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It sounds like a simple plan: eat right and exercise to stay fit. But for many Boston families, this is anything but easy. Poverty and lack of transportation often limit a family's access to healthful foods. Concerns about violence keep them from going outside to play, so children often stay inside watching TV and playing video games. The problem is so widespread that more than 40 percent of Boston Public School students are either clinically obese or borderline overweight.
Working to curb the crisis are clinicians at community health centers, who are educating families about how to make healthful choices and trying to remove the barriers that keep them from addressing their weight issues. Three years ago, Children's Hospital Boston's Office of Child Advocacy launched a program called Fitness in the City (FIC) to help these centers in their mission to prevent and treat pediatric obesity. Children's support has ensured that nutritionists are available to counsel health center patients and made free memberships available to local YMCAs, Body by Brandy Kid's Gym in Roxbury and GoKids Boston at UMass Boston. But more importantly, it has set up a system for the health centers to pool their knowledge and resources, share outcomes, and talk about which approaches they've found successful.
"Nobody totally understands which interventions are most successful for childhood weight management," says Shari Nethersole, MD, Children's medical director for community health, who developed the FIC concept. "Society hasn't had a lot of success helping people change their behavior and fight off obesity so far, so we wanted to partner with health centers to help them test out their ideas about what approaches can work. This is our chance to unite community expertise to identify solutions."
Currently, 11 Boston community health centers participate in FIC, including Children's Martha Eliot Health Center (MEHC). The benefit of centering weight and nutritional counseling at the community level is that it's often family-centered care, so clinicians can see parents and children at the same time and work on lifestyle changes for the whole family. There's also the advantage of families not having to leave their neighborhood for treatment. "That's really important when a child needs to come in weekly," says Nethersole. "This way, they don't have to deal with transportation issues like taking two busses to get to Children's, which can make them miss appointments."
Every FIC center equips patients and families with information about healthful eating and connects them with local physical activity opportunities, but each takes its own approach based on the unique needs of its patients. "To tell someone from a Latino culture not to eat rice isn't going to work," she says. "So we take the community's culture into account when trying to change their eating habits." At I'm iN Charge (INC) at MEHC, for example, the program takes the empowerment approach. "This community can feel disempowered, which is a common issue with people who are poor and often overwhelmed," says Nethersole. Here, patients learn how to take control of what they eat and listen to their body, eating when they're hungry and stopping when full. INC's registered dietician, Laura Sprauer, RD, IBCLC, has found this approach useful. "Individuals can implement dietary and lifestyle changes if they are educated, motivated, supported and empowered," she says.
Children's and the health centers' staff meet on a quarterly basis to share their approaches and discuss challenges and resources they need. Last year, the FIC team identified a need for more case management to help coach and motivate families and help them access local physical fitness programs. As a result, in addition to supporting part time case managers at the health centers, Children's recently added a case manager, Alison Cella-Mowatt, who is helping make it easier for families to connect with fitness programs and physical activity opportunities.
Cella-Mowatt has been the program coordinator for One Step Ahead, a weight management program in the Children's Hospital Primary Care Center. In her expanded role, she's establishing relationships with each of the FIC health centers, meeting with staff and helping link families with appropriate fitness activities. "It's a full-time job to stay on top of the many programs offered in Boston since locations, costs, age requirements and registration periods are constantly changing," she says. "I'm excited to serve as a resource. By working more closely with parents to match their children with programs, I hope I can remove some of the barriers that keep them from exercising."
Through FIC, Children's has helped community health centers to reach more than 500 children and families in Boston so far. "I like that we're using a different approach to improve community health," Nethersole says. "In the past, the standard has been to have our doctors go out and provide services in the community. That can be useful, but this way, we're creating more sustainable systems at health centers by helping them innovate and educate each other. We're strengthening their capacity to support themselves long-term. It's really about building expertise within the community."
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