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Objectives To describe the design, feasibility, and acceptability of a theory-informed obesity and dental caries prevention pilot study, Baby Steps to Health, conducted in an academic dental clinic among a primarily Asian immigrant population. Methods Baby Steps used self-determination theory and behavioral motivation strategies for a caregiver/child (6-36 months) nutrition and oral health behavior change intervention implemented in a pediatric dental clinic. Caregivers completed a dietary practice assessment to identify risk behaviors and potential courses of action. With assistance from dental providers, caregiver responses were matched to customized dietary behavioral guidance and a behavior change goal to reinforce caregivers' autonomous motivation to improve feeding practices. A 1-month, post-visit phone caregiver interview assessed adherence to the behavioral goal(s) and solicited qualitative input for further program development. Results Fifty caregivers (82 percent Asian) participated in the initial visit, and 46 (92 percent) participated in the follow-up interview. Reported obesogenic/cariogenic risk behaviors were prevalent: 57 percent of bottle-fed children consumed non-water beverages in bottles to aid sleep and 38 percent of parents offered snacks ad libitum. At follow-up, 93 percent of caregivers who selected goals reported positive behavior change and 91 percent said they would participate in a similar future program. Conclusions Tailored guidance delivered in a program that uses self-determination theory may represent a strategic use of the dental encounter to impart actionable information and motivate health-related behavior change for families with very young children. Partnerships between dental and nutrition professionals offer opportunities to address key dietary behaviors that may prevent obesity and improve oral health, particularly among at-risk children.

Objective: The purpose of this quasi-experimental study was to examine the effect of a computerized point-of-care alert with clinical decision support on the rates of diagnosis of childhood obesity in a multisite group practice in Massachusetts; Cambridge Health Alliance (CHA) which implemented an alert, relative to a separate group practice, Harvard Vanguard Medical Associates (HVMA), that did not. Design and Methods: Height and weight data from 19,466 children of 2-18 years with 34,908 well-child care visits in CHA and 123,446 children with 282,271 visits in HVMA between 2006 and 2008 were collected. The alert and decision support tool was activated for CHA patients with an age- and sex-specific body mass index of ≥95th percentile. The main outcome measure was documentation of an International Classification of Diseases, Ninth Revision [ICD-9] code for obesity before and after implementation of the alert at CHA in 2007. Results: Among obese children, the adjusted rate of an ICD-9 diagnosis of obesity increased from 2006-2007 to 2008 significantly more at CHA than at HVMA (P < 0.001 for time-by-provider group interaction). In 2006-2007, the rate of ICD-9 diagnosis of obesity was significantly lower at CHA than at HVMA (adjusted odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.52-0.62); but by 2008 was significantly higher at CHA than HVMA (adjusted OR: 1.25; 95% CI: 1.14-1.38). Conclusion: A point-of-care alert was effective in improving obesity diagnosis in a multisite group practice, relative to a separate group practice that did not adopt an alert. Clinical decision support tools could help improve obesity diagnosis in pediatric primary care.

Physical fitness is often inversely associated with adiposity in children cross-sectionally, but the effect of becoming fit or maintaining fitness over time on changes in weight status has not been well studied in children. We investigated the impact of changes in fitness over 1–4 years of follow-up on the maintenance or achievement of healthy weight among 2,793 schoolchildren who were first measured as 1st to 7th graders. Students were classified as “fit” or “underfit” according to age- and gender-specific norms in five fitness domains: endurance, agility, flexibility, upper body strength, and abdominal strength. Weight status was dichotomized by BMI percentile: “healthy weight” (

The objective of this study was to assess the impact of a community-based healthy weight intervention on child weight and fitness. Cambridge Public Schools (CPS) have monitored BMI and fitness annually since 2000. Annual increases of overweight and obesity from 2000 (37.0%) to 2004 (39.1%), triggered a multidisciplinary team of researchers, educators, health care, and public health professionals to mobilize environmental and policy interventions. Guided by the social-ecological model and community-based participatory research (CBPR) principles, the team developed and implemented Healthy Living Cambridge Kids (HLCK), a multicomponent intervention targeting community, school, family, and individuals. The intervention included city policies and community awareness campaigns; physical education (PE) enhancements, food service reforms, farm-to-school-to-home programs; and family outreach and "BMI and fitness reports". Baseline (2004) to follow-up (2007) evaluation design assessed change in children's weight and fitness status. A cohort of 1,858 K-5th grade children participated: 37.3% black, 14.0% Hispanic, 37.1% white, 10.2% Asian, 1.7% other race; 43.3% were lower income. BMI z-score (0.67-0.63 P < 0.001) and proportion obese (20.2-18.0% P < 0.05) decreased, and mean number of fitness tests (0-5) passed increased (3.7-3.9 P < 0.001). Whereas black and Hispanic children were more likely to be obese at baseline (27.0 and 28.5%, respectively) compared with white (12.6%) and Asian (14.3%) children, obesity among all race/ethnicity groups declined. Concurrent with a 3-year community intervention, modest improvements in obesity and fitness were observed among CPS children from baseline to follow-up. The CBPR approach facilitated sustaining policies and program elements postintervention in this diverse community.

OBJECTIVES: To determine relationships between physical fitness and academic achievement in diverse, urban public school children. METHODS: This cross-sectional study used public school data from 2004 to 2005. Academic achievement was assessed as a passing score on Massachusetts Comprehensive Assessment System (MCAS) achievement tests in Mathematics (fourth, sixth, and eighth grade, n = 1103) and in English (fourth and seventh grade, n = 744). Fitness achievement was assessed as the number of physical fitness tests passed during physical education (PE). Multivariate logistic regression analyses were conducted to assess the probability of passing the MCAS tests, controlling for students’ weight status (BMI z score), ethnicity, gender, grade, and socioeconomic status (school lunch enrollment). RESULTS: The odds of passing both the MCAS Mathematics test and the MCAS English test increased as the number of fitness tests passed increased (p < .0001 and p < .05, respectively). CONCLUSIONS: Results show statistically significant relationships between fitness and academic achievement, though the direction of causation is not known. While more research is required, promoting fitness by increasing opportunities for physical activity during PE, recess, and out of school time may support academic achievement.