Intervening with Primary Care Physicians and Parent(s) To Prevent Childhood Obesity: Planning and Enhancing Interventions using A Socio-Ecological Framework

Introduction: The prevalence of childhood overweight/obesity has grown three-fold since the early 1990's, and today's children face increased health burdens and shortened life spans. Objective: NYCRING -a practice based research network (PBRN) in Montefiore Medical Center's Department of Family and Social Medicine - introduced a simple clinic based intervention to: (1) increase screening in primary care for young children at risk of obesity, and (2) influence short-term parent and child activity and nutrition. Intervention: The Family Lifestyle Assessment of Initial Risk (FLAIR) project encouraged primary care providers (PCP) to help families set behavior change goals. There were 3 intervention and 3 control sites. At the intervention sites, the 2-to-3 year old well child visit was reframed to focus on family lifestyle risk assessment and behavior change. Clinician counseling was augmented by contact with a health educator. At the control sites families received usual care (brief PCP advice without enhanced screening or a health educator. Results: At the intervention sites there were 1102 well child visits, and 32% (N=354) were screened (“FLAIRED”). Of those FLAIRED, 59% participated in goal setting, and 55% were referred to a health educator. At these sites, 16 out of 17 clinicians participated in screening. There were no changes between initial and final assessments for the control or comparison group in adult nutrition or physical activity practices. There were no changes in children's physical activities, but there was a statistically significant decrease in unhealthy food children ate (11.7 vs 10. 7; p < .05). Challenges: Screening patients required office staff to take on a new task. Though the screener was short, self-administered, and simple for patients to complete, fewer families completed the screener than expected. In addition, while focus groups suggested parents were comfortable with the assessment, many health educator appointments were not kept. Lessons Learned: To effectively translate research into clinical practice the socio-ecological paradigm has to do more than remind us that children and physicians are nested within larger settings. We need design strategies that can apply theory-based interventions at each of the appropriate socio-ecological levels, provide practical, local strategies for implementation, and appropriate evaluations. One such strategy is intervention mapping. While resource intensive, usinga matrix of change objectives for each appropriate ecological level –which would include patients as well as physicians in planning the intervention- may result in context specific, sustainable interventions more likely to prevent or slow the rise of childhood obesity.