Using a Systems Approach to Achieve Impact and Sustain Results.

Successful implementation of the Food & Fitness Initiative depended on community partners transforming complex systems to support healthy eating and active living, while addressing health equity. To apply systems thinking in diverse communities and in partnership with stakeholders who had differing levels of education and experience, we assembled a clear conceptual framework, an effective toolkit, and multiple opportunities to build capacity. This article describes the ways that we deployed systems thinking within the initiative, both collectively and at individual sites, and what we learned.

Slowing BMI Growth Trajectories in Elementary School-Aged Children: The Northeast Iowa Food and Fitness Initiative.

This project examines the Northeast Iowa Food and Fitness Initiative, a policy-, community-, and school-based effort to slow children's body mass index (BMI) growth over 6 years. Kindergarteners (K) to fifth graders (5) from 10 different school districts participated (N = 4101). Students with 0 to 1 years of initiative exposure showed greater growth in BMI compared with children who had 2 to 6 years of exposure, resulting in K-5 BMI savings of 1.

The precision of digital X-ray radiogrammetry compared with DXA in subjects with normal bone density or osteoporosis.

Digital X-ray radiogrammetry (DXR) is a technique to estimate bone mineral density (BMD) that can be available in any area able to take a standard radiograph of the hand. We aimed to establish the precision of this technique and compare this with that obtained by dual energy X-ray absorptiometry (DXA) at the hip and spine. We compared DXA and DXR in 28 women with osteoporosis defined by DXA at the femoral neck and in 28 women with normal BMD.