Be Our Voice Blog

Thursday, May 10th, 2012

Serving the Most Vulnerable Kids: The Safety Net and Childhood Obesity

Posted by: Kristi Fossum Jones, MPH

Pediatric providers practicing in safety net settings—such as community health centers, free clinics, and public hospitals—face multiple and unique challenges when it comes to childhood obesity. First, they tend to care for more kids from low-income families, and since poverty and obesity are connected in multiple and complex ways,1-5 providers working in a safety net setting must address poverty-related barriers to healthy lifestyles. Second, safety net facilities are often themselves cash-strapped as a result of having to rely on uncertain federal grants and decreasing Medicaid payments, which makes sustaining obesity programming very difficult.

Pediatric providers and other healthcare professionals can have different roles within obesity programs.   Some working in safety net settings are actively involved in conducting such programs, while others in more mainstream settings might refer patients and their families to these programs. For example, a 5-year old child who is overweight, a US citizen, and enrolled in Medicaid may be eligible for a referral to a private hospital’s pediatric fitness program. But if his 12-year old sister, who is also overweight, was born in Mexico—and therefore not eligible for a referral to a private hospital through Medicaid—she could instead be referred to a community health center’s fitness program. 

Pediatric providers in mainstream settings can also collaborate with their safety net counterparts to meet the needs of a broader sector of the population beyond those normally seen in their clinics. So what can providers working in safety net settings do to support obesity programming for their patients? 

Some safety net facilities across the country are finding creative ways to implement childhood obesity programs in their neighborhoods and communities without relying on uncertain funding sources. These facilities are partnering with other organizations and groups to build on each other’s strengths, resources, and ability to reach kids and their families. Here are just a few examples of innovative childhood obesity programs being implemented at safety net facilities:

Educating Patients and Families:

  • Petaluma Health Center (California) has a garden onsite and pediatric patients in the Petaluma Loves Active Youth program help raise plants and harvest the food. There are weekly cooking demos, and classes on healthy eating with exercise for the kids.
  • Charles Drew Health Center (Omaha, NE) hosts a 12-week Healthy Families class so children and parents can learn about healthy eating and exercise, and benefit from the attention of multidisciplinary clinical teams. Incentives such as YMCA memberships are offered.
  • Community Health Center, Inc. (Meridien, CT) offers a six-week program for teen girls and women concerned about weight called “Food Smart and Fit.”

Infrastructure Projects:

  • The Community Health Centers Alliance (CHCA, Florida) plans to conduct electronic and chart surveillance of childhood obesity and to promote best practices among providers. They hope to create a Childhood Obesity Practice Manual with clinical guidelines and other resources.
  • CHAMPS (Community Health Association of Mountain/Plains States) has a website of obesity resources for member CHC’s and their providers.

There’s no need to reinvent the wheel when trying to build up an obesity program! Both Be Our Voice and the American Academy of Pediatrics provide childhood obesity advocacy resources that are relevant in safety net settings.  The Obesity Society and the National Association of Community Health Centers also created a resource specifically for providers in safety net settings entitled Childhood Obesity Resource Guide. The National Association of Children’s Hospitals and Related Institutions (NACHRI) developed the Survival Guide to Planning, Building, and Sustaining a Pediatric Obesity Program as a tool for healthcare professionals who are ready to roll up their sleeves and move their weight management program to the next level.

References

  1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among United States adults, 1999–2008. JAMA 303:235–41. 2010.
  2. National Institutes of Health. Clinical Guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-The evidence report. Obes Res 6 Suppl 2:51S–209S. 1998.
  3. Sobal J, Stunkard AJ. Socioeconomic status and obesity: A review of the literature. Psychol. Bull 105:260–75. 1989.
  4. McLaren L. Socioeconomic status and obesity. Epidemiol Rev 29:29–48. 2007.
  5. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey. Available from: http://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm

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General Childhood Obesity  Healthy Kids