U.S. Department of Health and Human Services
 |
||
|
||
|
Other Areas of Interest:
Maternal Child Topics
|
Maternal Child |
|
Maternal Child Health ‹ Child Health Notes ‹ June 12
IHS Child Health Notes"It doesn’t matter if the cat is black or white as long as it catches mice." - Deng Hsaio P’ing 1904-1997 This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org June 2012Quote of the month“The legitimate object of government is to do for a community of people whatever they need to have done, but can not do, at all, or can not so well do, for themselves.” Articles of InterestRandomized Controlled Trial to Improve Primary Care to Prevent and Manage childhood obesity The High Five for Kids Study Objective: To examine the effectiveness of a primary care–based obesity intervention over the first year of a planned 2-year study. Setting: Ten pediatric practices, 5 intervention and 5 usual care. Participants: Four hundred seventy-five children aged 2 to 6 years with body mass index (BMI) in the 95th percentile or higher or 85th to less than 95th percentile if at least 1 parent was overweight; 445 (93%) had 1-year outcomes. Intervention: Intervention practices received primary care restructuring, and families received motivational interviewing by clinicians and educational modules targeting television viewing and fast food and sugar-sweetened beverage intake Outcome: Change in BMI and obesity-related behaviors from baseline to 1 year. Results: Compared with usual care, intervention participants had a smaller, nonsignificant change in BMI (-0.21; 95% confidence interval [CI], -0.50 to 0.07; P = .15), greater decreases in television viewing (-0.36 h/d; 95% CI, -0.64 to -0.09; P = .01), and slightly greater decreases in fast food (-0.16 serving/wk; 95% CI, -0.33 to 0.01; P = .07) and sugar-sweetened beverage (-0.22 serving/d; 95% CI, -0.52 to 0.08; P = .15) intake. In post hoc analyses, we observed significant effects on BMI among girls (-0.38; 95% CI, -0.73 to -0.03; P = .03) but not boys (0.04; 95% CI, -0.55 to 0.63; P = .89) and among participants in households with annual incomes of $50 000 or less (-0.93; 95% CI, -1.60 to -0.25; P = .01) but not in higher-income households (0.02; 95% CI, -0.30 to 0.33; P = .92). Conclusion: After 1 year, the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI. Editorial Comment There have been a few programs with older, obese children and adolescents that have shown some limited, short-term reduction in BMI. This study looked to replicate those findings with preschool children. The most optimistic view of this study is it confirms the adage that change is hard. The intervention in this study required a huge commitment of these practices in terms of training, change in workflow, and time spent doing behavioral intervention with motivational interviewing. In spite of these efforts, there was no difference in the BMI measurements at one year between those who received the intervention and those who received usual care. There was a reduction in television viewing and a non-significant reduction in consumption of sugar sweetened beverages. Was the time and effort taken worth these small changes in behavior if there was no change in BMI? Tough questions that all pediatric practices will have to answer for themselves. |
||
