Academic journal article Childhood Obesity

Evaluation of a Primary Care Intervention on Body Mass Index: The Maine Youth Overweight Collaborative

Academic journal article Childhood Obesity

Evaluation of a Primary Care Intervention on Body Mass Index: The Maine Youth Overweight Collaborative

Article excerpt

[Author Affiliation]

Steven L Gortmaker. 1 Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.

Michele Polacsek. 2 School of Community and Population Health, University of New England, Portland, ME.

Lisa Letourneau. 3 Maine Quality Counts, Manchester, ME.

Victoria W. Rogers. 4 Kids CO-OP, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME.

Robert Holmberg. 5 Husson Pediatrics, Bangor, ME.

Kenneth A. Lombard. 6 Maine Medical Partners--Pediatric Specialty Care, Portland, ME.

Jonathan Fanburg. 7 Maine Medical Partners, South Portland Pediatrics, South Portland, ME.

James Ware. 8 Department of Biostatistics, Harvard School of Public Health, Boston, MA.

Joan Orr. 9 Population Health Management, MaineGeneral Health, Alfond Center for Health, Augusta, ME.

Address correspondence to: Michele Polacsek, PhD, MHS, Associate Professor of Public Health, School of Community and Population Health, 212 Linnel Hall, University of New England, 716 Stevens Avenue, Portland, ME 04103, E-mail: mpolacsek@une.edu

Introduction

High rates of obesity among children and adolescents call for intervention strategies that are broad based and include multiple sectors of society.1-3 One important focus for intervention is the primary healthcare setting, where providers already see most children and youths in the United States. Though primary care setting interventions alone may not be sufficient to change growth trajectories, they represent an important place where messages to improve nutrition and physical activity (PA) can create awareness and motivate change that can be reinforced across community sectors in a powerful way.4 Current gaps in care and provider attitudes highlight opportunities.5 Providers are not widely measuring BMI percentiles for children, are not delivering preventive behavioral messages, nor are they providing appropriate medical evaluation for obese children. There is also a documented lack of provider confidence (or self-efficacy) for addressing obesity in children, as well as addressing lifestyle issues with children and their families.6-10 Unfortunately, there is very limited evidence for effective clinical interventions to prevent or treat obesity in primary care settings or routinely deliver preventive messages related to healthy nutrition and PA.11-13 One major limitation is the very "low dose" of intervention possible because of the limited time parents/guardians and children spend with a primary care provider (PCP).

The Maine Youth Overweight Collaborative Intervention

The Maine Youth Overweight Collaborative (MYOC) is a primary-care-based intervention implemented from 2004 to 2009 over three phases (52 months) and targeted youth and their families ages 2-18. Phase 1, with 12 original sites, began in November 2004 and ended in November 2006. Phase 2, with 10 additional sites, began in November 2006 and ended in May 2008. Phase 3, with an additional 14 sites, began in May 2008 and ended in May 2009.

Overall, the MYOC intervention took place in 36 sites in both urban and rural areas of Maine. Intervention materials were based on the conceptual framework of the Chronic Care Model derived from the Institute for Healthcare Improvement's Breakthrough Series Collaborative model.14-16 Key change components of the MYOC intervention included: (1) approximately one 1.5-day learning session (for the practice team to attend) every 6 months; (2) 4-6 minutes during each well-child visit for the healthcare provider to deliver the 5210 healthy habits message (five servings or more of fruit and vegetables; 2 hours or less of screen time; 1 hour or more of PA; and zero sugar-sweetened beverages [SSBs]), to promote self-management skills, and set goals; (3) 5 minutes during each well-child visit for another practice team member (e. …

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