By: Reem Tawfik, MD; Hadley Pritchard; John Pantel, MS, RDN, LDN; and Julie Brennan, PhD, RD, LD
Reprinted from the winter 2019 issue of The Ohio Family Physician.
As one of the most pressing public health problems in the United States, obesity is linked to health issues such as hypertension, diabetes, hyperlipidemia, and sleep apnea, along with other medical and mental problems. The prevalence of obesity rose dramatically in the last few decades of the 20th century and the beginning of the 21st century. After the early 2000s, there was a plateau in overall cases of obesity, but the prevalence of severe obesity has continued to climb.
Approximately one-third of children and adolescents in the United States are either overweight or obese. Communities with lower household income and lower education show higher obesity rates in children, adolescents, and adults. Children residing in these communities often exhibit poorer dietary habits and have lower physical activity. Since most behavior, whether productive or maladaptive, is learned in childhood, programs targeted at the youth population to promote positive nutrition and physical activity behaviors to prevent obesity makes sense intuitively.1
Childhood obesity is believed to be multifactorial.2 Along with socioeconomic status, other factors including genetics, environmental factors, social influence, and family dynamics play a strong role in a child’s development of behavior. To address this public health problem and the factors within our control, we decided to target the pediatric population and their families in our South Toledo community who were interested in improving their nutrition and physical activity. Our program, Grow Well with Us, recognizes the complexity of preventing obesity and utilizes parental involvement in addition to child participation, to better understand and strengthen family dynamics supporting healthy nutrition practice and physical activity. The overall goal of the program is to increase healthy eating behavior and physical activity for program participants and their families.
Grow Well with Us Program
In partnership with the University of Toledo (UT) Family Residency Program, UT Medical Center (UTMC) family medicine residents organized a nutrition education and pediatric physical activity program to improve preference and consumption of healthier foods and increase physical activity for participating children and their families. This program progressed over seven weeks with participants meeting once per week for 90 minutes at the Morse Center on the UT Health Science campus. With no exclusion criteria utilized, the program enrolled 20 children and adolescents aged 5-18 along with their parents.
Learning Activities
Activities included 30 minutes of daily fitness and physical activity routines, focusing on aerobic activity. Additionally, programming included nutrition education, complemented with basic healthy meal and snack preparation and cooking. Attendees learned to reduce the amount of processed or prepared foods and sugar-sweetened beverages in their diet. Participants acquired strategies and methods to identify barriers to healthy eating and increased activity. After each session, presenters distributed prizes like cookbooks, string bags, water bottles, lunch boxes, and kids’ aprons. Those attendees who completed the full seven sessions received fitness trackers.
Residents’ Experiences
The UTMC family medicine residents facilitated the Grow Well with Us program to serve the community and increase their own nutrition and physical activity knowledge and skill. Studies show that medical residents perceive nutrition counseling as a priority, but often lack the confidence and knowledge to effectively provide adequate nutrition education.3 In a study, residency program directors from pediatric, internal medicine-pediatrics, and family medicine residency programs were surveyed about childhood obesity training offered in their programs. The study concluded that there should be a greater emphasis placed on development and use of effective training strategies suitable for training physicians to care for overweight/obese children given the high prevalence of childhood obesity.
The residents enjoyed facilitating the program. The program provided a great opportunity to interact with kids and deliver scientific facts in a simple way that keeps kids engaged and attentive. Residents liked that each session was focused on one food group and included a simple recipe that involved the kids in preparation. Families took samples home to taste. The experience also allowed the residents to further develop and refine their own nutrition knowledge causing some changes to their own dietary habits. A few participants, who were not current patients, decided to follow-up with residents at the family medicine center to continue to work on their nutrition and physical activity goals.
Challenges
The residents faced challenges in terms of the wide age range. It was difficult to keep the teenagers engaged with younger kids in the same class. Additionally, the class was occasionally too crowded, which made keeping a quiet environment difficult. Having additional facilitators or splitting up the groups would have been helpful. We found that some office staff didn’t understand the recruitment process. Lastly, some kids dropped out half-way through the program because of after school commitments.
Program Testimonies
“My grandson used to buy fast food every day for dinner. After participating in the program, he stopped that behavior. Even when we offer to buy him something on the go because of lack of time, he refuses.”
“My granddaughter is helping me shop; she reads food labels and helps me make healthy choices. She lost weight and I’m eating better.”
“My son is very picky eater, but after participating in your program, he is introducing more vegetables into his diet and is trying new fruits.”
“My son is eating less carbs and fast food after he participated in Grow Well with Us program”.
- Recruit your own pediatric patients in order to be able to follow-up with them effectively.
- Divide participants into small groups making it easier for the residents to keep them engaged.
- Encourage residents to participate in community services while they provide education to children. This will improve their confidence in teaching the pediatric age group.
- Orient and educate the office staff regarding the program and the recruitment process.
- Involve more than one person in leading the physical activity to keep all participants engaged and entertained at the same time. We suggest two facilitators per 20 participants.
- More time is needed for the first session to complete the necessary paperwork.
- Incentivize program participants by distributing prizes.
Conclusion
Based on the prevalence of pediatric obesity and the need for nutrition education, programs led by family medicine residents that target overweight/obese children benefit not only the community, but also the residents who learn how to better provide this information to patients.
References are available on the OAFP website.