FANtastic Kids: A community health center based intervention to address pediatric overweight

Julie L. Vanier, MANutrition and Fitness for Life Program, Department of Pediatrics,Boston Medical Center

AbstractCurrently, an epidemic of overweight and its negative health consequences are affecting Americanyouth with a disproportionate impact on youth of color. At Boston Medical Center, whichpredominantly serves low income communities of color, 45 % of pediatric patients are above ahealthy weight. Effective community-based responses to overweight must build upon strengths ofaffected communities. The FANtastic Kids (Fitness and Nutrition) model engages teen leaders aseducators in four community health centers to implement a nutrition and physical activity interventionfor pediatric overweight in their own community. FANtastic Kids supports and trains peer leaders inimplementing a 10-week intervention using a participatory learning approach. The intervention istargeted at children ages 8-11 who are at risk for overweight or overweight (BMI=>85%tile). Thismodel involves primary care providers, nutritionists and health center staff collaborating to supportprogram participants and their families in reaching and maintaining healthy weights. The programgoals are: To support youth in developing healthy lifestyles by incorporating healthy eating andincreased physical activity into their daily routines, empower families to make healthier choicesthrough experiential learning, to develop the leadership capacity of local teens to promote healthierlifestyles, and to strengthen the capacity of communities to support increased physical activityopportunities and improved nutrition. We will describe the FANtastic Kids intervention, highlightingsuccesses, challenges and best practices. Preliminary results from this community health centerbased intervention will be discussed. FANtastic Kids is an innovative approach to community-basedpediatric overweight intervention.

Project Goal and ObjectivesGoal: To provide an effective, youth and family focused, culturally

relevant and sustainable community health center-based intervention that supports nutrition and physical activity lifestyle changes for overweight youth.

Objectives: Implement FANtastic Kids at Boston HealthNet Health Centers for

240 physician referred overweight and at risk for overweight youth annually.

Train, orient, and develop at least 16 teen Peer Leaders annually. Provide 15 opportunities for family participation at each site

annually. Strengthen the capacity of five community health centers to support

healthier choices by working in partnership with health center staff, local food vendors, and recreational facilities.

Program Description The FANtastic Kids (Fitness and Nutrition) Program is a

clinical intervention for 8 -11 year old boys and girls who are overweight or at risk for overweight (BMI=>85%tile).

The FANtastic Kids model engages teen Peer Leaders to implement a 10-week nutrition and physical activity curriculum for health center patients.

Program topics include: hunger versus appetite, media and food label literacy, active alternatives to sedentary behavior, and healthy snack selection.

Program ComponentsThe 10 week clinical intervention includes: Nutrition Education

2 hours/week Physical Activity

2 hours/week Youth Development and Mentoring

1 orientation and 3 youth development sessions Family Involvement and Recreational Field Trips

Meet and greet with program staff, family dinner, 2 parent-only education sessions, program graduation and a recreational field trip.

Community Health Center Support Trainings for Site Coordinators, Peer Leaders, Fitness

Coordinators, Nutritionists, and Volunteers.

Monitoring and EvaluationProcess Measurements:

Attendance and retention for participants and peer leaders

Program readiness Program

implementation

Outcome Measurements:

Pre and post anthropometric measurements

Pre and post Knowledge, Attitude and Behavior (KAB) change

Successes and ChallengesSuccesses: Implemented 11 intervention

sessions at four community health center sites .

143 health center pediatric patients attended > 50% of the program days.

Oriented and trained 30 teen Peer Leaders.

Peer Leader attendance rate of 97%.

A total of 350 parents attended family events.

Collaborated with five local restaurants for creating healthier menu choices.

Challenges: Small number of physician

referrals. High staff turnover at

community health centers. Difficulty in securing

community based facilities for physical activity component.

Transportation and language differences were barriers for patient participation.

Preliminary ResultsSummer 2005- Summer 2006

Process: Average daily attendance for participants was 66%. Average daily attendance for Peer Leaders was 97%.

Outcome: Achieved desirable (negative) average changes in BMI for

age-gender adjusted % iles in 6/7 programs for girls and 5/7 programs for boys.

Significant difference in KAB scores for girls and Peer Leaders (p<.05)

Average Changes in Age and Gender Adjusted BMI for Participants, Fall 2005-Summer 2006

Site Overall Girls with Decreases

Girls with Increases

Overall Boys with Decreases

Boys with Increases

DotWell -0.4(n=21)

-1.1(n=12)

0.6(n=9)

-0.4(n=26)

-1.0(n=16)

0.5(n=10)

MCHC -0.2(n=11)

-0.6(n=7)

0.3(n=4)

0.2(n=4)

NA NA

SBCHC 0.3(n=5)

NA NA -0.6(n=9)

-1.0(n=6)

NA

Total -0.2(n=37)

-0.8(n=21)

0.6(n=16)

-0.4(n=38)

-1.0(n=23)

0.5(n=15)

NA=less than four cases and were not averaged separately.

DotWell=3 sessions, MCHC=2 sessions, and SBCHC=2 sessions

Results of Knowledge, Attitude and Behavior Survey (KAB), Spring-Summer 2006

* Significant at the p <.05 level

Group Pre-testMean % Correct

Post-testMean % Correct

P-value

Girls 71%(n=12)

85%(n=11)

0.03*

Boys 74%(n=16)

79%(n=7)

0.34

Peer Leaders 85%(n=8)

94 %(n=9)

0.01*

Total 75%(n=36)

84%(n=27)

<0.01*

Preliminary Lessons Learned Pediatric overweight interventions at the community

health center level seem to hold potential for: Addressing low attendance and retention rates usually seen in

hospital settings Increasing family involvement

Engaging teen age Peer Leaders to facilitate a nutrition and physical activity based intervention: Is an effective way to engage younger patient participants Provides mentoring and leadership development for teen

community leaders The most significant barriers to program success were:

Patient recruitment Transportation

FANtastic Kids Participants

FANtastic Kids Peer Leaders in Action

Boston Medical Center’s Department of Pediatrics Team and Community Health Center Sites

Vivien Morris, MS, RD, MPH, LDN, Principle Investigator

Julie Vanier, MA, Program Coordinator

Tara Agrawal, Youth Development Specialist

John Cook, PhD., Project Evaluator

Dorchester House Multi-Service Center and Codman Square Health Center (Dot Well)

Mattapan Community Health Center

Whittier Street Health Center (Roxbury)

South Boston Community Health CenterGenerous support provided by:

Rutland Corner Foundation