According to the Centers for Disease Control and Prevention (CDC), the prevalence of obesity has quadrupled among boys and girls ages 6 to 11 over the past 25 years. Obesity is especially common among African-American, Hispanic-American and Native-American children. The CDC reports that nearly 20 percent of African-American children are obese compared to 12 percent of obese white children.
A study spearheaded by Anne Lang Dunlop, MD, MPH, assistant professor in the Department of Family and Preventive Medicine at the Emory University School of Medicine and family physician with Emory Healthcare and Grady Health System, is tackling these alarming statistics. Dr. Dunlop has received a three-year, $425,000 grant from the CDC Foundation to develop and evaluate a primary care-based intervention strategy to help urban, African-American children ages 7 to 11 who are obese or at risk for becoming obese to achieve a healthier body weight. The Let's Get Fit, Kids! Program focuses on children whose body mass index, or BMI (a comparison of height to body weight), falls in the overweight category--the 95th percentile or greater--for gender and age as well as children at risk for overweight (BMI 85th to 94th percentile).
"We know that having a high body mass index in childhood is associated with being overweight in adulthood and with developing serious medical conditions later in life, such as high blood pressure, high cholesterol, diabetes, and heart disease," says Dr. Dunlop, who is principal investigator of the project. "Obesity in childhood is also associated with social stigmatization and the development of low self-esteem. Because almost all children receive health care in the primary care setting, where it is recommended that BMI be tracked, and because primary care physicians are perceived as a highly credible source of health information, the primary care setting represents an important opportunity for identifying children who are overweight or at risk for becoming overweight and for initiating interventions to help these children achieve a healthier body weight."
The first phase of the research, in which the health educational and behavioral components of the Let's Get Fit, Kids! curriculum were developed and pilot-tested, wrapped up in December 2005. Since January 2006, Dr. Dunlop and her team have been conducting a randomized trial of the Let's Get Fit, Kids! primary-care-based intervention strategy at two of the Grady Neighborhood Health Centers (DeKalb Grady and Asa Yancey), the Emory Family Medicine Clinic at South Dekalb, and a few private practices in the south metro area. Primary care providers at these sites refer children into the program.
To date, about 40 children and their parents have enrolled in the Let's Get Fit, Kids! Program. Upon enrollment, children and their parents are randomly assigned to two groups: the behavioral intervention group or a standard care "control" group. Both groups receive care and health information in accordance with the latest expert committee guidelines for the assessment and treatment of childhood overweight that involves measuring children's height and weight to obtain their BMI percentile; assessing them for medical problems that are associated with obesity in childhood (including obtaining a blood specimen to check for high cholesterol and high blood sugar for some children); obtaining a physical activity and eating habit history; and providing counseling to the family regarding ways to improve the child's eating and physical activity behaviors.
The behavioral interventional group also participates in a six-month behavioral intervention, which consists of instruction in a group-based setting led by a health educator with weekly meetings for the first four weeks of the intervention to teach the following curriculum: the concept of 'energy balance'; parent and child jobs around eating; conscious eating along with a specific eating plan; lifestyle physical fitness and reduction in "screen time"; and behavioral strategies for diet and activity (goal-setting, self-monitoring, stimulus control, social learning). Participants are then followed up as a group with a health educator for five months to address techniques for maintenance of behavioral changes.
After 6 and 12 months of enrollment, the groups of children are compared with regard to change in BMI, the number of servings of high-fat and high-sugar foods in their diet, and the number of hours they spend weekly in targeted sedentary activities.
As the program continues enrolling participants over the next year, study results are not yet available. However, preliminary findings are encouraging in that participants have given favorable feedback about the program, participating parents and children report success in changing key eating and activity behaviors linked with weight gain, and several children have lost weight and reduced their BMI.
"Let's Get Fit, Kids! is about helping families to make lifestyle changes in three important areas: eating fewer high-fat, high-sugar foods, spending more time being active, and spending less time watching TV, playing video games, and surfing the Internet," Dr. Dunlop says.
"This program is not about learning a diet or specific exercises for one child to do for a short time." she adds. "Changing habits for the long-run takes some time and effort and the sustained commitment of parents and children working together to identify problem areas for the family and to come up with feasible solutions that will work within the family. In addition to imparting the requisite health education for families to change eating and activity habits, The Let's Get Fit, Kids! program gives families the skills to work together to change behaviors."