It’s Never Too Early to Promote Healthy Weight: Kansas City Healthy Weight Team Focuses on Toddlers
By Julie Eisen (NICHQ)
Nationally, about a quarter of children between the ages of 2 and 5 are overweight or obese. Hovering just above that average, 28 percent of the pre-school-age children seen at the Children’s Mercy Primary Care Clinic in Kansas City, Missouri, are obese or overweight – a figure that is even higher for Hispanics at 39 percent and African Americans at 30 percent.
“Given these rates, we had a particular sense of urgency for our younger children,” says Deborah Markenson, the Director of Children's Mercy Hospitals and Clinics and the leader of the Kansas City Healthy Weight Collaborative team. “These kids are at a critical development stage, and they are at an age when prevention efforts can have a lot of reach.” So the team decided to focus their efforts on these young members of the Kansas City population, along with their families and caregivers.
To reach these young kids, the team has had to go where the kids go. This means the Children’s Mercy Primary Care Clinics, but it also means Women, Infants, and Children (WIC) sites, Head Start centers, and the YMCA. However, before the team could get down to business, they needed to unify their community partner groups with the right messaging.
To reach their target demographic, the Missouri team knew they needed a strong message that resonated with both toddlers and their families. At the same time, the development of messaging also offered the team an opportunity to establish strong relationships with their diverse community partners, including the Kansas City Health Department, the YMCA, and other local non-profit organizations like KC Healthy Kids. “We wanted to this be a true collaborative approach,” says Markenson. “We didn’t want this to be us saying ‘here’s the best way to do this.’ We wanted our partners to be fully engaged with our efforts.”
Looking at the variations of 5-2-1-0 and 5-2-1-Almost None messaging, the group of community partners collectively decided on either 5-4-3-2-1 or a 1-2-3-4-5 version, to keep it educationally appropriate for their young audience. After receiving pro-bono graphic design work from an advertising agency, the team had children and families at Children’s Mercy Weight Management program, YMCA sites, and the Kansas City Health Department vote on their favorite designs, and the team was able to narrow the logo down to two. From there, the team held three focus groups with parents and selected their final messaging, “5-4-3-2-1 Fit-tastic!” complete with a branding website.
Since they launched the messaging in May, Markenson says that they have 36 partner agencies ready to come on board and carry the message out in their settings. Most recently the team had shirts created with their logo to further unify the team and spread the message. “We had a lot of fun with the messaging,” says Markenson. “We probably had too much fun!”
Implementing New Protocols in the Clinics
The team has made many changes to support the delivery of the Fit-tastic campaign at Children’s Mercy Primary Care Clinics. Team members are rolling out a system, clinic by clinic, to incorporate a standardized Healthy Weight Assessment (HWA) and a Healthy Weight Plan (HWP) process seamlessly into every visit. To support the pilot with a select group of clinicians, Children’s Mercy’s incorporated both the HWA and HWP into their electronic medical records (EMR) system that serves all primary care clinics. While the team's target population is patients between 2 and 5 years old, providers were using the new system for all, so now healthy weight intake information and discussions are a standard part of visits with all patients two years and older.
Under the new protocol, care assistants check patients in by collecting the usual vital signs, like height, and blood pressure, but now they will also administer the Healthy Weight Assessment to the parent or guardian about the young patient and enter this information into the EMR. Then when the clinician comes in, he or she will already have the HWA information in the EMR and can start a conversation about healthy weight. “For example,” explains Kerri Wade, a nurse practitioner at Children’s Mercy and a Healthy Weight team member, “if a clinician sees that a patient’s healthy weight assessment shows that the child is spending too much time watching TV, he or she can start a conversation about what is a healthy amount of a screen time and some alternatives to screen time.”
The provider then discusses the Healthy Weight Plan with the family and they collectively select a topic on which to get more education, such as fruits and vegetables, physical activity, or screen time, which the nurse will provide as a patient leaves. “It is a shared responsibility among the whole health care team,” says Wade.
Heading to Head Start and WIC
The team identified the opportunity to engage with Head Start and WIC programs, perfect partners because of the ages these programs serve. Head Start provides child care, education, dental, and health services to low-income families with children ages six weeks thought pre-kindergarten. WIC is a federally-funded health education and nutrition program helping low-income women who are pregnant or recently had a baby, as well as children under five years old.
The team is working with six Head Start sites and three WIC clinics in the area to infuse the Fit-tastic! messaging into Head Start and WIC centers and events. They are working with them to incorporate the Healthy Weight Assessment and Plan into interactions with families and children, to increase their knowledge of the importance of physical activity and nutritious foods. Finally, they are also working to make policy changes at the Head Start centers, such as enhancing play opportunities and eliminating flavored milk, so they are more healthy-weight-friendly.
Reaching Toddlers Where They Play
Finally, the team has partnered with local YMCA chapters, which have incorporated the Fit-Tastic! messaging into high-profile events like Healthy Kids Day and their own communications with the public. Working with local child care facilities, the team is also reviewing policies and procedures for play time, such as ensuring there is adequate time and equipment to maximize physical activity and training staff to encourage children to play instead of watching from sidelines.
“Little tweaks with children under 6 can help control calories and decrease the velocity of the weight gain,” explains Markenson. “It is also a time when you are setting lifelong patterns for health.”