Pediatricians and family practitioners in Maine collaborated to prevent childhood obesity by improving primary care. The Maine Youth Overweight Collaborative (MYOC) is a joint project of the Maine-Harvard Prevention Research Center and the Maine Chapter of the American Academy of Pediatrics. Researchers created teams comprising doctors, nurse practitioners, nurses, and medical assistants in primary care practices. These teams were trained to use body mass index (BMI) percentiles to document patients’ risk for overweight, to make treatment decisions, and to motivate parents to help their children change unhealthy behaviors related to weight. Physicians were trained to counsel parents in the MYOC’s 5-2-1-0 Program, which uses numbers to identify behavioral goals. The program helps parents guide their children’s nutrition and physical activity (PA) by encouraging five (5) or more servings of fruits and vegetables on most days; limiting television, video game, or computer use (screen time) to two (2) hours or less a day; participating in at least one (1) hour or more of PA a day; and avoiding sugar-sweetened beverages (0).
Researchers evaluated the effect of this intervention in urban and rural areas of Maine. Project teams conducted the intervention at 12 sites and implemented it on a delayed schedule (18 months later) at 10 control sites. Results from chart audits and surveys found that by the end of the intervention, BMI monitoring had increased from 25% to 89% and use of the 5-2-1-0 tool had increased from 0% to 82%. Providers reported improvements in knowledge, self-efficacy, and counseling on 5-2-1-0 targets as well as in use of goal-setting and brief motivational counseling with parents. Parents at first-round intervention sites reported higher rates of providers counseling them on 5-2-1-0 goals at last check-up, compared with parents at control sites. In both the early and late intervention groups, BMI measurements declined significantly among all clients who were not underweight at the start of the intervention.
Overall, 31 primary care sites serving one-third of Maine’s child population have been trained in 5-2-1-0 counseling and receive technical support from MYOC. Approximately 25 states have adopted the 5-2-1-0 message. Researchers have published one article and are continuing to analyze data with plans to disseminate further results.
Polacsek M, Orr J, Letourneau L, et al. Impact of a primary care intervention on physician practice and patient and family behavior: Keep ME Healthy – The Maine Youth Overweight Collaborative. Pediatrics 2009;123:S258-66.