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0 0 777.01575 -1.128 -1.1948 cm /Im18 Do Q Q /GS1 gs 0 0 0 1 k -9.492 636.368 41.902 150.431 re f q -9.492 636.368 41.902 150.431 re W n /GS2 gs q -34.55772 0 0 140.14374 33.3771 635.3239 cm /Im19 Do Q Q Q /GS2 gs q BT /F8 1 Tf 0 -12 12 0 19.3846 656.3263 Tm 0 0 0 0 k 0.352 Tc (W)Tj 1.38802 0 TD (I)Tj 0.74001 0 TD (N)Tj 1.18402 0 TD (N)Tj 1.18402 0 TD (E)Tj 0.98202 0 TD (R)Tj ET q 99.5 355.984 m 207 355.984 l 217.4934 355.984 226 347.4774 226 336.984 c 226 97 l 226 86.5066 217.4934 78 207 78 c -8 78 l -18.4934 78 -27 86.5066 -27 97 c -27 336.984 l -27 347.4774 -18.4934 355.984 -8 355.984 c W* n 2 w 0.24 0.12 0.32 0 K 99.5 355.984 m 207 355.984 l 217.4934 355.984 226 347.4774 226 336.984 c 226 97 l 226 86.5066 217.4934 78 207 78 c -8 78 l -18.4934 78 -27 86.5066 -27 97 c -27 336.984 l -27 347.4774 -18.4934 355.984 -8 355.984 c s Q Q /GS1 gs q BT /F12 1 Tf 9 0 0 9 60.4253 329.0848 Tm 0 0 0 1 k -0.022 Tc 0.022 Tw (THE GOAL)Tj ET Q /GS2 gs q BT /F13 1 Tf 13 0 0 13 100.0143 328.0849 Tm 0 0.91 0.56 0.34 k (I)Tj ET Q /GS1 gs q BT /F9 1 Tf 9 0 0 9 107.3352 329.0848 Tm 0 0 0 1 k -0.009 Tc 0.022 Tw (Helping children establish good)Tj -5.21221 -1.22222 TD (health habits at an early age.)Tj ET Q /GS2 gs /GS1 gs q BT /F12 1 Tf 9 0 0 9 60.4253 296.0848 Tm 0 0 0 1 k -0.022 Tc 0.022 Tw (THE PLA)Tj 3.25595 0 TD 0 Tw (YERS)Tj ET Q /GS2 gs q BT /F13 1 Tf 13 0 0 13 112.4337 295.0849 Tm 0 0.91 0.56 0.34 k (I)Tj ET Q /GS1 gs q BT /F9 1 Tf 9 0 0 9 119.7546 296.0848 Tm 0 0 0 1 k -0.009 Tc 0.022 Tw (Duke Raleigh Hospital, Alice)Tj -6.59214 -1.22222 TD [(A)18(ycock Poe Center for Health Education, the)]TJ T* [(Duke Foundation, participating W)18(ake County)]TJ T* 0 Tw (schools.)Tj ET Q /GS2 gs /GS1 gs q BT /F12 1 Tf 9 0 0 9 60.4253 241.0848 Tm 0 0 0 1 k -0.022 Tc 0.022 Tw (THE PLAN)Tj ET Q /GS2 gs q BT /F13 1 Tf 13 0 0 13 100.0209 240.0849 Tm 0 0.91 0.56 0.34 k (I)Tj ET Q /GS1 gs q BT /F9 1 Tf 9 0 0 9 107.3418 241.0848 Tm 0 0 0 1 k -0.009 Tc 0.022 Tw (Promote healthful eating and)Tj -5.21294 -1.22222 TD [(physical activity)50(, help students identified as)]TJ 0 -1.22223 TD (overweight reach normal weight status for)Tj 0 -1.22222 TD (their age group, reduce risk factors attributed)Tj T* (to students identified as pre-hypertensive or at)Tj 0 -1.22223 TD (risk for hypertension.)Tj ET Q /GS2 gs /GS1 gs q BT /F12 1 Tf 9 0 0 9 60.4253 164.0848 Tm 0 0 0 1 k -0.022 Tc 0.022 Tw (THE RESUL)Tj 4.26429 0 TD 0 Tw (TS)Tj ET Q /GS2 gs q BT /F13 1 Tf 13 0 0 13 111.902 163.0849 Tm 0 0.91 0.56 0.34 k (I)Tj ET Q /GS1 gs q BT /F9 1 Tf 9 0 0 9 119.2229 164.0848 Tm 0 0 0 1 k -0.009 Tc 0.022 Tw (Prevalence of overweight)Tj -6.53307 -1.22223 TD (decreased from 43 percent to 34 percent, 20)Tj 0 -1.22222 TD (percent of participants reported having fewer)Tj T* (servings of fried snacks, 39 percent reported)Tj 0 -1.22223 TD [(increasing weekly physical activity)50(, and stu-)]TJ T* (dents increased nutrition and physical activity)Tj T* 0 Tw (knowledge)Tj 4.0977 0 TD 0.022 Tw (by 26 percent)Tj 4.81546 0.00001 TD 0 Tc (.)Tj ET Q /GS2 gs q BT /F8 1 Tf 42.898 0 0 42.898 277.4257 599 Tm 0.412 0 0.294 0 k (H)Tj ET Q /GS1 gs q BT /F11 1 Tf 8.55 0 0 9.5 313.9257 623 Tm 0 0 0 1 k -0.03 Tc 0.102 Tw (ow do you inspire children to improve their diets and get more)Tj 0 -1.26316 TD -0.019 Tw [(exercise without boring them to tears? The folks behind the R)23(eally)]TJ T* 0.213 Tw [(A)80(wesome H)23(ealth and Wholesome R)23(outines programs say the)]TJ -4.26901 -1.26316 TD 0.025 Tw (trick is to make it fun.)Tj 2.10526 -1.26316 TD -0.059 Tc 0.019 Tw [(As elsewhere, many children in W)70(ake C)25(ounty)80(, N.C., eat too much junk food)]TJ -2.10526 -1.26316 TD -0.02 Tc 0.005 Tw (and spend too much time sitting in front of their computers and television)Tj T* -0.033 Tc -0.007 Tw (sets. An alarming number are overweight, at risk for hypertension and facing)Tj T* -0.03 Tc 0 Tw (other weight-related ailments.)Tj 2.10526 -1.26316 TD -0.028 Tc 0.013 Tw [(In 2000, Duke R)23(aleigh H)23(ospital was looking for ways to support teach-)]TJ -2.10526 -1.26316 TD -0.033 Tc -0.007 Tw (ers in providing better health education to students at an early age, when they)Tj 0 -1.26315 TD -0.04 Tc 0 Tw [(are formulating lifelong health habits. \322W)60(e felt it was our obligation as a health)]TJ T* -0.038 Tc -0.002 Tw (care provider to go outside the domain of the hospital,\323 says C)Tj 23.57089 0 TD (arla H)Tj 2.39384 0 TD (ollis, chief)Tj -25.96473 -1.26316 TD -0.03 Tc 0 Tw [(marketing and planning of)5(f)20(icer)80(. )]TJ 2.10526 -1.26316 TD -0.004 Tw [(Duke R)23(aleigh H)23(ospital teamed up with the Alice A)23(ycock P)31(oe C)25(enter for)]TJ -2.10526 -1.26316 TD 0 Tc (H)Tj 0.78469 0 TD -0.03 Tc 0.008 Tw (ealth Education and R)Tj 8.6315 0 TD [(olesville Elementary School to create the R)23(eally A)80(we-)]TJ -9.41619 -1.26316 TD -0.024 Tc 0.009 Tw [(some H)23(ealth program, which sends professionally trained health educators)]TJ T* -0.033 Tc -0.007 Tw (into classrooms to provide interactive lessons to kids in kindergarten through)Tj T* -0.02 Tc 0.005 Tw (third grade in a range of topics, including dental health, nutrition, physical)Tj T* -0.03 Tc 0 Tw [(activity)80(, self)27(-esteem, dealing with bullies and prevention of germs. )]TJ 2.10526 -1.26316 TD 0 Tc 0.005 Tw [(The RAH program was used as a model for Wholesome R)23(outines,)]TJ -2.10526 -1.26316 TD -0.036 Tc -0.004 Tw (launched in 2006 to address overweight and obesity issues among students in)Tj T* -0.035 Tc -0.005 Tw [(third through f)20(if)16(th grade. The program has four main objectives: improve eat-)]TJ T* -0.03 Tc 0.002 Tw [(ing habits, increase physical activity)80(, reduce the body mass index among par-)]TJ T* -0.039 Tc -0.001 Tw (ticipants who are overweight, and decrease blood pressure among participants)Tj T* -0.03 Tc -0.008 Tw (who have primary pre-hypertension or primary hypertension. It features free)Tj T* 0 Tw (and reduced-fee lunches in addition to classroom lessons.)Tj 2.10526 -1.26316 TD -0.04 Tc -0.005 Tw [(Those lessons might not stick, though, if it weren)50(\325t for fun reinforcement)]TJ -2.10526 -1.26316 TD -0.046 Tc 0.001 Tw [(activities like storytelling, role-playing and games. Organizers even held a \322F)70(am)-1(-)]TJ T* -0.021 Tc (ily F)Tj 1.66707 0 TD [(eud)50(\323 style contest between student teams and school staf)5(f that featured)]TJ -1.66707 -1.26316 TD -0.039 Tc -0.006 Tw (health information and prizes like pizza stones, basketball hoops and scooters. )Tj 2.10526 -1.26316 TD -0.023 Tc 0.008 Tw (Wholesome R)Tj 5.64417 0.00001 TD (outines is having the intended results. In October 2007,)Tj -7.74943 -1.26316 TD -0.031 Tc -0.009 Tw [(22.2 percent of participating students were classif)20(ied as overweight according)]TJ T* -0.037 Tc -0.003 Tw (to their body mass index for age and gender)Tj 16.68237 0.00001 TD -0.0374 Tc (.)Tj 0.42252 0 Td -0.037 Tc (In M)Tj 1.92868 0.00001 TD (ay 2008, 8.3 percent of those)Tj -19.03358 -1.26317 TD -0.03 Tc 0.01 Tw (students had decreased their BMI by 5 percent to 10 percent, and 30 percent)Tj 0 -1.26316 TD -0.028 Tc 0.013 Tw [(had reduced their BMI by at least 1 percent. In the f)20(irst two years of the pro)-1(-)]TJ T* -0.035 Tc -0.005 Tw (gram, 49 percent of participating students said they reduced time spent doing)Tj T* (sedentary activities by at least one hour daily and 30 percent said they reduced)Tj T* -0.03 Tc 0 Tw [(consumption of trans)-220(fat and saturated fat by 20 percent or more.)]TJ 2.10526 -1.26316 TD 0 Tc (H)Tj 0.7679 0.00001 TD -0.047 Tc 0.007 Tw [(ollis says the programs have generated \322)25(amazing enthusiasm)50(\323 for devel-)]TJ -2.87316 -1.26316 TD -0.029 Tc 0.014 Tw (oping healthy habits\321and not just among the students. M)Tj 23.01897 0.00001 TD (any teachers now)Tj -23.01897 -1.26316 TD -0.041 Tc 0.001 Tw [(wear pedometers to track their steps. 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q BT /F9 1 Tf 9 0 0 9 412.5228 294.2571 Tm 0 0 0 1 k -0.009 Tc 0.022 Tw [(Create a five-month,)-235(weight-loss)]TJ -4.99104 -1.22222 TD (challenge focusing on teams of employees who)Tj T* (encourage one another to lose weight and get)Tj 0 -1.22223 TD 0 Tw [(healthier)70(.)]TJ ET Q /GS2 gs /GS1 gs q BT /F12 1 Tf 9 0 0 9 367.6035 239.257 Tm 0 0 0 1 k -0.022 Tc 0.022 Tw [(THE RESUL)58(TS)]TJ ET Q /GS2 gs q BT /F13 1 Tf 13 0 0 13 419.0802 238.2571 Tm 0 0.91 0.56 0.34 k (I)Tj ET Q /GS1 gs q BT /F9 1 Tf 9 0 0 9 424.4039 239.257 Tm 0 0 0 1 k -0.009 Tc 0.022 Tw (More than 3,000 individuals)Tj -6.31116 -1.22222 TD (and 225 businesses participated in Lighten )Tj T* (Up 4 Life; participants lost a total of 20,000)Tj 0 -1.22223 TD (pounds; businesses were so impressed they)Tj 0 -1.22222 TD (formed an Employesrs Council to keep the )Tj T* (program going.)Tj ET Q /GS2 gs q BT /F8 1 Tf 42.898 0 0 42.898 44.2474 599 Tm 0.412 0 0.294 0 k (C)Tj ET Q /GS1 gs q BT /F11 1 Tf 8.55 0 0 9.5 79.1224 623 Tm 0 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There was a lot less of her than when he)47(\325d lef)16(t)]TJ -4.07895 -1.26316 TD 0.025 Tw [(three months earlier)80(. \322Oh, he was surprised,\323 C)30(arra says. \322)80(And happy)80<2ED3>]TJ 2.10526 -1.26316 TD -0.027 Tc 0.012 Tw [(Almond had begun a weight-loss ef)5(fort before her husband went over-)]TJ -2.10526 -1.26316 TD -0.031 Tc -0.01 Tw [(seas, but she stuck with it while he was away)80(, continuing to exercise, eat right)]TJ T* -0.03 Tc -0.007 Tw [(and drop pounds. In all, she lost 65 pounds)-213(as part of the f)19(ive-month Lighten)]TJ T* 0 Tw [(Up 4 Life challenge sponsored by M)23(ission H)23(ealth System in Asheville. )]TJ 2.10526 -1.26316 TD -0.046 Tc -0.009 Tw [(M)23(ission launched LU4L in 2008 to tackle the weight issues that plague the)]TJ -2.10526 -1.26316 TD [(nation, including N)23(orth C)30(arolina, which ranks as the 18th most obese state. The)]TJ 0 -1.26315 TD -0.07 Tc 0.015 Tw (idea was to team up with the business community to encourage workers to improve)Tj T* -0.061 Tc 0.006 Tw (their eating habits and get more exercise. If successful, the ef)Tj 21.79919 0 TD (fort would also reduce)Tj -21.79919 -1.26316 TD -0.045 Tc 0 Tw (the number of employee medical claims attributable to being overweight.)Tj 2.10526 -1.26316 TD -0.035 Tc -0.005 Tw [100(eam)50(\323 is the operative word. \322T)100(rying to lose weight can be a lonely jour)-1(-)]TJ -2.10526 -1.26316 TD -0.025 Tc 0 Tw (ney)Tj 1.32994 0 TD 0.01 Tw (,\323 says J)Tj 3.03691 0 TD [(anet M)23(oore, M)23(ission H)23(ospital)50(\325s director of community relations.)]TJ -4.36685 -1.26316 TD -0.03 Tc -0.005 Tw [(\322It helps if you)50(\325ve got somebody to encourage and support you.\323 F)40(our)50(-person)]TJ T* -0.029 Tc 0.013 Tw [(teams of employees present a united front in their workplaces. C)30(andy bowls)]TJ T* -0.03 Tc 0.003 Tw (are removed)Tj 5.10068 0 TD (from break rooms and team members are more likely to get up)Tj -5.10068 -1.26316 TD -0.003 Tw [(from their desks at lunch time to take a walk and eat a healthy meal together)80(.)]TJ 2.10526 -1.26316 TD -0.027 Tc 0.012 Tw [(That)25(\325s certainly how it worked for Almond, who is a cafeteria manager)]TJ -2.10526 -1.26316 TD -0.037 Tc -0.004 Tw (at Emma Elementary School. 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It includes recipes, health tips, cooking demonstra-)]TJ T* -0.024 Tc 0.009 Tw (tions and accounts of monthly winners. Special events like a half)Tj 25.64317 0.00001 TD 0 Tw (-marathon)Tj -25.64317 -1.26316 TD -0.038 Tc -0.003 Tw [(and 5K)-210(run )-1(attract LU4L participants. \322Last year)81(, we tripled participation in the)]TJ T* -0.03 Tc 0 Tw (5K run,\323 M)Tj 4.41703 0.00001 TD (oore says proudly)Tj 6.73022 0.00001 TD (.)Tj -9.04199 -1.26317 TD -0.051 Tc 0.011 Tw (In the initial LU4L challenge, participants lost more than 20,000 pounds\321)Tj -2.10526 -1.26316 TD -0.03 Tc 0 Tw [(meaning the community was 10 tons lighter)80(. R)23(eaction has been so great that)]TJ T* (LU4L has been expanded to three rounds of competition annually)Tj 25.81158 0.00001 TD 0 Tc (.)Tj -23.70632 -1.26316 TD (M)Tj 0.84786 0.00001 TD -0.03 Tc 0.015 Tw (oore says other communities could easily replicate the program. \322I)Tj 26.01549 0.00001 TD 0 Tc (t)Tj 0.24385 0.00001 TD -0.03 Tc 0 Tw Tj -29.21246 -1.26318 TD -0.041 Tc 0.001 Tw [(very scalable. All you need is to f)20(ind partners, like the local media and chamber)]TJ 0 -1.26316 TD -0.02 Tc 0.005 Tw (of commerce, to make this work in a big city or a small town.\323 Don)Tj 26.78217 0.00001 TD (\325t worry)Tj -26.78217 -1.26316 TD -0.047 Tc 0.007 Tw (about of)Tj 3.06113 0.00001 TD (fering expensive prizes. \322P)Tj 9.89495 0.00001 TD (eople are in this because they want to change)Tj -12.95608 -1.26317 TD -0.03 Tc 0.015 Tw [(their eating and exercise habits, not for what they)6(\325ll win,\323 M)23(oore says. Prizes)]TJ 0 -1.26316 TD -0.023 Tc 0.008 Tw (are health-related, like exercise gear)Tj 14.00629 0.00001 TD -0.0234 Tc (,)Tj 0.46148 0 Td -0.023 Tc [(bicycles, spa certif)20(icates and gif)16(t certif)20(i-)]TJ -14.4678 -1.2632 TD -0.03 Tc 0 Tw (cates to the local organic grocery store.)Tj 2.1053 -1.2632 TD [(M)23(ission is putting together an LU4L guide for others to use. )]TJ T* -0.051 Tc 0.011 Tw [(P)31(articipants help spread the healthy lifestyle lessons. 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