Advertisement

Body Mass Index and Blood Pressure Improvements With a Pediatric Weight Management Intervention at Federally Qualified Health Centers

  • Author Footnotes
    ⁎ Contributed equally as co-first authors.
    Omoye E. Imoisili
    Correspondence
    Address correspondence to Omoye E. Imoisili, MD, MPH, 4770 Buford Highway NE, Chamblee, GA 30341
    Footnotes
    ⁎ Contributed equally as co-first authors.
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga

    Epidemic Intelligence Service (OE Imoisili and LS Womack), Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Ga

    United States Public Health Service (OE Imoisili, LS Womack, HM Blanck, and AB Goodman), Rockville, Md
    Search for articles by this author
  • Author Footnotes
    ⁎ Contributed equally as co-first authors.
    Elizabeth A. Lundeen
    Footnotes
    ⁎ Contributed equally as co-first authors.
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
    Search for articles by this author
  • David S. Freedman
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
    Search for articles by this author
  • Lindsay S. Womack
    Affiliations
    Epidemic Intelligence Service (OE Imoisili and LS Womack), Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Ga

    United States Public Health Service (OE Imoisili, LS Womack, HM Blanck, and AB Goodman), Rockville, Md
    Search for articles by this author
  • Jessica Wallace
    Affiliations
    Denver Health Ambulatory Care Services (J Wallace, SJ Hambidge, S Federico, R Everhart, D Harr, and J Vance), Denver, Co
    Search for articles by this author
  • Simon J. Hambidge
    Affiliations
    Denver Health Ambulatory Care Services (J Wallace, SJ Hambidge, S Federico, R Everhart, D Harr, and J Vance), Denver, Co
    Search for articles by this author
  • Steven Federico
    Affiliations
    Denver Health Ambulatory Care Services (J Wallace, SJ Hambidge, S Federico, R Everhart, D Harr, and J Vance), Denver, Co
    Search for articles by this author
  • Rachel Everhart
    Affiliations
    Denver Health Ambulatory Care Services (J Wallace, SJ Hambidge, S Federico, R Everhart, D Harr, and J Vance), Denver, Co
    Search for articles by this author
  • Delia Harr
    Affiliations
    Denver Health Ambulatory Care Services (J Wallace, SJ Hambidge, S Federico, R Everhart, D Harr, and J Vance), Denver, Co
    Search for articles by this author
  • Jillian Vance
    Affiliations
    Denver Health Ambulatory Care Services (J Wallace, SJ Hambidge, S Federico, R Everhart, D Harr, and J Vance), Denver, Co
    Search for articles by this author
  • Lyudmyla Kompaniyets
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
    Search for articles by this author
  • Carrie Dooyema
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
    Search for articles by this author
  • Sohyun Park
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
    Search for articles by this author
  • Heidi M. Blanck
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga

    United States Public Health Service (OE Imoisili, LS Womack, HM Blanck, and AB Goodman), Rockville, Md
    Search for articles by this author
  • Alyson B. Goodman
    Affiliations
    Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity (OE Imoisili, EA Lundeen, DS Freedman, L Kompaniyets, C Dooyema, S Park, HM Blanck, and AB Goodman), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga

    United States Public Health Service (OE Imoisili, LS Womack, HM Blanck, and AB Goodman), Rockville, Md
    Search for articles by this author
  • Author Footnotes
    ⁎ Contributed equally as co-first authors.
Published:December 03, 2020DOI:https://doi.org/10.1016/j.acap.2020.11.026

      Abstract

      Objective

      The Mind, Exercise, Nutrition, Do It! 7–13 (MEND 7–13) program was adapted in 2016 by 5 Denver Health federally qualified health centers (DH FQHC) into MEND+, integrating clinician medical visits into the curriculum and tracking health measures within an electronic health record (EHR). We examined trajectories of body mass index (BMI, kg/m2) percentile, and systolic and diastolic blood pressures (SBP and DBP) among MEND+ attendees in an expanded age range of 4 to 17 years, and comparable nonattendees.

      Methods

      Data from April 2015 to May 2018 were extracted from DH FQHC EHR for children eligible for MEND+ referral (BMI ≥85th percentile). The sample included 347 MEND+ attendees and 21,061 nonattendees. Mixed-effects models examined average rate of change for BMI percent of the 95th percentile (%BMIp95), SBP and DBP (mm Hg), after completion of the study period.

      Results

      Most children were ages 7 to 13 years, half were male, and most were Hispanic. An average of 4.2 MEND+ clinical sessions were attended. Before MEND+, %BMIp95 increased by 0.247 units/month among MEND+ attendees. After attending, %BMIp95 decreased by 0.087 units/month (P < .001). Eligible nonattendees had an increase of 0.084/month in %BMIp95. Before MEND+ attendance, SBP and DBP increased by 0.041 and 0.022/month, respectively. After MEND+ attendance, SBP and DBP decreased by 0.254/month (P < .001) and 0.114/month (P < .01), respectively. SBP and DBP increased by 0.033 and 0.032/month in eligible nonattendees, respectively.

      Conclusions

      %BMIp95, SBP, and DBP significantly decreased among MEND+ attendees when implemented in community-based clinical practice settings at DH FQHC.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Denver Public Health
        Denver Childhood Obesity Monitoring Report 2012-2016.
        2017
        • Kuczmarski RJ
        • Ogden CL
        • Grummer-Strawn LM
        • et al.
        CDC growth charts: United States.
        Adv Data. 2000; : 1-27
        • Sacher PM
        • Kolotourou M
        • Chadwick PM
        • et al.
        Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity.
        Obesity (Silver Spring, Md). 2010; 18: S62-S68
        • Grossman DC
        • Bibbins-Domingo K
        • Curry SJ
        • et al.
        Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.
        JAMA. 2017; 317: 2417-2426
        • Fagg J
        • Cole TJ
        • Cummins S
        • et al.
        After the RCT: who comes to a family-based intervention for childhood overweight or obesity when it is implemented at scale in the community?.
        J Epidemiol community health. 2015; 69: 142-148
      1. Healthy Weight Partnership. MEND: health lifestyle and weight management programs for children and families. 2020. Available at: https://healthyweightpartnership.org/. Accessed October 6, 2020.

        • Kolotourou M
        • Radley D
        • Gammon C
        • et al.
        Long-term outcomes following the MEND 7-13 child weight management program.
        Child obes (Print). 2015; 11: 325-330
        • Sacher PM
        • Kolotourou M
        • Poupakis S
        • et al.
        Addressing childhood obesity in low-income, ethnically diverse families: outcomes and peer effects of MEND 7-13 when delivered at scale in US communities.
        Int J Obes (2005). 2019; 43: 91-102
        • Kolotourou M
        • Radley D
        • Chadwick P
        • et al.
        Is BMI alone a sufficient outcome to evaluate interventions for child obesity?.
        Child obes (Print). 2013; 9: 350-356
        • Chang CH
        • J PWB
        • Lurie JD
        Geographic expansion of federally qualified health centers 2007-2014.
        J Rural Health. 2019; 35: 385-394
        • Kelleher KJ
        • Gardner W
        Are FQHCs the solution to care access for underserved children?.
        Pediatrics. 2016; 138: e20162479https://doi.org/10.1542/peds.2016-2479
        • Murphy AD
        • Griffith VM
        • Mroz TM
        • et al.
        Primary care for underserved populations: navigating policy to incorporate occupational therapy into federally qualified health centers.
        Am J Occup Ther. 2017; 717102090010p1–7102090010p5https://doi.org/10.5014/ajot.2017.712001
        • Freedman DS
        • Berenson GS
        Tracking of BMI z scores for severe obesity.
        Pediatrics. 2017; 140: e20171072https://doi.org/10.1542/peds.2017-1072
        • Freedman DS
        • Butte NF
        • Taveras EM
        • et al.
        BMI z-Scores are a poor indicator of adiposity among 2- to 19-year-olds with very high BMIs, NHANES 1999-2000 to 2013-2014.
        Obesity (Silver Spring, Md). 2017; 25: 739-746
        • Flynn JT
        • Kaelber DC
        • Baker-Smith CM
        • et al.
        Clinical practice guideline for screening and management of high blood pressure in children and adolescents.
        Pediatrics. 2017; 140: e20171904https://doi.org/10.1542/peds.2017-1904
        • Rosner B
        • Cook N
        • Portman R
        • et al.
        Determination of blood pressure percentiles in normal-weight children: some methodological issues.
        Am J Epidemiol. 2008; 167: 653-666
        • Ehehalt S
        • Wiegand S
        • Korner A
        • et al.
        Diabetes screening in overweight and obese children and adolescents: choosing the right test.
        Eur J Pediatr. 2017; 176: 89-97
        • Galhardo J
        • Shield J
        The role of haemoglobin A1c in screening obese children and adolescents for glucose intolerance and type 2 diabetes.
        Acta Medica Portuguesa. 2015; 28: 307-315
        • Vos MB
        • Abrams SH
        • Barlow SE
        • et al.
        NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: recommendations from the expert committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, hepatology and nutrition (NASPGHAN).
        J Pediatr Gastroenterol Nutr. 2017; 64: 319-334
      2. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.
        Pediatrics. 2011; 128: S213-S256
        • Daymont C
        • Ross ME
        • Russell Localio A
        • et al.
        Automated identification of implausible values in growth data from pediatric electronic health records.
        J Am Med Inform Assoc. 2017; 24: 1080-1087
      3. Cohen RA. An introduction to PROC LOESS for local regression. Paper presented at: Proceedings of the twenty-fourth annual SAS users group international conference, Paper 1999.

        • Friedman JH
        A Variable Span Smoother.
        Stanford Univ CA Lab for Computational Statistics, 1984
        • Centers for Disease Control Prevention
        A SAS Program for the CDC Growth Charts.
        2000
      4. Bates D, Mächler M, Bolker B, et al. Fitting linear mixed-effects models using lme4. arXiv e-prints. 2014. Available at: https://ui.adsabs.harvard.edu/abs/2014arXiv1406.5823B. Accessed June 01, 2014.

        • Flegal KM
        • Wei R
        • Ogden CL
        • et al.
        Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts.
        Am J Clin Nutr. 2009; 90: 1314-1320
        • Kelly AS
        • Barlow SE
        • Rao G
        • et al.
        Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association.
        Circulation. 2013; 128: 1689-1712
        • Copeland KC
        • Silverstein J
        • Moore KR
        • et al.
        Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents.
        Pediatrics. 2013; 131: 364-382
        • Peirson L
        • Fitzpatrick-Lewis D
        • Morrison K
        • et al.
        Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis.
        CMAJ Open. 2015; 3: E35-E46
        • Rhee KE
        • De Lago CW
        • Arscott-Mills T
        • et al.
        Factors associated with parental readiness to make changes for overweight children.
        Pediatrics. 2005; 116: e94-101
        • Warschburger P
        • Kröller K.
        Childhood overweight and obesity: maternal perceptions of the time for engaging in child weight management.
        BMC public health. 2012; 12: 295
        • Kostadinov I
        • Daniel M
        • Jones M
        • et al.
        Assessing change in perceived community leadership readiness in the Obesity Prevention and Lifestyle program.
        Health Promotion J Australia. 2016; 27: 208-214
        • Imoisili OE
        • Goodman AB
        • Dooyema CA
        • et al.
        Referrals and management strategies for pediatric obesity—DocStyles survey 2017.
        Front Pediatr. 2018; 6: 367https://doi.org/10.3389/fped.2018.00367
        • Barlow SE
        Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.
        Pediatrics. 2007; 120: S164-S192