“How many tortillas do you eat at dinner?” Francisca Guevara asks the boy and his parents. “Okay,” she says when they tell her three. “Do you think you could eat two instead? Or even just one?” They nod in agreement: That seems possible.
As the associate director of community health and outreach for Charles River Community Health, Guevara recognizes the need to meet families where they are, tailoring her suggestions to fit their traditions. “We can’t tell people that they can no longer eat the foods that are important to their culture,” she explains. “That just puts families on the defensive. But we can explain why certain foods aren’t healthy and suggest that they eat smaller or less-frequent portions.”
Charles River is just one of 10 Boston-area community health centers participating in Fitness in the City (FIC). This partnership with Boston Children’s Hospital connects overweight and obese kids and their families with nutritional information, opportunities for physical activity and motivational support within their own communities. As the program enters its 13th year, remarkable findings from a new analysis show that FIC is making a real impact on the health of Boston families.
Every year, FIC enrolls about 1,000 kids ages 5 to 18, all of whom have been identified by their primary-care physicians as being above 85th percentile for body mass index (BMI) or higher — the definition of overweight. These children and their families are then referred to a case manager, who provides personalized resources, whether that means access to family shopping trips, cooking classes, dance lessons or other opportunities. The goal is to help kids stabilize their weight and get healthy in a culturally sensitive and appropriate way, says Urmi Bhaumik, evaluation manager for Boston Children’s Office of Community Health.
To determine whether FIC was meeting that goal, Bhaumik and the hospital’s executive director of Community Health, Dr. Shari Nethersole, recently analyzed data from 291 children who had nine years of information about their height and weight and who took part in FIC during 2009 and 2010. They determined that the children’s BMI had increased for the three years prior to joining FIC and continued to drop even five years after they completed the program. This apparent reversal in weight gain suggests that kids who participate in FIC — particularly those who are overweight or mildly obese — can experience real benefits from the program.
“We find that FIC is a model that makes sense for these particular kids,” explains Bhaumik. “It allows us to help them now, before they become even heavier and unhealthier.” The analysis, which is currently out for review, includes the first data on FIC — and promises to add another level of achievement to what is already a thriving program.
A family affair
The key to success, say Bhaumik and Guevara, is to involve parents from the beginning. “No one wants to hear that their child is overweight,” says Guevara. “Instead, we frame the program as a preventive measure that can help ward off chronic conditions like diabetes and heart disease later in life.”
Parental involvement is critical to helping sustain that preventive approach. “It’s easy for us to say what people ‘need’ to do to be healthy,” explains Bhaumik. “It’s often harder for them to actually implement those changes. Community health centers can help by providing education and resources, without being rigid in our approach.”
Indeed, the results of Bhaumik’s recent analysis bolster this belief, suggesting that weight loss is usually small and incremental — but also lasting. “It can take time for families to shift their behavior,” she says. “Change doesn’t happen in a day, but for many of these kids, just a few small changes can ultimately make a difference.”
Learn more about Boston Children’s Office of Community Health.