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Improving Processes of Care for Overweight and Obese Children

June 30, 2014

An article from researchers at the School of Public Health on Improving Processes of Care for Overweight and Obese Children, using Evidence from the 215-GO! Program in Philadelphia Health Centers, asserts that the 215-GO! program improved most processes of care but did not translate into improved body mass index outcomes for all patients.  Clinic-based treatment of childhood overweight and obesity continues to fail to meet the burden of that condition.

The article appeared in the May/June 2014 issue of ASPPH’s Public Health Reports and was authored by Daniel M. Walker, MPH; Dr. Jessica M. Robbins, Dr. Darryl Brown and Dr. Zekarias Berhane.

The first author for this article, Daniel Walker, completed this work as his master's project at Drexel’s School of Public Health in 2011 with preceptor Dr. Jessica Robbins, an adjunct professor in the Department of Epidemiology and Biostatistics.  Dr. Darryl Brown, assistant professor in the Department of Health Management and Policy, served as Mr. Walker’s advisor, helping to conceptualize and edit the study.  Dr. Zekarias Berhane provided statistical guidance.  Mr. Walker is now a doctoral student at Tulane School of Public Health and Tropical Medicine.

The 215-GO! program, developed in 2004 in response to issues concerning childhood overweight and obesity, represents an interdisciplinary approach to treating the disease.  215-GO! is an acronym: 2 = limit screen time to <2 hours a day; 1 = include a minimum of one hour per day of physical activity; 5 =  eat five servings of fruit and vegetables per day; G = great; and O = opportunities.  The program ran in four of the Philadelphia Department of Public Health operated health centers that provide care without regard to ability to pay and serve predominantly low income and minority populations. 

According to this article, children are referred to the program staff by their pediatricians and the health center team develops a coordinated treatment plan, providing comprehensive disease management between a child’s physician and an onsite nutritionist and health educator.

Pediatric patients aged 3-18 who had a well-child visit at any of the health centers and a BMI >85th percentile rank and a follow-up visit at least six months after the initial visit were eligible for this study.

The authors of this study point out that childhood overweight and obesity has reached epidemic proportions in the U.S., yet there is a dearth of evidence for effective clinic-based programs to both identify and treat the condition.  The study provides an alternative model that promotes improved processes of care in an urban setting.  However, the 215-GO! program remains insufficient on its own to reduce BMI for all children.  Improvements in processes of care are necessary to begin to identify and develop treatment protocols for overweight and obesity.

According to Mr. Walker, "The results of this study fit into the larger framework of making clinic-based care more patient centered in order to improve health outcomes, particularly for patients with chronic conditions.  The results suggest that childhood obesity interventions in only one setting such as primary care clinics may be insufficient to reduce BMI.  Future research should explore the effect of multilevel interventions that include primary care components in addition to lifestyle changes and intervention at other levels including at home, school, and community groups."

"When we consider that childhood obesity has impacts that range from population health to future quality of life for young people,” explained Dr. Brown, “I credit Daniel for assembling a multidisciplinary team of public health professionals and academicians for his CBMP research."

Dr. Robbins commented, "Dan Walker’s work provided the most rigorous assessment of outcomes from the 215-GO! program.  The mixed results reflect the magnitude of the challenges primary health care providers face.  Other outcomes, including the prevention of obesity-related comorbidities, still need to be addressed.  The Philadelphia Health Centers remain committed to providing high-quality care to all of our patients, and continuing to work to improve outcomes for children impacted by the obesity epidemic in Philadelphia.  Clinic-based and community-based approaches need to develop side-by-side to promote children’s health."