2019 Family Medicine Cares Resident Service Award

Healthy Kids: Establishing Pediatric Obesity Group Visits at a Family Medicine Residency Clinic 

Marisa Yanez, MD with the Stanford-O’Connor Family Medicine Residency Program will collaborate with the Indian Health Center (IHC) of Santa Clara Valley to expand on an existing family-based group program (Healthy Kids) to educate and empower overweight and obese children and their families to make lifelong lifestyle changes to ensure a healthier tomorrow.

Clinic where the project will take place:

The Indian Health Center (IHC) of Santa Clara Valley is a non-profit, 501(c)3, Urban Indian Health Center supported by the Indian Health Service, a 330 Federally Qualified Health Center supported by the Bureau of Primary Health Care, and a certified Level 3 Patient Centered Health Home. IHC caters to individuals of low socioeconomic status with Medi-Cal insurance or who are uninsured. The Family Medicine Center (FMC) is one of many locations under the IHC umbrella.

Target population:

The target population for the project includes English-speaking children 6-12 years old who are overweight (body mass index [BMI] greater than or equal to the 85th percentile for their age) or obese (BMI greater than or equal to the 95th percentile for their age)​ and their support figures (family members, guardians, or any person that serves as a role model and support network).

Unmet health care need:

Pediatric obesity is the primary health disparity affecting the wellbeing and future of the young patients in our nation and particularly in our FMC clinic. It is a multifactorial problem that will require a multi-pronged approach. Cited barriers among patients with low socioeconomic status include limited health knowledge, decreased access to healthy, affordable food, lack of safe spaces for physical activity, and a complex healthcare system that is frustrating and confusing to navigate.

One evidence-based and effective solution to this problem is family-based group therapy. Family-based therapy (FBT) has been studied for over 30 years and has repeatedly been shown to be effective in treating childhood obesity.  Using a family-centered, comprehensive approach to behavior change to improve nutrition/dietary behaviors, promote physical activity, and reduce sedentary behaviors, parents are taught positive parenting techniques and are assisted in achieving their own weight loss goals (if applicable). In this way, the end goal of FBT is to help parents and their children build and establish lasting behavioral changes.

How this need will be addressed:

The need for patient-centered and family-based education and empowerment will be a series of eight 90-minute biweekly mixed-format classes (group visits that include one-on-one time with a physician) led by a resident physician and assisted by a nurse practitioner and nutritionist. Each visit will include educational and physical activities, healthy snacks, and individual sessions with a physician. Each session will focus on a particular topic (e.g., sugar, fat, stress, sleep, etc.) in which teaching will be aided by posters and 3D models. Each learning point will be reinforced by a thematic game designed to keep the patients’ attention while having them think critically about the lesson. A Smart Snack activity will include an interactive demonstration of food preparation, which will expose patients to healthy foods and encourage consumption of these foods in session and at home. Each session will also include a fun, family-friendly exercise activity that the family can feasibly replicate at home.

To enable participants to undergo our suggested lifestyle changes, items will be available if patients are not able to afford or prioritize on their shopping list. Examples include reusable water bottles to encourage drinking more water (rather than soda or juice), recipe books to encourage home cooking, appropriately sized plates and bowls for easy proportion control, and fitness trackers to measure steps and other physical activity.

To encourage patient participation, a reward and tracking system will be implemented in which each patient will keep a Snack Diary to allow parents to track their progress and reward healthy choices. Bringing the diary back to added sessions will also confer additional rewards, encouraging patients to complete the entire program. Patients who complete all eight sessions will be rewarded with a certificate signed by themselves and the resident physician and be eligible to win a grand prize via raffle.

Measurable outcomes that will be used to assess the impact of this project:

The program will be evaluated through collection of qualitative and quantitative measures. Patients and support members will fill out pre- and post-implementation surveys prior to beginning their first session and after their final session. These anonymous surveys will include behavioral assessments as well as participant feedback on the impact of the program on their lifestyle and behaviors. Also collected will be baseline and post-implementation quantitative measurements of BMI percentile.

How the project and/or its components will continue to provide an enduring benefit to patients, even after you have completed the project:

Early and intensive intervention during childhood is the key to addressing the growing obesity epidemic. Through Healthy Kids, patients and their families will be empowered to lead healthier lives. By promoting and sustaining meaningful lifestyle changes across the entire family unit, participants will decrease their risk of morbidity and mortality related to adult obesity, including but not limited to cardiovascular disease, diabetes, liver, and kidney disease.

The goal of the project is to reach a wider audience by eventually providing classes in Spanish (the second most spoken language in our clinic), as well as to launch a teen-friendly program for 13-17year-olds. Lastly, pediatric patients with BMI percentiles approaching the overweight category or with rapidly up trending BMIs would be future candidates for the Healthy Kids classes. A secondary but no-less important benefit is that this program helps resident physicians to develop and improve their knowledge, counseling, and clinical management skills as they pertain to pediatric obesity. These sessions provide a platform to increase continuity, community involvement, and quality improvement, which in turn improves patient-provider relationships and clinical outcomes. Every year, eight new residents grace our program with their presence and fresh ideas, and as they become involved in group classes they bring progression and revolution to Healthy Kids.

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