200719 Impact of 4 key behavioral strategies on BMI change in the Maine Youth Overweight Collaborative

Tuesday, November 10, 2009

Steve Gortmaker, PhD , Prevention Research Center, Harvard School of Public Health, Boston, MA
Michele Polacsek, PhD, MHS , Programs in Public Health, University of New England, Portland, ME
Joan Orr, CHES , Maine Harvard Prevention Research Center, Maine Center for Public Health, Augusta, ME
Taliser Avery, MS , Prevention Research Center, Harvard School of Public Health, Boston, MA
Lisa Letourneau, MD, MPH , MaineHealth, Portland, ME
Victoria Rogers, MD , Kids' Coop, Barbara Bush Children's Hospital, Portland, ME
Robert E. Holmberg, MD, MPH, FAAP , Eastern Maine Medical Center, Husson Pediatrics, Bangor, ME
Karen O'Rourke, MPH , Maine Harvard Prevention Research Center, Maine Center for Public Health, Augusta, ME
Cynthia Hannon, MSW , UCLA Prevention Research Center, UCLA, Los Angeles, CA
Kenneth Lombard, MD , Maine Medical Center, Barbara Bush Children's Hospital, Portland, ME
James Ware, PhD , Biostatistics, Harvard School of Public Health, Boston, MA
Background and Purpose:

The health care setting, where providers see the majority of children and youth may be opportune for interventions to reduce and prevent obesity. The Maine Youth Overweight Collaborative (MYOC) adopted, as a framework for intervention, four key messages consisting of encouraging five (5) or more servings of fruits and vegetables daily; limiting screen time to two (2) hours or less daily; participating in at least one (1) hour or more of physical activity daily, and; avoiding (0) sugar-sweetened beverages, limiting fruit juice to one-half cup or less daily, and encouraging water and 3-4 servings of fat free milk daily, known as “5-2-1-0” . We describe the impact of MYOC on BMI z-score change using longitudinal chart review data.


Chart reviews from patients ages 6-18 were gathered in 9 MYOC and 10 comparison sites; height and weight data were gathered for one year beginning 03/2007 and for all visits prior to start of MYOC (11/2004). Multilevel regression models were used to account for the clustered sampling plan, and control for pre-intervention growth trajectories in estimating impact of the intervention on change in BMI z-scores following initiation of MYOC.


Longitudinal data for 1178 intervention and 1260 comparison participants found no baseline differences in patient demographics. Baseline BMI z-scores were higher in MYOC versus comparison sites (0.61 vs 0.53) and rates of obesity (>95th) were higher in intervention (19%) vs comparison (15%)(P=0.03). Regression models of change in mean BMI z-scores indicate increasing trends pre-MYOC and significantly decreasing trends post-MYOC for subjects obese at baseline (pre-trend: 0.136; post -.267: P<0.0001). Significant decreases in trend were also seen for those overweight at baseline, and in the entire sample (Both P<0.0001). The declines were not significantly different for MYOC and comparison sites.


Results indicate substantial declines in BMI z scores in this longitudinal cohort of 2438 children in Maine following initiation of MYOC in 2004, particularly among obese and overweight children. Similar declines are seen in both MYOC and control sites indicating that major determinants of overweight and obesity in youth may be primarily environmental and that the impact of MYOC alone may be minimal. Alternatively, the substantial spread of MYOC throughout the state may also have “contaminated” the comparison sites by encouraging 5210 interventions. The reductions in BMI z-scores may also have been aided by other community and school changes initiated through Healthy Maine Partnerships funded in 31communities statewide.

Learning Objectives:
1. Participants will be able to define “5210” 2. Participants will be able to describe how MYOC providers used the “5210” framework to impact patients 3. Participants will be able to describe how BMI z-scores may be used to measure the impact of a clinical office system intervention 4. Participants will be able to discuss the implications of using clinical interventions alongside community interventions to impact patients’ relative weight

Keywords: Obesity, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: PhD in Sociology, tenured faculty member Harvard School of Public Health over 20 years, many articles and other publications in this area.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.