Abstract P371: Healthy Clinics, Healthy Kids - Lifestyle Intervention on Cardiometabolic Disease Prevention in Pediatric Clinical Settings

Abstract

Childhood obesity should be addressed in multiple sectors, including the health services/clinical setting. While many physicians believe it is their responsibility to help adult patients lose weight, the majority feels they are not equipped to manage weight problems of their patients. Healthy Clinics, Healthy Kids (HCHK) was designed to test the impact of addressing obesity, using a lifestyle approach, among pediatric patients and families in a variety of primary care clinical settings. HCHK interventions took place over a 2-year period (2010-2012) in three states (MI, MS and NM). Lifestyle interventions (nutrition, healthy living, physical activity education/technical assistance), targeted children and caregivers in low-income clinical settings that care for children. 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. 21 sites completed pre and post surveys (MI (9), MS (9), and NM (3)). Respondents included nurses (14), managers (2), physicians (2), coordinators (1), and a registered dietitian. 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 they discuss weight with parents of “normal” weight children, and about 73% indicated they discuss this with parents of “overweight” children. Statistically significantly (at the p<.05 level) more respondents indicated, at the end of the project than at the beginning, that they discuss “the impact of childhood obesity on their future risk for chronic diseases in adulthood” (70% versus 57%). Statistically significantly more indicated that they discuss 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). Overall, HCHK showed that implementation of a nutrition and healthy living program for clinics is feasible and effective.