organizations with knowledge of the needs of Philadelphians and the local groups working to address health and wellness. Finally, HWP continues to support a wide variety of community events through both active tabling and donation of materials to support event attendees. LOOKING INTO THE FUTURE We anticipate the continued growth of our Healthy Weight Clinic and development of key capacities to support primary care settings. In addition, we also anticipate the completion of our research studies over the course of the next year and look forward to potential publication. While the HWP has dramatically expanded its scope of work in all aspects of the program, there still remains a great need for additional faculty and research that can strengthen our reputation as a national leader. Reflecting upon our second year of expanded operations, we are pleased with the progress throughout all aspects of our program. The American Beverage Foundation for a Healthy America’s contributions to CHOP are game-changing, both for our institution and in the national effort to reduce and solve the challenges of childhood obesity. Because of your support, we have been able to develop a broader vision for our work and raise the bar of excellence for the treatment of children, families, and communities. We are breaking new ground in research that is lacking in the field and are bringing energy and expertise to communities that need our leadership. As always, we are incredibly grateful for your partnership, and we hope to continue our important collaboration in the years to come. 34th and Civic Center Boulevard, Philadelphia, PA 19104-4399 • 267-426-6500 • www.giftofchildhood.org Hope lives here. Because our doctors successfully treat the most devastating childhood diseases. Because our scientists make discoveries that save kids’ lives. Because someone like you took a moment to give.