Be Our Voice Blog

Tuesday, May 1st, 2012

Promoting Obesity Prevention through Practice Design

Posted by: Kristi Fossum Jones, MPH

Most pediatric care providers talk about healthy eating and exercise when patients and families are in the exam room. And while this is an important part of obesity prevention, providers can actually start promoting healthy habits even earlier in the visit: when patients and families first enter the healthcare facility. Be Our Voice advocates can help to create a practice environment that is designed to support obesity prevention by making sure that their healthcare facility not only “talks the talk” but also “walks the walk.”

The AAP Policy Opportunities Tool lists evidence-based, practice-level interventions according to the 5-2-1-0-Breastfeeding-BMI healthy message framework. Some of these recommendations are discussed here, along with examples of facilities currently implementing them. But please note that these facilities are not the only ones putting these recommendations into practice—they are just examples! 

Healthy Eating Strategy: Require menu labeling in hospital cafeterias and vending sites to provide consumers with calorie information on menus and menu boards.
This strategy helps empower consumers to make healthier food choices. The information provided may range from complete nutrition information to a simple display of the number of calories in a particular food item. As part of a research study, Massachusetts General Hospital in Boston implemented a red-yellow-green stoplight system to help cafeteria customers know which foods and drinks were the healthiest (“green” items offered the best nutrition, “yellow” items offered nominal nutrition, and “red” items were the least healthy options). During Phase 1 of the study, there were statistically significant reductions in sales of “red” food items and increases in sales of “green” food items. Throughout Phase 1 and Phase 2, there were significant reductions in sales of “red” beverages and increases in sales of “green” ones.1

Screen Time Reduction Strategy: Limit the use of televisions in practice and hospital waiting rooms.
Many pediatric providers tell patients to limit TV at home, but this advice may ring a little hollow when patients are allowed to watch big-screen TV’s in waiting rooms or to spend their entire hospital stay glued to video games. Pediatric care providers will gain credibility with the “limit TV” message by following the AAP’s recommendation to “serve as good role models by using television appropriately and by implementing reading programs using volunteer readers in waiting rooms and hospital inpatient units.”2 Waiting room books and reading activities are frequently part of Reach Out and Read practices, but they are feasible in other practices as well.

Physical Activity Strategy: Create opportunities for physical activity in clinical settings for employees, patients, and their families via events or design/built environment.
Practice-level interventions to increase physical activity may differ depending on the target audience, whether it consists of employees or patients. But all interventions should be designed to get people to move more! For employees, there are many ways to support exercise and to promote physical activity. One example comes from Cleveland Clinic, which offers exercise classes and discount/free health club memberships as part of employee wellness efforts. In pediatric settings, patient-focused events will, out of necessity, target parents and families as well as children. These events could include walks and runs that offer opportunities for fun family exercise and health education, such as the Super Kids Sunday 5K and Fun Run organized by Miller Children’s Hospital in Long Beach.

Limit Sugar-Sweetened Beverages Strategy: Restrict sugar sweetened beverages from cafeterias and mobile vending machines in practices and hospitals.  
Pediatric care providers can ensure that their practices set good examples by providing healthy beverages. This means limiting the availability of soda and other sugar-sweetened beverages while increasing more nutritious options. A practice could start on a small scale by having a Soda-Free Summer event and go soda-free for one summer along with other community organizations. Hospital-wide possibilities include no-soda policies, such as the one implemented in January 2011 at Nationwide Children’s Hospital in Columbus, Ohio. In Boston, 10 hospitals recently pledged to get rid of all high-sugar beverages, offer healthier beverage options, install free water dispensers, and educate patients and staff about nutritious beverages. 

Breastfeeding Strategy: Provide lactation room and adequate breaks for nursing mothers. 
Providing private lactation rooms and sufficient breaks to pump breast milk are ways for practices to support breastfeeding, both among mothers of patients and among employees. This is becoming an increasingly common practice in healthcare facilities. One of the first milestones in Boston Medical Center’s journey to Baby-Friendly Designation was opening a breastfeeding and pumping room in 1998—their Breastfeeding Center is now one of the foremost programs of its kind in the country. A simple Internet search will yield many other examples of places that do it (and do it very well)!

BMI Strategy: Advocate for payment by public and private insurance for obesity related services.
This practice-level intervention for BMI involves advocating for insurance and Medicaid plans to cover ongoing, multidisciplinary obesity care. Two studies conducted by the Robert Wood Johnson Foundation found that the groundwork is in place for Medicaid, but most state Medicaid manuals do not provide clear or adequate information about coverage levels and appropriate reimbursement codes for specific elements of care. 3 Therefore, providers remain uncertain about which services they can provide and if they can be reimbursed.  Individual practices can make use of the AAP’s Obesity Practice Management Resources that provide information and tools so providers can ensure payment for multidisciplinary obesity care for their patients.

The strategies mentioned above are only a sampling of the many practice-level interventions recommended by the AAP. There are also other interventions related to the 5-2-1-0-BF-BMI areas that are not mentioned in the Policy Opportunities Tool. For instance, several of the teams participating in NICHQ’s Collaborate for Healthy Weight initiative aren’t focusing on payment models in their BMI-related interventions, but rather on aiming to consistently assess BMI, help patients understand it, and incorporate it as part of obesity prevention efforts for both children and adults.   

Practices can, and should, think creatively when it comes to creating an office environment that supports healthy eating and active living for their patients. While the interventions recommended in the AAP Policy Opportunities Tool are by no means exhaustive, they are a great place to start thinking about ways you can transform your practice into a part of your obesity prevention strategy!


  1. Thorndike, AN et al. American Journal of Public Health. 2012 Mar;102(3):527-33. Epub 2012 Jan 19. Erratum in: Am J Public Health. 2012 Apr;102(4):584.
  2. AAP Committee on Public Education. “Children, Adolescents, and Television.” Pediatrics Vol. 107 No. 2. 02/2001. pp. 423 -426.
  3. Robert Wood Johnson Foundation. “Study of State Medicaid Resources for Childhood Obesity Prevention.” 2005/2006.

General Childhood Obesity 


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