Community Mission: Program Stories

Fitness in the City: A low-tech, community-based, highly effective approach to weight management

Watching fewer hours of television.  Drinking fewer cans of soda. Increasing the amount of time spent exercising. Lowering body mass index (BMI). What’s this a prescription for? Reducing obesity among children aged 6 – 18 who are seen in 11 Boston community health centers. That’s the goal of Fitness in the City (FIC), a partnership between Children’s Hospital Boston and the health centers, which is supported by Kohl’s Cares. Launched in 2005, FIC relies on nutrition services, education, and physical activity opportunities coordinated at each site by a case manager. Over 900 obese and overweight children are referred by their health center-based primary care provider to participate every year.

“The case manager is the program’s secret weapon,” said Shari Nethersole, MD, medical director for community health in the Office of Child Advocacy at Children’s. “He or she serves as a ‘coach’ to participants –providing motivation and connecting them with culturally appropriate, accessible and affordable resources. Case managers are the main link with the child’s primary care provider and parents.”

Case managers conduct intake and follow-up surveys with participants, engage parents to help develop wellness goals, support participants through nutrition and physical activity referrals, educate health center staff about available local resources, perform data management and meet to share best practices.

Grassroots approach helps health centers build capacity

While Children’s has a well-established and highly successful hospital-based obesity management program, OWL (Optimal Weight for Life) is only able to reach a fraction of the overweight and obese children in Boston’s urban core neighborhoods. So the hospital explored a more grassroots, community-based approach and capitalized on its longstanding relationships with community health centers.

“Many obesity initiatives focus on schools, but we felt that the participation of family members was vital to a child’s success in managing overweight and obesity,” said Nethersole. “Health centers were chosen because family members would be more likely to be engaged in a child’s treatment program if it was located in their health center. In addition, health centers know their populations intimately, can address cultural and linguistic needs, and can mold the program to address barriers and leverage resources in their own communities.”

FIC has become an integral part of the health centers’ obesity efforts. “We have benefited greatly from our participation in regular meetings convened by Children’s with other health centers in the program,” says Roland Tang, MD, a pediatrician at South Cove Community Health Center in Chinatown. “The meetings often include best-practice presentations, and the open exchange of ideas about what works and what doesn’t for other health centers. It has helped us make informed decisions about the direction of our own program.” The program also has helped centers develop or improve their data collection systems. “Prior to having Fitness in the City, we were not collecting BMI data on all our young patients,” said Katherine Cook, PNPC, MSN, at Bowdoin Street Health Center in Dorchester. “Today, through Children’s evaluation support, we’re able to track BMI measures as well as other important behavioral change indicators.”

FIC’s grassroots approach has proven to be a “low-tech” solution to a vexing and increasing child health problem.