How many times have you participated in the Holiday Challenge?

Eat Smart, Move More, Maintain, don t gain! Holiday Challenge Holiday Challenge Registration: 15,605 2016 Final Report Pre Challenge Survey: 7,732 (49.5% response rate) Post Challenge Survey: 2,428 (15.6% response rate) Weight gain during the holidays is common, with many Americans gaining between 1 to 5 pounds. Too often these extra pounds are not lost. To address this, the Holiday Challenge offers resources to help and encourage participants maintain their weight throughout the holiday season. The Holiday Challenge is a free online weight maintenance program, offered from Thanksgiving to New Year s Eve. This 7 week program includes weekly e newsletters, daily tips, healthy recipes, and small ways to increase physical activity during the holidays. 1. Participant Profile In 2016, 15,605 people participated in the Holiday Challenge. This represents an increase of 14.5% when compared to 2015. This year, 77.1% of participants joined the Holiday Challenge for the first time. How many times have you participated in the Holiday Challenge? 2.4% 1.3% 3.7% 5.3% 10.1% Five or More Four Three Two One 77.1% This is my first time participating 1

What is your gender? 6.2% 0.3% Age of Participants 14.5% 17.2% 17.2% 11.0% 9.5% 10.8% 7.4% 7.3% 93.5% 3.6% 1.5% Female Male Rather not say Age 18 24 25 30 31 35 36 40 41 45 46 50 51 55 56 60 61 65 65+ When asked about their weight, 79.3% reported being slightly or very overweight. When asked what they were trying to do about their weight, 84.9% of participants said that they were trying to lose weight, and 13.2% said they were trying to maintain their weight. How would you describe your weight? Which of the following are you trying to do about your weight? 30.5% 0.8% 1.6% 18.3% 48.8% Very Underweight Slightly Underweight About the Right Weight Slightly Overweight 0.3% 13.2% 1.6% 84.9% Lose weight Gain weight Stay the same weight Very Overweight Not doing anything about your weight 2

When asked about their weight, 49% percent of participants reported they have struggled with their weight for most of their life. Of those participants, 14.1% reported they are currently attending a class or are part of a group to lose weight. Approximately 35% reported they have attended a class or have been part of a group to lose weight in the past. Which statement best describes you? 29.6% 14.1% 34.9% I have struggled with my weight most of my life. Currently, I am attending a class or part of a group to lose weight. I have struggled with weight most of my life. In the past, I have attended a class or been part of a group to lose weight. I have not had a weight problem. 21.3% None of these statements describe me. Before the Holiday Challenge began, participants were most interested in the Facebook feature as an extra resource. During the Holiday Challenge, which of the following are you interested in using for extra resources and support? 39.7% 34.6% 26.7% 15.5% 21.5% 3.5% Facebook Twitter Pinterest Blogs None of the above Support Group on MyFitnessPal.com 3

All 50 states participated in the Holiday Challenge. In addition, 13 other countries joined the Holiday Challenge for the first time. The table below represents the top 10 participating states (a complete listing of all states and countries is also included on page 12 and 14). State Number of Participants Percentage of Total Participants North Carolina 6,040 38.7% Florida 2,145 13.7% South Dakota 1,292 8.3% Wisconsin 751 4.8% Arkansas 617 4.0% Louisiana 476 3.1% Texas 290 1.9% New Jersey 248 1.6% Georgia 243 1.6% Missouri 237 1.5% The map below represents the number of participants from each state with pink displaying the least amount and red displaying the most. 4

Of the 15,605 participants that registered for the Holiday Challenge, 38.7% of were from North Carolina. The table below shows the top 15 counties in North Carolina (a complete list of counties is also found on page 15). Counties Number of Participants Percentage of North Carolina Participants Wake 1041 17% Mecklenburg 296 5% Guilford 272 5% Davidson 242 4% Orange 226 4% Durham 213 4% Haywood 172 3% New Hanover 171 3% Pitt 157 3% Johnston 149 2% Forsyth 129 2% Cabarrus 120 2% Buncombe 119 2% Cumberland 103 2% Iredell 100 2% The map below shows the concentration of participants across North Carolina. The counties are colored with dark to light green to show the highest to lowest concentration of participants, respectively. 5

2. Holiday Challenge Results 67.6% Maintained their weight 16.9% Lost 3 5 pounds 7.4% Lost more than 5 pounds 8.1% Gained weight 16.9% In the Holiday Challenge did you... 1.1% 7.0% 7.4% 67.6% Maintain your weight (within 1 2 pounds) Lose 3 5 pounds Lose more than 5 pounds Gain 3 5 pounds Gain more than 5 pounds How confident are you that you can continue to maintain your weight or lose weight using these strategies? 31.2% 0.9% 6.6% 42.2% 19.2% Not at all confident A little confident Somewhat confident Fairly confident Very Confident 73.4% of participants were confident they could continue to maintain or lose weight. 95.7% of participants will continue to use the strategies learned during the Holiday Challenge. Do you plan on using any of the strategies you learned from the Holiday Challenge? 4.3% Yes No 95.7% 6

Once the Holiday Challenge was completed, participants reported their confidence level in regards to their ability to implement healthy behaviors. The majority of participants noted they felt more confident in themselves to implement and maintain healthy behaviors after participating in the Holiday Challenge. Exercise 30 min/day several days out of the week. Increase my physical activity throughout my day. "I feel confident in my ability to..." Choose correct portion sizes. Make healthy food substitutions. Actively try to avoid high total fat. Be mindful of what and how much I eat. After Before Choose healthier food options. Maintain a healthy weight. 0 200 400 600 800 1000 1200 1400 1600 1800 2000 3. Holiday Challenge Participation Those that signed up for the Holiday Challenge participated in varying degrees. 46.4% of participants reported skimming or reading through all 7 newsletters. 87.8% of participants reported reading four of more newsletters. 96.3% reported using the tips found in the newsletters they skimmed or read. During the Holiday Challenge, how many newsletters did you read/skim through? 1.1% 0.8% 3.8% Of the newsletters you did read or skim through, how many provided tips that you used in the past seven weeks? 3.7% 6.6% 0 1 12.4% None 46.4% 11.5% 15.6% 2 3 4 5 37.0% 46.9% A few Most All of them 14.3% 6 7 7

What features did you utilize during the Holiday Challenge? 48.8% 53.7% 30.7% 9.5% 7.8% 9.9% 5.6% 0.4% 5.4% 5.0% 8.1% 9.3% Features Weekly Challenges Daily Blog Page Race Across Iceland Free Webinar(s) Food/Weight/ Activity Logs Facebook Page Twitter Page Pinterest Page Recipes MyFitnessPal Support Group Promotional Materials for None of these Participants provided feedback as to what features they utilized throughout the Holiday Challenge. Recipes were reported to be the most popular feature, followed by weekly challenges and the food log, weight log, and activity log. The social media websites were the least utilized features. Daily tips were considered to be most useful Holiday Challenge resource reported by participants. What feature(s) did you find the most helpful as you tried to maintain your weight? 53.0% 29.4% 39.5% 32.7% 19.2% 4.9% 4.1% 2.8% 1.4% 3.1% 5.2% Features Weekly Challenges Weekly Newsletters Daily Tips Race Across Iceland Free Webinar(s) Daily Blogs Facebook Page Pinterest Food Log, Weight Log, Activity Log Recipes None of these 8

The Race Across Iceland was a new feature for the 2016 Holiday Challenge. Participants created teams of up to five people and virtually raced across the coast of Iceland by reporting the miles they walked each day. As participants logged miles, they saw Google Street Views of waterfalls and mountain peaks throughout Iceland. There were also a message board to support and cheer on fellow participants. This year, 7.9% of participants had joined the virtual race. The race had 876 participants and 286 teams. Forty two percent of participants were interested in another free virtual race for next year s Holiday Challenge. Would you be interested in another free virtual race for next year's Holiday Challenge? 39.3% 42.0% Yes No Not sure 18.6% Over 98% of participants reported they were likely to participate in the Holiday Challenge again next year. 9

4. Holiday Challenge Promotion A majority of participants heard about the Holiday Challenge through their workplace. Twentyone percent were informed about the Holiday Challenge from an Eat Smart, Move More, Weigh Less email and 12% heard about it through a co worker. Where did you hear about the Holiday Challenge? 56.4% 20.7% 11.9% 3.3% 1.2% 2.7% 1.7% 1.2% 1.3% 5.0% 7.5% Eat Smart, Move More, Weigh Less or Eat Smart, Move More, Prevent Diabetes Class Eat Smart, Move More, Weigh Less Email Social Media Someone told me about it Email from friend or relative Email from Co worker At Work (HR Newsletter, flyer, Wellness Committee) Internet Search List Serv From Eat Smart, Move More NC Other 10

Email was the primary method of promotion for the Holiday Challenge. Emails were distributed through various professional organizations and partners of Eat Smart, Move More, Weigh Less, the North Carolina Division of Public Health, and NC State University. Four different fliers were available for download on the Eat Smart, Move More Weigh Less website as well as a worksite guide. These were distributed via partner organizations and other interested parties. A direct link to the Holiday Challenge page (located on www.esmmweighless.com) was the most used method for page visits. The top referring websites (external) include: Google.com, Constant Contact (via newsletters and announcements), myeatsmartmovemore.com, Facebook.com, and shpnc.org. The 2016 Holiday Challenge was the largest and most successful Holiday Challenge since it began in 2006. The popularity of the Holiday Challenge across the United States, and around the world, demonstrates a need for convenient online programs to address the issue of weight gain during the holiday season. 18000 Holiday Challenge Through the Years 16000 14000 12000 10000 8000 6000 4000 2000 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Total Participants Participants outside of NC 11

The chart below ranks The United States from highest to lowest number of participants. State Number of Participants Percentage of Total Participants North Carolina 6,040 38.7% Florida 2,145 13.7% South Dakota 1,292 8.3% Wisconsin 751 4.8% Arkansas 617 4.0% Louisiana 476 3.1% Texas 290 1.9% New Jersey 248 1.6% Georgia 243 1.6% Missouri 237 1.5% Nevada 230 1.5% Kentucky 224 1.4% South Carolina 210 1.3% Virginia 209 1.3% Arizona 196 1.3% Kansas 192 1.2% California 181 1.2% Mississippi 166 1.1% New York 163 1.0% Washington 153 1.0% Massachusetts 144 0.9% Minnesota 128 0.8% Ohio 110 0.7% Colorado 85 0.5% Oklahoma 76 0.5% West Virginia 72 0.5% Pennsylvania 70 0.4% Michigan 55 0.4% North Dakota 55 0.4% Illinois 49 0.3% Indiana 46 0.3% Tennessee 43 0.3% Alabama 41 0.3% Iowa 41 0.3% Vermont 40 0.3% Delaware 37 0.2% Maryland 36 0.2% Montana 34 0.2% 12

Maine 19 0.1% New Hampshire 17 0.1% Idaho 16 0.1% Nebraska 14 0.1% Alaska 12 0.1% Oregon 12 0.1% Connecticut 9 0.1% Utah 9 0.1% District of Columbia 7 0.0% Wyoming 7 0.0% Hawaii 6 0.0% New Mexico 6 0.0% Rhode Island 2 0.0% 13

The chart below demonstrates the participation from other countries in the 2016 Holiday Challenge. Country: Number of Participants Percentage of Total Participants United Arab Emirates 12 0.1% Ontario, Canada 6 0.0% Denmark 1 0.0% Switzerland 1 0.0% Germany 1 0.0% United Kingdom 1 0.0% Ireland 1 0.0% Swaziland 1 0.0% Nigeria 1 0.0% Lesotho 1 0.0% India 1 0.0% Mexico 1 0.0% Quebec, Canada 1 0.0% Malaysia 1 0.0% 14

The chart below ranks North Carolina counties from highest to lowest number of participants. Counties Number of Participants Percentage of North Carolina Participants Wake 1041 17% Mecklenburg 296 5% Guilford 272 5% Davidson 242 4% Orange 226 4% Durham 213 4% Haywood 172 3% New Hanover 171 3% Pitt 157 3% Johnston 149 2% Forsyth 129 2% Cabarrus 120 2% Buncombe 119 2% Cumberland 103 2% Iredell 100 2% Randolph 90 1% Catawba 83 1% Henderson 80 1% Craven 77 1% Alamance 76 1% Wayne 76 1% Halifax 73 1% Rowan 64 1% Granville 63 1% Jackson 62 1% Burke 61 1% Macon 61 1% Union 56 1% Chatham 54 1% Nash 52 1% Rutherford 51 1% Robeson 50 1% Brunswick 47 1% Gaston 47 1% Beaufort 46 1% Harnett 46 1% 15

Franklin 41 1% Lincoln 41 1% Lee 40 1% Cleveland 38 1% Moore 38 1% Onslow 37 1% Surry 37 1% Wilson 37 1% Pasquotank 34 1% Lenoir 33 1% Watauga 33 1% Carteret 32 1% Edgecombe 32 1% Pender 32 1% Sampson 32 1% Stokes 32 1% Caldwell 31 1% Chowan 30 0% Bertie 29 0% Person 29 0% Dare 28 0% Martin 27 0% McDowell 27 0% Stanly 27 0% Duplin 26 0% Rockingham 26 0% Scotland 26 0% Richmond 18 0% Vance 18 0% Ashe 17 0% Davie 16 0% Greene 16 0% Swain 16 0% Alexander 15 0% Bladen 15 0% Columbus 14 0% Northampton 14 0% Hertford 13 0% Perquimans 12 0% 16

Warren 11 0% Camden 10 0% Currituck 10 0% Polk 10 0% Transylvania 10 0% Jones 9 0% Alleghany 8 0% Hoke 8 0% Cherokee 7 0% Graham 7 0% Pamlico 7 0% Yancey 7 0% Anson 6 0% Avery 6 0% Madison 6 0% Mitchell 5 0% Tyrrell 5 0% Washington 5 0% Gates 4 0% Hyde 4 0% Caswell 3 0% Clay 3 0% Montgomery 3 0% Wilkes 1 0% Yadkin 1 0% 17

TESTIMONIALS FROM PARTICIPANTS OF THE HOLIDAY CHALLENGE: "I went into this challenge thinking it was just another pointless challenge, The Holiday Challenge is definitely different. The daily reminders and tips really helped me stay motivated and provided excellent information." "I really love the quotes at the beginning of the newsletters, I wrote down several of them to share with and motivate my children." "Each year I look forward to participating. It gives me the motivation and challenge to be aware of what and how much I eat throughout the holidays." "I feel more sure of myself and in my ability to continue being motivated to build a stronger, healthier me." "This was the best challenge for me because I always gain weight during the holidays, but to see that I was not only maintaining but losing just made the holidays more enjoyable." This was the first time I have joined the Holiday Challenge. I was surprised by how much I liked the daily tips, emails, and boost it gave me." "While I didn't succeed in my goal of losing weight, I did maintain, which is a start. If it weren't for the Holiday Challenge, I wouldn't have done what little I did, so I'm grateful for that." "I enjoyed taking part of the Holiday Challenge. This is my third year of participation and I find that it's a helpful strategy as part of a maintenance program." "Most helpful article was the one about picking yourself up after an overindulgence and getting right back on track! I printed that on to refer back to throughout the coming year." "I want to thank the program team and efforts of everyone who did a wonderful job to put this together. 18