An ounce of prevention avoids big problem with childhood pounds

Keys to success: Family involvement and interactive teaching

The need to address childhood obesity is often in the news because the numbers are staggering. According to the Center for Disease Control and Prevention (CDC), childhood obesity has more than tripled in the past 30 years. CDC data shows the prevalence of obesity among children aged 6-11 years increased from 6.5% in 1980 to 19.6% in 2008. In teens it increased from 5.0% to 18.1%.

In light of the statistics, many children's medical centers are putting into place programs to reverse the trend. Education is a strong component.

Cincinnati (OH) Children's Hospital Medical Center set in place an initiative to "reverse the trend of increasing childhood obesity through policy and initiatives incorporating specific programs to reach schools, private practices, and the community by June 30, 2015."

To accomplish the initiative the organization has focused on body mass index (BMI) screening education. A multidisciplinary committee developed a handout for families that educates them on what BMI means, why it's important, and what they can do to help their child stay healthy, says Joan Morgan, MSHA, MBA, RN, an education consultant for patient/family education at Cincinnati Children's Hospital. [For a copy of the BMI Screening handout, see the online issue of Patient Education Management. Go to www.reliasmedia.com. On the right side of the page, select "Access Your Newsletters – Sign In." You will need your subscriber ID from your mailing label. For assistance, contact customer service at (800) 688-2421 or customerservice@ahcmedia.com.] The handout educates families on what BMI means, why it's important, and what they can do to help their child stay healthy. The patient education materials are available as handouts in each of the outpatient areas or can be printed off the patient/family education web page at www.cincinnatichildrens.org. (Under "Health Topics," select "Your Child's Health." Under "Nutrition and Diet," select "More" and then "Body Mass Index.")

A comprehensive pediatric wellness initiative at Florida Hospital for Children in Orlando, with the goal of giving kids the best chance of living to a healthy 100 years old, resulted in a program to address obesity called Healthy 100 Kids.

The program is for children ages 6-17 with a BMI of 85th percentile or above in children of the same age and sex. According to the CDC, overweight is defined as a BMI at or above the 85th percentile, and obesity is defined as above the 95th percentile.

Before designing the program, staff researched similar programs, according to Kristen Duquaine, MSN, MHA, RN, CDE, director of outpatient services and community health and wellness, which includes educational programming. They found the most successful programs were long-term. They also learned that programs with the best outcomes involved the families.

Although a pediatrician is part of the team, the program is not a medical model where children visit a physician every 3-6 months and see a nutritionist. It is a one-year program that includes 10 educational workshops and the weekly support of a health coach. Through literature searches and reading about successful programs, staff learned that they needed to engage children in something that was social, fun, and interactive to help them change behavior. Children don't want to be lectured on what not to do, she says, therefore lessons are positive. For example, during a workshop on how the body works, children learn the function of organs with the use of models and a felt board. The workshop focuses on how good food choices positively impact body organs, rather than the negative consequences of poor choices.

Interaction boosts confidence

Interactive teaching is key, says Carolyn Landis, PhD, a clinical psychologist at University Hospitals Rainbow Babies & Children's Hospital in Cleveland, OH, A program named "Healthy Kids, Healthy Weight" for children ages 4-18 with a BMI above the 85th percentile is taught in a participatory way at the children's hospital.

For example, during the behavioral component of a group session, children go through a handout on binge eating and discuss what might be their triggers. Strategies for addressing binge eating are covered such as eating regularly scheduled meals and snacks, and waiting 20 minutes before eating chips or cookies when the urge arises. Children make a list of things they might do during the 20 minutes they are waiting, such as taking a walk or calling a friend. During the nutrition portion, they might make a healthy snack.

"Our main goal is to increase the kids self efficacy because we find if you participate in the activity, you are more likely to find you can do it and feel confident that you can do it," Landis says. "You have done it; you haven't just heard about it."

Offering a Healthy House

Hands-on education at Catawba Valley Medical Center (CVMC) in Hickory, NC, is provided in the rooms of a house on campus. Healthy House is a prevention and treatment program created by Vondell Clark, MD, who was a dietitian and returned to school to become a family physician. With a house as a classroom, families can be taught how to stock their pantry and refrigerator and how to do inexpensive activities that are physically active using items around the house. For example, the activities specialist will have families roll socks from dresser drawers into balls and have a "snowball" fight.

Education addressing childhood obesity is needed in Catawba County because 61% of adults and 40% of children are overweight or obese, says Lynn Winkler, MA, RD, LDN, the wellness coordinator for CVMC's Healthy House and the pediatric dietitian for the program. The teaching team, which includes Winkler, the physician who is the program director, and an activities specialist, adjust the teaching as they see what works and what doesn't. For example, initially families were taught individually, but now they are taught in a group setting for more dialogue and input.

Education is hands-on with few handouts. This strategy is to get families to take ownership of the concepts being taught, explains Winkler. Families have a notebook but it is used primarily to collect the recipes and activity tips, she adds.

All three programs mentioned are a year long, because good outcomes are linked with longevity. Landis says the statistics they are collecting for Healthy Kids/Healthy Weight show that improvements in BMI are related to the number of educational sessions attended. The more sessions attended, the better they do.

Sources

For more information about addressing childhood obesity through education, contact:

Kristen Duquaine, MSN, MHA, RN, CDE, Director of Outpatient Services and Community Health and Wellness, Florida Hospital for Children, 601 E. Rollins St., Orlando. FL 32803. E-mail: kristin.duquaine@flhosp.org.

Carolyn Landis, PhD, Clinical Psychologist, Associate Professor of Pediatrics, Division of Developmental/Behavioral Pediatrics & Psychology, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, WO Walker Center, Suite 3150, 105524 Euclid Ave., Cleveland, OH 44106-6038. Telephone: University Hospitals -- Healthy Kids/Healthy Weight at (216) 844-8447.

Joan Morgan, MSHA, MBA, RN, Education Consultant, Patient/Family Education, Center for Professional Excellence/Education, Cincinnati Children's Hospital Medical Center, MLC 8006, 3333 Burnet Ave., Cincinnati, OH 45229-3039. Telephone: (513) 803-0031. E-mail: joan.morgan@cchmc.org. Web: www.cincinnatichildrens.org.

Lynn Winkler, MA, RD, LDN, Wellness Coordinator/Pediatric Dietitian, Healthy House, Catawba Valley Medical Center, 810 Fairgrove Church Road, Hickory, NC 28602-9617. E-mail: lwinkler@catawbavalleymc.org.