Combating Obesity with Nature: DC Park Rx Implemented in a Community Health Center

Friday, October 10, 2014: 9:10 AM
Room 29 (San Diego Convention Center)
Robert Zarr, MD, MPH1, Linda Cottrell, MPH2, Marie DeYoung, MS3 and Chaya Merrill, DrPH2, (1)Unity Health Care, Inc., Washington, DC, (2)Children's National Medical Center, Washington, DC, (3)George Washington University Milken Institute School of Public Health, Washington, DC

"Purpose "

In the US, 33% of children and adolescents are overweight or obese.  Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.  This increase in obesity can in large part be attributed to an increase in sedentary lifestyles.  The likelihood of being obese is twice as high for black and Hispanic children as for their white counterparts.  Regular physical activity reduces the risk of obesity.  Spending time in natural environments increases physically activity, hence decreasing risk of obesity.  In Washington, DC, 40% of children are either overweight or obese.  Unity Health Care, DC's single largest provider to DC's underserved (~600,000 visits/yr), serves 100,000 patients.  Unity's patients are: 72% black, 17% Hispanic, 91% living below the poverty line, and 45% of its pediatric patients are either overweight or obese. The CDC, AAP, and DHHS, all stress the importance of physical activity in reducing obesity, and encourage time spent outdoors in natural settings like parks.  Green space comprises 20% of DC land (>350 parks).

 Unity's location and patient population make it an ideal setting to prescribe parks to children and their families, and evaluate behavioral changes before and after being prescribed a park.

"Methods "

      Developed a standard park-rating (based on SOPARC and PEAT)

Recruited and trained Park Rangers, physical therapists, and students to rate parks

      Mapped and rated >350 parks

      Developed Park Pages (one-page summaries highlighting accessibility, safety, programming/activities) searchable database and linked database to Unity's Electronic Health Record (EHR)

      Trained 27 primary care providers to use the hyperlinked Park Pages

      Developed and administered surveys (pre and post intervention) to parents of patients with previous diagnosis of obesity, overweight, asthma, and/or who were scheduled for well child visit between July 1 and October 1, 2013

"Results "

      Participants: birth to 18 years old

      317 pre and post intervention surveys completed

      Response rate: 80% (317 of 400)

      Twenty-two more minutes per week on physical activity

      Six more days per year at a park for at least 30 minutes

      Increase in:

1. number of children who visit a public park

2. number of parents who believe that physical activity affects the health of their child

3. number of parents who reported their provider discussed the importance of physical activity and recommended their child spend time at parks

"Conclusions "

DC Park Rx is a community health initiative whose mission is to prescribe parks to prevent and treat childhood obesity. Spending time in parks reduces a child's risk of obesity.  Prescribing Nature using Park Rx increases a patient's time spent in parks and overall physical activity. Given the worsening epidemic of childhood obesity, the existing park resources, and their underutilization, DC Park Rx plays an important role in reducing childhood obesity.