• Article
  • April 27, 2018

How to Change the Conversation About Obesity

A program to encourage healthy behaviors in kids spreads to the adult population.

By Amanda Bertholf

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In the early 2000s, when Tory Rogers, M.D., was working in the primary care clinic at The Barbara Bush Children's Hospital (BBCH) in Portland, Maine, she began noticing more patients were coming in with weight issues. "At the time, I was interested in quality improvement work, lead screening, asthma—I didn't know what to do," she says. "I didn't know how to talk to them, what labs to get or if their weight was a problem."

When Rogers and her team started looking at the patient population in the electronic medical record, they noticed numerous patients with excess weight issues. Maine has a population of 1.3 million people, which includes about 280,000 kids. "In pediatrics, we all know each other," she says. When she talked to her colleagues across the state about their patients with weight issues, they told her they were experiencing the same thing.

Getting started

With help from the Maine Center for Public Health, Rogers and colleagues from 11 pediatric practices across Maine took action. In 2004, they started a group that developed messaging for patients around the concept of 5-2-1-0, which became the foundation for Let's Go!, a childhood obesity prevention program.

Let's Go! uses evidence-based strategies to increase healthy eating and physical activity among children from birth to age 18. "At the time I thought, 'We have a cute message we'll use for a few years, and I'll go back to working on another quality improvement project,'" says Rogers, the medical director of the Let's Go! program at BBCH. "I had no idea we'd be continuing to evolve 14 years later."

This simple message crossed literacy, culture and multidisciplinary lines in the health care setting. "I could talk about 5-2-1-0 even though I was never trained in nutrition and didn't know about nutrition," she says. "My assistant could talk about it; my nurse could talk about it. The whole message shifts the emphasis away from weight to behaviors, and that's an easier conversation for everyone to have."

News of the program spread across the state. In 2006, 15 other pediatric practices wanted to join the initiative. Rogers also piloted the program at her kids' school. "We found the messages resonated in schools and were easily delivered by a teacher, principal and school nurse," she says.

Lowering obesity rates

Rogers says a strong evaluation strategy and a sociological model is helping measure what's happening at the nearly 1,400 participating sites across Maine today, including pediatric clinics, child care programs and more than half of the public schools. "We look at behaviors—if kids are changing, and they are," she says. "If a child goes to a Let's Go! school, he or she is eating more fruits and veggies than a child who doesn't go to a Let's Go! school."

Rogers says obesity rates in Maine are leveling off faster than national rates. "This is proof a multi-setting model like Let's Go! is working," she says. What started 14 years ago as a philanthropically funded project for kids is now 75 percent funded by MaineHealth, the system the children's hospital belongs to, and has expanded into the adult population.

"It became clear we needed to address the adults so they can support the kids," Rogers says. "There was a demand to do it, and it made sense for our program because we know parental behavior affects kids' behavior."

But the original 5-2-1-0 message was not sophisticated enough for adults. So Rogers and her team tailored the messaging: Drink Water, Move More, Eat Real, and Rest Up. The messaging was piloted in six primary care practices in 2016, and the reaction was positive. "We found providers liked it, staff liked it, and we surveyed patients, and they liked their doctor talking about it," she says. "And previously, they weren't talking about weight, they only talked about things like diabetes once a patient got diabetes."

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Workplace initiatives

The program is also rolling out within the MaineHealth System with the aim of improving workplace wellness. The program includes messaging around getting up and walking every 60 minutes, conducting walking meetings, and making smart decisions in the cafeteria.

The next phase of Let's Go!, Rogers says, will be to continue to do the work as deeply as possible in all of the sites. "We've been concerned about sustainability," she says. "We work with nearly 1,400 sites, and I travel the state a lot. But we're in it for the long haul." Rogers says this work provides children's hospitals an opportunity to stand up for a major issue for kids, without the stigma or bias.

"We need to lead. This is an opportunity for children's hospitals to lead in the effort around obesity prevention and treatment. Our voice is powerful as physicians—we can use our efforts to lift up kids."

Send questions or comments to magazine@childrenshospitals.org.