Well Baby Group Care: Evaluation of a Promising Strategy for Primary Prevention of Childhood Obesity

Friday, October 10, 2014: 9:00 AM
Room 29 (San Diego Convention Center)
Hildred Machuca, DO, Sandra Arevalo, RD, CDE, MPH, Barbara Hackley, CNM, Arielle Mishkin, BA, Jo Applebaum, MPH and Alan Shapiro, MD, Montefiore Health System, Bronx, NY

Purpose: Overweight young children are at high risk of becoming obese adolescents and adults. Nationally, approximately 24% of preschool children are overweight or obese. A recent study estimated incremental lifetime medical cost of $19,000 for an obese child versus a healthy weight child. Yet, few interventions have targeted attaining and maintaining healthy weight at an early age. The purpose of this observational comparison group study was to compare the effect of Well Baby Group Care versus traditional one-on-one care on rates of overweight and obesity at age 2, among children receiving primary care at an urban community health center. To date, no study has evaluated group care for primary prevention of childhood obesity.

Methods: South Bronx Health Center serves a predominantly Latino and Black population located in one of the poorest congressional districts in the US, where a disproportionate percentage of children are overweight or obese. Well Baby Group Care (WBGC) was launched in 2007 for infants aged 1-18 months offering bilingual, culturally competent well child care visits in a group setting. This model includes health assessment, enhanced health education, group discussion, peer support, and nutrition intervention. The group visit, co-facilitated in a non-didactic style by a pediatrician and registered dietitian, empowers parents to adopt positive health and parenting behaviors through 11 visits over 18 months. To assess the impact of group care, we compared rates of overweight (BMI 85th-94th percentile) and obesity (BMI ³95th percentile) at age 2 among children receiving WBGC versus traditional care at our health center. Comparison group children were born over the same time period (2007-2011), seen within the first 3 months of life, and had ≥3 well child visits by their second birthday.

Results: A total of 425 children were eligible, 50 in WBGC and 375 in traditional care. Demographics, including race, ethnicity, maternal preferred language and age, were similar in both groups. Mean age at BMI measurement was 2.2 ± 0.25 years. Overall, 12.9% of children were overweight/obese (BMI ≥85th percentile); 7.0% overweight and 5.9% obese. Among children in WBGC, 2.0% were overweight/obese compared with 14.4% in traditional care (P=.012, Fisher’s Exact Test). In WBGC, none were obese versus 6.7% in traditional care. Children in WBGC were nearly 90% less likely to be overweight/obese at age 2 than children in traditional care (OR .12; 95% CI .02, .90). Final analysis of results, controlling for birth weight, breastfeeding, and maternal BMI, will be presented.

Conclusion: Shifting the paradigm of primary care, Well Baby Group Care is an effective and replicable model that allows for in-depth education and skill building to improve outcomes. Further study is needed on the potential of group care to prevent pediatric obesity.