Healthy Weight Management in a Health Care Home: A

Feasibility Study

Katharine Wickel, MS, LAMFTJerica M. Berge, PhD, MPH, LMFT, CFLE

Dianne Neumark-Stzainer, PhD, MPH

Objectives

1. Understand the progression from focus group to intervention within a primary care Health Care Home.

2. Understand how Health Care Homes can be utilized in additional ways to treat adolescent female obesity.

3. Learn innovative ways to treat obesity for racial/ethnically and socio-economically diverse families.

Adolescent Obesity• Obesity among children has doubled in the

past two decades (Ogden, Carroll, Curtin, Lamb, & Flegal, 2010)

– Increased risk of hypertension, cardiovascular disease, metabolic syndrome, type 2 diabetes, and psychosocial problems

• Adolescents from low-income families and who belong to racial/ethnic minorities are disproportionately at higher risk (Singh, Kogan, Van Dyck, & Siahpush, 2008)

Adolescent Obesity

• Significant associations between weight gain and dieting, dissatisfaction with body image, and teasing about weight and familial encouragement to diet (Field et al., 2003; Haines, Neumark-Sztainer, Wall, & Story, 2007; Neumark-Sztainer et al., 2006; Neumark-Sztainer et al., 2007)

• Innovative approaches are needed to address such a complex problem

Focus Groups

• Triadic-level feedback– Parents (n = 11)– Pre-adolescent girls (n = 9)– Adolescent Girls (n = 21)– Clinic Staff at Health Care Home primary care

clinic (n = 14)• Community-based participatory approach

– Based on community and clinic needs

Focus Groups

• Goals/Questions to be Answered:– Would the intervention fit into a busy, outpatient

primary care clinic?– Would the adolescents and their parents be

satisfied with the intervention?– Feedback from participants regarding their

current dietary and physical activity patterns and their knowledge/understanding regarding body image

Methodology

• Adolescent girls (and parents) recruitment– Primary care clinic in a low-income and

racially/ethnically diverse neighborhood• Electronic Medical Records• Primary care providers (Behavioral health, medical

residents, and 3rd year medical student)

– Eligibility• Age, Weight Status, Gender, English

speaking/reading)

UMatter (i.e. YOU Matter!)

• Intervention for girls ages 10-14– One of her parents also attends

• 7 Educational sessions– First and last are measurement sessions– Parents come to 5 of the sessions (including

measurement sessions)– Every session includes healthy snack/meal and

physical activity

UMatter Sessions

• Daughter Sessions– Healthy Eating– Body Image– Family Meals– Physical Activity– Weight Talk and

Teasing

• Parent Sessions– Modeling– Family Meals– Communication

UMatter

• Home Visits– Goal setting with parent-daughter dyad– Motivational interviewing

• Social Media Component– Google+

• Incentives

Participants

• Spring 2013 (n = 7)*• Fall 2013 (n = 14)*

– Currently on-going

*Indicates number of mother-daughter dyads.

Initial Findings

• Typical Goals– Daughters

• Work on flexibility• Take family walks• Eat healthier and cook meals together• Learn new exercises

– Parents• Play ball with daughter• Go for more walks• Have meals together as a family

Initial Findings• Successes

– Daughters• Trying yoga• Jump roping• Family talks more• Family discussions about healthy eating

– Parents• Maintain good, healthy attitude • Eating healthier meals• Walking as a family

Feedback – Parents

• Best part of the program?– “Getting to share stories with the other parents…

setting goals and actually doing them, and I learned a lot from coming to the class about how to approach questions, or, I would say, basically how I could have discussions with [my daughter] about weight. That was one of the most important things I learned.”

– “Spending time with my daughter and learning new ways to communicate.”

Feedback – Parents

• What did you learn?– “How to approach conversations with [my

daughter] about her weight or my weight. Or over all, even other people’s weight…I try not to think negative now when I see over weight people.”

Feedback – Daughters

• What was your favorite lesson?– “Working on body image. [We] talked about what

it means to stay healthy and what our body would be like.”

• What did you think about having your mom being involved?– “It felt less [scary], so we wouldn’t be here by

ourselves. I wasn’t as shy. Usually my first time doing something I’m more shy.”

Feedback – Daughters

• What did you learn?– “Be more active. To eat a lot more healthy foods.

To stretch a lot.”– “Learned how we could eat healthy.”

• Would you do the program again?– “Yeah, I loved it!”

Final Thoughts

• Results from the pilot study will inform the development of an NIH R01 application for a full Randomized Controlled Trial (RCT).