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A young man at Body by Brandy's Kids Gym in Roxbury.
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. Rather than going outside to play, children may prefer to 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 barriers that keep them from addressing their weight issues. Three years ago, Children's Hospital Boston's Office of Child Advocacy (OCA) launched Fitness in the City (FIC) to help these centers prevent and treat pediatric obesity. Children's support has ensured that nutritionists are available to counsel health center patients and that free memberships are offered to local YMCAs, Body by Brandy Kid's Gym in Roxbury and GoKids Boston at UMass Boston. 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. "Children's 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 that will improve the health of families."
Currently, 11 Boston community health centers participate in FIC, including Children's Martha Eliot Health Center. By bringing community health centers together, Children's is able to help them unify around the obesity issue and evaluate outcomes to assess what type of programs can have the greatest impact. Another benefit of delivering fitness 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.
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 and community. At South Cove Community Health Center, providers have added bilingual nutritional counseling and case management for their patients. Through a partnership with the Boston Chinatown Neighborhood Center (BCNC), South Cove also provides children and families with individualized fitness coaching and physical activity plans.
Children's encourages cooperation and communication among health centers by hosting bi-monthly meetings, where staff can share their approaches, discuss successes and challenges, and brainstorm about the resources needed to improve patient health. Last year, the FIC team identified a need for more case management to help coach and motivate families and help them access physical fitness programs. As a result, in addition to supporting part-time case managers at the health centers, Children's added another case manager to the program to help make it easier for families to connect with physical activity opportunities. Preliminary outcomes have shown improvements in certain targeted behaviors: limiting TV time, decreasing sugar-sweetened beverages, increasing physical activity and eating more fruits and vegetables.
Through FIC, Children's has helped community health centers reach more than 800 children and families in Boston so far. "Obesity is a complex medical, social and lifestyle issue, especially for families in urban areas," says Nethersole. "Our hope is that FIC can help improve prevention and treatment programs by figuring out the best ways to remove barriers and encourage parents and children to eat better and be more physically active."
For more information visit childrenshospital.org/communityhealth.
• Bowdoin Street Community Health Center
• Brookside Community Health Center
• The Dimock Center
• Joseph M. Smith Community Health Center
• Martha Eliot Health Center
• One Step Ahead at Children's Hospital Primary Care Center
• Roxbury Comprehensive Community Health Center
• South Cove Community Health Center
• South End Community Health Center
• Southern Jamaica Plain Health Center
• Upham's Corner Health Center
• Whittier Street Health Center |
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