A Childhood Obesity Program in Federally Qualified Community Health Centers

Physicians and practitioners working in health centers may face challenges when trying to trying to encourage healthy lifestyles in an underserved patient population. One of the most challenging diseases to address is obesity. As the prevalence of childhood obesity reaches a new high, efforts must be made to reverse and protect children from this preventable disease. This column will describe how two federally qualified health centers used a modified version of a nationally known obesity prevention program called We Can to implement childhood obesity clinics.

Background

The obesity epidemic in the U.S. is multi-factorial, and children are among the most vulnerable to it. While the 2008 National Health and Nutrition Examination Survey (NHANES) reports that the number of children who are overweight or obese may have peaked, the current statistics are alarming. Rates of obesity among children age 2–19 have tripled since 1980.¹ The National Survey of Children’s Health (NSCH) found that one third of children ages 10–17 are obese (16.4%) or overweight (18.2%).² In Washington, D.C., the percentage of obesity rates for 10–17 year olds is 35.4%, placing it at number nine among all cities in the country.³ The implications of this include a staggering number of children who are at risk for developing serious chronic health conditions, such as diabetes and coronary heart disease.⁴

In underserved primary care settings, there are barriers to achieving healthy weight goals for patients. The parents of children in resource-poor locations face monetary restrictions and environmental challenges that inhibit change. Lack of education and language barriers are also impediments. The State of Education study of the District of Columbia reports that approximately 37% of D.C. residents are functionally illiterate.⁵ For providers, the lack of time, inadequate training, and the paucity of culturally and linguistically sensitive materials for patients are all factors that make achieving healthy lifestyles difficult.

Upper Cardozo Clinic is a comprehensive primary care clinic located in Washington, D.C., and is a part of the Unity Health care system. The patient population is primarily Hispanic and African American, with the remaining patients being of African, European, and Asian descent. Unsurprisingly, in view of the statistics for Washington, D.C., childhood obesity is a problem practitioners at the clinic routinely encounter. At the time of the project described here, there were not any current programs in local community health centers that had childhood obesity programs functioning inside of their clinic. Overweight and obese children were being referred to locations several miles away from their homes in locations vastly different from their current environments. Multiple factors, including time, distance, and unfamiliarity contributed to the historically poor results. Practitioners within the clinic were left to try and address this very complex issue during routine visits, although did not know how to connect patients with programs addressing social deterrents to health care.

To address these barriers, an educational program centered on the notion of a medical home was developed. The medical home model is defined by the Association of American Medical Colleges (AAMC), as a model of care delivery that includes an ongoing relationship between a provider and patient, around-the-clock access to medical consultation, respect for a patient’s cultural and religious beliefs, and a comprehensive approach to care and coordination of care through providers and community services.⁶ The design of the program at the Upper Cardozo Clinic incorporated cultural sensitivity, community resources, and provider involvement and focused on the entire family to obtain coordinated comprehensive care. Emphasis was placed on a holistic and multidimensional approach to family involvement, along with a coordinated and comprehensive care team at the clinic. The intent was to provide a safe, easily-accessible environment for overweight children ages 7–13 and their families to learn healthy eating choices, and promote physical activity under the guidance of primary care providers.

The program was developed as a Quality Improvement project for Upper Cardozo Clinic by a Georgetown University Family Medicine Fellow. The...