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Healthier Cumberland Completes Three-Year Grant with the Healthier Wisconsin Partnership Program

Early in the morning, when the air is filled with birdsong and hope, Shannon Bents pulls on workout clothes and heads for Cumberland High School. By 6 a.m. each workday, she has finished one round of exercises on the machines in the fitness center there and is walking fast laps through the hallways. Daily exercise is one of several new behaviors that Bents learned in a Healthy Lifestyles Coaching class sponsored by the Healthier Cumberland project. Healthier Cumberland Coalition has started or co-sponsored many programs and events during its just completed 3year Healthier Wisconsin Partnership Program grant to educate and empower Cumberland area residents to improve their health. For Bents, the coaching class came along at just the right time. She quit smoking in March 2008 because the price of cigarettes had risen beyond her means and gained 25 pounds by January. "Everyone said, ,,You must feel better not smoking," said Bents. "But I really didnt, which surprised me." So she went to local resources in search of help: to the high school to find out about walking the halls; to Healthier Cumberland project director Jeanette Olsen, who suggested that she also enroll in a Healthy Lifestyles Coaching class; and to Gina Simon of Cumberland Community Education, who gave her a 1-week pass to the schools fitness center. By the end of January, Bents was a member of the fitness center and was meeting weekly with Mary Jean Jergenson, HC community contact and lifestyle coach, for a one-on-one lifestyle coaching class, because the group classes did not fit her work schedule. The 16-week, interactive class included the option to weigh-in and conversation emphasizing healthy food choices, daily exercise, emotional eating and the effects of being overweight on mind and body. The result was a heightened awareness that gave Bents the strength to trade her daily 12-pack of Mountain Dew for water, juice and green tea. "Lets be clear on this," she said. "Nutrition and exercise were words that were not in my vocabulary. This body used to run on nicotine and caffeine. "Who wouldve thought?" she smiled. "Im not perfect on this healthy eating thing. If I want cake, I eat it and go for a walk later. I like food, and Im around it all the time." Bents works in Cumberland at the Tower House, Das Lach Haus and the post office. "My schedule sometimes gets a little hectic," she said. "But Healthier Cumberland taught me that you need breakfast. I never used to eat breakfast. A couple of Mountain Dews and half a pack of cigarettes before I left home and I was good to go." Now she starts the day with fresh fruit and cereal and takes the time to snap on her pedometer and grab a piece of paper to track her dietary intake, including fiber to ward off irritable bowel syndrome. "Healthier Cumberland taught me how to eat healthy and to pay attention to what Im putting into my body," Bents said. "I read labels now. I never used to read labels. "I write down everything that goes in my mouth," she said. "This isnt dieting. This is just awareness. Ive discovered foods that I never would have looked at before." Her new preferences add fiber and subtract calories with no loss of flavor. She lunches on large salads and snacks on green beans, both drizzled with fat-free Italian dressing and often served with whole grain hamburger buns. "I never ate fresh fruits. I never ate vegetables," said Bents. "Now when I crave something, its usually carrots or a banana. Thats the sweets I want." "Once I joined the fitness center and Healthier Cumberland, then I started feeling a big change," Bents said. "They taught you what foods are good for you, what foods arent good for you and that you feel better if you exercise. "When I first started walking, I couldnt breathe after one lap around the school. I would say after one month of working out and walking the halls, my breathing capacity was tremendously different." Bents workout has increased from five repetitions on six or seven machines and a one-mile walk to two rounds of 14 reps per machine, two miles of walking and 10 minutes on the stationery bicycle. She also tries to walk a mile or two around town each day or return to the fitness center Shannon Bents works out at the Cumberland when it reopens to the public at the end of the school day. High School Fitness Center.

It hasnt been easy. Bents also struggled with anxiety issues that were addressed in the coaching class, and there are still times when she craves a cigarette. But there have been multiple payoffs. Bents is 20 pounds lighter and has lost 1.5 inches from her waist, and her blood pressure, triglyceride and fasting glucose levels are well within the target levels set by the American Heart Association and National Heart, Lung and Blood Institute to protect her from Metabolic Syndrome, a combination of conditions that increases the risk of heart disease, diabetes and stroke. The money that Bents once spent on cigarettes has outfitted her basement with exercise equipment and a Wii fitness system, and she is also planning to take her daughter, Dani, to the country of her choice when she graduates from Cumberland High School in 2013. But even more, Bents is happy. "Here I was thinking that Mary Jean was going to teach me to be healthy physically, and she was also teaching me to be healthy mentally and emotionally," she said. "I wouldnt have known where to start without Healthier Cumberland. "When they talk about life changing, this has been life-changing. I like me now," she said. Community commitment Healthier Cumberland Coalition was formed in 2004 when a policy statement from the American Academy of Pediatrics recommending that schools remove soda pop from vending machines made its way from Jergensons desk at Cumberland Memorial Hospital, where she was education coordinator, to the desk of then Cumberland School District superintendent Don Groth and Cumberland School Board members. Jergensons job responsibilities included community outreach, and her two children were district students. Groth called the data contained in the policy statement "overwhelming" and "a catalyst for parents, health professionals and community leaders to jump start an action plan by bringing together a network of people to make something happen in Cumberland." "We wanted Cumberland to be a leader in helping change habits, attitudes and the prevailing culture," he said. The result was a group of volunteers who represented a cross-section of the community and a shared vision of improved community health. The fledgling coalition decided to focus its efforts on better nutrition and increased physical activity and in 2005 received a planning grant through the Medical College of Wisconsins Healthier Wisconsin Partnership Program. Almost 800 people participated in the coalitions Cumberland Fitness Challenge that fall. The event featured a walking fitness test and then sent participants home to track their daily activity for 6 weeks before returning for another fitness test. "The number of participants who completed that challenge and the outcomes of their increased physical fitness level were notable," said Jergenson, a coalition board member. The results inspired HCC to apply for an impact grant from the Medical College of Wisconsin with assistance from academic partner Dr. Jane Kotchen. The Healthier Cumberland proposal was among 12 applications that were chosen from 113 submissions to receive funding for a 3-year community and school program to improve community health, Jergenson said. The coalition chose to address the nationwide trend toward overweight among adults and students based on input from respondents to a community survey and those who attended several community focus group discussions. Evidencebased programming has focused on helping area residents assess their health and address their risks through improved nutrition and increased daily physical activity. Project director Jeanette Olsen said that Metabolic Syndrome screening targets stood out as a way to redirect attention from weight to other risk factors like waist measurement, blood pressure and cholesterol and still achieve reduced rates of heart disease and diabetes. The coalition introduced its Healthier Cumberland project at a community kick-off event in March 2007that featured adventure cyclist and author Willie Weir; speaker Tom Lingen, a local physician; health screenings and healthy foods and displays by local health care professionals and fitness experts. HC also offered on-site health screenings and presentations to the school district, businesses, churches, health care facilities and community organizations. "We have consistently engaged as many worksites as possible in participating in our programs or in lending whatever support we could to their current employee health activities," said Olsen. Area residents welcomed the project and embraced its mission and campaigns designed specifically to reach every sector of the community. "We targeted school and community-based interventions," said Jergenson. "Our overall goal is to decrease heart disease. Barron County has one of the highest rates in the state."

Cumberland Memorial Hospital and Cumberland Medical Clinic have teamed up with HC to co-sponsor annual health fairs and worksite screenings that provided 767 area adults with one or more free screenings for Metabolic Syndrome plus speakers, displays, giveaways and healthy foods. The health fairs were an important intervention, because adults who were shown to be at risk of heart disease or other chronic illnesses were referred to health care providers and given information on the coalitions Healthy Lifestyles Coaching classes, said Olsen. "Once you do the screening, you want to provide some resources for people so that they can make these choices," she said. "We didnt just randomly decide to do things that might be fun, though we tried to make it fun, too." The 16-week classes used the Diabetes Prevention Program curriculum because of its success in preventing the onset of diabetes, she said. Studies done at centers in 27 cities where the curriculum was used show that it was more effective than medication in achieving reduced rates of diabetes. Coaching was added locally at the suggestion of physician assistant Clare Janty, a certified master life coach through the Learning Journeys International Center for Coaching in Columbia Heights, MInn. Janty uses the approach in her practice and is HCs lead health coach. HC provided a 2-day training seminar with instructors from the center for Cumberland health care professionals who taught the local classes. Olsen said that coaching is a unique approach because it allows clients to decide how to address the problem, set goals and direct their education. Coaches provide knowledge, tools and support. Healthy Lifestyles Coaching classes also featured Motivational Interviewing, a communication tool used in coaching that was designed by clinical psychologists to help people understand the consequences of specific behaviors and commit to making the necessary changes to reach their goals. HC provided a 2-day Motivational Interviewing training seminar for its health coaches that was also open to health care providers from the local hospital, Lakeview Medical Center in Rice Lake, Luther Midelfort Northland Hospital in Barron and Barron County Public Health Department. The Healthy Lifestyles classes became one of HCs signature programs, with 113 graduates from the 17 classes offered. Graduates lost an average of 11.3 pounds and 3 inches from their waist and averaged reductions of 9.4milligrams per deciliter in total cholesterol levels, 6.7-mg/dL in LDL levels, and 22.4-mg/dL in triglyceride levels. They increased weekly exercise by an average of 40 minutes, daily fruit and vegetable consumption from four servings to five servings, and cut their daily servings of high fat foods in half. A recent survey of class graduates shows that 89% have maintained or increased their daily fruit and vegetable consumption, 80% have maintained or reduced daily fat gram consumption within 5 grams, 56% have maintained their weight loss within 5 pounds or lost more weight, and 70% maintained or increased weekly physical activity within 15 minutes. Steve and Maggie Wickre Cumberland native Steve Wickre said that his weight went up and down like a yo-yo on every diet he had ever tried until his wife, Maggie, decided that they should attend a Healthy Lifestyles Coaching class. "Ive been dieting forever," he said. "It never worked. Id drop 30 pounds and gain it back. But this time were together on it, and thats whats making the difference." Maggie first heard about Healthier Cumberland when she was handed an apple and an informational booklet by HC volunteers during a community challenge kick-off event at the citys four-way stop. She was on medication for high cholesterol, and the challenge to eat more fruits and vegetables was enough to pique her interest in lifestyle changes that could lower her cholesterol without medication and help Steve reach and maintain a healthy weight. "I wanted to take the class because it was so cheap," she said. "I thought 10 bucks. We could do it." They dropped out of the first class during the holiday season, when Steve assists Santa locally and at Macys in Minneapolis and couldnt make it to class.

Steve and Maggie Wickre enjoy preparing healthier food together.

"It took us two classes, and it took the whole class the second time," Maggie said. "Ive told everyone to take it a second time. The first time I think we were like, ,,We dont need to do this to lose weight. The second time it kind of clicked. "For me the light bulb came on when she said ,,fat grams," said Maggie. "So we started on the fat grams and focused on the protein portions. We went to chicken and turkey and smaller portions." Dietitian Marla Prytz coached the Wickres class and emphasized fat-free, portion size and label reading and included tips for meal planning and shopping, said Maggie.

At first the couple wore pedometers and tried to walk 10,000 steps each day. Now its a way of life. Steve drives charter buses and works at Menards in Rice Lake, where he walks as much as 6 miles in a workday and can now trot up the 22 steps that he routinely climbs while on the job. Maggie works for Polk County and counts on the family dog to remind her that exercise is fundamental. Together, and sometimes with Steve, they walk 3 miles every day. "Its such a good grant, that after we started hearing about it, we went to the health fairs and the screenings," said Maggie. The Wickres agree that stepping onto the scale is no fun, but it is an easy and inexpensive indicator of progress between blood screenings. Maggie has maintained a 13-pound weight loss and between Metabolic Screenings in January 2008 and May 2009 lost almost 3 inches from her waist. Her good cholesterol was in the safe range before she began the class and improved as a result of it. Her blood pressure and triglyceride and fasting glucose levels were also in the safe range, and two of the three fell further during the class. From October 2007 to May 2009, Steve lost 7 inches in his waist, his blood pressure fell from 160/80 to 124/82, his triglycerides dropped from 456 to 81, his fasting glucose fell from 147 to 101 and his good cholesterol fell slightly from 44 to 43. All are within or barely outside the safe range, and his weight loss to date is 43 pounds. Steves goal is to lose another 20 pounds before his 40 th Cumberland High School class reunion in August and another 20 pounds after that. Knowing what to eat and deciding what to eat were crucial to success, said Steve, who has given up pop, caffeine, and alcohol. And there are no snacks in the house. When there is bread, chips or ice milk, theyre homemade. The Wickres prioritize planning meals together to ensure that what they eat supports what they learned in class, maintains their success in controlling risk factors and keeps them happy. If youre not eating out, its critical to have "fun foods" at home, Maggie said. Maggie often chooses salad for lunch. At suppertime, the couple usually replaces meat with vegetables, including Portabella mushrooms in sandwiches and large servings of seasoned onion, green peppers and mushrooms sauteed lightly in cooking spray and served alongside eggs or pasta with homemade tomato sauce. They also enjoy vegetable soups with little or no meat. The Wickres have always tried to make healthy food choices, but the coaching class sensitized them to the effects of sugar and the importance of choosing low fat or fat-free products. "My splurging now is low-fat yogurt," Steve said. They grow herbs at home and buy fruits and vegetables at the local farmers market to eat fresh, can and freeze. There is a sense of comfort and security in living more like their parents did in the past. "The farmers market here is wonderful," said Maggie. "We have a lot of fun making things. We kind of like to think of ourselves as a couple of hippies. "We were always conservative on our food purchases," she said. "But I think eating like this is cheaper, because we never buy the packaged stuff. We shop the perimeter of the store." The Wickres have also taken advantage of HCs low- or no-cost opportunities like dance events and, for Maggie, Strong Women, a strength training program for women that is now available through Cumberland Community Education. "Im into every program I can get my hands on that is cheap," she said, including Polk Countys employee wellness program. "Without all that support, I probably couldnt do it." "We no longer huff and puff and drag our butts around but can move faster, with more agility and with less pain and feel good about doing it," said Steve. "Simple things like jogging up steps instead of clinging to the hand rail and pulling ourselves up and stopping halfway up for a small, deep breathing session help us to feel younger again." Maggie said that Healthier Cumberland provided the community with "a lot for a little money." "Everybody there is supportive. They all became really good friends and good resources," she said. Programming for tomorrow's leaders "From the beginning, school interventions have been a priority, because early intervention in young families means healthier, longer lives," said Jergenson. "We know that the school environment has a huge impact on health as well as learning. There is evidence that school-age children learn better if they are physically active and eating healthy foods." The school board and district administrators and staff have partnered with HC to offer countless fun, educational programs and events and to implement healthy changes including the removal of pop from vending machines, the end of candy sales for fund-raising and healthier school meals. The district food service was commended by the Wisconsin Department of Public Instruction following a Nutrition Analysis in February for offering more fresh fruits and vegeta-

bles per month and for achieving DPI target fat and saturated fat content standards in its menus. Programming at Cumberland High School involved students as well as staff and community volunteers. The Students Offering Support group sponsored a springtime Wellness Day that included a play and break-out sessions led by health professionals, school staff, area fitness experts and HC health coaches. HC also presented Healthy Student at the schools Freshman First Day event and Nutrition for Athletes , and elementary and middle school students began Fridays last fall with fitness activities led by National Honor Society students and HC volunteers. The HC project also offered a summertime Healthy Lifestyles Coaching program for students that was designed and presented by a student from the Medical College of Wisconsin in Milwaukee with assistance from high school guidance counselor Kate Koehler. Koehler said that the medical student offered a flexible class schedule and "gave the students lots of individual time, which was very valuable to them." The weekly classes emphasized the role of healthy food options and exercise in lowering the risk of Metabolic Syndrome. "I think the students learned a lot about their current health situation: seeing their numbers from the testing was valuable for them," said Koehler. "The focus with the teens in the group was to work on realistic goalsetting and developing healthy habits. It wasnt focused on losing weight at all. That was just a nice outcome with the work they did." The medical student also designed and presented a 2-day Summer Shindig nutrition and fitness camp for elementary students.

At the Middle School, students and community members enjoyed interactive displays on health and safety topics at the 2007 Fall Into Health community wellness event, which featured about 20 area health-related businesses and agencies. Fitness Fridays is an ongoing program that involves teachers and students in one-half hour of unstructured games and sports.

High school students learn about nutrition and healthy snacks from HC nutrition coach Glenda Severson during the CHS Wellness Day.

Cumberland Elementary School has implemented many new, exciting programs for children including Walk to School Day, an annual March Nutrition Month lesson, the annual recess walking program and the new, 10-week Movin and Munchin program developed by staff that featured local fitness experts and interactive sessions about choosing nutritious foods. The younger students also have recess before lunch now to encourage them to take more time eating their meals. The school district and HC also partnered with the Barron County UW Extension to offer the Raising Healthy Eaters program in Cumberland and Rice Lake. Groth said that health and fitness education is "a lifelong learning experience" and that HC gave Cumberland students the "opportunity to learn and live healthier lives." "This is a journey that never ends and needs constant stimulation or we fall back into earlier habits," he said. "Cumberland School District will continue to be an integral partner as we move forward in making change for healthier lifestyles," said district superintendent Barry Rose. Healthier Cumberland Coalition has made a difference in many lives and in the community mindset, and the school district is committed to sustaining the gains that have been made and in future collaboration including an increased emphasis on policy and environmental changes related to nutrition and physical activity health behaviors, Rose said. Power of self-talk Sue Clark of Almena has maintained a 30-pound weight loss since graduating from a Healthy Lifestyles Coaching class last summer. She didnt have high blood pressure or high cholesterol, but she was shocked to find her weight in the obese range when she was screened at the Healthier Cumberland kick-off event. "Because [health care professionals] dont usually use that word, but on the chart they do," Clark said. "I went to the class, and I made it a priority. So if something else was coming along, it had to be pretty darn good for me to miss a class. "And I actually did what they told me to do, which is amazing. Its really a no-brainer, because its not like we havent heard this stuff before," said Clark. Registered nurse Kathy Riemer and physicians assistant Clare Janty coached Clarks class. They recommended exercise, self-talk and documenting food intake. Riemer and Janty also occasionally skipped a week between classes to extend the time that their students could access the safety net of coaches and peers. It was a combination that helped

Clark shed the weight she hadnt realized was a problem. "I was overweight but healthy, but eventually its all going to catch up with you. So its thinking long-term," said Clark. "There was a lot of absent-minded eating going on. I think it really takes care of that eating dinner while youre making dinner and then eating dinner at the dinner table." Clark was making a common mistake: cooking healthy meals and taking care of her family but forgetting to take care of herself. Change came when she understood that she had to make better food choices and eat smaller portions. Now she walks when possible, tries not to eat between meals, doesnt eat candy bars and packs her lunch for work as a Distance Learning technician at WITC-Rice Lake. Clark bakes less and enjoys healthy dishes like grilled zucchini and fish. To grill large zucchini, cut them lengthways, season with spices and olive oil, put it on grill like a burger and eat it with a steak knife, she said. "It was the writing stuff down and having those little chats with yourself," said Clark."The butter went away. I dont know where it went." She and her husband Joe also own Snowshoe Valley Christmas Tree Farm in Almena, so theres a short busy season each year when exercise comes naturally, followed by a long off-season when its more difficult. So Clark has learned to take advantage of downtime by walking. Even short walks make a difference, she said. "Its a lot easier to move around," said Clark. "And I feel healthier." `Eat Healthy, Be Active, Know Your Numbers' Olsen said that partnership has been key to the projects success. HC has teamed up with Cumberland Memorial Hospital on health presentations and newsletter articles; with local restaurants to offer fruits and vegetable side dishes as options to French fries; with local grocery stores to hang "Color of the Week" posters for use during the Fruit and Vegetable Challenge and after; and with community businesses and organizations to market healthy food choices in social settings including Chef at the Market at the local farmers market, four-way stop challenge kick-offs and Taste and Tips events at grocery stores; and to promote physical activity at many community events including Drop In and Dance, bike rides and an expanded Rutabaga Olympics. "One of the things people continually talk about is the challenge with the kick-off events that we had at the Four Corners," Olsen said. "Its a surprise and its kind of crazy." At one kick-off, Healthier Cumberland assistant project director Beth Narges sported a banana costume, and 3M partner and Healthy Lifestyles coach Lisa Janty donned an apple costume to remind motorists that healthy eating and fitness can be fun. HC has also carried its message to "Eat Healthy, Be Active and Know Your Numbers" to other communities, including presentations for the Chetek School District and at Wheatridge Ministrys National Symposium on Health and Hope in Milwaukee. Healthier Cumberland Coalition has also joined the new Marshfield Clinic Worksite Wellness Toolkit Users group to share best practices with area employers. "There is more awareness about the importance of eating healthfully, particularly eating more fruits and vegetables, and of being more active," said Olsen. "Within organizations there seems to be more thought about what can be done to make meetings, work or school a healthier place to be." Marla Prytz RD and Audrey Held, nutrition Obesity among local students has dropped, and the percentage of students educator, promote eating more fruits and who are at-risk of obesity has stabilized since the 2004-2005 school year vegetables at the Cumberland Farmer's Market during a Chef at the Market based on Center for Disease Control and Prevention criteria. presentation. A recent community survey indicates that 10% of responding adults are eating at least 5 servings of fruits and vegetables a day, up from 7% in 2006. The survey also indicates that 31.4% of responding adults are active 5 or more days per week compared to 11% of responding adults in 2006. "Its about making an informed choice," Jergenson said. "Were not about telling people what to do. Were about building an environment that supports health. It benefits all of us in the long-run." "People often think if you regain weight, or you eat a bunch of junk, or you dont exercise for a week, then youve failed," Olsen said. "As a community, the thought can never be, ,,Were finished here. "We need to be real about the fact that for most of us, its going to be a continual struggle. Hopefully well be able to continue doing activities and supporting people in the future."

Healthier Cumberland Coalition has received a new, 1-year obesity prevention grant from the Centers for Disease Control and Prevention. Funding through the Wisconsin Nutrition and Physical Activity State Plan will strengthen and expand the coalitions initiatives to educate area residents and support their efforts to defend themselves against heart disease, diabetes and other chronic diseases. That project will focus on helping area residents eat less non-nutritious, high-calorie food and increase their intake of fruits and vegetables. Healthier Cumberland participants can look forward to more Chef at the Market events and community challenges plus additional community assistance to increase the availability of fruits and vegetables and create environments that support healthy food choices. Information on how to join the effort and about HC programs for individuals and organizations to use at no cost is at www.healthiercumberland.org and by calling the HCC contact person at Cumberland Memorial Hospital at 822-2741.

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