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Stanforth, Dixie Ph.D., FACSM; Graham, Kelsey M.Ed., CHES

ACSM's Health & Fitness Journal: March/April 2018 - Volume 22 - Issue 2 - p 9–15
doi: 10.1249/FIT.0000000000000372

Apply It! The purpose of this article is to highlight real-world, positive change that is happening in many communities. There are numerous examples of ordinary people doing extraordinary things to shift the curve of health and fitness in a positive direction. Change is happening at all levels of the socioecological framework, from individuals to organizations, communities, and improved public policy.

By reading this article the health and fitness professional will:

  • Be inspired by the success of the three programs highlighted
  • Be motivated to change his or her world for the better

Dixie Stanforth, Ph.D., FACSM,is a senior lecturer in the Department of Kinesiology and Health Education at The University of Texas at Austin. She developed and directs the Personal Training Specialization for undergraduates. She serves on the editorial board of ACSM’s Health & Fitness Journal® and is a frequent presenter at ACSM’ s Health & Fitness Summit & Expo and other national conferences.

Kelsey Graham, M.Ed., CHES,is an assistant professor in the Exercise Science Department at Mesa College in San Diego. She also teaches group fitness and works as a health coach. Her love of movement lies in its ability to improve physical, mental, and emotional health.

Disclosure:The authors declare no conflict of interest and do not have any financial disclosures.

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Ever feel like all we hear in the fitness industry is bad news and wonder if anything we do makes a difference? Maybe this week, it’s that the U.S. Centers for Disease Control and Prevention had to add more map colors to capture the nationally increasing BMI picture. Or despite hundreds of millions of dollars spent on programming and education, Americans today are fatter and less fit than previous generations. Most fitness professionals enter this industry because they care about people and want to help them; yet, the consistent and persistent negative messages about low physical activity (PA) levels, obesity, and diabetes pandemics can make change seem not just elusive, but impossible.

Our intention is not to deny reality, but to focus instead on real-world, positive change that is happening in many communities. There are numerous examples of ordinary people doing extraordinary things to shift the curve of health and fitness in a positive direction. These changes are happening at all levels of the socioecological framework: individual, interpersonal, organizational, community, and public policy (1). We hope you find the following three stories encouraging, and that you are moved to act on your own dreams of what could be rather than accepting what is. That is how each of these amazing organizations began — conceived in the imagination of professionals, just like you, who saw an unmet need and decided to go for it.

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Power to the People!

Their Story: The National Weight Control Registry (NWCR) started, like many great ideas, over a shared meal with a conversation about a topic that Jim Hill and Rena Wang were passionate about: weight loss and maintenance. They had lunch together at a conference and chatted about how everything you read about weight loss in both research journals and the media makes it seem like a hopeless battle. As they discussed the evidence, though, they agreed that there were people “out there” losing weight and decided that they simply needed to find them so they could learn from what they were doing. If they could do that, perhaps they could identify what leads to success rather than failure. Hill says it was as simple as that — they decided to start a registry, gather information, analyze the data, and publish papers to share the findings. This was in 1993, though, so simple involved getting the word out the old fashioned way — print media. Hill got a call for an interview with an Orange County paper, and he put a plug in for this brand-new registry… and the letters started rolling in. They had an amazing response on the front end of approximately 500 participants. Incredible, really, when you consider the time-consuming application process, which included a personal letter and lengthy forms that had to be completed by hand and returned via mail. The group published a few initial papers and then continued to grow the Registry through media relationships, where publications would feature participant stories and spread the word about NWCR and how to join. Once they were up to about 4,000 participants, they backed off actively recruiting but have continued to grow. At last count, they had about 10,000 participants providing a robust research database to help us understand what works for long-term weight loss maintenance in the real world.

Challenges/Bumps in the road: Hill notes that they initially knew nothing about creating and managing a registry, but decided it couldn’t be that hard. They worked together to figure it out by looking at other registries and using their different strengths, which helped them approach problems from multiple viewpoints. The most difficult task was figuring out how to ask the right questions. They learned early on that those who succeeded with weight loss would write 10 pages about it, so they had to figure out what was important to learn/ask instead of just gathering stories. Surprisingly, the response to the NWCR has been largely positive within the academic community. There were the expected criticisms regarding the use of self-reported data, non-representative samples, lack of pre- and post-testing, etc., but their humble response defused negativity. Simply saying, “Yes, you are right, but we know so little about weight loss maintenance, and this gives us ideas we’ve never had before,” went a long way towards successful long-term sustainability. The June 2017 TIME magazine cover story “The Weight Loss Trap,” featured the findings of the NWCR, highlighting the useful and practical nature of the information they have uncovered by simply asking people who have lost weight and kept it off, “how did you do that?” See Sidebar 1 for some of the Registry’s findings.

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Sidebar 1

7 Secrets of successful losers

Here are some of the National Weight Control Registry’s biggest findings about what helps people lose weight and keep it off:

  1. Eating a low-calorie/low-fat diet (average 26.6% calories from fat).
  2. Engaging in high levels of physical activity, with walking being the most common form of activity.
  3. Limiting time spent watching TV (most watch less than 10 hours a week, while the national average is 28).
  4. Having a high level of dietary restraint.
  5. Frequent self-weighing (75% weigh more than once a week).
  6. Maintaining dietary consistency.
  7. Eating breakfast regularly.

Growth/Partnerships: Because it might affect perception of their research outcomes, the NWCR made a conscious decision to not solicit sponsorship. They have received very little funding for the Registry and have been able to make it work through university and grant support. They have conducted some company-supported research to ask and answer specific questions, discovering, for example, the fact that most people who lose weight and keep it off report eating breakfast regularly.

Social media: Hill notes that starting their work in the “paper and pencil” age slowed their transition to an online platform and that electronic data collection at an earlier stage might have led to increased productivity. However, the NWCR was designed because they wanted to learn through collecting data — the goal was not to get the group to do anything or to build community. He feels there is great opportunity in connecting these individuals, however, and hopes that at some point, they will have the opportunity to tell the success stories of many of their participants to encourage and help others.

The Future/Recommendations: There are many more questions to answer! They initially were interested in the behaviors that correlate with weight loss and maintenance success; now, the question of why some people are able to change and what allows them to make permanent changes is on the horizon.

Advice? Do excellent work and develop a vehicle, like the NWCR, that will give you a voice in the media. Because of the NWCR, they get to talk regularly about the importance of maintaining a healthy weight and how to promote positive change. By creating content that is easy to understand and applies to almost everyone, their message resonates across the weight loss/maintenance continuum, amplifying their impact. Their story, which is really the story of all their participants, helps to show others the way in an inclusive and supportive framework. “One of the most satisfying things about this project is that we give people hope,” says Hill. “It isn’t easy, but it is possible to lose weight and keep it off.”

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Train up a Child

Their Story: Kay Morris, a self-described “middle-aged, slow runner,” founded Marathon Kids (MK) in 1995 after being motivated by completing her first-ever running log. She created a program based on the idea that this same simple concept could motivate kids, boost their PA, and introduce them to the joy of running, offering a visual running log that could be colored in by the children participating. MK began as a grassroots effort with the help of local physical educators in Austin Independent School District, a local running store, and a lot of local volunteers. To celebrate significant moments, MK hosted a party at the beginning of the season to get everyone excited about their commitment and a party six months later to celebrate their accomplishments. The inaugural year had an estimated 2,000 elementary school children participating, growing steadily and expanding beyond Austin to Dallas, Houston, Rio Grande Valley, Los Angeles, Baltimore, and El Paso, which for many years would comprise the organization’s “Marquee City” service areas.

For 18 years, MK incentivized kids to run the equivalent of one marathon over the course of a school year. With more than 350,000 kids participating, the board began to wonder if this level of PA was actually impacting participants’ health. Partnering with health professionals through a grant from the Michael and Susan Dell Foundation, three separate research studies revealed the core components of Marathon Kids’ success: goal setting, group tracking, incentivizing, celebration, behavior modeling, and social support. However, despite their growing popularity and expanding footprint, the increasing rates of youth physical inactivity led them to delve deeper into existing research on moderate to vigorous physical activity in youth. They concluded that their program was popular but recreational and not sufficient for improved fitness/health, causing them to move toward a new model, where participants are challenged to run, or walk, the equivalent of four marathons (104.8 miles) over the course of a 3-, 6-, or 9-month season. MK believes this distance, performed incrementally, is better aligned with national health/fitness goals and based on the reality that nearly every kid should be able to complete at least 1 mile within 20 minutes. MK suggests having at least 60 sessions over the course of a season for the majority of participants to reach the goal of 104.8 miles.

Their revised goal of 104.8 miles within an identified “running season” took place just before a new partnership with Nike, which has enabled MK to take their youth running program to the next level. Now, anyone can start a running club at any school, organization, community, or even at home. The kids come together with a “coach,” set an audacious goal, run together, track how much they run, and celebrate each short-term goal along the way. Volunteer coaches are trained and supported, while kids earn exclusive Nike rewards for each marathon milestone. In the first year, 36% (46,660 kids) completed 104.8 miles — the equivalent of four marathons — within their “season,” and in the current year, they anticipate that completion rate will increase.

Know Your North Star: The key to success has been keeping the program simple, but Ray Blue, MK’s chief development officer, says “the engine underneath the hood is pretty sophisticated with a lot of nuance.” MK targets elementary school-aged kids because their “north star” is developing long-term active behaviors, and social contagion is the common thread that runs throughout the program. Creating a simple, effective, and fun experience makes it likely kids will enjoy PA more, have a better understanding of the need to fuel their bodies with healthy food and drink, and increases the likelihood that family and friends also will become more active. The key is to get the right coaches who want to use the running club as a catalytic converter in their own communities. The magic happens through their efforts. Blue says their biggest epiphany occurred a few years ago, when they realized MK doesn’t work directly with the runners — MK works with the adults who work with the runners. So, now, they focus on recruiting committed, passionate adults, who then create the running clubs. MK provides resources and builds community through their Leadership Academy, teaching coaches everything from what an MET is to effective strategies for club advocacy. Establishing a national coaching community with the running clubs is their connective tissue and keeps them both connected and aiming for “true north” in all they do.

Managing Change: When they created their new model, the staff understood they were taking a big risk because MK was already beloved in many communities. Changing it was kind of like retooling a pretty good golf swing. As they benchmarked the four-marathon model, they built it to be nationally scalable beyond the school space — they wanted anyone in the country to be able to register online, receive a curated package, and create a standup running club anywhere.

MK committed to doing any and everything only if it was nationally scalable, based on evidence-based research, and reflected their 20-year track record in multiple states. This larger vision coincided with Nike searching for ways to partner meaningfully with nonprofits. Like many opportunities, the match was made through fortuitous conversations between Nike and a number of individuals who were champions for MK and their vision.

Social Media Advice: Blue notes that organizations need to be laser focused and willing to stay true to their ultimate objectives because social media is an endless universe of possible strategies. He recommends knowing your audience in the most intimate way you can: use social media to find out what matters to them most, what information they want to hear, what struggles/barriers they experience, etc. MK uses social media to build community and share stories that highlight best practices and solutions for their coaches.

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A Social Movement in the Lone Star State

Their Story: The story of IT’S TIME TEXAS (ITT) is actually the story of Baker Harrell, founder and CEO. After founding a successful personal training company while completing his master’s degree at the University of Texas at Austin, Harrell knew he wanted to make a larger impact. Harrell sold that company in 2003 and started a youth health and fitness nonprofit organization called Youth InterACTIVE. Through his experience growing that after-school organization, Harrell became convinced that the time was ripe in Texas for an organization that could help lead the nascent movement to improve health at a systemic level. In 2009, Harrell and the team created a bridge organization called ACTIVE Life, which served as an incubator for the development of the organizational model and services necessary to drive community-level change. In 2014, they launched ITT, a social change organization that empowers Texans to build healthier lives and communities. Harrell describes ITT’s systemic approach as critical because the health crisis they are tackling is so pervasive and complex. ITT is focused not only on reducing the rates of preventable chronic disease, which they describe as a symptom of the problem, but also addressing the root problem itself. ITT’s goal is to bring meaningful change to a society that has largely environmentally engineered healthy behaviors out of our daily lives and that, for far too many, has created unequal access to healthy behaviors and resources.

ITT’s service model is equal parts collaborator, convener, and catalyst. ITT works with some of Texas’ largest agencies, corporations, and organizations to accelerate the work being done across the state. As one example, ITT partnered with H-E-B, Texas’ largest grocery chain, to create the IT’S TIME TEXAS Community Challenge. This annual initiative pits communities against each other to recognize and celebrate those that demonstrate a strong commitment to health. The Web-based program mobilizes tens of thousands of people and hundreds of communities across the state. Collaborating with the University of Texas System, ITT annually hosts the state’s largest population and community health conference, the Healthier Texas Summit. The event brings together hundreds of state leaders from diverse sectors to share best and emerging practices and create collaborative opportunities. Finally, ITT provides a wide range of services for individuals, places (i.e., schools, workplaces, and faith-based organizations), communities, and policymakers — all stakeholders and infrastructure that must be engaged to create systemic change. See Sidebar 3 for a list of resources currently offered by ITT to understand the full scope of services they provide.

Harrell believes we are closer than ever to a tipping point for real change. When he goes to the Rio Grande Valley, for example, he see things he never did years ago: Mayor’s Wellness Councils and community health coalitions; investments in sidewalks, bike lanes, and gardens; businesses to support those who are making health a priority, and medical and philanthropic organizations supporting and addressing these issues. He is more hopeful than ever that ITT is advancing a movement for positive change.

Lessons Learned: Harrell offers three key points for anyone wanting to make a difference. First, be intentional in seeking out mentors and be clear about what you are trying to learn and what you are passionate about achieving. His boards have served as a mentor network, and faculty members from his Ph.D. program also have been instrumental in supporting and advancing his ideas. Second is the value of collaboration. He suggests that you can’t create something that has the ability to be both great and sustainable if you try to do it by yourself. There needs to be a sense of selflessness at the heart of it, where you authentically seek out the win-win. Third is the value of listening and asking questions. When ITT was starting, they reached out and received help from Livestrong to develop a business model. Livestrong had successfully organized the survivorship movement and gotten people to rally around that cause, and Harrell was trying to do something similar in the health/fitness space. GSD&M, an iconic ad agency in Austin, also provided early and foundational advice when they recommended leveraging “the brand that is Texas,” giving them permission to start with what they knew, where they could gain quick advantage and traction, rather than attempting a national approach. Becoming IT’S TIME TEXAS enabled them to identify sponsors and investors who cared deeply about Texas and who told them they were the first organization to offer a plan that allowed them to serve multiple audiences and do so at scale.

Harrell offers three key points for anyone wanting to make a difference. First, be intentional in seeking out mentors and be clear about what you are trying to learn and what you are passionate about achieving. His boards have served as a mentor network, and faculty members from his Ph.D. program also have been instrumental in supporting and advancing his ideas. Second is the value of collaboration. He suggests that you can’t create something that has the ability to be both great and sustainable if you try to do it by yourself. There needs to be a sense of selflessness at the heart of it, where you authentically seek out the win-win. Third is the value of listening and asking questions.

Social Media Advice: Harrell says it is impossible to communicate cost-effectively or efficiently with a diffuse and diverse audience without social media — you have to use it. ITT spends a lot of time and money on this, determining how to engage their audience and give them the ability to engage others using their tools, relying increasingly on mobile platforms. Technology is core to everything they do, Harrell says, not because they are trying to be innovative or trendy, but because “tech is part of their DNA, and you can’t do work at scale without it.” In addition, their goal is to enable a broad conversation around what’s happening in the state, and social media is a great way to spotlight and celebrate local heroes. If you are strategic about building and supporting community through social media, you can achieve both deep and wide. Because ITT is trying to solve a systemic issue, they need to do both.

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Not the End of the Stories

Thomas Edison is credited with a saying fitness professionals can embrace: “Genius is 1% inspiration and 99% perspiration.” Each of these stories told of an individual or group inspired to make their dreams reality, but the journey took hard work and effort… and they are all continuing to learn while refining and growing their vision. A few consistent recommendations stand out regardless of the organization or target population:

  1. Clearly define your purpose and goals: Don’t be afraid to expand or shift over time, but always be able to clearly articulate what you want to accomplish in simple terms. ITT started as a health and fitness after-school program for kids…and then became Active Life…and is now ITT. They have expanded dramatically, but still offer after-school programs.
  2. Know your audience: Make sure you are targeting the right group. Marathon Kids thought for years they were developing programs for kids; it was a total game changer once they realized they were developing programs for coaches to deliver to kids.
  3. Know what you need and be ready to ask for it: When Harrell met with a state agency, he had 30 seconds to tell them about his vision for grant funding. They loved it and asked, “How much money do you need?” Because he was totally unprepared, he threw out a number he thought would cover it. As he walked out with one of the key decision-makers, he was told, “You should have asked for three times that because we would have given it to you.” Harrell assured him he would prove the concept would work and that he’d be back to ask for more. He eventually did, but also knows that the limited resources early on forced them to be innovative and highly cost-effective.
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Share Your Success Stories!

We hope that you, too, will be inspired and willing to sweat to bring about meaningful change in the realm of health and fitness. We would love to hear how you are changing your world! Please send us your stories for publication consideration. If your story is selected for publication in ACSM’s Health & Fitness Journal®, we will contact you for additional information. To submit, simply email the following to

A Word file with:

  • Your Story
  • Lessons Learned
  • Advice
  • Your contact information (name, affiliation, mailing address, phone number, and email address)
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Sidebar 2: Milestones — Marathon Kids
  • 1995 – Kay Morris starts inaugural year of 26.2 Mile Challenge with 2,000 kids in Austin Independent School District.
  • 2004 – Program grows beyond Austin to four new cities: Dallas, Houston, El Paso, and Rio Grande Valley.
  • 2006 – MK expands to Los Angeles by partnering with LA Unified School District and LA County Office of Education.
  • 2008 – MK expands to Baltimore City School District and Baltimore County School District.
  • 2012 – Scalable program is piloted in six Texas cities (Lubbock, Abilene, Fort Worth, Marshall, Waco, and Wichita Falls) that ultimately inform the current nationwide model.
  • 2013 – MK serves more than 250,000 children per year in Texas, Los Angeles, and Baltimore. MK Board declares organizational imperative to assess our impact in kids’ health.
  • 2015 – Following a 2-year dive into youth physical activity, MK emerges with scalable 104.8 model and partners with Nike. Sets goal of lacing up 500 k by 2020.
  • 2016 – Three separate research studies conducted by the University of Texas School of Public Health, concludes that: participants get more physical activity, eat more fruits and vegetables, and have a higher athletic self-perception than non-Marathon Kids.
  • 2016 – Marathon Kids partners with Kids Run Free to start first international Marathon Kids running clubs in London.
  • 2017 – Marathon Kids have clubs in all 50 states; elite runner Mo Farah joins Team Marathon Kids as global ambassador.
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Sidebar 3: IT’S TIME TEXAS services
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1. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.
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Suggested Reading:

  • Sifferlin A. The weight loss trap: why your diet isn’t working. TIME Magazine, 2017;189(21): 48–55.

Success; Health; Fitness; Change; Breakthrough

© 2018 American College of Sports Medicine.