Examining the feasibility and characteristics of realistic weight management support for patients: Focus groups with rural, micropolitan, and metropolitan primary care providers.

The purpose of this investigation was to understand perspectives of physicians, nurses, and staff regarding the feasibility of implementing an evidence-based weight management program to support primary care practice. An exploratory aim was to examine differences in responses based on the clinic location. Ten focus groups were conducted with primary care staff from rural, micropolitan, and metropolitan clinics. The Promoting Action on Research in Health Services (PARIHS) framework was used to inform the interview guide. Transcripts were reviewed to identify common themes among PARIHS constructs (evidence, context, and facilitation). Presence of comorbidities (e.g., diabetes, hypertension) were typical prompts for provider-led discussions about patient weight. Metropolitan clinics reported the availability of health coaching, diabetes education, or dietician consultation, but no clinic reported offering a comprehensive weight management program. Participants agreed it is possible to implement a weight management program through primary care, but cited potential facilitation challenges such as costs, clinic resources, and individual patient barriers. More enthusiasm arose for a referral program with patient tracking. Program characteristics such as proven efficacy, individual tailoring, program accessibility, and patient feedback to the providers were desired. Rural focus group participants reported unique barriers (lack of local resources) and facilitators (more flexibility in practice changes) to weight management when compared to metropolitan and micropolitan focus groups. Primary care staff are interested in weight management solutions for their patients and would prefer an evidence-based program to which they could refer patients, receive feedback on patient progress, and sustainably include as part of their regular services.

Understanding the impact of rural weight loss interventions: A systematic review and meta-analysis.

Rural adults have a higher risk of developing obesity than urban adults. Several evidence-based interventions have targeted rural regions, but their impact, defined as reach (number and representativeness of participants) by effectiveness, has not been examined. The purpose of this review was to determine the impact of rural weight loss interventions and the availability of data across dimensions of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. A systematic review was conducted to identify rural weight loss interventions that targeted adults. RE-AIM-related data were abstracted from each article. We performed a meta-analysis to examine effectiveness. Sixty-four articles reported on rural weight loss interventions, describing 50 unique interventions. The median number of participants was 107. Median participation rate differed between values reported by the authors (62%) and values computed using a standard method (32%). Two studies reported on sample representativeness; none reported comparisons made between target and actual delivery settings. Median weight loss per participant was 3.64 kg. Meta-analyses revealed the interventions achieved a significant weight reduction, and longer-duration interventions resulted in greater weight loss. Rural weight loss interventions appear to be effective in supporting clinically meaningful weight loss but reach and cost outcomes are still difficult to determine.

Evaluation of school transportation patterns and the associated impact on BMI in 2 Midwestern communities.

BACKGROUND: The decline in active commuting to and from school in the United States is, in part, due to urban design standards and public policies that promote automobile travel and discourage pedestrian activity. PURPOSE: The current investigation examines active commuting at neighborhood schools and how it is altered by distance to school, student age and its potential impact on Body Mass Index. METHODS: Demographic and transportation datasets were obtained for 5367 elementary students (K-5th grade) and middle school students (6th-8th grade) in 2 Midwestern communities. RESULTS: 4379 (81.6%) students were successfully geocoded and 21.9% actively commute to school at least half of the time meeting the Healthy People 2010 objective 22-14. Of those students who could potentially actively commute to school (0.5 mile for grades K-5 and 1 mile for grades 6-8) 36.6% are passive commuters. No significant negative associations were found between BMI z-score or BMI percentile with accumulation of activity through active commuting (frequency × distance) for elementary (r = -0.04, P = .27) or middle school students (r = .027, P = .56). CONCLUSION: Many elementary students living within 0.3-0.4 miles are being driven to school. Promoting pedestrian-friendly communities and making healthy and sustainable transportation choices should be priorities for community leaders and school administrators.

Evaluation of a policy to integrate physical activity into the school day.

BACKGROUND: Implementing physical activity (PA) within academic curricula increases energy expenditure and enhances academic achievement in elementary students. The purposes of the study were to determine the extent teachers met the 20-minute PA policy, identify how teachers met the policy, and measure the level of intensity of PA provided. METHODS: Four elementary schools (grades K-5; 68 classroom teachers) implemented a district-mandated 20-minute PA policy. Teachers recorded PA for 1 week in September 2010 and February 2011. A sample of 142 students (grades K-5) wore accelerometers to measure school day PA. RESULTS: While 40% and 4% of teachers in September and February respectively met the policy all 5 days, 72.5% and 45.7% of teachers in September and February respectively implemented PA at least 3 days/week. Accelerometry results indicated curriculum-based lessons (CBL; 59.92 ± 20.38 min) or walk/run periods (51.56 ± 18.67 min) significantly increased school day MVPA (P < .05) above no additional activity (30.96 ± 22.57 min). CONCLUSIONS: Although the teachers did not meet the 20-minute policy every day, the increased amount of PA achieved each week through the teachers' efforts is a significant contributor to total daily PA levels of children.

Outcomes of a Family Based Pediatric Obesity Program - Preliminary Results.

Children that are classified as obese (body mass index (BMI) > 95th percentile for age and sex, Centers for Disease Control and Prevention) have an increased risk for metabolic and cardiovascular complications. Family based programs that focus on physical activity (PA) and healthy eating are recommended for treatment of pediatric obesity. The purpose of the current study is to determine the outcomes of Building Healthy Families (BHF), a family-based pediatric weight loss treatment program composed of nutrition, physical activity and behavioral modification strategies. In addition, mediating variables that are associated with weight loss in children, in order to enhance the retention and success of this program will be identified. Twenty-two obese (>95th percentile BMI) children (age: 9.94 ± 1.58 yrs) volunteered to participate. Children and their parents (20 moms, 20 dads, 68% obese; BMI > 30 kg·m-2) participated in weekly nutrition education, family lifestyle PA, and one-on-one meetings with a behavioral psychologist. Overall, child participants lost an average of 2.3 ± 2.0 kg of body mass in 12 weeks while parents lost 6.4 ± 4.3 kg of their body mass. There was a significant inverse association between percentage of program goals met and weight loss (r = - 0.67, p < 0.05). Decreases in the child participants intake of high fat, high calorie foods significantly predicted weight change (R2=0.98, p<0.05). In conclusion, family based pediatric obesity programs may offer significant benefits and lead to healthier lifestyles for obese children and their parents.