Sustainability of the Maine youth overweight collaborative improvements three years post-intervention

Background and Purpose: The health care setting, where providers see the majority of children may be opportune for interventions to reduce and prevent obesity. The Maine Youth Overweight Collaborative (MYOC) focused on office system change to encourage four key behavioral changes (fruit and vegetable consumption; physical activity; screen time; and sugared drinks) known as “5-2-1-0”. Significant provider, office system, and patient improvements were found immediately post intervention. The current study describes the impact of MYOC on patient experience and provider practices three years post intervention. Methods: Chart reviews and Parent surveys from patients aged 2-18 were gathered in 7 original MYOC and 2 comparison sites in the winter of 2012. Chart reviews and parent survey results from immediately post MYOC (2009) were compared to 2012 results and comparison sites. Logistic regression models taking into account the intra-site correlation among responses was used. Results: Chart review analyses demonstrated a significant (P< .05) increase in BMI percentile recorded in the chart in 2012 compared to 2009 (89.4% to 98.1%). We found no significant differences in having recorded weight classification, blood pressure and having completed a “5210” lifestyle survey between 2009 and 2012. Comparison sites were significantly less likely to have completed a lifestyle survey than the intervention sites in 2012. Although not significant, weight classification was found in only 56% of comparison sites compared to in 91 % of intervention site charts in 2012. Parent survey analyses demonstrated a significant drop in having heard messages about nutrition from their providers 91.4% in 2009 to 76.4% in 2012) and a marginally significant drop (p=.094) in having heard messages about sugar-sweetened drinks (a drop from 81.3% in 2009 to 66.1% in 2012). There was no significant difference in parents having heard messages about television/scree time or physical activity/exercise between the two years. Although there is a trend of parents having heard more lifestyle messages in intervention versus comparison sites in 2012, only physical activity messages were heard significantly less often in comparison sites (57.5% vs.76.7%). Conclusion: In an environment where obesity has become a priority for healthcare providers and systems, The MYOC intervention demonstrates persistent improvements three years post intervention indicating a sustainable primary care based approach to improving diet, physical activity, reducing TV viewing and addressing overweight risk among children and youth. Some declines were observed for more complex behavioral and system outcomes for which there may not have been institutionalized system change.