FANtastic Kids: A community health center based intervention to address pediatric overweight Julie L. Vanier, MA Nutrition and Fitness for Life Program, Department of Pediatrics, Boston Medical Center

Abstract Currently, an epidemic of overweight and its negative health consequences are affecting American youth with a disproportionate impact on youth of color. At Boston Medical Center, which predominantly serves low income communities of color, 45 % of pediatric patients are above a healthy weight. Effective community-based responses to overweight must build upon strengths of affected communities. The FANtastic Kids (Fitness and Nutrition) model engages teen leaders as educators in four community health centers to implement a nutrition and physical activity intervention for pediatric overweight in their own community. FANtastic Kids supports and trains peer leaders in implementing a 10-week intervention using a participatory learning approach. The intervention is targeted at children ages 8-11 who are at risk for overweight or overweight (BMI=>85%tile). This model involves primary care providers, nutritionists and health center staff collaborating to support program participants and their families in reaching and maintaining healthy weights. The program goals are: To support youth in developing healthy lifestyles by incorporating healthy eating and increased physical activity into their daily routines, empower families to make healthier choices through experiential learning, to develop the leadership capacity of local teens to promote healthier lifestyles, and to strengthen the capacity of communities to support increased physical activity opportunities and improved nutrition. We will describe the FANtastic Kids intervention, highlighting successes, challenges and best practices. Preliminary results from this community health center based intervention will be discussed. FANtastic Kids is an innovative approach to community-based pediatric overweight intervention.

Project Goal and Objectives Goal:  To provide an effective, youth and family focused, culturally relevant and sustainable community health center-based intervention that supports nutrition and physical activity lifestyle changes for overweight youth. Objectives:  Implement FANtastic Kids at Boston HealthNet Health Centers for 240 physician referred overweight and at risk for overweight youth annually.  Train, orient, and develop at least 16 teen Peer Leaders annually.  Provide 15 opportunities for family participation at each site annually.  Strengthen the capacity of five community health centers to support healthier choices by working in partnership with health center staff, local food vendors, and recreational facilities.

Program Description  The FANtastic Kids (Fitness and Nutrition) Program is a clinical intervention for year old boys and girls who are overweight or at risk for overweight (BMI=>85%tile).  The FANtastic Kids model engages teen Peer Leaders to implement a 10-week nutrition and physical activity curriculum for health center patients.  Program topics include: hunger versus appetite, media and food label literacy, active alternatives to sedentary behavior, and healthy snack selection.

Program Components The 10 week clinical intervention includes:  Nutrition Education 2 hours/week  Physical Activity 2 hours/week  Youth Development and Mentoring 1 orientation and 3 youth development sessions  Family Involvement and Recreational Field Trips Meet and greet with program staff, family dinner, 2 parent-only education sessions, program graduation and a recreational field trip.  Community Health Center Support Trainings for Site Coordinators, Peer Leaders, Fitness Coordinators, Nutritionists, and Volunteers.

Monitoring and Evaluation Process Measurements:  Attendance and retention for participants and peer leaders  Program readiness  Program implementation Outcome Measurements:  Pre and post anthropometric measurements  Pre and post Knowledge, Attitude and Behavior (KAB) change

Successes and Challenges Successes:  Implemented 11 intervention sessions at four community health center sites.  143 health center pediatric patients attended > 50% of the program days.  Oriented and trained 30 teen Peer Leaders.  Peer Leader attendance rate of 97%.  A total of 350 parents attended family events.  Collaborated with five local restaurants for creating healthier menu choices. Challenges:  Small number of physician referrals.  High staff turnover at community health centers.  Difficulty in securing community based facilities for physical activity component.  Transportation and language differences were barriers for patient participation.

Preliminary Results Summer Summer 2006 Process:  Average daily attendance for participants was 66%.  Average daily attendance for Peer Leaders was 97%. Outcome:  Achieved desirable (negative) average changes in BMI for age-gender adjusted % iles in 6/7 programs for girls and 5/7 programs for boys.  Significant difference in KAB scores for girls and Peer Leaders (p<.05)

Average Changes in Age and Gender Adjusted BMI for Participants, Fall 2005-Summer 2006 SiteOverallGirls with Decreases Girls with Increases OverallBoys with Decreases Boys with Increases DotWell-0.4 (n=21) -1.1 (n=12) 0.6 (n=9) -0.4 (n=26) (n=16) 0.5 (n=10) MCHC-0.2 (n=11) -0.6 (n=7) 0.3 (n=4) 0.2 (n=4) NA SBCHC0.3 (n=5) NA -0.6 (n=9) (n=6) NA Total-0.2 (n=37) -0.8 (n=21) 0.6 (n=16) -0.4 (n=38) (n=23) 0.5 (n=15) NA=less than four cases and were not averaged separately. DotWell=3 sessions, MCHC=2 sessions, and SBCHC=2 sessions

Results of Knowledge, Attitude and Behavior Survey (KAB), Spring-Summer 2006 * Significant at the p <.05 level GroupPre-test Mean % Correct Post-test Mean % Correct P-value Girls71% (n=12) 85% (n=11) 0.03* Boys74% (n=16) 79% (n=7) 0.34 Peer Leaders85% (n=8) 94 % (n=9) 0.01* Total75% (n=36) 84% (n=27) <0.01*

Preliminary Lessons Learned  Pediatric overweight interventions at the community health center level seem to hold potential for: Addressing low attendance and retention rates usually seen in hospital settings Increasing family involvement  Engaging teen age Peer Leaders to facilitate a nutrition and physical activity based intervention: Is an effective way to engage younger patient participants Provides mentoring and leadership development for teen community leaders  The most significant barriers to program success were: Patient recruitment Transportation

FANtastic Kids Participants

FANtastic Kids Peer Leaders in Action

Boston Medical Center’s Department of Pediatrics Team and Community Health Center Sites  Vivien Morris, MS, RD, MPH, LDN, Principle Investigator  Julie Vanier, MA, Program Coordinator  Tara Agrawal, Youth Development Specialist  John Cook, PhD., Project Evaluator  Dorchester House Multi- Service Center and Codman Square Health Center (Dot Well)  Mattapan Community Health Center  Whittier Street Health Center (Roxbury)  South Boston Community Health Center Generous support provided by: Rutland Corner Foundation