Clinicians in Maine Learn to Address Overweight in Young Patients

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Harvard University Prevention Research Center on Nutrition and Physical Activity

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Maine Youth Overweight Collaborative

Addresses CDC Winnable Battle: Obesity

Case Study

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Background

The prevalence of overweight among children in the United States has tripled since 1980, and it continues to increase, resulting in increasing pediatric problems of childhood diabetes and hypertension. Because nearly all children are served in health care settings (e.g., for school vaccinations), this venue could be useful to help prevent overweight among children at risk, and to intervene with overweight children. First, however, physicians must know the health consequences of childhood overweight, the criteria for diagnosis, and ways to address the problem with children and their families. The American Academy of Pediatrics and the American Medical Association have recommended active assessment, prevention, and treatment options for obese or overweight children and adolescents.¹

Context

The Maine Bureau of Health and the Maine Center for Public Health joined with Harvard University’s CDC-sponsored Prevention Research Center to form a new entity named the Maine-Harvard Prevention Research Center (MHPRC). The partners focused attention on the statewide problem of obesity, and in 2004, the MHPRC established the Maine Youth Overweight Collaborative (MYOC) in partnership with the Maine Chapter of the American Academy of Pediatrics. Together they developed an approach to addressing overweight in children via physicians’ offices. They obtained funding from the Maine Health Access Foundation to launch an intervention to improve care of overweight children and their families by improving providers’ knowledge, attitudes, and practices.

Methods & Results

During 2 phases of the study, 22 practice teams throughout Maine volunteered to take part in the intervention. An expert panel selected 4 main messages for children and parents: eat 5 servings of fruits and vegetables per day, limit screen time (television and computer use) to 2 hours per day, get 1 hour of physical activity every day, and avoid sugar-sweetened beverages. The slogan “5-2-1-0” was adopted to help promote these messages, and a counseling tool was developed. Practice teams took part in baseline surveys and subsequent training in how to monitor children’s weight and counsel children and their families about the importance of 5-2-1-0, by using a technique called brief, focused negotiation. Progress was assessed via chart review and surveys of practice teams and parents. Data from before and after the intervention were compared and showed large and statistically significant improvements in physicians’ documentation of body mass index (BMI) (from 38% to 94%) and BMI percentile (from 25% to 89%). Eighty-two percent of providers reported use of the 5-2-1-0 counseling tool. Improvements were also seen in physicians’ knowledge about ideal weight and their ability to identify children at risk of becoming overweight. Providers reported feeling more comfortable talking with patients about nutrition, physical activity, screen time, and sweetened beverages and helping overweight patients and their families set behavioral goals. Eighty percent or more of parents reported that the 5-2-1-0 topics had been discussed with them at the last visit, corroborating the practice teams’ reports.

Consequences and Potential Impact

The intention of this promising program is to train all physicians in Maine so that addressing children's weight becomes a routine part of clinical practice. MYOC has been recognized by the National Initiative for Children's Healthcare Quality for outstanding achievements in preventing and treating childhood obesity.²
 

One innovation of the MYOC is a set of simple, low-cost tools developed to help clinicians address overweight with their patients. One of these tools is a flip chart for office use that includes reference charts, recommends screening tests, lists resources, provides a prevention protocol, and suggests intervention techniques. The tools will be updated as recommendations change.

A larger outcome evaluation of the intervention is now under way using follow-up BMI data to assess whether the clinician intervention can reduce overweight among children in Maine.

References

Polacsek M, Orr J, Letourneau L, Rogers V, Holmberg R, O'Rourke K, Hannon C, Lombard KA, Gortmaker SL. Impact of a Primary Care Intervention on Physician Practice and Patient and Family Behavior: Keep ME Healthy - The Maine Youth Overweight Collaborative. Pediatrics 2009;123;S258-S266.

American Academy of Pediatrics. Prevention of pediatric overweight and obesity: policy statement. Pediatrics 2003:112(2)424 30.