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St. Louis Plans Coordinated Approach To Fighting Obesity

(City of St. Louis Department of Health)

From the outside, Regal Meat Market, at 5791 Thekla Ave. in north St. Louis looks like a typical urban corner store. Situated in Walnut Park East, an area where few outsiders go, it has bars on the windows and a large sign next to the door advertising Newport cigarettes. 

But on the inside, signs dot the walls pointing to “Healthy Options” and “Fruit and Vegetables Here.”  In addition to moneymakers like cigarettes and liquor, which are stashed behind the counter, baskets of sweet potatoes, onions and other produce are at the end of one aisle. Bunches of bananas greet customers as they come in, and a produce refrigerator near the back of the store advertises a frequent buyer program.

Aziz Hamed, who has owned the store for 20 years, says he has always offered produce and other healthy options. What has changed, he says, is the way that he and his staff talk to customers about them. And customer behavior has changed as well.

“They started using more sweet potatoes, vegetables, and buying more oranges, apples and bananas,” he said.

As a result, Hamed has been offering a wider selection of produce at lower prices and taking suggestions for new offerings.

“People started paying more attention to the healthy items,” he said.  “Not like before. Now they’ve started looking at the calories, how much sugar.”

As a result, Hamed, who has watched many of his customers’ children grow up and become customers themselves, is now playing a more active role in their health and wellness.

Healthy Corner Store Project

In terms of educating customers about healthy foods, Regal Meat Market has gotten a boost from the Healthy Corner Store Project, a program run out of the University of Missouri Extension. The program is partnering with the St. Louis Health Department to help improve access to healthy food in some of the city’s “food deserts.” The U.S. Department of Agriculture defines “food deserts” as poor areas lacking a full-service supermarket within a half mile. Walnut Park East is one such area. (See map.)

Kara Lubischer, community health specialist for University of Missouri Extension, worked with Hamed to set up cooking classes, product demonstrations and other events at the grocery store to raise awareness of the healthy choices he is stocking. Hamed was paired with a mentor, another owner of a local corner grocery store also in the Healthy Corner Store Project, so that they could share ideas about how to market the healthier food.

The St. Louis Healthy Corner Store Project is based on a community partnership model. Hamed’s store was nominated by a local partner, Walbridge Elementary School, which is also involved in educational activities around health and wellness, Lubischer said.

The program focuses on educating customers because “you can’t just put healthy foods somewhere and assume that people will purchase them, that people want it, or even that it’s the right food or the culturally appropriate food,” Lubischer said.

Lubischer said that increasing food choice in corner stores is an important way to help stem the tide of obesity in food deserts such as Walnut Park East. 

Credit (City of St. Louis Department of Health)

“So [in St. Louis] you’re left with these 100-plus corner stores that we have in the city.”  Most of them, she said, don’t offer low-fat snacks and beverages or produce.

Without easy access to healthy food, it’s difficult for residents to improve their diets, especially as many don’t drive.

“There’s a positive association between retail environment and diet,” she said. So offering a greater selection of healthy choices in a small store makes a big difference.

St. Louis Obesity Plan Partnership

Even before “food desert” and “obesity epidemic” became the latest buzzwords, many St. Louis organizations were working to stem the rising tide of obesity in St. Louis. Gateway Greening works to make city spaces more hospitable to spending time outside. The YMCA tries to make workout facilities accessible to all. The St. Louis Public Schools have improved their menus, and the Mathews-Dickey Boys and Girls Club brings physical fitness to children. 

Other partners include United for Children, American Heart Association, Trailnet, Regional Health Commission, Operation Food Search and Washington University.

This year, St. Louis intends to bring together these organizations to help lower the obesity rate by 5 percent by 2018. It’s the health and wellness goal of the city’s sustainability plan and led by the city's Health Department.

“The request came from the White House for cities and towns to get involved. When that came to Mayor Slay, he said yes. He signed us up as a city and handed it off to us to implement,” said Warren Nichols, director of public information for the city's Health Department. “We just happened to be one that took it and has gone a little further with it.”

The “Let’s Move” program, first lady Michelle Obama’s initiative, encourages cities to help children become more physically active and to eat more nutritious foods. St. Louis has already been recognized by the program for meeting several benchmarks, but Nichols conceded that more effort is needed.

“For years we’ve been on the top 10 fattest city list. So, while we’ve doing things to try to address it, we knew there needed to be a more concerted effort to address it,” said Nichols. “When the mayor indicated he wanted zero lead by 2010 and resources were put into that, people came together and started addressing lead. It went from 33 percent down to 2 percent. So, there is power in saying hey, we’re going to do this. Putting a number out there and going for it.”

The obesity plan has not yet been released, but the Health Department is meeting with community partners on Feb. 13. At this point, the plan has no money budgeted for it although some of the individual programs are currently funded by grants. City officials hope to apply for grants to cover the entire initiative.

The plan has several major components, including data collection, a marketing campaign, and access to preventive health care among poor residents, said Carl Filler, assistant to the Health Department's director.

* Data collection

According to the CDC’s Behavioral Risk Factor Surveillance System, St. Louis has an obesity rate (a body mass index of greater than 95 percent of the average) of 26.8 percent. However, said Filler, because of the way the data were collected, the actual number could be as little as 17 percent or as large as 35 percent, as the survey randomly called several hundred St. Louis residents to obtain that number.

“The first goal is even identifying exactly where we are because if we are going to reduce obesity by 5 percent we need to have that baseline data,” Filler said.  The city hopes to partner with local universities to determine a better data collection model, he said.

* Marketing campaign

Although the city already participates in several online media programs, such as the JumpN2Shape, Health Institute St. Louis and Let’s Move STL, the city hopes to communicate about healthy living and reach an even greater number of people through various communications channels.

“A lot of folks are doing a lot of good stuff every day. But people don’t know about it,” Filler said. “Sometimes there’s money to do the effort, there’s no money to market it.”

So, while neighbors of the O’Fallon Park Recreation Complex may know about it and use it, and children may benefit from dieticians teaching nutrition classes in schools, many others do not know about these opportunities.

“So, part of it is getting the word out that these things are going on, giving folks a multitude of options to try and impact their health. The other part is, hopefully it’ll bring additional resources to us to do more research, collect more data,” Nichols said.

The city, he said, is partnering with Emmis Communications, Clear Channel, Radio One, and other organizations to spread the word about fitness, healthy diet and the city's programs.

* Worksite wellness

What do Wells Fargo, the Red Cross and the Federal Reserve have in common?  All have used internet-based programs to promote worksite wellness. The city has developed Small Changes for Health, a website in which participants can track their weight loss and fitness goals online. The city pitches this website to human resources departments in downtown businesses and then provides it to interested businesses.

* Access to preventive care

Although the Missouri Legislature has opted not to expand Medicaid, resulting in the closing of public health clinic Connect Care, city officials are optimistic about promoting health and wellness in the remaining clinics, including People’s Clinic and Grace Hill.