Abstract
Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital. Primary outcomes: (1) family attendance rate and (2) program satisfaction. Secondary outcomes: change in body mass index (BMI), eating behaviors, and sedentary activity. Adult parents (BMI ≥ 25 kg/m2) ≥18 years and their child(ren) (BMI ≥ 85th percentile) ages 6-12 years from adult or pediatric weight management clinics were recruited. One group visit per month (n = 12) consisting of a nutrition and exercise component was led by a nurse practitioner and registered dietitian. Height and weight were recorded during each visit. Participants were queried on program satisfaction, food logs and exercise journals, Food Stamp Program's Food Behavior, and the Expanded Food and Nutrition Education Program food checklists. Thirteen participants from lower socioeconomic zip codes consented [n = 5 mothers mean age 33 years, BMI of 47.4 kg/m2 (31.4-73.6 kg/m2); n = 8 children; mean age 9 years, BMI of 97.6th percentile (94-99th percentile); 60% enrolled in state Medicaid]. Average individual attendance was 23.4% (14-43%; n = 13); monthly session attendance rates declined from 100 to 40% by program completion; two families completed the program in entirety. Program was rated (n = 5 adults) very satisfactory (40%) and extremely satisfactory (60%). Pre-intervention, families rated their eating habits as fair and reported consuming sugar-sweetened beverages or sports drinks, more so than watching more than 1 h of television (p < 0.002) or video game/computer activity (p < 0.006) and consuming carbonated sodas (p < 0.004). Post-intervention, reducing salt intake was the only statistically significant variable (p < 0.029), while children watched fewer hours of television and spent less time playing video games (from average 2 to 3 h daily; p < 0.03). Attendance was lower than expected though children seemed to decrease screen time and the program was rated satisfactory. Reported socioeconomic barriers precluded families from attending most sessions. Future reiterations of the intervention could be enhanced with community engagement strategies to increase participant retention.
Highlights
Obesity causes significant cardiovascular disease, diabetes, hyper tension, and overall morbidity and mortality in the United States (US) [1, 2]
Inclusion criteria were as follows: African-American parents ≥18 years from the NWMC with either overweight or obesity (BMI ≥ 25 kg/m2) with one or more children aged 6–12 years with at least overweight status (BMI ≥ 85th percentile for weight and height based on the Centers for Disease Control (CDC)′s BMI Percentile Calculator for Child and Teen [http:// nccd.cdc.gov/dnpabmi/]) or if the parent and/or guardian from the NWMC had a child currently being treated at the NFL program or if a child from NFL had a parent with overweight or obesity who may have not been part of NWMC
All participants were of African-American descent living in an urban metropolitan area in lower socioeconomic zip codes; 60% of participants were enrolled in Mass Health Medicaid program
Summary
Obesity causes significant cardiovascular disease, diabetes, hyper tension, and overall morbidity and mortality in the United States (US) [1, 2]. About 18 and 7.9% of children and adolescents have obesity and severe obesity (≥120% of 95th percentile for BMI; class II and class III obesity) respectively [4]. There has been a rise in obesity in adolescents between the ages of 16–19 years with 41.5% having obesity and 4.5% meeting criteria for class III obesity (>140% of 95th percentile for BMI); children ages 6–11 years have had simi lar increase in obesity prevalence to 37.3% with respective 12.8% meeting criteria for class II and III obesity [4]. In the US, the epidemic is marked by racial and ethnic disparities: nonHispanic Black (15.8%) adolescents have the highest prevalence of this disease than non-Hispanic Whites (13.1%), non-Hispanic other race or multi-race (10.9%), and Hispanic (15.2%) adoles cents with obesity [5]. Persistent barriers and disparities to care among racial/ethnic minorities exist likely due to a combinatory effect of social, economic, biological, and environmental factors affecting macro- and micro-environments [8] with US medical professionals not adept or trained at addressing the complexity of care and higher attrition rates for medical weight loss visits [9,10,11,12]
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