Academic journal article Childhood Obesity

Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as Treatment for Pediatric Obesity in an Underserved Community

Academic journal article Childhood Obesity

Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as Treatment for Pediatric Obesity in an Underserved Community

Article excerpt

[Author Affiliation]

Jeffrey S. Geller. 1 Department of Family Medicine, Greater Lawrence Family Health Center, Lawrence, MA.

Eileen T. Dube. 2 Department of Alternative Medicine, Greater Lawrence Family Health Center, Lawrence, MA.

Glavielinys A. Cruz. 3 Department of Psychology, Massachusetts School of Professional Psychology, Lawrence, MA.

Jason Stevens. 4 Department of Physics, University of Massachusetts, Amherst, MA.

Kara Keating Bench. 1 Department of Family Medicine, Greater Lawrence Family Health Center, Lawrence, MA.

Address correspondence to: Jeffrey S. Geller, MD, Director of Integrative Medicine and HIP Fellowship, Department of Family Medicine, Greater Lawrence Family Health Center, 73D Winthrop Avenue (Plaza 114) Lawrence, MA 01843, E-mail: JGeller@glfhc.org

Introduction

The motivation for this study is to evaluate the pediatric obesity empowerment model group medical visit (POEM-GMV) program being used to treat obesity and overweight at a federally qualified community health center (CHC). From the beginning of the program in 2001, there has been anecdotal and visible evidence that this model is a viable and effective treatment program for obesity in children. There are not many programs like this, which are as large, or have been as sustaining in poor communities. This article presents a 3-year retrospective cohort of consecutive children who participated in the POEM-GMV program with evaluation to answer the question of efficacy. Though the primary outcome is weight change, these data can also be seen as a viability study. Subgroup analysis is provided to give hints as to behaviors and sex differences that emerged as significant. These data can be used to help guide future directions for improvement and evaluation of treatment for children with obesity in poor communities.

Obesity in the pediatric population has been defined by the CDC as a "BMI at or above the 95th percentile for children of the same age and sex" based on the 2000 CDC Growth Charts.1 Obesity is a known risk factor for many health problems, including type II diabetes and cardiovascular disease. Between 1999 and 2010, the overall prevalence of obesity in children and adolescents has remained steady at 16.9%,2 and the Healthy People 2020 state a goal of reducing the overall prevalence to 14.5% by 2020.3 Obesity in lower-income preschool children (2- to 4-year-olds) had been increasing over the period of this study, with 1 in 7 found to be obese. Hispanic children are over-represented in this group: 18.5% of Latino children are obese compared to 14.6% of all low-income children.4 In addition, Latino male youths may be particularly prone to obesity-related morbidities, making this population more vulnerable.5

The Alternative Medicine Program at Greater Lawrence Family Health Center (GLFHC) serves a poor, predominantly Latino community. The poverty level in this community is twice that of the national average, with 28.6% living below the poverty line,6 and pediatric obesity is a significant issue with 46.6% of students in grades 1, 4, 7, or 10 in Lawrence classified as overweight or obese.7 The POEM-GMV is a novel approach to address the pediatric obesity crisis in our community. It is based on the hypothesis that, particularly in a disadvantaged population, empowering participants, rather than simply educating, will lead to healthier behaviors and a reduction in weight. This empowerment and self-direction is facilitated through the use of a group model that provides support and features participatory decision making. The primary aim of this retrospective cohort study is to assess the impact of the POEM-GMV intervention on the weight of participants. The secondary aims of this study include evaluating the relationship of sex, lifestyle, social, biometric, and empowerment factors to change in weight. …

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