Comprehensive program improves measures of childhood obesity at community health center

June 27, 2017

BOSTON - A comprehensive program to reduce or prevent childhood obesity in low-income communities led to significant improvements in obesity-related measures among children cared for at a Massachusetts community health center. The report of a study led by a MassGeneral Hospital for Children physician is one of three in the July issue of Obesity describing implementation of the Mass. Childhood Obesity Research Demonstration (MA-CORD) )at community health centers, in public schools and in WIC (Special Supplemental Nutrition Program for Women, Infants, and Children Program) offices in two Massachusetts cities.

"Community health centers are very well positioned to conduct programs such as MA-CORD," says hElsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children, who led that study. "Community-based health centers serve the needs of low-income families, who often have higher-than-average prevalence of obesity and chronic diseases, making them good sites for delivering interventions to the populations needing them most. Health centers already work to tackle the social factors that can interfere with families' making behavior changes, and they have community health workers who can help link families to both clinical and community services."

Developed through a partnership between the Massachusetts Department of Public Health, the Harvard T.H. Chan School of Public Health, MassGeneral Hospital for Children/Harvard Medical School, the National Initiative for Children's Health Care Quality and two cities with substantial low-income populations, MA-CORD was designed to reduce levels of overweight and obesity in children ages 2 to 12. The current study was launched in 2012 to test implementing MA-CORD at two community health centers, along with parallel obesity prevention initiatives in all elementary and middle schools and the community-wide WIC programs in each town.

The tested intervention included:

The community health workers participated in the Healthy Weight Clinics, counseled participating children and their parents, participated in quality improvement projects at the centers, helped children and families connect to resources in the community, and acted as program liaisons to the broader community. Unfortunately, several institutional challenges not directly related to MA-CORD itself reduced the number of children receiving care at one of the centers, preventing full implementation of the MA-CORD intervention at that site.

At the other participating center -- the Greater New Bedford Community Health Center (GNBCHC) -- 3,765 children had at least two well-child visits at which height and weight measurements were taken during the 20-month study period; 187 of them had an elevated body mass index, were referred to and participated in the Healthy Weight Clinic. Among all children seen at least twice at the center during the study period, BMI z scores -- an age- and sex-specific measure used to track weight status changes in children -- improved over time, compared to those of children at a third community health center where the intervention had not been implemented. Similar levels of improvement were seen among children with overweight and obesity who participated in the Healthy Weight Clinics at that site.

"The best way to explain our findings is to imagine a typical 8-year-old child in our study," says Taveras. "At the beginning of the trial at both intervention sites and at the comparison site, that 8-year-old weighed an average of 67 pounds and had an average height of 4 feet and 3.5 inches. In New Bedford we found, over the course of the intervention, that now-9-year-old would have gained about 1.5 pounds less than the 9-year-old in the comparison community. This difference in weight gain and body mass index can make a difference in preventing long-term weight problems and the development of chronic diseases that result from obesity."

Nancy Langhans, MD, a pediatrician at GNBCHC, says, "The success we've had with the MA-CORD intervention is a result of the collaborative effort of the Pediatric Department, the Wellness Center staff, our families, and the other MA-CORD community initiatives. We recognize that many of our families have different cultural backgrounds and often have economic challenges. We considered these factors when helping families to make healthier choices about physical activity, screen time and sleep, and we didn't ask families to stop making their traditional foods but instead helped them to adapt recipes into healthier and affordable versions." Located on the south coast of Massachusetts, GNBCHC serves 25,000 patients every year.

"As both the former Commissioner of Public Health and the new CEO at GNBCHC these findings are important to insure we can continue to provide resources that support families with children at risk for obesity," says Cheryl Bartlett, newly instated chief executive officer of at GNBCHC.

The two studies reported in the companion Obesity papers also reported positive outcomes. The school system study, led by a Harvard T.H. Chan School investigator, showed significant decreases in obesity among 7th graders, who had the greatest exposure the intervention, and improved behaviors related to sugar-sweetened beverages and the amount of "screen time" among 4th to 7th graders. The WIC program intervention - led by Jennifer Woo Baidal, MD, MPH, formerly of MGHfC and now at New York-Presbyterian/Columbia University Medical Center - showed improved BMI z scores and reduced obesity-related behaviors among children ages 2 to 5.

Taveras says, "The MA-CORD intervention is continuing at New Bedford, and we're hoping to spread it to other health centers along with local and national partners. These three studies underscore the potential of rigorous, multi-level interventions for childhood obesity prevention, while also illustrating the challenges of sustaining and expanding access to such programs." A professor of Pediatrics at Harvard Medical School, on July 1 Taveras will become executive director of the Kraft Center for Community Health at Massachusetts General Hospital.
Additional co-authors of the Obesity paper are Meghan Perkins, MPH, and Neil Kamdar, MA, MassGeneral Hospital for Children; Shikha Anand, MD, National Institute for Children's Health Quality; Jennifer Woo Baidal, MD, MPH, NewYork-Presbyterian/Columbia University Medical Center; Candace Nelson, MA, ScD, Jo-Ann Kwass, MS, MDiv, and Thomas Land, PhD, Massachusetts Department of Public Health; and Steven Gortmaker, PhD, Jessica Barrett, MPH and Kirsten Davison, PhD, Harvard T.H. Chan School of Public Health. The study was supported by award U18DP003370 from the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention, and National Institute of Diabetes and Digestive and Kidney Diseases grant K24 DK10589.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2016 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals.

Massachusetts General Hospital

Related Obesity Articles from Brightsurf:

11 years of data add to the evidence for using testosterone therapy to treat obesity, including as an alternative to obesity surgery
New research covering 11 years of data presented at this year's European and International Congress on Obesity (ECOICO 2020) show that, in obese men suffering from hypogonadism (low testosterone), treatment with testosterone injections lowers their weight and improves a wide range of other metabolic parameters.

Overlap between immunology of COVID-19 and obesity could explain the increased risk of death in people living with obesity, and also older patients
Data presented in a special COVID-19 session at the European and International Congress on Obesity (ECOICO 2020) suggests that there are overlaps between the immunological disturbances found in both COVID-19 disease and patients with obesity, which could explain the increased disease severity and mortality risk faced by obese patients, and also elderly patients, who are infected by the SARS-CoV-2 virus that causes COVID-19 disease.

New obesity guideline: Address root causes as foundation of obesity management
besity management should focus on outcomes that patients consider to be important, not weight loss alone, and include a holistic approach that addresses the root causes of obesity, according to a new clinical practice guideline published in CMAJ (Canadian Medical Association Journal)

Changing the debate around obesity
The UK's National Health Service (NHS) needs to do more to address the ingrained stigma and discrimination faced by people with obesity, says a leading health psychologist.

Study links longer exposure to obesity and earlier development of obesity to increased risk of type 2 diabetes
Cumulative exposure to obesity could be at least as important as actually being obese in terms of risk of developing type 2 diabetes (T2D), concludes new research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]).

How much do obesity and addictions overlap?
A large analysis of personality studies has found that people with obesity behave somewhat like people with addictions to alcohol or drugs.

Should obesity be recognized as a disease?
With obesity now affecting almost a third (29%) of the population in England, and expected to rise to 35% by 2030, should we now recognize it as a disease?

Is obesity associated with risk of pediatric MS?
A single-center study of 453 children in Germany with multiple sclerosis (MS) investigated the association of obesity with pediatric MS risk and with the response of first-line therapy in children with MS.

Women with obesity prior to conception are more likely to have children with obesity
A systematic review and meta-analysis identified significantly increased odds of child obesity when mothers have obesity before conception, according to a study published June 11, 2019 in the open-access journal PLOS Medicine by Nicola Heslehurst of Newcastle University in the UK, and colleagues.

Obesity medicine association announces major updates to its adult obesity algorithm
The Obesity Medicine Association (OMA) announced the immediate availability of the 2019 OMA Adult Obesity Algorithm, with new information for clinicians including the relationship between Obesity and Cardiovascular Disease, Diabetes Mellitus, Dyslipidemia, and Cancer; information on investigational Anti-Obesity Pharmacotherapy; treatments for Lipodystrophy; and Pharmacokinetics and Obesity.

Read More: Obesity News and Obesity Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to