Residents Find What Works in Childhood Obesity Fight

July 27, 2015 03:46 pm Chris Crawford

The AAFP's final report from its Family Medicine Residency Childhood Obesity Initiative shares success stories from family medicine residency programs that addressed childhood obesity by promoting fitness to at-risk patients and their families.

Residents at the Drexel University Family Medicine Residency Program in Philadelphia lead fitness activities in the "Move It With Mommy and Me" program at the Eliza Shirley House, a facility for homeless women and children.

Funded by a grant from the MetLife Foundation and provided through the Academy's Americans In Motion-Healthy Interventions (AIM-HI) initiative, the projects ran as part of eight residencies' community health training with emphasis on physical activity, healthy eating and/or the emotional well-being of patients and families.

More than 400 residents participated in the projects along with more than 200 support staff, reaching more than 6,000 children and adults through 400 events in clinics as well as out in communities.

While the project did not directly measure decreases in childhood obesity, measures of success included increased awareness of the problem and the proficiency of residents, patients and families in treating the issue with interventions.

Participating children and families noted increases in physical activity and healthier eating habits after the program and some residencies reported efforts to sustain their programs past the award period, continuing training for new residents in years to come.

Story highlights
  • The AAFP's final report from its Family Medicine Residency Childhood Obesity Initiative shared successes from the eight participating family medicine residency programs.
  • Funded by a grant from the MetLife Foundation and provided through the Academy's Americans In Motion-Healthy Interventions initiative, projects ran as part of each residency's community health training program.
  • More than 400 residents participated in the projects along with more than 200 support staff, reaching more than 6,000 children and adults through 400 events in clinics as well as out in communities.

Three of the participating residency programs described their experience to AAFP News.

Drexel University Family Medicine Residency Program

The Drexel University Family Medicine Residency Program in Philadelphia implemented its "Move It With Mommy and Me" program at the Eliza Shirley House, a shelter for homeless women and children in the city. Residents held monthly interactive sessions with mothers and their children, getting them to participate in games and activities focused on nutrition and physical exercise.

The program's nutritional education sessions taught children about making healthy food choices, the difference between good and bad foods, avoiding high-sugar, low-nutrient foods and introducing nutritional options that taste good.

Annette Gadegbeku, M.D., an assistant professor in the Department of Family, Community and Preventive Medicine at the Drexel University College of Medicine, told AAFP News, "At the end of each session, we hope they take home at least one important lesson or activity from our program. We also offer giveaways, such as balls, Hula-Hoops and pedometers, at the end of each session to help promote our message."

Exercise was encouraged through games such as Four Factors of Fitness, which directs players to cardiovascular, stamina, strength and stretching activities based on the suit and number of cards drawn from a deck.

"We also do a physical activity based on the reading of the book 'A is for Active' from AIM-HI," Gadegbeku said. "We do a variety of other activities as well including Hula-Hooping, an obstacle course, freeze dance and yoga."

The families enjoy the program, she said, and mothers and children want to participate if they're still in the shelter the following month.

"Some of the mothers really get involved, sometimes leading the activities themselves with the children. They really enjoy watching and participating in their child’s learning about nutrition and having fun," Gadegbeku said.

The residents enjoy participating in the program, as well, and it has been eye-opening for them.

"They have learned about the plague of childhood obesity, particularly in Philadelphia, including resources and lack thereof, and barriers to healthy eating and safe physical activity," she said. "They have learned how to implement, evaluate and sustain a community program and how to manage groups, be flexible and work with personnel at the shelter."

Gadegbeku said Drexel University Family Medicine plans to continue the program that it started in 2011. It has expanded into a bimonthly program by including sessions run by medical students in between the resident-led sessions.

Move It With Mommy and Me has become part of the longitudinal community medicine curriculum for the residency program, with each resident attending or leading a session at least twice each academic year.

The program also has partnered with a local produce market to supply participants with fruit and vegetable samples, natural juices, coupons and expertise in workshops.

"We are grateful to have been given the opportunity and funding by AIM-HI/AAFP to create and sustain such a special program," Gadegbeku said.

University of California, Davis, Health System Family Medicine Residency Program

For the University of California, Davis, Health System's Residents Improving People's Eating (RIPE) program, a registered dietitian trained 32 residents. Then third-year resident Mary Clegg, M.D., who led the project, set up five group visits for patients who were diabetic or overweight. During the visits, she provided health education and spent time with patients individually.

Brian Hayes, research development officer for the Department of Family and Community Medicine at the UC Davis Health System, in Sacramento, Calif., told AAFP News that following the group visits, participating patients (and some family members) and residents walked to the farmer’s market on campus and received $20 of vouchers to buy fresh produce.

A patient named Kathryn said, "Participating in the program was so helpful because it's sometimes hard for us to purchase fruits and veggies. We try to eat more fruits and veggies because of our high blood pressure.”

Following the intervention, 59 percent of the patients said they were more likely to increase their family’s consumption of fruit and vegetables. Hayes said the residents seemed to appreciate using the vouchers as a tool to motivate their patients to eat more produce.

But due to the cost and logistics of tracking and redeeming the vouchers, the residency has decided not to continue the program at this time.

"If we were to launch it again, I think we learned lessons that would help us structure the program more efficiently," Hayes said. "We are glad that we tried it because we learned more about patient needs and challenges in maintaining healthy diets."

University of Oklahoma Family Medicine Residency Program

The University of Oklahoma Family Medicine Residency Program in Oklahoma City partnered with a local high school that has a high level of students in poverty to present its Ruf-Nex for LIFE (Living – Inspiring Fitness Everyday) program, which encourages more physical activity and healthier eating.

Once a month, residents spoke to the high school's health classes about increasing activity levels, improving food choices and being aware of additional local programs that provide free nutritional education to low-income families.

James Barrett, M.D., residency director for the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center in Oklahoma City, told AAFP News the program also included a "walk with the doctor" session before school and the school received resources including basic fitness equipment, Xbox fitness equipment and gift cards to incentivize activity.

Following a session, a 16-year-old student named John said the program helped him encourage his family to exercise, too: "Fitness has not been important to my family until I told them about what happened at school."

Barrett said this program will be sustained with easy-to-use short presentation templates on nutrition and physical activity that subsequent residents can use to educate more high-school students. The residency also agreed to continue to offer the education at the same high school through its community medicine outreach program. And the residents seem to understand the weight of the work that they are doing.

"I didn't know how many obstacles there were to fitness in this school until I gave a talk and heard some of the questions and concerns of the students," said Adam Rivadeneyra, M.D., a teaching resident in the program. "It was a great chance to work with young people outside of a medical environment but still have an impact on their health."

More From AAFP
American Family Physician: AFP by Topic: Obesity

Familydoctor.org: Childhood Overweight and Obesity: Helping Your Child Achieve a Healthy Weight(familydoctor.org)