A comprehensive program to reduce or prevent childhood obesity in low–income communities led to significant improvements in obesity–related measures among children cared for at a Massachusetts community health center. The report of a study led by a MassGeneral Hospital for Children physician is one of three in the July issue of Obesity describing implementation of the Mass. Childhood Obesity Research Demonstration (MA–CORD) at community health centers, in public schools and in WIC (Special Supplemental Nutrition Program for Women, Infants, and Children Program) offices in two Massachusetts cities.

“Community health centers are very well positioned to conduct programs such as MA–CORD,” says Elsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children, who led that study.“Community–based health centers serve the needs of low–income families, who often have higher–than–average prevalence of obesity and chronic diseases, making them good sites for delivering interventions to the populations needing them most. Health centers already work to tackle the social factors that can interfere with families’ making behavior changes, and they have community health workers who can help link families to both clinical and community services.”

Developed through a partnership between the Massachusetts Department of Public Health, the Harvard T.H. Chan School of Public Health, MassGeneral Hospital for Children/Harvard Medical School, the National Initiative for Children’s Health Care Quality and two cities with substantial low–income populations, MA–CORD was designed to reduce levels of overweight and obesity in children ages 2 to 12. The current study was launched in 2012 to test implementing MA–CORD at two community health centers, along with parallel obesity prevention initiatives in all elementary and middle schools and the community–wide WIC programs in each town.

The tested intervention included:

• specialized training for health care providers and other clinic staff on best practices for treating childhood obesity and encouraging heathy changes;
• electronic support tools, including computerized alerts when physicians opened electronic health records of children with overweight or obesity during well–child visits;
• Healthy Weight Clinics, to which children with overweight or obesity and their parents could be referred;
• environmental changes at the health centers designed to encourage healthy behaviors;
• a community health worker dedicated full time to the program.

The community health workers participated in the Healthy Weight Clinics, counseled participating children and their parents, participated in quality improvement projects at the centers, helped children and families connect to resources in the community, and acted as program liaisons to the broader community. Unfortunately, several institutional challenges not directly related to MA–CORD itself reduced the number of children receiving care at one of the centers, preventing full implementation of the MA–CORD intervention at that site.

At the other participating center – the Greater New Bedford Community Health Center (GNBCHC) – 3,765 children had at least two well–child visits at which height and weight measurements were taken during the 20–month study period; 187 of them had an elevated body mass index, were referred to and participated in the Healthy Weight Clinic. Among all children seen at least twice at the center during the study period, BMI z scores – an age– and sex–specific measure used to track weight status changes in children – improved over time, compared to those of children at a third community health center where the intervention had not been implemented.