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Consistent with trends nationwide, obesity rates in Virginia have generally been steadily rising for the last decade and more. Within Virginia, obesity rates also rose in most regions in 2014, although many had seen their rates decline at least once across 2011-2013. Like many states, Virginia's efforts to embrace these updated standards and best practices for preventing obesity are still a work in progress.
At particular risk are Baby Boomers (those born between 1945 and 1964), who not only represent a bulge in the overall population, but are as a generation reaching those years where obesity-related illnesses, such as Type 2 diabetes and heart disease, tend to manifest themselves.
However, this same study found that losing just a small amount of weight could significantly alter outcomes.
NOTE: 2011-2014 BRFSS results cannot be compared to earlier years because of changes in the sampling methodology.
See the Data Sources and Updates Calendar for a detailed list of the data resources used for indicator measures on Virginia Performs. HealthBites is an interactive website from VDH to help users learn more about providing the best nutritional care for their children, from infancy on up. The Virginia Department of Agriculture coordinates the state's Farm-to-School program, which promotes opportunities for schools, distributors and growers to work together to increase the volume of locally grown foods served in school cafeterias and dining halls at all levels of education.
The evidence is clear: physical activity and healthy eating are effective strategies to manage, and even prevent, chronic physical conditions such as diabetes and heart disease. Since 2008, the Minding Our Bodies project has been working to increase capacity within the community mental health sector to promote physical activity and healthy eating for people living with depression, anxiety, schizophrenia and other mental health conditions. Minding Our Bodies is rooted in CMHA Ontario’s policy work in the area of chronic disease prevention and management (CDPM).
There is growing evidence that diet plays a role in specific mental health problems including attention deficit hyperactivity disorder (ADHD), depression, schizophrenia and Alzheimer’s disease. Compared with other forms of treatment, healthy eating and physical activity offer several advantages. If the research evidence shows that healthy eating and physical activity can have significant positive effects in preventing chronic disease, improving chronic disease outcomes and supporting recovery from mental illness, why isn’t everyone who lives with a mental illness being physically activity and eating a healthy diet?
Since 2008, the Minding Our Bodies project has been working to improve mental and physical health for people living with serious mental illness.
Beyond providing support for individual recovery from mental illness, and helping to prevent and manage chronic physical conditions, Minding Our Bodies also builds partnerships and creates new opportunities for peer support and peer leadership development.
To build the evidence base needed by policy decision-makers and program leaders, Minding Our Bodies is working not only to contribute new, practice-based knowledge, by supporting innovative program development and evaluation, but also to shape the community-based research agenda. The Minding Our Bodies project started with an environmental scan to gather information about existing physical activity and healthy eating programs for people with mental illness, and to identify start-up challenges, perceived barriers and program success factors. Literature reviews were also conducted in the first two phases of the Minding Our Bodies project, to synthesize evidence on the effects of physical activity and diet on mental health.
The Minding Our Bodies online toolkit brings together good advice and a selection of practical resources to guide organizations through the program planning stage. The website also houses a program directory that describes more than 50 existing physical activity and healthy eating programs designed for mental health clients.
A regular newsletter was distributed online and in print during the first phases of the project, to raise awareness, invite participation and report on our successes. To mark the release of the Minding Our Bodies project toolkit, staff at CMHA Ontario participated in a pedometer challenge during Mental Health Week (May 3–9, 2010).
Getting the word out has also included interviews and articles in the media, webinars hosted by ParticipACTION, Ophea and other organizations, as well as conference posters and workshops. Starting in 2011, we delivered a series of full-day knowledge exchange forums for priority audiences (mental health program managers, peer support workers, fitness instructors, dietitians and other nutrition professionals), to raise awareness of Minding Our Bodies, share lessons learned from the pilot phases, present successful program models, facilitate networking and partnership building, introduce participants to the toolkit resources and grow the community of practice. Minding Our Bodies has supported the launch of 32 new programs in communities across Ontario, through a combination of seed funding, training, and online resources to support program planning and evaluation. Training for seed-funded programs was delivered during one-day face-to-face workshops during the first two pilot phases.
During phase two, the Mood Disorders Association of Ontario (MDAO) developed a unique program called Boost Your Mood, designed to be co-delivered by a dietitian, a fitness instructor and a mental health peer facilitator. As Minding Our Bodies evolved, it became apparent that we should also be focusing attention on the various professionals, such as dietitians and fitness instructors, who could support mental health organizations to deliver their programs. Recognizing that the post-secondary curriculum for nutrition students contains very little information on mental health, Minding Our Bodies engaged with Jacqui Gingras, Associate Professor in the School of Nutrition at Ryerson University, to conduct a study exploring the perceptions of mental health and illness among nutrition students. Minding Our Bodies recruited an evaluation consultant in each phase of the project to perform two functions: (a) design and implement an evaluation plan for the overall project, and (b) support the local seed-funded organizations to conduct their own internal program evaluations.
The evaluation approach was designed as an evolving self-reflection process, and lessons from each phase were applied to planning for the next phase.
In phase three, greater emphasis was placed on building evaluation capacity within participating organizations. Final reports from each program were shared with the Minding Our Bodies project evaluator and the course instructor. To find out how evaluation results are being applied by the Minding Our Bodies seed-funded organizations that ran local programs, a York University graduate student is conducting a follow-up study.
When all the final reports are in hand, our next action will be to reflect on lessons learned and to engage in a discussion with the evaluation community about best practices in capacity building for the mental health sector. With funding provided by the Accessibility Directorate of Ontario, CMHA Ontario recently launched a new initiative called Enabling Minds.
CMHA Ontario recently announced a new partnership with Conservation Ontario to promote their Healthy Hikes campaign.

Looking beyond our provincial borders, the Minding Our Bodies project has begun connecting with similar initiatives in other jurisdictions. Includes a program planning toolkit, directory of programs, literature reviews, evaluation reports, expert interviews, news and event listings, and more. Fall 2010 issue of CMHA Ontario’s Network magazine, featuring articles on the social determinants of health, food insecurity, Aboriginal diabetes prevention and management, mental health peer support, and innovative programs for people living with mental illness who have metabolic syndrome and other chronic conditions. Produced in 2011 by the Public Health Agency of Canada’s Chronic Disease Interventions Division, this monograph presents six descriptive narratives that illustrate the successful use of evaluation findings to inform programs and practices in chronic disease prevention and health promotion. Published in December 2012 by the Dietitians of Canada, the goal of this role paper is to support the work of dietitians and to guide future dietetics practice as it relates to mental health. Co-edited by Guy Faulkner, professor in the Faculty of Kinesiology and Physical Education at University of Toronto.
Produced by the Ontario Chronic Disease Prevention Alliance, this document presents common messages and related actions that health practitioners, organizations, and groups can take to collectively move forward in addressing chronic disease and its prevention. The goal of the Enabling Minds project is to reduce barriers and improve access to physical activity programs and services for people living with mental illness. Resources to provide diabetes competency training for mental health peer support workers, and to increase awareness in the diabetes community of the role mental health peer support workers can play in prevention and self-management support.
Although the state's obesity rate declined two percentage points from 2011-2013, it rose again by nearly that same amount in 2014, to 28.5 percent -- ranking the state 20th nationally. In 2010, Congress passed the Healthy, Hunger-Free Kids Act, which reauthorized federal child nutrition programs such as National School Lunch and National School Breakfast, eased and expanded access, strengthened and updated nutritional standards, and initiated efforts to bring fresh, local produce into school-provided meals. According to various sources, the Commonwealth has a vigorous Farm-to-School program and has implemented several of the recommended policies to encourage healthy eating and physical activity. The rate of obese Baby Boomers in Virginia is 34.2 percent, more than 5 percentage points higher than the overall adult obesity rate. An adult is considered obese if his or her body mass index (a measurement of fatty to lean tissue) is 30 or above.
For instance, if average BMI is reduced by 5 percent by 2020 in the Commonwealth, over 345,000 cases of obesity-related disease could be avoided, for a potential cost savings of nearly $6.3 billion. The state also participates in programs, such as National School Lunch, National School Breakfast, and Farm-to-School, that set high standards for foods served in the public schools. The site offers fun, informative videos on nutrition and ideas for simple, healthy recipes; WIC participants can complete modules to receive nutrition education credit. Emerging research also points to the significant impact of exercise and diet on positive mental health and recovery from mental illness. Our advisory committee brings together a range of organizations that share a common interest in mental health and chronic disease prevention and management, including the Canadian Diabetes Association, Dietitians of Canada, Heart and Stroke Foundation, Ophea, Parks and Recreation Ontario, and the Schizophrenia Society of Ontario. For example, risk factors for depression include low intake of fish, omega 3 fatty acids and fruits and vegetables, and high intake of refined sugar and processed foods. Healthy living interventions are less likely to cause adverse side-effects, in contrast to medications.
Put up your hand if you know that physical activity is good for you, but you still don’t act on that knowledge. For many reasons, community mental health providers are ideally positioned to provide healthy lifestyle programs.
Longer-term goals of the project include influencing a shift in health policy towards upstream action on prevention and promotion. The results were combined with the environmental scans to support our project planning and toolkit development. Rather than recreate the wheel, our resource library draws on many excellent pre-existing documents produced by our project partners and other organizations. The listings are intended to serve as models to educate and inspire other organizations to launch their own programs.
Minding Our Bodies now produces a quarterly e-bulletin with news and event listings, research summaries, new resource announcements, and interviews with experts in the field (such as John Ratey, author of Spark: The Revolutionary New Science of Exercise and the Brain). Minding Our Bodies has presented at the Ontario Public Health Association Fall Forum, the 3rd International Congress on Physical Activity and Public Health, Making Gains in Mental Health and Addictions, the Dietitians of Canada annual conference, the Health and Wellbeing in Developmental Disabilities conference, the Move Your Mood workshop in Red Deer, Alberta, and the 1st International Forum on Health Promotion and Disease Prevention in Wroclaw, Poland. Forums were held in Toronto, London, Ottawa and Thunder Bay, and each event had a unique theme or population focus. Each program is unique to the community it serves, often developed with direct input from participants.
Boost Your Mood was then revised and expanded in phase three and delivered as a train-the-trainer workshop in three locations (Hamilton, Ottawa and Thunder Bay). We worked with the Dietitians of Canada to deliver two full-day workshops for dietetic interns, to improve mental health literacy. A systematic review was conducted to summarize current literature on mental health literacy and education among students in health professions, and a three-hour mental health literacy workshop was delivered to students enrolled in a second-year Interpersonal Relationships course in the Nutrition and Food undergraduate program at Ryerson.
In phases one and two, the final evaluation report included in-depth case studies of each program, created by the Minding Our Bodies evaluator in collaboration with the local program leaders.
Local program leaders were offered a four-week, online evaluation training program, developed by York University that combined self-study with interactive group discussions and mentorship by the instructor.
Lessons learned in phase three about our approach to evaluation capacity building have been synthesized to inform future discussion and planning. Interviews have been conducted with program leaders from all three phases of the Minding Our Bodies project, and results are now being analyzed. The goal is to reduce barriers and improve access to physical activity programs and services for people with mental health-related disabilities.

Over the next year, CMHA and Dietitians of Canada will collaborate on a dissemination strategy to get the word out about key policy and practice recommendations contained in the paper.
Running from May through October 2013, Healthy Hikes will challenge Ontarians to spend time hiking in the province’s over 270 Conservation Areas and track their progress for a chance to win prizes. Our intention is to develop a national network, or community of practice, to share lessons learned, promote the exchange of promising practices and identify research gaps and opportunities. The document also provides policy makers with an evidence-based summary of the current literature about the promotion of mental health through healthy eating and nutritional care. The Northern region had the lowest rate of obesity at 21.2 percent and was the only region with a rate below the statewide average. A related initiative, Smart Snacks in School, was launched in 2013 to set nutritional standards in public school foods sold a la carte, for fundraisers, and in vending machines.
If Virginia could reduce the average body mass index (BMI) of its residents by just 5 percent, for example, the state could help prevent thousands of cases of Type 2 diabetes, coronary heart disease and stroke, hypertension, cancer, and arthritis. Ontario’s CDPM framework, launched by the Ministry of Health and Long-Term Care in May 2007, recognizes the need to create supportive environments and strengthen community action, but the place of mental illnesses and mental health within the CDPM framework in Ontario has yet to be well-defined. The good news is that the combination of nutrients most commonly associated with good mental health and well-being is the same type of balanced diet that is recommended to reduce our risk of developing chronic physical diseases. They can be sustained indefinitely by the individual, unlike medical treatments which are often time-limited. Now imagine that you also live with depression or anxiety, making it difficult to get out bed or out of the house, let alone go to the gym. Physical activity and healthy eating programs align well with the recovery philosophy of community mental health services. We want to create a culture that encourages physical activity and healthy eating as core features of mental health promotion. Proposing a similar challenge to all CMHA branches in Ontario during the month of July, we distributed over 2,000 pedometers, generously donated by ParticipACTION, the Ministry of Health Promotion and Sport and the National Quality Institute (NQI). This direct engagement increases the chances of program success, by ensuring that it meets the expressed needs of participants. Registration for these online sessions was open to any organization, in order to extend our reach beyond the funded programs, and presentations were later posted on the project website.
The events took place in Toronto and Ottawa, with remote participation via the Ontario Telehealth Network.
Findings from the literature review were presented at the Dietitians of Canada annual conference in 2012, while results from the pre- and post-workshop survey are being prepared for journal submission. Additional one-on-one and group support was provided to all program leaders to help them plan and implement their internal program evaluations. In addition, a scoping review of the scientific literature was commissioned to see how other healthy living programs serving marginalized populations had approached evaluation and what tools were used. Working in collaboration with Parks and Recreation Ontario and YMCA Ontario, CMHA will develop tools and training resources to support organizations in the physical activity sector to meet the requirements of the customer service and information and communication standards under the Accessibility for Ontarians with Disabilities Act, 2005. CMHA will focus particularly on mechanisms that can increase access to and quality of dietetic services for people with mental health conditions in the community, as well as on the need for research that evaluates the impact and outcomes of community-based healthy eating programs.
Healthy Hikes is designed to teach participants about the ways our environment can boost both physical and mental health. Some psychiatric medications can lead to significant weight gain, itself a risk factor for diabetes and other health problems.
They are normalizing, health-focused experiences, unlike drug treatments and other clinical interventions that are a constant reminder of one’s illness. Imagine that you have diabetes, that you live on a fixed income, that you have trouble finding a safe and stable place to live. Many individuals with serious mental illness already have frequent contact with mental health service providers and have established relationships. It also aligns well with mental health recovery principles that insist on client empowerment and self-determination. MDAO will continue to run the Boost Your Mood program in Toronto and offer train-the-trainer sessions as needed. For a 6-foot-tall person weighing 200 pounds, a 5 percent reduction in BMI would be the equivalent of losing approximately 10 pounds. Stigma and discrimination also present barriers to care and often result in social exclusion.
Healthy eating and physical activity programs can serve as a bridge to other services offered by community health care providers. Mental health service providers have specialized training and sensitivity to address barriers facing this vulnerable population. Resources are interspersed with lessons learned from programs funded by Minding Our Bodies, and the online toolkit is regularly updated as new resources emerge. And group programs are especially successful at promoting social inclusion, which is strongly associated with positive mental health.
And offering healthy lifestyle programs in collaboration with community partners creates an opportunity to improve service coordination, both within and outside of the mental health care sector.

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