Body & Soul - A Celebration of Healthy Eating and Living
Today’s Dietitian
By Kate Jackson
Vol. 7, No. 2, p. 38

For Black History Month, here’s the story of a program that could help change a long history of healthcare disparities in the African American community.

Decades of social change and governmental policies upholding civil rights have made
significant strides in combatting racial inequality in America, yet when it comes to healthcare, statistics suggest that the races are anything but equal. Disparities in the rates of disease among ethnic groups suggest that the healthcare needs of African Americans have not been met and that healthcare education in this community has been woefully inadequate.

According to the National Cancer Institute (NCI), one of the National Institutes of Health, more African Americans are diagnosed with cancer and more succumb to the
disease than any other ethnic or minority group in the country. In addition, they are at increased risk for devastating chronic diseases such as stroke, heart disease, diabetes, and hypertension. Although research indicates that the risk of developing many of these debilitating diseases can be reduced by eating five to nine servings of fruits and vegetables, African Americans eat only an average of three servings per day.

Taking aim at these inequities and using a grassroots approach to transmit the 5 A Day message, the NCI has implemented and expanded a faith-based initiative designed to tap into the power of the church in African American communities to inspire healthy eating habits among their congregants. The program, Body & Soul: A Celebration of Healthy Eating and Living, draws in part from the recommendations of the national 5 A Day program to encourage Americans to consume five to nine servings of fruits and vegetables each day and promote an active lifestyle.

“Our people are dying,” says Rev Glovioell Rowland, PhD, assistant pastor, Pasadena Church of God, California, who describes her church’s involvement as both a spiritual and pragmatic issue. “We looked at ourselves and saw that there were factors contributing to chronic disease—cancer, diabetes, strokes, heart attacks—and we concluded that we had to stop and make a difference. We began to systematically look at what it would take for us to turn this crisis around and decided to implement policy issues that communicated to the church that healthy lifestyles are important to us.”

Divine Intervention
Body & Soul emerged from five years of NCI-funded intervention research and an additional five years of an NCI and American Cancer Society (ACS) joint effectiveness study. According to Alexis Williams, a health education specialist at the NCI, the ACS conducted a literature review looking for evidence-based programs that could be disseminated nationally. It assembled a blue ribbon panel to look at research in nutrition and physical activity and identified a number of tested interventions.

“Among these interventions were the Black Churches United for Better Health program and the Eat Better Live Better program,” says Williams, who notes that the ACS contacted the primary investigators of these programs who were willing to work together and with the ACS and the NCI to merge these programs into something that could be deployed on a national basis. Together, they identified components of each program that worked, combined them, and conducted an evaluation of the combined intervention—hence the genesis of Body & Soul. African American churches in California, Delaware, Georgia, North Carolina, and Virginia piloted the program.

The program began being disseminated widely in 2002, and the materials were revised when the results from the evaluation of that effort became available later that year. The NCI, says Williams, took on the task of making the final revisions and producing the program guide that became available in summer 2004. The NCI, partnering with the ACS, the Centers for Disease Control and Prevention, and the 1890 Historically Black Land Grant Universities, is now launching the program nationwide.

Dietitians helped put together the materials that were used in the original study and the Body & Soul pilot program and had a major role in the evaluation of the program when it was being tested by churches. In many cases, Williams explains, dietitians who were members of participating churches ran the programs. Many RDs, she says, continue to be involved, providing the NCI with expertise, reviewing its materials, and making suggestions for refinements.

Through this program, the NCI provides a comprehensive training program and training materials with which African American churches can employ to infuse their activities with the Body & Soul message based on their own needs. To implement a program, the church pastor appoints a Body & Soul program coordinator to manage the church’s program and manage the planning team, which tailors the program to meet the unique needs of the church members. The team may be comprised of members of the healthy ministry; the kitchen committee; healthcare professionals such as doctors, nurses, and dietitians; and church leaders. The team begins by integrating Body & Soul principles and activities into existing church programs and then developing programs devoted to Body & Soul goals. The program’s key strengths rest in this specifically targeted approach and in the willingness of individual church programs to share their successes and strategies with other church programs.

In getting the word out about the program, Health and Human Services Secretary Tommy G. Thompson cited the strong influence that African American churches can wield to deliver and reinforce the message that healthy eating is essential to chipping away at the rates of disease within their communities.

Eventually, says Williams, the NCI would like to develop a community of users that allows churches to connect with community groups—perhaps on the Internet—so people can easily access and support the programs.

Rowland and her church were drawn to the program because of its emphasis on spirituality. Aware of the importance of nutrition, the church merely needed a way to absorb it into its mission. “We found that placing the Biblical scriptures into the message, teaching on it, preaching on it, and posting them in our classrooms made all the difference. People who believe in Jesus Christ can relate when you give them scriptures,” she says. “One that I use in First Corinthians 6:19 says, ‘Know you not that your body is the temple of the Holy Spirit.’” Explains Rowland, it’s the motivation needed for compliance and discipline. “Even if they couldn’t do it for themselves, they understand that it’s what God wants and they want to be their best for God, so they begin by taking care of themselves.” It made an enormous difference, she says, and created a buzz about healthy nutrition.

The cornerstone of the program is pastoral leadership. The pastors must buy in, Rowland explains, because they’re the shepherds of the flock and they lead the flock to good health. “First, the pastor inspires the people to believe that physical health is as important to God as spiritual health [III John 2], and then he or she becomes a model of healthy eating and physical activity.” One of her pastors has ridden a bike in the Rose Bowl, for example, and another joined a gym and takes some of the young men in the congregation with him. One of the copastors removed all sodas from women’s meetings and replaced them with water and 100% juice in the vending machines. The pastor’s third task is to develop a policy and structure for including healthy activity throughout the fabric of the church.

Soul Food
That last responsibility is key, she explains. The healthy eating message isn’t merely broadcast to the congregation. Rather, it’s absorbed into all church activities. Policy might dictate, for example, that fruits and vegetables will be included at all church gatherings. “Yesterday at our Harvest Festival, for example,” says Rowland, “we allowed children to have just a tiny bit of candy, but everything else was largely fruits and vegetables—carrot sticks and apples, for example,” she says, adding that the children’s staff is trained that nutritious foods and healthy activities will be part of all events and programs.

In the pilot program, explains Williams, there was a program guide and workshop options were suggested, but churches were given flexibility to identify their own projects and offered help to find workshop facilitators. “Most of the program suggestions found in the final Body & Soul guide were developed by churches involved in the pilot program.”

Gale Pearson, MS, RD, CDE, a nutritional consultant in private practice and an advisor to the review group, was involved in the pilot project, absorbing into it the principles of the 5 A Day program, the tenets of which she continues to use with the Body & Soul program she’s implementing now in eight churches in Williamsburg, Va.

Dietitians, says Williams, can play an important role by providing workshops for local churches on the benefits of healthy eating and how to incorporate healthy eating into a healthy lifestyle. They can also lend their expertise to educating church members about issues such as hypertension and diabetes and the role diet plays in preventing and managing these conditions. Dietitians can also provide technical assistance to churches that are planning their programs, she notes, by helping select or evaluate topics for workshops, providing resources, and helping publicize the program to others.

Another component of the program is peer counseling, and dietitians can contribute by offering tips and strategies to peer counselors for encouraging the consumption of 5 A Day, says Williams. Peer counselors work to help motivate church members to bolster their diets with fruits and vegetables and demonstrate how diet and lifestyle are linked with spiritual and personal values. Peer counselors are individually trained by the church through the use of an interactive DVD. Dietitians who wish to become involved can contact the NCI, a local office of the ACS, or the state health department to find out whether there’s a Body & Soul program in their area.

Amen!
The NCI is trying to reach people all across the country to let them know that the program is available and has launched the rollout of a media campaign that has involved a radio media tour and will include radio and print advertisements, grassroots promotion to community-based and health organizations, and direct promotion to churches around the country. “We’ll be working with African American denominations to introduce the program and encourage churches to access the materials and implement the program strategies,” says Williams. “Interested professionals and church leaders can request a free copy of the guide by calling 800-4-CANCER, and we encourage people to use its resource section to connect with community-based organizations that support these kinds of programs, such as the ACS and the American Heart Association. The national program, like participating churches across the country, also invites local dietitians, 5 A Day coordinators, and hospital personnel to become involved and help with the program.”

Says Rowland, “We love the Body & Soul program because it’s a practical way of inviting the church to be a part of change.” It’s an effective program, says Williams, and “a great way to bring information about eating to a setting where people are engaged, interested, and ready to hear about it.” Body & Soul, agrees Pearson, “is a great way for dietitians to get a foot in the door to give nutrition education information to the community—to the people who actually need it.” It empowers people, she says, to make positive decisions on their own.

“Nutrition education is something we’ve done a poor job with in this community at large, which is why they’re so vulnerable,” says Rowland. “Any opportunity to educate the public as to what healthy eating is all about is to everyone’s benefit, and the Body & Soul program helps educators reach an overlooked segment of the population.”

To order the Body & Soul program guide, call 800-422-6237, and for more information visit www.5aday.gov.

— Kate Jackson is a staff writer for Today’s Dietitian.

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