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Federal program aims to prevent obesity in girls.

Physicians can now turn to a free federally-developed program that provides the tools to educate parents and caregivers on how to help their young adolescent daughters make small and specific behavior changes to maintain a healthy weight and prevent obesity.

The program provides welcome information for physicians, who are bombarded with alarming messages about the rising number of children and adolescents who are overweight or obese and the dangerous effects down the road.

"I feel frustrated as a physician. We're hearing from all directions that we need to identify these kids but we don't know what to do after that," said Dr. Monica Richter, a pediatrician based in Washington State. Then she discovered the BodyWorks program, developed by the Department of Health and Human Services' Office on Women's Health, which aims to provide physicians with tools to educate parents and caregivers so they can help their young teen daughters prevent obesity.

Parents attend 8-10 weekly sessions and receive a free toolkit. Girls are asked to attend two or three of the meetings, although they can participate in all of the meetings if they choose.

Everyone in the program gets a pedometer, to help measure activity. Refrigerator magnets also are given out to remind the family to sit down and plan out meals for a week. There is a recipe book, coupled with nutritional information. There also is a journal for girls to use to keep track of what they're eating, how they feel when they are eating, and what kind of exercise they are doing.

Dr. Richter saw the program advertised on the Internet a few months prior to a train-the-trainer course offered in the Seattle area, where she practices. The aim of these sessions is not only to teach physicians, nutritionists, and others to provide the program to families but also to train other physicians how to provide the program to families.

Dr. Richter approached the medical staff at Valley Medical Center with a proposal to run this program. They funded the program for the first year, and then the hospital matched the funds for the second year. The hospital provides the room and the equipment for free. She was funded to provide two 10-week sessions for families and also to train other trainers.

"We're not telling kids something they don't know already They know if they're heavy, The thing that we need to do is tell them what they can do to change ... in an office visit--we can't give them all of this information. This way I can hand them a flyer and tell them what the program is all about," said Dr. Richter.

"'My limited experience has been that when a physician says to a family, "Your child has a problem with a high BMI [body mass index] and obesity.... I want you to make some changes and this program is for you.' ... That is an extra push for people to get motivated and committed," said Dr. Richter. Physicians can refer parents to the Web site (http: // / bodyworks/) to find out about upcoming parent/caregiver sessions and a list of trainers in their state.

The program isn't limited to those with a weight problem though. "There are people who are perfectly fine with their weight and are interested in healthy eating and exercise," said Dr. Richter. "It's basically an education program that is good for anybody," The nutritional information is based on the federal government's 2005 Dietary Guidelines for Americans.

The program actually started with some work on eating disorders done through the Office on Women's Health. "As that work was evolving, the experts around the table were really sounding the early warning that this same [age] group of girls was actually seeing huge increases in overweight and obesity. If we were going to be addressing eating disorders, we should seriously be thinking about disordered patterns of eating," said Wanda Jones, D.P.H., the deputy assistant secretary for health in the U.S. Department of Health and Human Services and the director of the Office on Women's Health.

At the time, there were no materials aimed at addressing healthy eating in this age group of girls, so the office started working on a program to address this gap.

The program was initially aimed at young adolescent girls, aged 9-13 years, for whom there can be a fine line between encouraging healthy eating and regular exercise and straying into eating disorder territory. To this end, the program was designed to focus on body image by presenting different images of health and perspectives on body image to help girls understand that they are unique and different. "Some girls are going to grow much more quickly than other girls. They may be naturally heavier than other girls at the same age--and these patterns may change as they get older," said Dr. Jones.

There is no weigh-in, noted Dr. Richter. Instead, "we talk about health and small changes for a healthy lifestyle. That's the emphasis--not weight but health."

While the program for families is free, it does require a commitment of 1 night a week (1.5-2 hours) for 10 weeks. "It's a big time commitment," said Dr. Richter. The program has struggled not only with getting families to sign up but also to complete it.

There is also a big time commitment for physicians who train to be trainers. "We ask that the folks who come in as trainers commit to providing a certain number--at least one--of training opportunities in their community. We've also had many of the trainers train other trainers," said Dr. Jones. To date, there are almost 800 trainers who have gone through the program.

While the focus has always been on the family, once the program was out in the field, parents started pointing out that they had boys at home with poor eating and exercise habits. In response to this, the office developed a set of materials aimed at boys that is now in the final stages of review, said Dr. Jones.

The Office of Women's Health is currently evaluating the program nationally to determine if it can help parents and caregivers make and maintain behavior changes. The evaluation will specifically assess the impact of the program on the awareness, knowledge, attitudes, and practices of parents and adolescent girls regarding physical activity and healthy eating. The results should be available later this year.


Senior Writer

Percentage of Overweight
U.s. Youth Are Increasing

Age           2003-2004   1999-2000

2-5 years       10.3%       13.9%
6-11 years      15.1%       18.8%
12-19 years     14.8%       17.4%

Source: Centers for Disease Control and Prevention

Note: Table made from bar graph.
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Title Annotation:Obesity
Author:Wachter, Kerri
Publication:Family Practice News
Geographic Code:1USA
Date:Feb 1, 2008
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