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Nurse practitioner shares award for tackling childhood obesity

June 24, 2009

Nurse practitioner Pat Bartels recently shared an award for a poster presentation about an MIT Medical research project on childhood obesity—but more rewarding than the professional recognition was the significant success she and her colleagues had in tackling the problem among MIT pediatric patients.

The Sigma Theta Tau nursing honor society presented the third-place award in May for the presentation by Bartels, F.N.P.-B.C., of MIT Medical’s Pediatrics Service, and her colleagues Mary Aruda, Ph.D., P.N.P.-B.C., a Boston College faculty member, and Katie Wentzell, R.N., a pediatric nurse practitioner student whose preceptor was Bartels.

“Pediatric obesity is increasing at alarming rates in the U.S.,” Bartels says. “Children and teens are beginning to be diagnosed with high blood pressure, diabetes, and high cholesterol due to lifestyle issues as well as heredity.” Most attempts to tackle the problem so far have been school-based (for example, improving the quality of cafeteria food). “There’s been very little written about how primary care practices can help by providing support, information, and referrals to address changes in a child's growth,” she adds.

Childhood obesity rates doubling, tripling

Research has shown that since the 1970s, the rate of obesity has more than doubled in preschoolers age 2-5 and teenagers age 12-19, and has tripled for children age 6-11, Bartels says. Unfortunately, most children don’t grow out of it; 80 percent of children who are overweight at ages 10-15 will be obese adults, she adds. In 2007, the second year of the study, 11.2 percent of the MIT children were found to be overweight and 8.9 percent were obese (the statewide figures were 17 percent and 10 percent, respectively).

During the three-year project, providers in Pediatrics calculated children’s body mass index (BMI) as it changed over time. They also gathered information from parents about their children’s eating, exercise, and time in front of the TV or computer, as well as medical history data for parents of children found to be overweight. Finally, they offered coaching in ways to change the eating and exercise behavior of overweight children and then monitored the results over time.

For example, they taught parents to recognize their young child’s nonverbal cues for hunger and satiation, and they offered tips on packing healthier lunches and cutting down on screen time. They also explained why water is much better for children than soda or juice by showing them just how much sugar those drinks contain (the answer: 15 teaspoons per 20-ounce bottle of Coke or Pepsi, more than 11 teaspoons in a 15-ounce bottle of 100% apple juice, and more than nine teaspoons in 14 ounces of orange juice).

Clinical provider efforts paying off

Their efforts were more successful than anyone expected. Over a period of three years, 66 percent of the pediatric patients classified as overweight or obese lowered their BMI. Of the group studied, 28 percent moved from being overweight to the normal range; almost 30 percent moved from obese to overweight; and another 8 percent lowered their BMI from the obese range all the way down to the normal range.

“We expected resistance from some parents, but we were pleasantly surprised to see positive change in so many children,” Bartels says. “We did worry about discussing these issues with parents who are themselves thin or overweight, because it seems we might hit a nerve either way. But our approach, which is educational rather than being accusing or negative, seems to be working.”

Although the three-year study period is past, Pediatrics continues to incorporate the obesity-fighting measures into its daily practice. “We may not be so data-driven in the future, since we know this works for us, but it’s good to keep track of some of the measures to assure we’re still on target and making a difference,” Bartels said.

The first year of the study was funded by Blue Cross Blue Shield of Massachusetts. Also participating were Boston College graduate student Leah Porter, R.N., clinic assistant Phyllis Jordan-Gill, parent advisors, and Jocelyn O. Joseph, M.D. (chief of Pediatrics) as well as the other MIT Medical pediatricians.