Boston Team Takes STEPS to Health

October 17, 2012
By Julie Eisen

Collaborate for Healthy Weight Boston Team
Members of the Boston Healthy Weight Collaborative team.
In Boston’s neighborhood of Roxbury, 29 percent of adults are obese – a rate that is 8 percent higher than the rest of the city’s population. Roxbury’s population of predominantly low-income minorities also holds the city’s highest rates of diabetes and cardiovascular disease – indicating a widening health disparity. To close this gap, the Boston team in the Healthy Weight Collaborative chose to focus their efforts on its youngest residents: children ages two to five and their families. “Increasing evidence shows that early interventions are more effective,” says Dr. Jennifer Cheng, team leader and pediatrician at Boston Children’s Hospital Primary Care Center. “So we chose to target kids.”

With the help of local Head Start programs, WIC sites and childcare centers, the team developed their messaging plan and focused on improving patient education about obesity and its causes at three neighborhood health centers – the Dimock Center, Whittier Street Health Center, and Boston Children’s Hospital Primary Care Center.

Helping Parents Understand the Problem
From Dr. Cheng’s experience, a major barrier to healthy behavior change in her patient population is lack of education about obesity and its causes. To address this issue, the team, consisting of representatives from primary care, public health and community sectors created the STEPS to Health plan to be used at the three designated clinic sites. With built-in talking points, the plan helps guide providers through discussions with parents about their child’s weight and about healthy lifestyle changes.

STEPS is an acronym for sugar sweetened beverages, television and screen time, exercise, having a balanced plate of food, and sleep. The plan also serves as an unofficial contract between parent, patient and provider that the child will take the agreed-upon behavior change steps. One goal of the STEPS for Health Plan is simplification. The team solicited input from families and made sure to create a tool that was family-centered and culturally sensitive. “We also wanted to make we were’t talking over people’s heads, so we avoided jargon and made it in a low literacy level,” says Dr. Cheng.

To help parents better understand their children’s weight status, the team scrapped the old black-and-white Body Mass Index (BMI) chart and created a new color-coded tool that clearly translates risk and severity. The standard BMI chart depicts age and BMI in a grid with curves denoting weight status. The old chart was confusing to read and “again and again we saw that parents didn’t understand it,” says Dr. Cheng. With the new chart, which marks healthy weight in green, overweight in yellow, and obese in red, providers can help parents find their child’s status on the chart. “When they go through it visually and their finger passes through the green and the yellow into the red, they get the concept more easily,” she says. “No one likes being in the red zone.”

Finding a Healthy Weight Goal
What parents find most valuable about the STEPS for Health plan is the opportunity to work with their provider to develop goals that are specific and individualized for their child. The goals section is a blank space, so there are no pre-determined check boxes to easily prescribe and speed up the appointment. The process of completing the plan facilitates discussion and opportunities for patient education that otherwise might not happen.

Parents sometimes don’t know what is good and what is bad, Dr. Cheng says. While she was reviewing the STEPS for Health plan with a mother of a young patient, she recalls, it became clear that no one had ever told her that sugar was unhealthy, particularly with respect to juice. “Parents often don’t realize how much sugar is in juice and there is no need for all that juice in a kid’s diet. Most people know that soda isn’t good for you, but with juice most people think that that if it’s all natural, it’s OK. Even if it is 100% organic, it still contains a huge amount of sugar.” In the case of this parent, she and Dr. Cheng completed the STEPS to Health plan for the child and set a goal to reduce intake of sugar sweetened beverages, including juice. “I think she really got it,” says Dr. Cheng.

The STEPS for Health plan is now making its way beyond the primary care setting and into Head Start, WIC and childcare centers. The team has taken tangible goals and sees achievable behavior change within reach.