Elsie M' Taveras, MD, MPH

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Clinically-Based Interventions to Prevent Obesity
Among 0-5 Year Old Children

• Elsie M. Taveras, MD, MPH
• Obesity Prevention Program, Department of
  Ambulatory Care and Prevention, Harvard Medical
  School and Harvard Pilgrim Health Care
• Pediatric Obesity Prevention
• Bridging Two Fields Conference
• December 8, 2008

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Overview

• Uniqueness of the primary care setting for
  promoting child development and preventing
  obesity
• Summary of ongoing, clinically-based obesity
  interventions
• Example of incorporating child developmental
  stage into a clinically-based obesity
  intervention
• First Steps for Mommy Me Study
• Challenges to obesity prevention efforts

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Background

• The primary care setting offers unique
  opportunities to intervene and alter the
  subsequent course of health and disease for
  children at risk for obesity
• Children 0-5 years visit their primary care
  clinicians for routine health supervision more
  often than later in childhood and adolescence
• From 0 through 5 years, at least 10 health
  supervision visits are recommended by the AAP
• Regular visits allow both detection of elevated
  BMI levels and opportunities for intervention.

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Background

• Regular visits in this early childhood period
• Allow for counseling that is family-centered and
  comprehensive
• Promotes parental receptivity to suggestions for
  changes in obesogenic and other health-related
  behaviors
• Takes advantage of a period of life when parents
  are more open to advice about their child, and
  the motivation of their childs health can be
  used to alter their own health behaviors

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Background

• While there is clear evidence for the potential
  effectiveness of obesity prevention in the
  clinical setting, there have been few published
  clinical interventions designed to reduce
  overweight risk among children 0-5 years.

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Published Clinically-Based Obesity Interventions

• Systematic review in 2005 of interventions to
  prevent or treat obesity in preschool children
  identified 7 total published studies 2 were
  clinically-based (Bluford, Sherry, and Scanlon,
  2007)
• Literature review published in 2007 on preventing
  obesity in children lt 5 years concluded there is
  a limited and immature evidence on effective
  strategies to prevent obesity in younger
  children (Saunders, 2007)

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Published Clinically-Based Obesity Interventions

• Since 2005
• Pilot, office-based intervention using
  motivational interviewing to prevent childhood
  obesity among children 3-7 years found to be
  effective in preventing obesity (Schwartz et al,
  2007)
• Pilot, primary-care based intervention (SNAPP)
  among children 2-10 years increased growth
  documentation and provider counseling on
  lifestyle behaviors (Ariza et al, 2009)

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Ongoing, Clinically-Based Interventions
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Incorporating child developmental stage into
obesity prevention interventions First Steps
for Mommy Me Study
PI Elsie M. Taveras, MD, MPH
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First Steps for Mommy MeOverall Goal

• To assess the feasibility of a pediatric primary
  care based intervention among 0- to 6-month old
  children and their mothers to encourage healthy
  eating and physical activity behaviors

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First Steps for Mommy MeOverview

• Pilot intervention in 3 HVMA Pediatric Practices
  (Cambridge, Somerville, Watertown)
• 2 non-randomized intervention sites
• 1 usual care site
• Targeted group infants 0-6 months of age and
  their mothers
• Duration of intervention 6 months
• 84 mother-infant pairs enrolled

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First Steps for Mommy Me Main Intervention
Components

• Pediatrician endorsement of mother-infant
  behavior change using brief focused negotiation
• Individualized coaching using motivational
  interviewing by a study health educator
• Matching parent counseling and educational
  materials to childs developmental stage

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First Steps for Mommy Me Main Intervention
Components

• 4. Focus on evidence-based behaviors
• 5. Group meetings to reinforce content and
  promote peer support and social networking

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Evidence-Based Targets of Behavioral Counseling
Infancy Early Childhood

• Gestational weight gain (Oken, 2006)
• Maternal smoking during pregnancy (Oken, 2006)
• Rapid infant weight gain (Taveras et al. 2008,
  in press)
• Breastfeeding promotion (Taveras et al. 2005)
• Improved responsiveness to infant hunger and
  satiety cues

• Sleep duration and quality (Taveras et al. 2008)
• Television viewing (Taveras et al. 2007)
• TV sets in bedrooms
• Fast food intake (Taveras et al. 2006)
• Sugar-sweetened beverages
• Physical activity

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First Steps for Mommy MeBehavioral Targets
Mother-Infant

• Prolonged breastfeeding
• Improved responsiveness to hunger and satiety
  cues
• Support babys healthy sleep patterns
• Discourage TV/video viewing and TV in bedrooms
• Delayed introduction of solids until at least 4
  months 6 months for breastfed infants
• Delay introduction of sugary beverages

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First Steps for Mommy MeBehavioral Targets
Mothers

• Improve dietary factors
• Avoid fast food sugary drinks
• Eat 5-9 servings of fruits vegetables/day
• Support healthy sleep quality and quantity
• Improve physical activity
• Limit TV video watching to 2 hours/day

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Breastfeeding Promotion (in-hospital)
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Developmentally appropriate materials - Sleep
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Hunger and Fullness
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Challenges to Obesity Prevention Efforts for
Children 0 to 5 Years

• Involving the entire family in obesity prevention
  efforts
• Supporting clinically-based efforts in
  multi-settings, i.e. home, community
• Developing low cost, sustainable, culturally
  relevant interventions
• Integrating obesity screening into pediatric
  primary care
• Training pediatric workforce on the use of expert
  committee guidelines for the care of obesity in
  children