by Aimee Nielson
Photography by Matt Barton

Facing a daunting statistic of more than 40 percent of the population classified as obese, University of Kentucky Cooperative Extension and College of Public Health professionals took on the task over the past four years of building community coalitions to shrink the waistlines of nearly half their clientele.

Christy Nuetzman

Christy Nuetzman

Armed with hefty funding from the Centers for Disease Control and Prevention, Cooperative Extension family and consumer sciences agents and specialists from the UK College of Agriculture, Food and Environment have been fighting back hard. In Clinton, Elliott, Letcher, Lewis, Logan, and Martin counties, agents have strengthened or built new community coalitions to fight obesity and improve healthy eating habits and physical activity.

“It seems like a huge problem to solve, but when you collaborate with others and target specific things in a community, you can make positive changes,” said Janet Kurzynske, extension professor in the Department of Dietetics and Human Nutrition. “That's what we have seen. Of the six counties we started with in 2014, five have reduced their obesity rate to the point where they no longer qualify for CDC funding.”

This is the first time the CDC has partnered with Cooperative Extension on such a project.

“This project has given the CDC a chance to learn a lot about us,” Kurzynske said. “The funding was an infusion of support that allowed us to grow a lot of the things we were already doing into long-lasting, sustainable programs and partnerships.”

Coalition Strength

In Clinton County, FCS extension agent Christy Nuetzman already had a fairly strong community coalition in place, which allowed her to hit the ground running. She regularly meets with coalition members from all facets of county life including county government, public school officials, medical centers, the health department, managed care facilities, faith-based community representatives, and the public library.

“The CDC funding allowed our coalition to spearhead a variety of projects to make our community healthier and fit,” Nuetzman said. “We installed filtered water stations in schools, fit trails, and a disc golf course to make fitness fun. We were able to purchase playground equipment, update our parks, and establish educational programs to address food insecurity and healthy eating. All our coalition members made these things a reality through their vision and, in many cases, physical labor installing elements.”

Partnering with the UK College of Public Health gave a new energy and perspective for both colleges.

“Public Health has not historically worked closely with extension agents in these communities,” said Kathryn Cardarelli, associate dean for the UK College of Public Health. “Through this project, I've learned how important extension agents are as key catalysts to effect change. Public health and extension is an important collaboration for these rural communities.”

In Clinton and most of the other counties, filtered hydration stations have been a big hit. Most counties have noticed an increased interest in and consumption of water. Tim Armstrong is the principal at Clinton County's Albany Elementary School. He said the priority on hydration has already made a big difference for his students.

“We’ve noticed some positive changes by encouraging our students to stay hydrated,” he said. “They perform better on tests, they are able to think more clearly and stay focused, and it seems like we are rewiring their brains to prefer water over sugary beverages.”

Armstrong also pointed out that the disc golf course added at the school has provided more than physical fitness opportunities.

“One of our teachers has even used the course as an outdoor science lab when teaching a lesson about energy,” he said. “So all of these things are strengthening our students' minds and bodies.”

Charlotte Nasief, superintendent of Clinton County Schools, is a member of the coalition. Even though the funding for Clinton County is coming to an end, she believes the changes they have seen will continue.

“For many years, our county has been very close knit,” she said. “We all worked together to make each project successful, because we are all working for our kids and toward a healthier community.”

Martin County has faced an ongoing clean water crisis, so the hydration stations are especially popular there. But their community collaborators also renovated parks and playgrounds and offered samples of Kentucky Plate It Up recipes at the local IGA grocery store. Agents in Lewis County also offered samples of recipes at their IGA in Tollesboro, but the store took it a step further.

“The store is partnering with us weekly now,” said Broderick. “They now try to incorporate a Plate It Up recipe each week for purchase in their deli and make the recipe cards available to the public.”

The Clinton County Extension Service used CDC funding To help purchase frisbee golf equipment FOr the elementary school in Clinton County.

The Clinton County Extension Service used Centers for Disease Control funding to help purchase frisbee golf equipment for the elementary school in Clinton County.

Walkable Communities

The funding enabled Cooperative Extension to invite national public health, planning, and transportation consultant Mark Fenton to visit participating counties. Kurzynske said Fenton knows rural areas and how to work with them.

“Mark is very helpful in finding ways to make a community more walkable and identifying barriers to physical activity and safety,” she said. “He's very insightful in creating ways to get people to come to your community and figure out ways to encourage them to walk around once they get there.”

Fenton toured each county with community partners to identify the strengths and weaknesses of each area, and he made recommendations about non-motorized transportation and how it can safely coexist with motorized transportation.

“Mark made some great recommendations for us,” said Gwenda Johnson, FCS agent in Elliott County. “He showed us places where we needed crosswalks to safely connect different entities. He gave us great ideas about multiuse trails and areas where we need bike stands, so they'll have a safe place to leave their bikes while they participate in other activities. We have an ambitious plan going forward, but it's very doable with community collaboration.”

Implementing Fenton's ideas has already made a difference in Lewis County. A bridge children use to walk to school was not safe enough.

“Fenton recommended that we make the shoulder wider on one side for our walkers,” said Amanda Broderick, FCS agent in Lewis County. “We were able to work with our county partners to do that. They also went a step further and added delineators (reflective posts) to make our walkers even safer.”

The Clinton County Extension Office installed exercise stations on a trail near the local high school.

The Clinton County Extension Office installed exercise stations on a trail near the local high school.

Sustainable Outcomes and
Future Vision

The former director of UK family and consumer sciences extension, Ann Vail, was inspirational in obtaining the funds and helping the CDC see the value of using the Cooperative Extension model to enact community change and collaboration. Kurzynske said her influence lives on through the commitment and further visioning of the agents and their community partners.

“This was a unique opportunity for the CDC and for the college,” said Vail, who is now the interim dean of the UK College of Social Work. “We did what we set out to do, and we have been able to see many positive changes. We fostered an environment and a cooperation that showed the CDC what extension can do when given the necessary resources.”

Janet Mullins, professor and interim chair of the UK Department of Dietetics and Human Nutrition is the evaluation specialist on the project. She said the goal across the board was to enact sustainable policy, system, and environmental changes.

“We know that extension offices are great at doing community-level work,” she said. “We’ve always been good at that. With this project, our goal was to make visible, environmental changes. We have improved facilities and educational opportunities, increased access to food retail and farmers markets—these are very visible changes.”

The true test of success is changing social norms, which Mullins said is long, hard work.

“We are always working to help people learn to manage their time and increase their skills to make healthy changes at home,” she said. “Visible changes in the community will help us make those changes (at home). Each county made appropriate and successful changes for their unique community.”

At the end of the project, five of the six counties have improved so much that obesity levels have dropped below 40 percent.

Exercise and hydration were important parts of clinton County's plan.

Exercise and hydration were important parts of Clinton County's plan.

“Our plan for sustainability takes advantage of the way we do traditional programming,” Mullins. “Fenton led a workshop at UK to expand the cadre of people interested in conducting walking studies in their communities. It was attended by more than a dozen folks from a variety of disciplines, interests, and expertise. In 2019, our teams will join teams from Tennessee and host a joint academy to teach other agents what we learned, so they can spread it across both states.”

As part of the project, researchers developed an app for smart devices that will support physical activity and challenges and integrate with physical activity trackers. It will allow extension agents to create unique programs to get folks moving in their counties.

Jennifer Hunter, associate director for family and consumer sciences extension said the project has been a great way to highlight what the college does best—taking the university to the people.

“This has just given us yet another opportunity to take research-based information and give it to the people of Kentucky,” she said. “Our subject matter is very nimble, and that gives us the unique opportunity to be proactive and reactive to the needs of our communities.”