Childhood obesity is a growing problem across the US, particularly in rural areas. Rural children are disproportionately affected by obesity due at least in part to limited resources. Ann Davis, MPH, PhD, ABPP, and her team of co-investigators are trying to change that through a remotely delivered, family-based obesity intervention. iAmHealthy is composed of a 25-hour behavioral intervention focused on nutrition, physical activity and behavioral change. Families receive eight weekly group sessions followed by monthly group sessions, in addition to individual family-based health behavior coaching.
Listen as Ann Davis, MPH, PhD, ABPP discusses the iAmHealthy program at Children's Mercy.
Rural Disparities in Pediatric Obesity: The iAmHealthy Intervention
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Learn more about Ann Davis, MPH, PhD, ABPP
Ann Davis, MPH, PhD, ABPP
Ann Davis, MPH, PhD, ABPP, is the Director of the Center for Children’s Healthy Lifestyles & Nutrition and Professor of Pediatrics at University of Kansas Medical Center with an adjunct appointment at the University of Missouri-Kansas City School of Medicine. She specializes in pediatric psychology.Learn more about Ann Davis, MPH, PhD, ABPP
Transcription:
Rural Disparities in Pediatric Obesity: The iAmHealthy Intervention
Dr. Michael Smith (Host): Our topic today is “Rural Disparities in Pediatric Obesity. The I Am Healthy Intervention Program.” My guest is Dr. Ann Davis. She’s the Director of the Center for Children’s Healthy Lifestyles and Nutrition at Children’s Mercy, and she’s also a professor of pediatrics at the University of Kansas Medical Center. Dr. Davis, welcome to the show.
Dr. Ann Davis (Guest): Thank you, I’m delighted to be here.
Dr. Smith: First off, let’s talk a little bit about why we see this difference in pediatric obesity in rural versus urban communities. Why is that?
Dr. Davis: Well, that’s an interesting phenomenon, and when I moved – I grew up in Kansas City, and when I moved back, I had this assumption that children from rural areas of our states were going to be healthier, that they lived on the farm, they were participating in food production, and outside a lot. It actually turns out that’s not the case. We did a series of studies that showed that rates of obesity are actually higher among rural children for a variety of health behaviors that are related to nutrition and physical activity. They’re more likely to be on a sports team, children in rural areas, but they engage in lower rates of physical activity. They eat higher numbers of fruits and vegetables, but they also eat higher portions of what we call red foods, which are our unhealthy foods. When you break it down, it’s due to specific health behaviors. It’s true across the United States that children from rural areas generally have higher rates of overweight and obesity than children from urban areas.
Dr. Smith: And so the I Am Health Program is really geared towards the rural pediatric obesity problem, so tell us a little bit about what I Am Healthy is?
Dr. Davis: Sure, happy to do that. We need to get pediatric obesity to these children from rural areas who are underserved, but pediatric obesity treatment programs that are successful have a high number of treatment hours. If we were to deliver these interventions in person, these kids and their families would have to drive back and forth all the time to our academic medical centers or children’s hospitals where we’re able to deliver these types of interventions. What I Am Healthy is, is a way to deliver that type of multidisciplinary evidence-based intervention over an iPad.
Dr. Smith: Nice.
Dr. Davis: The children and families can actually stay at their home. We give them the electronic equipment and then they can communicate with us in a series of group programs and individual family-based programs in order to deliver that treatment right to their home.
Dr. Smith: When the child is there with their family, and they’ve got the iPad open, what exactly are they doing there? Is it games that teach them about proper nutrition? What really is the program itself?
Dr. Davis: Sure, so research has taught us that empirically based pediatric obesity programs need to have certain things. They need to focus on nutrition, physical activity, and behavior modification. Research suggests that group-based programs are more effective than individual-based programs. I Am Healthy is composed of a series of meetings that take place over the iPad, so the families are meeting together in a group of eight to ten families for series of weekly meetings followed by a series of monthly meetings. What they see when they open up the iPad is what looks like the old-fashioned Brady Bunch screen with a bunch of tiles on it. [LAUGHTER] Each one of those tiles will be a child and a parent together.
Dr. Smith: Oh, how nice. Obviously, it’s an iPad, so the kids probably have no problem with this, but how are the parents taking on this technology? Are they as engaged as the kids? What do you think?
Dr. Davis: Yeah, we had some concerns about that, too, especially the rural areas we weren’t sure how good the coverage would be, but we provide them all with the wireless coverage as well, and we have a great technology team here that’s very used to handling any issues that come up. We’re well-prepared for that, and so far, everyone is very excited about the technology. They get to use the iPads for other things like healthy apps and other activities that we have on the iPad for them all related to improving their nutrition and physical activity.
Dr. Smith: Speaking of the physical activity part of this, so when they’re on the iPad, and they’re in their group, what is the physical activity deal? Do they talk about what they’ve done in the past week to stay active, or how does that work?
Dr. Davis: Yeah, so we monitor their physical activity, and then we give them feedback on that. That’s part of the I Am Healthy program. We give them an hour-by-hour display that shows whether they’ve been engaged in sedentary, light, moderate, vigorous or very vigorous physical activity and we use that to teach the children and parents about – for example, that soccer practice might night actually be a great outlet for physical activity because they’re spending some time learning, for example.
Dr. Smith: Right, okay.
Dr. Davis: So a better opportunity for physical activity might be to go for a walk after dinner with the family, or to engage in a soccer game with the family where they’re all going out and kicking the ball around together. It’s unique for each family, but in general, we’re trying to get them to decrease their screen time and increase their activity levels.
Dr. Smith: On the nutrition side of this, is it teaching them proper portion size, calories, eating the rainbow? What approach is used there?
Dr. Davis: With children, the most commonly used approach is called the Stoplight Diet. If you Google around, you’ll see something called, “Slow, Go, and Woah,” or different versions of the Stoplight Diet. The original Stoplight Diet was invented by Dr. Len Epstein and his team, and so we follow that plan. It’s not so much a diet as it is just a way of categorizing foods. Green foods are “Go” foods. You eat as much of those as you want, as often as you want. Yellow foods are caution foods – think of that blinking yellow traffic light, so you have to watch the number of servings per day and portion size. And then red foods are foods that we probably should not be eating, but that we all love [LAUGHTER]. Those are your typical junk foods. There’s only one thing the kids have to remember, and that’s the dividing line between red and yellow, and that’s 12 grams of sugar and 7 grams of fat. If it has either 12 or 7, then it’s a red food. We teach them that and then we focus on cutting down the number of red foods per day. That’s our primary nutrition aim because research has shown that that’s going to have the most bang for the buck.
Dr. Smith: So that covers the nutrition part of this program, the physical activity part, what about the behavioral aspect of this? What techniques are used there to help the behavioral changes that are often necessary?
Dr. Davis: We all know that we should be living healthier – I even know that myself. It’s much different to think about doing it. The behavioral part is the magic of how do we get ourselves to do what we know we should be doing? We use techniques like goal-setting. Parents can use praise and reinforcement, and we can talk about ways to rearrange the environment – getting certain foods out of the house, changing the way screens are used at home – rearranging that environment to make it more likely that people will be successful in meeting their goals. We involve the kids and the parents in that part, so the kids are helping the parents to improve their health behaviors too.
Dr. Smith: Are you targeting kids that are already obese and you’re trying to get them to make these changes to lose the weight, or is it open to just about anybody where you’re also educating kids for prevention?
Dr. Davis: All of the techniques we’ve been talking about would be good for all kids, but the specific I Am Healthy funding that we received from the National Institutes of Health is for targeting children who are overweight or obese. We are also specifically targeting second through fourth graders, so we’re targeting younger kids, and kids who are already overweight.
Dr. Smith: Yeah, that seems young.
Dr. Davis: It does seem young to a lot of people, but we really want to nip this problem in the bud, so to speak. Research has shown that treatment of obesity with adolescents is extremely difficult and so if we can treat these children before they get to that age, that’s important. Plus, research has shown that the longer a child is overweight or obese, it almost taxes the body to such an extent that even if they lose that weight later, they still have an increased risk of heart disease and the other issues that can come from being overweight or obese.
Dr. Smith: Are the local schools getting involved with this?
Dr. Davis: That’s a good question. I Am Healthy is – we really rely on our schools. We recruit the rural elementary schools, and they help us to recruit the children who are overweight or obese. As part of the I Am Healthy program, we are training school staff in rural areas, and they will be able to continue to deliver the intervention to their students if they choose to do so, even after the grant ends. That’s our hope with sustainability.
Dr. Smith: Yeah. When you tell me about this, Dr. Davis, and you describe the I Am Healthy program --obviously, this has application for so many other issues, disorders, what have you, just by bringing people together and learning together. What a fascinating program that you have going, and thank you for the work that you’re doing on this and at Children’s Mercy. Thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy, Kansas City. For more information, you can go to ChildrensMercy.org, that’s ChildrensMercy.org. I’m Dr. Mike Smith. Thanks for listening.
Rural Disparities in Pediatric Obesity: The iAmHealthy Intervention
Dr. Michael Smith (Host): Our topic today is “Rural Disparities in Pediatric Obesity. The I Am Healthy Intervention Program.” My guest is Dr. Ann Davis. She’s the Director of the Center for Children’s Healthy Lifestyles and Nutrition at Children’s Mercy, and she’s also a professor of pediatrics at the University of Kansas Medical Center. Dr. Davis, welcome to the show.
Dr. Ann Davis (Guest): Thank you, I’m delighted to be here.
Dr. Smith: First off, let’s talk a little bit about why we see this difference in pediatric obesity in rural versus urban communities. Why is that?
Dr. Davis: Well, that’s an interesting phenomenon, and when I moved – I grew up in Kansas City, and when I moved back, I had this assumption that children from rural areas of our states were going to be healthier, that they lived on the farm, they were participating in food production, and outside a lot. It actually turns out that’s not the case. We did a series of studies that showed that rates of obesity are actually higher among rural children for a variety of health behaviors that are related to nutrition and physical activity. They’re more likely to be on a sports team, children in rural areas, but they engage in lower rates of physical activity. They eat higher numbers of fruits and vegetables, but they also eat higher portions of what we call red foods, which are our unhealthy foods. When you break it down, it’s due to specific health behaviors. It’s true across the United States that children from rural areas generally have higher rates of overweight and obesity than children from urban areas.
Dr. Smith: And so the I Am Health Program is really geared towards the rural pediatric obesity problem, so tell us a little bit about what I Am Healthy is?
Dr. Davis: Sure, happy to do that. We need to get pediatric obesity to these children from rural areas who are underserved, but pediatric obesity treatment programs that are successful have a high number of treatment hours. If we were to deliver these interventions in person, these kids and their families would have to drive back and forth all the time to our academic medical centers or children’s hospitals where we’re able to deliver these types of interventions. What I Am Healthy is, is a way to deliver that type of multidisciplinary evidence-based intervention over an iPad.
Dr. Smith: Nice.
Dr. Davis: The children and families can actually stay at their home. We give them the electronic equipment and then they can communicate with us in a series of group programs and individual family-based programs in order to deliver that treatment right to their home.
Dr. Smith: When the child is there with their family, and they’ve got the iPad open, what exactly are they doing there? Is it games that teach them about proper nutrition? What really is the program itself?
Dr. Davis: Sure, so research has taught us that empirically based pediatric obesity programs need to have certain things. They need to focus on nutrition, physical activity, and behavior modification. Research suggests that group-based programs are more effective than individual-based programs. I Am Healthy is composed of a series of meetings that take place over the iPad, so the families are meeting together in a group of eight to ten families for series of weekly meetings followed by a series of monthly meetings. What they see when they open up the iPad is what looks like the old-fashioned Brady Bunch screen with a bunch of tiles on it. [LAUGHTER] Each one of those tiles will be a child and a parent together.
Dr. Smith: Oh, how nice. Obviously, it’s an iPad, so the kids probably have no problem with this, but how are the parents taking on this technology? Are they as engaged as the kids? What do you think?
Dr. Davis: Yeah, we had some concerns about that, too, especially the rural areas we weren’t sure how good the coverage would be, but we provide them all with the wireless coverage as well, and we have a great technology team here that’s very used to handling any issues that come up. We’re well-prepared for that, and so far, everyone is very excited about the technology. They get to use the iPads for other things like healthy apps and other activities that we have on the iPad for them all related to improving their nutrition and physical activity.
Dr. Smith: Speaking of the physical activity part of this, so when they’re on the iPad, and they’re in their group, what is the physical activity deal? Do they talk about what they’ve done in the past week to stay active, or how does that work?
Dr. Davis: Yeah, so we monitor their physical activity, and then we give them feedback on that. That’s part of the I Am Healthy program. We give them an hour-by-hour display that shows whether they’ve been engaged in sedentary, light, moderate, vigorous or very vigorous physical activity and we use that to teach the children and parents about – for example, that soccer practice might night actually be a great outlet for physical activity because they’re spending some time learning, for example.
Dr. Smith: Right, okay.
Dr. Davis: So a better opportunity for physical activity might be to go for a walk after dinner with the family, or to engage in a soccer game with the family where they’re all going out and kicking the ball around together. It’s unique for each family, but in general, we’re trying to get them to decrease their screen time and increase their activity levels.
Dr. Smith: On the nutrition side of this, is it teaching them proper portion size, calories, eating the rainbow? What approach is used there?
Dr. Davis: With children, the most commonly used approach is called the Stoplight Diet. If you Google around, you’ll see something called, “Slow, Go, and Woah,” or different versions of the Stoplight Diet. The original Stoplight Diet was invented by Dr. Len Epstein and his team, and so we follow that plan. It’s not so much a diet as it is just a way of categorizing foods. Green foods are “Go” foods. You eat as much of those as you want, as often as you want. Yellow foods are caution foods – think of that blinking yellow traffic light, so you have to watch the number of servings per day and portion size. And then red foods are foods that we probably should not be eating, but that we all love [LAUGHTER]. Those are your typical junk foods. There’s only one thing the kids have to remember, and that’s the dividing line between red and yellow, and that’s 12 grams of sugar and 7 grams of fat. If it has either 12 or 7, then it’s a red food. We teach them that and then we focus on cutting down the number of red foods per day. That’s our primary nutrition aim because research has shown that that’s going to have the most bang for the buck.
Dr. Smith: So that covers the nutrition part of this program, the physical activity part, what about the behavioral aspect of this? What techniques are used there to help the behavioral changes that are often necessary?
Dr. Davis: We all know that we should be living healthier – I even know that myself. It’s much different to think about doing it. The behavioral part is the magic of how do we get ourselves to do what we know we should be doing? We use techniques like goal-setting. Parents can use praise and reinforcement, and we can talk about ways to rearrange the environment – getting certain foods out of the house, changing the way screens are used at home – rearranging that environment to make it more likely that people will be successful in meeting their goals. We involve the kids and the parents in that part, so the kids are helping the parents to improve their health behaviors too.
Dr. Smith: Are you targeting kids that are already obese and you’re trying to get them to make these changes to lose the weight, or is it open to just about anybody where you’re also educating kids for prevention?
Dr. Davis: All of the techniques we’ve been talking about would be good for all kids, but the specific I Am Healthy funding that we received from the National Institutes of Health is for targeting children who are overweight or obese. We are also specifically targeting second through fourth graders, so we’re targeting younger kids, and kids who are already overweight.
Dr. Smith: Yeah, that seems young.
Dr. Davis: It does seem young to a lot of people, but we really want to nip this problem in the bud, so to speak. Research has shown that treatment of obesity with adolescents is extremely difficult and so if we can treat these children before they get to that age, that’s important. Plus, research has shown that the longer a child is overweight or obese, it almost taxes the body to such an extent that even if they lose that weight later, they still have an increased risk of heart disease and the other issues that can come from being overweight or obese.
Dr. Smith: Are the local schools getting involved with this?
Dr. Davis: That’s a good question. I Am Healthy is – we really rely on our schools. We recruit the rural elementary schools, and they help us to recruit the children who are overweight or obese. As part of the I Am Healthy program, we are training school staff in rural areas, and they will be able to continue to deliver the intervention to their students if they choose to do so, even after the grant ends. That’s our hope with sustainability.
Dr. Smith: Yeah. When you tell me about this, Dr. Davis, and you describe the I Am Healthy program --obviously, this has application for so many other issues, disorders, what have you, just by bringing people together and learning together. What a fascinating program that you have going, and thank you for the work that you’re doing on this and at Children’s Mercy. Thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy, Kansas City. For more information, you can go to ChildrensMercy.org, that’s ChildrensMercy.org. I’m Dr. Mike Smith. Thanks for listening.