Pediatricians learn to fight fat at front lines

Cook talks with pediatric ambulatory technologist Beth Scanlan.

With an obesity epidemic sweeping the globe, Rochester’s certainly not been left behind – 30 percent of Monroe County kids over age 2 are either overweight or obese, a figure that’s comparable to national averages.

“This isn’t caused by one single factor, but a thousand tiny issues that feed into the problem,” said Stephen Cook, M.D., M.P.H., an assistant professor of Pediatrics at URMC’s Golisano Children’s Hospital, who mapped the county’s childhood obesity rates by zip code this past winter. “Kids say that school lunches are gross, so they fill up on chips and candies. Busy families have less time to sit down to nutritious, home-cooked meals. Parents feel uncomfortable letting their kids run around the neighborhoods till dusk, and instead, kids resort to watching TV, surfing the net, and texting constantly. Plus, our society has increased portion sizes and cheap, fast food outlets are open all hours."

While Rochester may be saddled with extra pounds like the rest of nation, what’s less typical is the community’s sense of shared responsibility when it comes to kids’ health – a practice called “community pediatrics.” Area daycare experts, health policy pundits, school boards, pediatricians (including Cook), even food suppliers all have pulled together for the Greater Rochester Health Foundation’s five-pronged Strategic Plan for the Prevention of Overweight and Obesity. Jointly, they’re aiming to dramatically scale back the county’s childhood obesity rates over the next decade.

Some task force members are focusing on policy change; others are incorporating developmentally appropriate teaching tools, like nutrition-themed puppet shows, into daycares. Still others are overhauling school lunches.

“My project is focusing on another front – the pediatrician’s office,” Cook said.

He estimates that, by working with the 20 largest local practices to step up obesity surveillance and prevention efforts, the project will reach two-thirds of the kids in Rochester. “That’d be a sort of tipping point, and chance to do some really good interventions with families, one-on-one,” he said.

But doctors are already burdened with constantly changing best-practice guidelines and busy schedules. It can be overwhelming for them to adopt new approaches to keeping kids on a healthy weight trajectory – techniques such as “motivational interviewing” to more effectively broach issues of weight, nutrition and physical activity, using the correct BMI growth curves (a clinical measure by which healthy weights are assessed), and even administering simple lifestyle surveys during well-child visits.

“The last thing we want to do is demand that pediatricians simply tack more items onto their checklists,” Cook said.

Via one-year “learning collaboratives,” Cook and Health Foundation collaborators are offering individual practices the chance to seriously rethink their roles in stemming the obesity tide. Core teams (composed of a physician, nurse, office staff member, and even a patient’s parent) at each participating practice attend quarterly training workshops and monthly conference calls. They also gain access to a tool-kit of helpful resources, like BMI measurement tools for quick, in-office computing and sample “scripts” for counseling overweight patients. Perhaps most importantly, though, is the built-in networking support: these teams can swap clever ideas of what works and what doesn’t with other learning collaborative peers.

“One practice held a canal-side run with their patients,” Cook said. “Another shared a trick – setting the office’s electronic medical record to remind him to update parents on their kid’s ‘weight status.’ Others advised that discussions about a child’s unhealthy weight were more effective when the talk revolved around adopting healthier lifestyle habits, not dropping a certain number of pounds.”

And that’s the goal, Cook said – shared learning.

“We’re figuring out what works. At the end of the year, these learning collaborative participants emerge as the experts; they’re veterans who have found practical ways to incorporate new clinical guidelines,” he said. “They, in turn, will talk to next year’s round of newcomers – allowing us to rely less on outside consultants, because more or less, we’ve grown our own.”

Last year, nine practices completed their cycle in the learning collaborative. This year, eight more will.

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