1. Discussion Background Fitwits MD: An intervention to prevent childhood obesity Diane J. Abatemarco, PhD, MSW, School of Population Health, Thomas Jefferson University, Philadelphia, PA, Ann McGaffey, MD, University of Pittsburgh School of Medicine, Medical Director, UPMC St. Margaret Bloomfield Garfield Family Health Center, Ilene Katz Jewell, MSHyg, Center for Health Promotion Research, Case Western Reserve University, Cleveland, OH, Susan K. Fidler, MD, Ambler Medical Associates, Ambler, PA, Kristin Hughes, MFA, Carnegie Mellon University School of Design, Pittsburgh, PA Background Materials & Methods Results PAST 3 decades, national prevalence of overweight has tripled for children and adolescents. Prevalence of overweight is: 15.5% among 12- 19-year-olds 15.3% among 6- 11-year-olds 10.4% among 2- 5-year-olds Prevalence of overweight among non-Hispanic black & Mexican-American adolescents increased more than 10% between 1988-1994 & 1999-2000. The purpose of this presentation is to describe a comprehensive evaluation undertaken to study the feasibility of Fitwits MD, an intervention designed to assist primary care physicians to increase health fluency and affect wellness choices of children and their families. Childhood obesity is a growing epidemic but there are few if any successful interventions to alter the course of childhood obesity. The intervention was created through the use of participatory design. References Developed using Participatory Design methods. Implemented in 3 family health centers in western PA in family medicine residency program; in urban, lower SES areas. Evaluation - determine feasibility of intervention Pre/post assessments w/physicians & families. Quantitative & qualitative methods to study process & impact of Fitwits MD w/families of 9 to 12 year old patients. Theoretical foundation - Complex Adaptive Systems - understanding the practice culture Physician leadership - Active participation Office Champions Continuous evaluation feedback Mid-course corrections Fitwits Tools Response Rate: 33 (all 3 rd yr residents & physicians) <40% of physicians used Fitwits MD for < 50% of visits. Findings: < 95% who used Fitwits MD reported ↑ comfort & competency 75% who used Fitwits MD reported ↓ barriers identified at baseline ↑ time discussing obesity prevention from average of 3.6 to 7 mins. Qualitative Findings: Tool provided easy way to address obesity & decrease perceived parent barriers noted at baseline data. Physicians became more empathic to families re: came to understand financial problems parents face to providing healthier food. The intervention ↓ barriers identified by physicians in discussions about obesity prevention w/families. Physicians reported ↑ comfort & competence in discussions of obesity prevention w/patients & families after Fitwits MD. Implications Fitwits MD is a relatively simple intervention that changed and increased discussions between physicians, children & families. Fitwits MD appears to have affected behavior change to increase nutrition and exercise in low socioeconomic communities. Objectives Children’s Card Games and Facts Physician Tools. Physicians Parents Strong leadership support effected project success Implementation of intervention is more successful with enhanced environmental support (e.g. having staff play a greater role, using chart data to determine outcomes) Office champions were key to project success The evaluation found the intervention was feasible and changed physician and parent behavior Next steps – test health outcomes (i.e. BMI) Response Rate: 93 families recruited to the study Families reported ↑ healthy eating choices & exercise related to Fitwits MD. Findings: 96% recalled office visit Fitwits discussion 93% reporting talking about Fitwits at home after office visit (i.e. healthy eating/healthy choices, portion control) 80% reported child played Fitwits games at home 73% said games helped ↑ discussions at home (i.e., obesity prevention, nutrition, exercise & portions) 24% reported having used Fitwits recipes 57% noted that a family member ↑ physical activity since Fitwits office visit 50% noted change in types of foods prepared at home 53% ↓ in fast food meals served at home 57% ↓ in sugar beverages served at home 1. O’Brien SH, Holubkov R, Reis EC. Identification, evaluation, and management of obesity in an academic primary care center. Pediatrics. 2004;114(2):e154-e159. http://pediatrics.aappublications.org/cgi/reprint/114/2/e154. http://pediatrics.aappublications.org/cgi/reprint/114/2/e154 2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA. 2010;303:242-249. 3. US Department of Health and Human Services. The Surgeon General’s vision for a healthy and fit nation.Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General, January 2010. http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf. Accessed February 11, 2010. http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf. Accessed February 11 4. Abatemarco DJ, Kairys SW, Gubernick RS, Kairys JA. Expanding the pediatrician’s black bag: a psychosocial care improvement model to address the new morbidities. Jt Comm J Qual Patient Saf. 2008;34(2):106-115.