Win With Wellness
- Need: To reduce risk of obesity and chronic disease in rural northwest Illinois.
- Intervention: Win With Wellness (WWW) collaborates with community organizations and worksites to improve physical activity and eating behaviors and reduce weight among adults through a multi-component approach.
- Results: Since 2015, the two participating counties have initiated 28 Take Off Pounds Sensibly (TOPS) groups with 367 participants. An additional 360 people attended short community sessions related to healthy eating, physical activity, and overall wellness.
Residents in northwest Illinois face increased risks of obesity and chronic disease due to unhealthy behaviors and limited access to physical activity opportunities and healthy foods.
University of Illinois College of Medicine at Rockford researchers compared county data to overall state data from the Illinois Behavioral Risk Factor Surveillance System and found that residents of Stephenson County and Carroll County showed higher rates of diabetes, heart disease, and current smoking than the state average. The premature age-adjusted mortality rate was markedly higher in both of these counties, especially Carroll.
In addition, these researchers found that a significant proportion of the population in both counties is overweight or obese. In Stephenson County, 73.5% of adults were obese or overweight in 2014; in Carroll County, the percentage was 72.6%.
Started through a 2015-2018 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant, the project Win With Wellness (WWW) is designed to reduce obesity and chronic disease risk for adults in these counties using a multi-component, community-based approach that promotes healthy lifestyles through:
- Take Off Pounds Sensibly (TOPS), a weight-loss support group for adults
- Heart-to-Heart (HH) education sessions for worksites and community groups
WWW received additional funding from local foundations. With a renewed three-year FORHP grant, WWW added the following components:
- Physical activity and nutrition environmental assessments for rural communities
- Step-2-It Texting Program in which participants can receive information and motivational messages
The WWW partnership includes county health departments, clinics and healthcare systems, colleges of medicine and nursing, a United Way branch, and a school district. Medical and nursing students gain experience in community-based research, and WWW benefits from their volunteer work. Three medical students have helped with the WWW Facebook page and two nursing students have helped with the environmental assessments.
TOPS membership is provided through the FORHP grant. Established in 1948, TOPS is a weight-loss support group for adults that focuses on small changes participants can make to their diets and activity levels. Weekly group sessions held in community settings include private weigh-ins and professionally prepared, informational chapter programs, featuring up-to-date information on nutrition, exercise, and healthy lifestyles. The program provides positive reinforcement and motivation to adhere to food and exercise programs.
Heart-to-Heart presentations are health education sessions led by health educators for worksites and community groups. These presentations emphasize small, practical changes that attendees can make to their lifestyles.
Food demonstrations were piloted in the fall of 2017 using the evidence-based Cooking Matters curriculum. Educational content focused on topics such as pre-planning meals for the week, freezing foods, and preparing healthy meals using shelf-stable foods.
Faithful Families, a United Way of Northwest Illinois-funded program, is a nine-week evidence-based program that promotes healthy eating and physical activity in communities of faith by addressing individual behavior, family norms, organizational policies and environments, and community-level change. So far, three faith communities in rural Freeport have enrolled in the program.
Results from the 2015-2018 FORHP grant:
WWW initiated 28 TOPS groups with a total of 367 participants. Currently, there are 16 active groups, 10 at worksites and 6 at community locations with 167 participants: 92% female and 8% male. Participants who completed one year of the program have seen significant reductions in weight (a mean weight loss of 8.8 pounds), which translates to a 1.5-point average reduction in body mass index (BMI). In addition, 42% of participants lost 5% of their body weight or more.
Thirty-nine Heart-to-Heart sessions have been conducted, with 348 participants (79% female, 21% male): 72% of respondents reported planning to make one or more changes in physical activity, and 83% of respondents reported planning to make one or more changes in eating habits as a result of attending a Heart-to-Heart session.
To date, WWW has implemented 5 community food demonstrations with 86 participants, and 84 of them completed satisfaction surveys. Among survey respondents:
- 94% found the sessions useful
- 89% said they were likely to use the recipes from the food demonstrations
- 88% were interested in attending more food demonstrations
Results from the 2018-2021 FORHP grant:
As of March 2019, 98 people have been enrolled into the project. Of those enrolled, 41.8% were receiving treatment for hypertension, 8.2% were current smokers, and 78.6% had diabetes. A majority of participants were overweight or obese with a mean BMI of 34.0. The average age of participants was 59.6 years old, and 86.7% were women.
A two-year cohort study called the Health Improvement Special Project (HISP) was created to specifically reduce cardiovascular disease in adults between the ages of 30 to 71 through WWW interventions. Using the CDC Heart Age Calculator, heart age will be measured before enrollment and at one- and two-year follow-up. Of the 98 participants, 71 were eligible for the HISP and completed the CDC Heart Age Calculator.
The Town-Wide Assessment (TWA) and Program and Policy Assessment (PPA) have been completed for the rural communities of Freeport, Lena, Mount Carroll, and Savanna. The TWA assesses 18 town characteristics including topography, schools, and recreational amenities. The PPA assesses 11 town-level policy and program items that support physical activity. These two assessments will enable the development of a comprehensive database of the amenities and policies that promote or limit physical activity within each town. The information is currently being used to create online community asset maps.
Structural barriers to participation in wellness initiatives: The rural geography, lack of or distance to physical activity facilities and resources, lack of availability of healthy food options, and lack of transportation pose significant barriers to accessing healthcare and engaging in wellness initiatives in Carroll County and much of Stephenson County, especially for low-income residents. Currently, efforts are underway to expand the Freeport public transportation system to all of Stephenson County. However, the system is considered inconvenient, as all rides must be arranged in advance and it would likely be viewed as expensive for low-income residents.
WWW conducts programs where residents in these two counties live, work, play, and pray, to make programming as accessible and convenient as possible. WWW health educators have provided rides to participants or suggested carpooling to TOPS sessions. The United Way of Northwest Illinois has also provided bus fares for participants who needed it, although this is only possible in Freeport. To broadly address the lack of access to health resources and facilities, project coordinators have incorporated a community/policy component to assess the physical activity and nutrition environments with the goal of planning and implementing environmental improvements.
Retention of TOPS participants for three years of the project: In WWW, TOPS was effective for weight loss among those who stayed in the program, but some participants faced barriers to staying in TOPS. Of the 352 participants recruited, 96 (27.3%) dropped out of the program. An additional 77 (21.9%) stayed in the program but did not renew at one year. Reasons for dropping out include the group no longer meeting; lack of time due to work, family, or other reasons; and lack of interest.
WWW provides ongoing support to existing TOPS groups and future groups to help retain participants. WWW health educators maintain regular contact to provide technical assistance and to support, motivate, and empower groups.
Recruitment of rural participants for a cohort study: Project coordinators planned to recruit 325 adults for the HISP cohort but have only recruited 100 participants so far through new and existing TOPS groups and new HH groups. It's challenging to engage local worksites to participate in HISP. Barriers include scheduling meetings with appropriate worksite contacts and conflicting work schedules among employees.
Project coordinators extended the HISP enrollment period to ensure all participants can be followed for at least one year instead of two. This will allow coordinators to analyze and evaluate the impact of HISP programming on heart age and other outcome measures. To mitigate the challenges related to scheduling HH in worksites, coordinators are in the process of creating online versions of HH lessons.
Bring people from multiple sectors to the table in the planning and development stages, and consider incorporating sectors that are not directly related to health. For example, if community members want to walk outside but have safety concerns, police officers could volunteer to exercise with them.
WWW held annual meetings with all participants to provide them feedback on the data and to celebrate their successes. It was also an opportunity to obtain feedback from participants about the project.
Community engagement and volunteerism
Obesity and weight control
Wellness, health promotion, and disease prevention
February 27, 2017
Date updated or reviewed
April 2, 2019
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.