Program

Mar 23, 2012

OVERVIEW

High Five for Kids is an obesity intervention program designed for children ages
two through six. The intervention targets how family pediatric practitioners
address childhood obesity. This study was conducted after the first of two
years of intervention. The study had a positive impact on overall BMI for girls
and participants with household incomes of less than $50,000. Behavioral
outcomes included a significant impact on total television and video viewing,
and a marginally significant impact on fast food consumption.

DESCRIPTION OF PROGRAM

Target population:
Two to six year olds with a body mass index (BMI) in the 95th
percentile or higher, as well as two to six year olds with a BMI between the 85th
and 95th percentile if at least one parent is overweight.

High Five for Kids is a two year obesity intervention (a year of intense
intervention followed by a less intensive maintenance period) designed for
children ages two through six. The program is modeled on the Chronic Care
Model, which emphasizes changes in primary care to produce functional patient
outcomes and stresses that this is not possible without changes for all members
of the practice team. All members of the healthcare practice team are trained
to play specific active roles in the intervention.

Pediatric nurse practitioners are the key intervening clinician. Nurse
practitioners conduct motivational interviews (a communication technique that
enhances self-efficacy, increases recognition of and skills to reduce
inconsistencies between actual and desired behaviors, and enhances motivation
for change) through four 25-minute, in person chronic disease management visits
as well as three 15-minute telephone calls in the first year of the
intervention. Primary care pediatricians are trained in intervention practices
to use brief, focused negotiation skills at all routine well-child care visits
to endorse family behavior change. Educational modules targeting television
viewing, fast food eating, and sugar-sweetened beverage intake were developed
for chronic disease management visits. Modules were matched to a family’s stage
of readiness to change.

EVALUATION(S) OF PROGRAM

Taveras, E. M., Gortmaker, S. L., Hohman, D. H., Horan, C. M., Kleinman, K. P.,
Mitchell, K., Price, S., Prosser, L. A., Rifas-Shiman, S. L., & Gilman, M. W.
(2011) Randomized controlled trial to improve primary care to prevent and manage
childhood obesity. Archives of Pediatric Adolescent Medicine, 165,
714-722.

Evaluated population:
A total of 475 overweight children between age two and six (M=4.9) were involved
in this study: 253 were in the intervention and 192 were in the control
condition. The sample in this study was 48 percent female, 57 percent white, 19
percent black, and 17 percent Latino. The participants had a mean BMI score of
19.2.

Approach:
Ten primary care pediatric offices were cluster randomized to implement either
the High Five for Kids intervention or usual care. Though the intervention
lasts for two years, this study reports findings after one year of
intervention. The main outcome measured was change in BMI (with subgroup
analyses conducted for age, sex, race/ethnicity, parent education, household
income, and parental overweight/obesity status at baseline). Behavioral
outcomes include amount of sugar-sweetened beverages consumed, fast food
consumption, total television and video viewing, whether or not there was a
television in the bedroom, fruit and vegetable intake, and outdoor active
playtime.

Results:
Though overall BMI change was not significant, subgroup analyses did reveal
significant impacts for female participants as well as participants with a
household income less than $50,000. Child age, race/ethnicity, parent education
and parental overweight/obesity status at baseline were not significant. For
behavioral outcomes, the intervention impacted total television and video
viewing. Also, there was a marginally significant impact on fast food
consumption. All other behavioral outcomes (sugar-sweetened beverages consumed,
whether or not there was a television in the bedroom, fruit and vegetable
intake, and outdoor active playtime) were not significant.

SOURCES FOR MORE INFORMATION

Website:

http://www.populationmedicine.org/research/OPP/high-five-kids-toolkit

References

Taveras, E. M., Gortmaker, S. L., Hohman, D. H., Horan, C. M., Kleinman, K. P.,
Mitchell, K., Price, S., Prosser, L. A., Rifas-Shiman, S. L., & Gilman, M. W.
(2011) Randomized controlled trial to improve primary care to prevent and manage
childhood obesity. Archives of Pediatric Adolescent Medicine, 165,
714-722.

KEYWORDS:
Toddlers, Children, Males and Females, Clinic/Provider-based,
Counseling/Therapy, Family Therapy, Obesity, Nutrition, Health Status/Conditions

Program information last updated on 3/23/12.

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