“215-GO!” - A Working Model for Combating Childhood Obesity in a Public Health Care Clinic

Problem Statement: More than nine million children in the U.S. are overweight or obese. Obesity-related medical conditions, including diabetes, hyperlipidemia, and hypertension, have also increased in prevalence in children over the last decade. It is essential to diagnose childhood obesity early to reduce and prevent secondary complications associated with obesity.

Methods: The Philadelphia Department of Public Health (PDPH) has started the “215-GO!” program for management of childhood obesity at 4 of its 8 Public Health Care Clinics. It is staffed with a pediatrician, a nutritionist and a health educator. They employ motivational interviewing techniques to set small, achievable goals for weight and physical activity. Here, we will discuss the outcomes of intervention at “215-GO!” Childhood Obesity Clinic at Health Center #6.

Results: Data were collected and analyzed to assess retention rate, change in BMI-percentile, BP-percentile, motivation to lose weight, and lab indices. From June 2006 to October 2008, 274 patients enrolled with >60% return rate. At 6-month post-enrollment (n=102), 60% reduced BMI-percentile and 4% maintained BMI-percentile. Of 28 patients with BMI>99th percentile at baseline, 9 (29%) decreased to BMI< 99th percentile. In terms of motivation, 68% could be motivated toward weight loss. At baseline, 17% (45 of 274) had abnormal BP, 47% (88 of 186) had dyslipidemia, and 16% (24 of 149) had abnormal glucose (IFG). Of these abnormalities, in patients with 1-year follow-up data, 71% (10 of 14) normalized BP, 76% (13 of 17) improved lipids, and 83% (5 of 6) normalized blood glucose. However, some patients with normal BP and normal lab indices at baseline developed abnormalities during follow-up period – 13 patients developed abnormal blood pressure and 5 patients developed IFG (Impaired Fasting Glucose).

Discussion: Our results demonstrate the efficacy of intervention measures. More than 60% return rate demonstrates patients' willingness to participate in this program. Childhood obesity intervention programs should focus on change toward healthy life style rather than weight loss. For assessing outcomes, we recommend evaluating change in BMI-percentile in children as this indicates relative weight loss to height gain for age/gender specific norms. We also recommend monitoring changes in co-morbidities. This model is simple enough that it can be replicated at community health centers at state and national level.