Healthy Clinics, Healthy Kids – A lifestyle intervention on obesity and cardiometabolic disease prevention in pediatric clinical settings

Introduction. Childhood obesity should be addressed in multiple sectors, including the health services/clinical setting. While physicians feel responsible to help adult patients lose weight, the majority feel unequipped to manage weight problems of children. 

Methods. Healthy Clinics Healthy Kids tested the impact of addressing obesity among children and families in 21 sites over two years (2010-2012) in three states (MI, MS, NM). Interventions (nutrition, healthy living, physical activity), targeted low-income children and caregivers, and took place in a variety of settings including community clinics as well as school-based clinics. The goal was to help clinical staff address obesity issues and concerns of patients and families.
Impact of interventions was assessed using pre and post surveys. 20 respondents completed pre and post surveys including nurses (14), managers (2), physicians (2), coordinators (1), and a registered dietitian.

Results. Prevalence of obesity among children was higher than the national average (respondents reported that only 56% were “normal”, as compared to approximately 66% nationally). 32% indicated private insurance pays for some obesity care, and 42% indicated public insurance. 44% indicated discussing weight with parents of “normal” weight children, and 73% indicated discussing this with parents of “overweight” children.
 Statistically significantly (p<.05) more respondents indicated, at the end of the project than the beginning, that they discuss “the impact of childhood obesity on their future risk for chronic diseases in adulthood” with pediatric patients (70% versus 57%). Statistically significantly more indicated discussing this topic with parents at the end (76% versus 57%).There was an increase in discussing obesity with patients, topics including exercise and physical activity (+8.5%) and limiting sedentary behaviors (+5.0%). There was an increase in conversations with parents, topics including healthy food and beverage choices (+4.8%), physical activity (+9.4%), limiting sedentary behaviors (+4.7%), “creating a healthy home environment” (+19.1%), and “removing the TV from the bedroom” (+14.3%). Although at baseline it was not discussed much (22.2%), at follow-up, there was an increase in “encouraging breastfeeding for childhood obesity prevention, if pregnant” (38.1%). Regarding parents, although already a topic with high comfort level at baseline, statistically significantly more respondents indicated at the end of the project that they felt comfortable discussing exercise and physical activity (76.2% versus 90.5% respectively).

Discussion. Implementation of obesity intervention in the pediatric primary care setting was feasible and effective.