TAKING IT TO THE COMMUNITY: Translation of a Hospitalbased Pediatric Weight Management Program

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IN AFTER SCHOOL
A Collaboration between Hospital Providers and
Schools to Build Capacity in After School
Programs to Promote a Healthy Lifestyle for
Families
Megan Rose Lipton September 2008 City
MatCH Urban Leadership Conference
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BackgroundKids N Fitness
The Center for Diabetes Endocrinology Metabolism

• Began in 2000 as a weight management program for
  overweight children (ages 8-16 yrs) and their
  parents
• 12 weekly 90 minute sessions
• Focus was to reduce weight velocity by altering
  behaviors that led to weight gain through
• Interactive Nutrition Education
• Physical Activity
• Self Monitoring and Goal Setting

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Kids N Fitness CHLA

• Hospital Based
• Taught by Registered Dietitians and Physical
  Therapists, with certain sessions taught by
  Social Workers, and MDs
• Free to Families
• Family Centered

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Significant Weight Health Benefits
Plt0.005
Plt0.0005
Plt0.01
Plt0.05
Monzavi, R. et al. Pediatrics 2006
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Challenges

• Expensive to teach
• Space limitations
• Long Waiting List
• Low Retention Rate (43)
• Stigma attached to clinical setting
• Difficulty for families to get to class on time
  transportation, travel time, parking

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KIDS N FITNESS? 6-WEEK HEALTHY LIFESTYLE
PROGRAM AFTER SCHOOL PILOT 2006-2007

• Motivation
• Address some of the barriers
• Increase the number of families served
• Find a sustainable way to replicate our program

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Kids N Fitness? After School Pilot Objectives

• Develop a cost effective model to replicate an
  evidence based hospital based program in an after
  school setting
• Determine the effectiveness of a 6 week after
  school, family centered healthy lifestyle program
  on measures of adiposity
• Strengthen local capacity to provide the Kids N
  Fitness Healthy Lifestyle Program

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Kids N Fitness? PilotMethods

• Longitudinal controlled trial with families in 8
  paired elementary schools Measured 4 times in 12
  months
• Pilot program locations
• In Northern CA, San Jose and Vacaville
• In Southern CA, Downtown LA and South LA
• School criteria Ethnically diverse, low-income,
  medically undeserved and in high-risk communities
• Student criteria 3-6th graders with willing
  parent/guardian. NO Weight Requirement.

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The Collaboration
Made possible by a grant from LINC Telacu
Childrens Hospital Los Angeles
Training Oversight Research
Public Elementary Schools
Public Elementary Schools
Public Elementary Schools
Public Schools
Johnson Johnson California Coalition
Staff Students Venue
Volunteers In-Kind sponsorship
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Methods KNF Instructors and Training

• Instructors
• - Elementary teachers
• - After school personnel
• - Two instructors were trained
• from each school by CHLA staff
• - Received stipend for training and prep time
• Training CHLA RDs conducted 6-8 hr training
• Materials Instructor Manual and Bilingual
  Handouts, Toolkit and Weekly Incentives
• Sessions Pilot instructors co-taught two 6-week
  sessions of Kids N Fitness

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Kids N Fitness After School Program Intervention

• Length 6 weekly sessions
• Time 3 hour class (e.g. 300 to 600 pm with
  parents arriving at 400)
• Program components
• Weights and heights obtained (Week 1 and 6)
• Children exercise (60 minutes)
• Family nutrition education (40 minutes)
• Goal Setting Self-Monitoring (5 minutes)
• Parent Session (45 minutes)
• Healthy Dinner (30 minutes)

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Subject Population

• 325 Students
• 161 intervention (77 Male / 84 Female)
• 164 control (71 Male / 93 Female)
• 229 Parents
• Mean child age was 9.88 years (/-1.11)
• Mean parent age was 35.17 (/- 6.49)
• 88.6 Hispanic, 2.7 African American, 4.6
  Caucasian, 3.1 Asian, 1 other
• At baseline, 53 of all youth had BMI percentile
  85 (62 control, 60 intervention)

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RESULTS Mean Change in BMI Z-SCORE over 6 weeks
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Change in mean BMI PercentilesBaseline to
Follow-up(Mean time elapsed 9.1 months /-1.7)
n187 p 0.0237
p0.013
pNS
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Change in Body Fat from Baseline to Follow-up
meantime elapsed 9.1 /-1.7 months
n185
p-0.0075
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Health Behavior Questionnaire BMI ile 85
Eating Behavior
Nutrition Knowledge
n 96 P0.0568
n 97 P 0.0051
n 92 Pgt0.05
Nutrition Self-Efficacy
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Barriers and Advantages to the after school
program

• Barriers
• Getting initial buy-in to do the program from the
  school principals
• Getting parents to participate regularly

• Advantages
• School setting more comfortable for both children
  and parents
• Access to outdoor space, gym, equipment
• After school teachers were bilingual from the
  community

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Lessons Learned

• KNF can be successfully delivered by non health
  professionals in an after school setting with
  positive results on weight and behavior change.
• KNF can be effective in reducing BMI z score and
  Body Fat and the effect persists for at least
  3.36 /- 1.9 months.
•  
• After training and initial start up costs, the
  program can be maintained for anywhere between
  1,500 and 4,500 per 6- week program.
• Model of training school-based instructors and
  engaging local corporate volunteers was
  successful in terms of student outcomes,
  decreasing cost, building capacity for school and
  community health promotion.

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Kids N Fitness Pilot Team

• Co Investigators and Pilot Team
• Francine Kaufman, MD Principal Investigator
• Megan Lipton
• Mary Helen Black
• Sharon Braun
• Katie Klier
• Blanca Sanchez

• CONTACT INFO
• Megan Lipton, MA
• Director, Kids N Fitness
• Center for Diabetes,
• Endocrinology Metabolism
• Childrens Hospital Los Angeles
• 323 361-5423
• Mlipton_at_chla.usc.edu

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