Goal
The goals of Fit WIC Virginia were to:

Methods

The Fit WIC Virginia team developed six health messages to promote in the WIC clinic and among partnering community agencies. The health messages were: 1) Active play: encourage your child to get moving every day, 2) Memorable mealtimes: take time to eat together and talk with your family, 3) Television viewing: limit television viewing to one hour per day, 4) Drink more water: serve water at snacks, 5) Eat more fruits and vegetables: offer your child 5 fruits and vegetables each day, and 6) Active families: play with your kids.

In order to promote these health messages, a variety of strategies were employed. First, WIC health professionals (e.g., nutritionists) were trained to use specially designed guidance cards, a tabletop display that guided the practitioner through the obesity prevention strategies while using the concept of anticipatory guidance. The guidance cards helped the practitioner identify the needs and concerns of the WIC parent regarding the child's activity, nutrition and growth related to maintaining a healthy weight. In addition, the guidance cards helped to guide the participant towards setting a realistic goal related to the key message being discussed

To encourage staff to role model healthy behaviors and demonstrate that physical activity and nutrition is a goal for everyone, not just "clients", WIC staff were encouraged to use the stairs rather than the elevator, to engage in health and wellness "competitions" and to bring brown-bag healthy lunches from home. In addition, WIC parents were also encouraged to become role models for their children.

In order to effectively provide community linkages, a database of physical activity, nutrition and parenting resources was prepared. WIC nutritionists made client referrals to community agencies that emphasized physical activity and discussed the importance of physical activity and nutrition during group education classes and individual counseling sessions. Clients were encouraged to set small but realistic physical activity and nutrition goals at the end of each session.

Accomplishments
The Fit WIC Virginia project's action plan was developed and successfully applied and integrated into an existing WIC clinic in Northern Virginia. Parents were able to change their behaviors based on the key messages of the prevention plan. The action plan was successfully converted into part of the larger Fit WIC manual. There is a plan for statewide implementation underway. Positive pre/post test changes in health behaviors were demonstrated.

Implications
The six key messages used in the Fit WIC Virginia project are simple messages that can readily be used by any population to promote healthy behaviors that are associated with healthy weight in children. Barring any language barriers, the six key messages could be integrated into settings with a diverse ethnic or cultural group by a WIC professional.

This project demonstrated that to ensure a climate conducive to sustaining a childhood obesity prevention program, 1) all staff, including the "front-line" support staff, must be involved in the adapting of a childhood obesity prevention action plan into the clinic; 2) adequate time must be made available for health professionals to work with parents; 3) time must be provided for staff to "walk the walk" by attending to their own nutrition and physical activity needs.

Staff trainings on issues of parenting and physical activity are recommended. By increasing the self-efficacy of the WIC staff members through training events on sensitive subjects they are more likely to be successful in their counseling of WIC clients. The nutrition staff could also benefit from additional training on tailoring the food package and on educating clients to select appropriate products based on their age and health status.