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• incorporate the concept of anticipatory guidance into the individual and group counseling sessions with WIC nutritionists;
• foster staff role modeling of healthy behaviors and encourage staff to present themselves as co-participants in nutrition and physical activity behavior change;
• and provide community agency linkages to expand physical activity opportunities.

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.

Information

Fit WIC Virginia
Mena Forrester, MS, RD
Project Director
Virginia Department of Health
Phone: 804-225-4462
E-mail: mforrester@vdh.state.va.us