Skip Navigation
Service Delivery Innovation Profile

Tools, Education, and Technical Assistance Help Primary Care Providers Promote Healthy Eating and Physical Activity in Youth


Tab for The Profile
Comments
(2)
   

Snapshot

Summary

Let’s Go! is a multilevel, multisector initiative in Maine that promotes physical activity and healthy eating in an effort to increase the proportion of children at a healthy weight. The program, which began as a demonstration project in greater Portland and now operates throughout Maine, consists of complementary interventions in six sectors (schools, after-school programs, primary care practices, child care centers, work sites, communities). Key components for primary care include a toolkit, questionnaires, posters, educational conferences, training, and onsite technical assistance. The initiative has encouraged primary care providers to better support children and youth in adopting healthier behaviors, through more consistent documentation of body mass index and other indicators related to healthy weight.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of the degree to which primary care providers document BMI and other related health measures in pediatric patient medical records, along with a post-implementation survey on the number of participating practices employing recommended program components.
begin doxml

Developing Organizations

Let's Go!
Let’s Go!’s seven founding partners include Hannaford, Anthem Blue Cross and Blue Shield, Unum, TD Bank, Maine Medical Center, MaineHealth, and The United Way of Greater Portland. Harvard Pilgrim Health Care Foundation became a major partner soon after project initiation. Nearly 30 organizations throughout the state now serve as partners in Let’s Go!, which is housed at the Kids CO-OP at the Barbara Bush Children's Hospital at Maine Medical Center.end do

Date First Implemented

2006
begin pp

Patient Population

Vulnerable Populations > Childrenend pp

Problem Addressed

Childhood overweight/obesity is a widespread, growing public health problem with devastating consequences. Much of the problem stems from the failure of children and adolescents to eat healthfully and engage in adequate levels of physical activity. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing it by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, primary care providers face competing priorities that make it difficult for them to play this role effectively without outside support.
  • A growing epidemic: The prevalence of obesity (defined as having a body mass index, or BMI, at or above the 95th percentile) among children and adolescents has grown significantly over the last several decades, both nationally and in Maine:
    • Nationwide: Between the 1976–1980 and 2007–2008 time periods, the prevalence of obesity rose from 5.0 to 19.4 percent in 2- to 5-year-olds, from 6.5 to 19.6 percent in 6- to 11-year-olds, and from 5.0 to 18.1 percent in 12- to 19-year-olds.1
    • Maine: Maine has not been immune from the overweight/obesity epidemic. Data from the National Conference of State Legislatures show that approximately 28 percent of Maine children age 10 to 17 were overweight or obese in 2007, more than double the 12.7 percent rate in 2003.2 A 2006 review of 3,000 charts representing roughly 50,000 Maine patients between the ages of 3 and 18 produced similar findings, with roughly a third (32.8 percent) being overweight or obese.3
  • Driven by poor health-related behaviors: High rates of overweight/obesity stem in large part from poor health-related behaviors, including unhealthy diets and lack of physical activity:
    • Poor diet: According to the 2009 Maine Integrated Youth Risk Survey, only 14.9 percent of high school students and 18.4 percent of children in grades 7 and 8 ate at least five servings of fruits and vegetables a day during the week before the survey.4
    • Lack of physical activity: The same survey found that less than half of Maine children met national physical activity guidelines during the prior week, while roughly a third watched 3 or more hours of television on the average school day.4
  • Leading to severe health consequences: A critical public health issue, overweight and obesity put children at current and future risk of many serious health problems, including cardiovascular disease, type 2 diabetes, and mental health conditions such as anxiety and depression.5 Approximately 60 percent of obese children between the ages of 5 and 10 have at least one risk factor for cardiovascular disease, such as elevated total cholesterol, triglycerides, insulin, or blood pressure, while 25 percent have two or more such risk factors.6
  • Failure to assist primary care in doing its part: Primary care providers can play a critical role in supporting healthier behaviors by consistently documenting BMI, offering lifestyle counseling, and developing individualized care plans for overweight/obese patients and their families. Yet these providers face many competing priorities during busy office visits, and hence need systems and other support to help in providing such services.

What They Did

Back to Top

Description of the Innovative Activity

Key components of the Let’s Go! primary care program include a toolkit, questionnaires, posters, educational conferences, training, and onsite technical assistance to help physicians adopt policies and strategies to promote healthier behaviors in children. To date, 65 practices (out of approximately 300 primary care practices in Maine) have received a toolkit and/or attended an educational session. Key elements include the following:
  • Toolkit for primary care providers: This toolkit includes resources to facilitate conversations between providers and patients about physical activity and healthy eating during well-child visits, using motivational interviewing techniques. Examples include the following:
    • A list of practical steps that primary care physicians can take to incorporate healthy lifestyle messages and activities into their practices.
    • Tools to facilitate documentation of height, weight, BMI, weight classification, and blood pressure (referred to as the “Healthy Weight Bundle.”
    • Tips on effective communication with families.
    • Brochures on each component of Let’s Go!’s “5-2-1-0” social marketing campaign. (For details about the 5-2-1-0 message, which focuses on fruit and vegetable consumption, recreational screen time, physical activity, and avoidance of sugary drinks, see the related profile.)
    • Tools to facilitate patient/family goal-setting around 5-2-1-0 behaviors.
    • Handouts related to sleeping habits, portion size, family mealtime, fiber and calcium consumption, breakfast consumption, physical activity, and breastfeeding resources.
    • Materials for practice staff that emphasize the importance of being good role models for patients and creating a healthy office environment.
  • Healthy Habits Survey: To help physicians initiate respectful conversations about weight, the Let’s Go! toolkit includes two versions of the 5-2-1-0 Healthy Habits Survey (one for ages 2 to 9 and one for ages 10 to 18). These questionnaires prompt physicians to ask patients about 5-2-1-0 behaviors, along with other behaviors related to nutrition and physical activity (such as whether patients regularly eat breakfast, have family mealtime, and have good sleep habits).
  • Posters: Posters for waiting and examination rooms provide information about Let’s Go! and convey the 5-2-1-0 message. The posters help ensure that children receive the same message about healthy lifestyles in multiple community settings.
  • Education and technical assistance: In collaboration with partners, Let’s Go! sponsors educational programs and provides onsite technical assistance, as outlined below:
    • Childhood obesity institutes: Held three times a year, these 1-day conferences for primary care physicians and their office staff include speakers on a range of topics, such as strategies to combat childhood obesity, obesity-related health complications, complementary medicine, how to teach patients to read food labels, and translation of research into practice.
    • Training on motivational interviewing: Let’s Go! holds day-long training sessions on motivational interviewing skills. Participants receive followup coaching via telephone for 6 months after attending.
    • Onsite technical assistance: Let’s Go! staff and physician partners throughout the state visit physician practices to help them embed the toolkit into their workflow. During this 20- to 40-minute meeting, the Let's Go! physician presents information about Let’s Go!, reviews the toolkit components, and discusses BMI measurement. Let’s Go! promotes this component through the Maine Medical Center's physician hospital organization (PHO) and department of pediatrics, as well as through the American Academy of Pediatrics e-mail list.
  • Recognition program: Physicians who belong to the Maine Medical Center PHO and participate in Let’s Go! are eligible to receive recognition through the PHO’s "practice of distinction" program, which recognizes practices for performing well on quality measures. Currently, 90 percent of physician practices participating in Let’s Go! belong to the PHO. These physicians receive recognition if they display the Let’s Go! poster in their waiting and examination rooms; document BMI, BMI percentile, and weight classification in the medical chart of pediatric patients (age 2 to 18); and document use of the Healthy Habits Survey.

For information about other aspects of the larger Let’s Go initiative, see the related profile. For information about program-related activities in other sectors, see the related profiles on schools and child care.

Context of the Innovation

Development of Let’s Go! started with tools and other resources created by the Maine Youth Overweight Collaborative, a program that provided education and practical tools (e.g., BMI assessment, an obesity management algorithm, motivational interviewing techniques, and a counseling tool) to support pediatric practices in assessing and managing overweight and obesity in their patient populations. (See related profile.) Given their concern about the ongoing obesity problem among Maine youth, business leaders in the greater Portland area (a multicultural area with 230,000 residents, including many immigrants and low-income families) created Let’s Go! in an effort to further assist primary care practices and to expand the fight against obesity to nonmedical settings that can have a significant impact on youth. Recognizing the importance of primary care providers in identifying, supporting, and treating overweight/obese youth, Let’s Go! leaders made providing further support to these practices a major part of their efforts (along with providing support to the five other sectors). For more information on the overall Let’s Go! initiative, see the related profile.

Did It Work?

Back to Top

Results

The program has encouraged primary care providers to better support children and youth in adopting healthier behaviors through more consistent documentation of BMI and other indicators related to healthy weight.
  • Rapid growth in documentation of key metrics: Primary care providers receiving a Let’s Go! toolkit and/or educational intervention better supported youth in adopting healthier lifestyles. By June 2010, 12,169 of these physicians’ patients had a documented Let’s Go! “Healthy Weight Bundle” (height, weight, BMI, weight classification, and blood pressure) in their medical record. This figure represents a 44-percent increase from the previous year (when 8,434 patients had this information recorded), and a 650-percent increase from the first half of 2008 (1,862 patients).3
  • Sizable number of practices following guidelines: To be designated a Let’s Go! Healthcare Site, practices need to consistently apply four components: Create awareness of 5-2-1-0 and Let’s Go!, assess weight, listen to patients and families, and be a role model to patients and families. A June 2010 survey of the 65 participating practices showed that just under half did each of the first three (30, 32, and 30, respectively), with 9 practices applying all four components. (Data on the number of practices applying the fourth component—being a role model—are not available.3)
The overall initiative raised public awareness of desired behaviors and encouraged Maine youth to adopt such behaviors, which in turn has helped to halt the increase in childhood overweight/obesity in the state; for details, see the related profile.

Evidence Rating (What is this?)

Moderate: The evidence consists of pre- and post-implementation comparisons of the degree to which primary care providers document BMI and other related health measures in pediatric patient medical records, along with a post-implementation survey on the number of participating practices employing recommended program components.

How They Did It

Back to Top

Planning and Development Process

Selected steps included the following:
  • Enhancing tools for primary care: Let’s Go! staff developed a comprehensive toolkit for physicians based on a review of clinical evidence for strategies related to healthy lifestyles. Dietitians, primary care physicians, subspecialists, parents, and other local and national experts assisted in developing the components, which were then tested by practices that had participated in the Maine Youth Overweight Collaborative.
  • Hiring staff: Program leaders hired a program manager and part-time coordinator to oversee implementation in the primary care setting.
  • Creating learning opportunities: Program leaders developed the Let’s Go! Learning Institute to teach motivational interviewing skills. Let’s Go! also formed a partnership with physicians across the state who could provide onsite presentations and coaching to colleagues interested in implementing the toolkit.
  • Soliciting interest: Let’s Go! partnered with existing health care organizations—including MaineHealth, the Eastern Maine Healthcare System, the Maine Academy of Pediatrics, and the Maine Academy of Family physicians—to promote the program to primary care practices throughout the state.

Resources Used and Skills Needed

  • Staffing: Activities specific to the primary care setting are overseen by a full-time program manager and a half-time coordinator. The Let’s Go! project director and a data coordinator also devote part of their time to program-related activities in this setting.
  • Costs: Data on the costs of primary care–related program activities are not available. For information on total program costs, see the related profile.
begin fsxml

Funding Sources

Let's Go!
Let’s Go! is funded by local business and health care partners in the greater Portland, ME area. Major financial partners include the American Academy of Pediatrics/Healthy Active Living, the Maine Department of Health and Human Services, the Anthem/WellPoint Foundation, the Francis Hollis Brain Foundation, Hannaford, the Harvard Pilgrim Health Care Foundation (the program’s Platinum Supporter), Maine Medical Center, MaineHealth, the New Balance Foundation, the Rite Aid Foundation, TD Bank, the Bingham Program, the Mattina R. Proctor Foundation, the United Way of Greater Portland, UNUM, and the Walmart Foundation.end fs

Tools and Other Resources

More information about this program, along with sector-specific toolkits and resources, can be found at: http://www.letsgo.org.

Adoption Considerations

Back to Top

Getting Started with This Innovation

  • Support both policy and practice-based changes: Success with this type of population-based initiative depends on changes at the policy level (via guidelines, regulations, and/or legislation) and ground-level support (e.g., toolkits and training) for organizations and individuals involved in implementation.
  • Develop and reinforce consistent message: A social marketing campaign can ensure a clear, consistent message for all program elements, conveying an action-oriented prescription for health that can influence the population as a whole. This message is embedded in the physician toolkit and reflected in the posters physicians hang in their offices.
  • Stick to the evidence: Developing a program based on evidence can help ensure physician support. For example, all components of the 5-2-1-0 campaign come from established evidence that these behaviors help reduce overweight/obesity.
  • Create strong partnerships: Identify community-based stakeholders with a similar mission that can help to create tools and assist practices in using them. To facilitate dissemination, identify partner organizations that already serve targeted stakeholders, such as PHOs.

Sustaining This Innovation

  • Develop and maintain strong dissemination model: Partner with organizations that can take ownership of dissemination activities. Partners can work with physicians in their local areas to spread the message and provide guidance on toolkit adoption.
  • Provide usable data: Provide data to physicians that they can use to meet other reporting requirements or needs. This approach helps to create real value for physicians, thus keeping them interested in the program. For example, pediatricians can refer to their participation in Let’s Go! and their documentation of the Healthy Weight Bundle when reporting quality measures to local, state, or national organizations
  • Keep support programs in place: Ongoing technical support helps physicians master motivational interviewing skills and use tools appropriately.
  • Monitor progress, refine program as needed: Program developers should collect key data from physicians on an ongoing basis, periodically analyze the data to gauge program impact, and regularly ask physicians for feedback about the results. These steps help maintain enthusiasm for the program, and ensure prompt responses to any problems or concerns that emerge.
  • Be opportunistic: External events may present an opportunity to create or expand policies and programs targeted at key stakeholders. For example, changes in health system policies regarding BMI documentation can be used by Let’s Go! staff to promote the need for changes in policy and practices in primary care settings.

More Information

Back to Top

Contact the Innovator

Victoria Rogers, MD
Director, The Kids CO-OP and Let's Go!
Barbara Bush Children's Hospital at Maine Medical Center
22 Bramhall Street
Portland, ME 04102
Phone: (207) 662-3747
E-mail: rogerv@mmc.org

Innovator Disclosures

Dr. Rogers has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

Let's Go! program Web site: http://www.letsgo.org.

Footnotes

1 Ogden C, Carroll M. Prevalence of Obesity Among Children and Adolescents: United States, Trends 1963-1965 Through 2007-2008. June 4, 2010. Available at: http://www.cdc.gov/obesity/childhood/data.html
2 National Conference of State Legislatures. Childhood Overweight and Obesity Trends. Available at: http://www.ncsl.org/research/health/childhood-obesity-trends-state-rates.aspx
3 Let’s Go! Annual Report Year Five, 2011. Available at: http://www.letsgo.org/wp-content/uploads/Lets-Go-Year-5-Annual-Report.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
4 2009 Maine Integrated Youth Risk Survey. Highlights—2009 State of Maine. Available at: http://www.maine.gov/youthhealthsurvey/fact_sheets.shtml
5 Koplan J, Liverman C, Kraak V (eds). Preventing childhood obesity: health in the balance. Washington, DC: National Academies Press; 2005.
6 Institute of Medicine of the National Academies. Childhood Obesity in the United States, Facts and Figures. September 2004. Available at: http://www.iom.edu/~/media/Files/Report%20Files/2004/Preventing-Childhood-Obesity-Health-in-the-Balance
/FINALfactsandfigures2.pdf
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: August 03, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: May 21, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.