Evaluation of Medicare's Intensive Behavioral Therapy for Obesity: the BieneStar Experience.

INTRODUCTION: In 2011, the Centers for Medicare and Medicaid Services began to reimburse primary care providers for intensive behavior therapy for obesity. This study evaluated a Centers for Medicare and Medicaid Services intensive behavior therapy for obesity program as implemented in primary care clinics. METHODS: Data for this retrospective cohort study were obtained between May 2012 and February 2015 and statistical analysis was performed in 2017. The sample included 643 participants who attended at least one BieneStar intensive behavior therapy for obesity program session. The primary outcome was weight, and covariates were number of sessions, age, race/ethnicity, diagnosis of hypertension and diabetes, and type of health insurance. RESULTS: Of 643 participants that initiated the BieneStar program, 641 had complete data. The median reduction in weight of participants was as follows: those who attended fewer than four sessions, 0 kg (95% CI=0, 0.11 kg); between four and eight sessions, 1.1 kg (95% CI=0.86, 1.59 kg); and more than eight sessions 3.7 kg (95% CI=3.36, 4.55 kg). Medians of weight were significantly different between each classification of session numbers (p<0.01). Participants lost on average 0.102 kg of weight per session attended. CONCLUSIONS: The BieneStar program showed that the weight of participants decreased as they attended more sessions. Further studies are needed to determine if these results can be reproduced in other office-based primary care clinics and the program's impact on chronic disease.

Outcome of a food observational study among low-income preschool children participating in a family-style meal setting.

INTRODUCTION: In the United States, one out of every seven low-income children between the ages of 2 and 5 years is at risk for overweight and obesity. Formative research was conducted to determine if preschool children participating in family-style meals consumed the minimum food servings according to U.S. Department of Agriculture dietary guidelines. METHOD: Participants were 135 low-income children aged 3 to 4 years who attended an urban child care center. Participant's parents completed a Family Demographic Questionnaire to provide information on race/ethnicity, parent's level of education, and household income. Direct observation of children's food and beverage consumption during school breakfast and lunch was collected over 3 consecutive days. Dietary data were assessed using the Nutrition Data System for Research software. Height and weight measurements were obtained to determine risk for obesity. Descriptive statistics were reported by using the Statistical Package for the Social Sciences Version 16. RESULTS: Among 135 participants, 98% identified as Mexican American, 75% lived at or below poverty level, and 24% reported a family history of diabetes. Children consumed less than half of the calories provided between breakfast and lunch and did not consume the minimum recommended dietary food servings. Despite the poor dietary intake, physical measurement findings showed 25% obesity prevalence among study participants. CONCLUSIONS: Findings support the need for evidenced-based early childhood obesity prevention programs that provide behavior change opportunities for children, their families, teachers, and menu planners. Family-style meal settings are ideal opportunities for implementing nutrition education strategies to prevent early childhood obesity.