Food insecurity and obesity in New York City primary care clinics.

BACKGROUND: Hunger continues to be a problem in New York City; paradoxically, the city also has disproportionally high rates of diabetes and obesity. Some research suggests that food insecurity leads to obesity. METHODS: We undertook a cross-sectional "card study" in which doctors working at 8 New York City area primary care practices administered a brief, anonymous survey to patients they saw during clinic sessions. The survey included a 2-question food insecurity screen and questions about enrollment in nutrition assistance programs. Height and weight were also measured at the visit. RESULTS: Cards were completed for 558 patients (65.1% female; 74.7% adults; 78.5% conducted in English). Fifty-five percent of patients were receiving some form of food assistance. More than half of patients (51.7%) reported some degree of food insecurity. Of adult participants, 21.8% had normal weight, 29.1% were overweight, and 48.2% were obese. Food insecurity was significantly associated with increasing body mass index in women not receiving food assistance. There was no significant association between body mass index and food insecurity in children. DISCUSSION: In an urban population, overweight and obesity are very common as is food insecurity. We found an association between food insecurity and obesity only among women not receiving food assistance suggesting a possible protective role for food assistance. Providers should consider food insecurity in similar populations when trying to address obesity.

Implementation of a pilot primary care lifestyle change intervention for families of pre-school children: lessons learned.

OBJECTIVE: We used Glasgow's RE-AIM framework to evaluate the feasibility of a primary care-based intervention to decrease behaviors that place urban children at risk for obesity. METHODS: During preventive visits of 2-5-year olds between February 2006 and May 2007, parents completed a health behavior assessment. Primary care providers engaged parents in brief goal setting and referred them to a lifestyle counselor. Evaluation involved medical record review, interviews with staff and clinicians, and health behavior assessment via a pre- and post-intervention telephone survey. RESULTS: Families reached by the intervention did not differ from families who were not. The intervention was adopted by 14 of 17 clinicians. The health assessment was implemented in 32% of preventive visits (N=354). Of those, goal setting by physicians occurred in 59%, with 55% referred to the lifestyle counselor. We were unable to demonstrate effectiveness to change adult or child nutrition or physical activity, as complete data were available for only 34 families. CONCLUSION: Goal setting with referral for more intensive lifestyle counseling for obesity prevention in high risk families is feasible and acceptable in primary care. PRACTICE IMPLICATIONS: Patient educators can be integrated into primary care to achieve preventive care goals.

Counseling to prevent obesity among preschool children: acceptability of a pilot urban primary care intervention.

PURPOSE: To help design effective primary care-based interventions, we explored urban parents' reactions to a pilot and feasibility study designed to address risk behaviors for obesity among preschool children. METHODS: We conducted 3 focus groups (2 in English, 1 in Spanish) to evaluate the pilot intervention. Focus group participants explored the acceptability of the pilot intervention components (completion of a new screening tool for risk assessment, discussion of risk behaviors and behavior change goal setting by physicians, and follow-up contacts with a lifestyle counselor) and the fidelity of the pilot intervention delivery. RESULTS: Parents expressed a desire to change behaviors to achieve healthier families. They believed that doctors should increase their focus on healthy habits during visits. Parents were more accepting of nutrition discussions than increasing activity (citing a lack of safe outdoor space) or decreasing sedentary behaviors (citing many benefits of television viewing). Contacts with the lifestyle counselor were described as empowering, with parents noting her focus on strategies to achieve change for the whole family while recognizing that many food behaviors relate to cultural heritage. Parents expressed frustration with physicians for offering advice about changing behavior but not how to achieve it, for dismissing concerns about picky eating or undereating, and in some cases for labels of overweight that they believed were inappropriately applied. CONCLUSIONS: Parents welcomed efforts to address family lifestyle change in pediatric visits. The model of physician goal setting with referral for behavior change counseling is highly acceptable to families. Future interventions should acknowledge parental concerns about undereating and perceived benefits of television viewing.