An energetic team of health care professionals is working to reduce the prevalence and consequences of pediatric obesity in Los Angeles through the Fit For Los Angeles program (Fit for L.A.). Funded in 2008 with a three-year $750,000 grant from UniHealth Foundation, Fit For L.A. combines professional development for UCLA resident physicians and LAUSD physicians, nurse practitioners and medical assistants, quality improvement strategies, motivational interviewing, and access to specialty care at community sites via telemedicine to provide comprehensive and coordinated services for overweight children and their families. Under the leadership of Dr. Wendy Slusser, Fit for L.A. merges the resources of Mattel Children’s Hospital at UCLA, the Los Angeles Unified School District’s Student Medical Services Division and Venice Family Clinic to make it easier for families to get the help their children need.
Esther Okafor is one of eighteen LAUSD Nurse Practitioners who perform required health assessments for children entering first grade in LAUSD’s 450 elementary schools. Services are funded via the Child Health and Disability Prevention (CHDP) program. Ms. Okafor explains that while doing assessments, she meets young families who are eager to learn how to help their children. And she has only one opportunity — in the one hour she has with their child — to link them to the services they need. “CHDP is all about prevention and intervention,” Ms. Okafor stresses, “and motivational interviewing has really helped get parents to change the way their children eat.”
When Ms. Okafor discovered that Janet’s Body Mass Index was approaching the 95th percentile, she explained to her mother why it’s important to keep an eye on Janet’s weight. She learned that mom works seven days a week but that she tries to cook the foods her family likes to eat at home, and she limits her kids’ TV time to one hour a day. “Cooking at home and limiting TV time is great,” stressed Ms. Okafor. Then she used the Toolkit for Maximizing the First Impact, created by LAUSD Nurse Practitioners in the Fit for L.A. program, to help mom understand how much fat is in various foods and what should be on the dinner plate. With Janet’s mom, she explored other changes the family could make to adopt good health habits. “You’re doing lots of things right,” Ms. Okafor told Janet’s mom, “so build on what you’re doing.” After an hour, Janet and her mom left with a completed school physical exam, nutrition and exercise guides, phone numbers for other resources and smiles on their faces.
“This program does make a difference,” Ms. Okafor insists, “one kid at a time.” Dr. Slusser agrees. “We’re at a tipping point with motivational interviewing,” she insists. We’re finding that over the past three years, 70% of the kids assessed by Nurse Practitioners trained in motivational interviewing are maintaining or losing weight. That’s huge!”
Fit for L.A. has also made accessing specialty care easier for families whose children are not improving under the care of their primary care physicians and are referred to the multispecialty clinic at UCLA. Telehealth patient care services at Venice Family Clinic in Santa Monica and the LAUSD San Miguel Clinic in South Gate mitigate the barriers of distance, transportation, and navigating and parking at the campus hospital. Patients go to the clinic site closest to their home and are seen in-person and via telehealth by primary care and specialists physicians in a single visit.
That’s how Manny and his dad regularly meet with Dr. Slusser, a nutritionist, a psychologist and other UCLA specialists as needed. Their visit begins in an exam room at Venice Family Clinic where a UCLA Resident Physician sees Manny and collects clinical information such as weight, height and blood pressure. They then move to the telehealth room where, with the help of a translator, they see and speak with their health care providers at UCLA over a secure computer network. Today Dr. Slusser has good news for Manny. He’s gotten taller and his weight is stable, so his BMI has dropped. Dr. Slusser asks Manny’s dad if Manny exercises at home. “He rides his bike and has a scooter,” responds dad. “Have him play as much as he can,” suggests Dr. Slusser, and turns Manny over to registered dietician, Yasmin Firouzman.
“How’s it going?” Ms. Firouzman asks. “Are you reminding Manny to eat slowly and chew his food well?” Dad responds that Manny is eating slower and not drinking juice any more. Dad asks what kind of cereal Manny should eat at breakfast and gets several ideas, a few of which are to Manny’s liking. They agree that the focus for improvement for the next week will be finding a healthier breakfast item. “We can do that,” dad says.
Finally, Manny and his dad meet with psychologist Amanda Feinstein. They talk about what’s going on at home, how Manny is sleeping and what he does for fun. Dad reports that Manny is a happy kid who likes watching TV and playing with his older brothers. Ms. Feinstein encourages dad to read to Manny as much as possible and gives him some suggestions for good books that he can get at the library. Manny likes that idea. Manny’s dad says that he is happy to be able to come to Venice Family Clinic because it would be too hard to get to UCLA. “It’s just like talking to the doctor in person,” he says, “and this way we can keep our appointments. They are teaching us how to help Manny so he won’t be sick when he grows up.”
And that’s the whole point of Fit for L.A — helping families learn how to keep their children fit so they won’t be sick when they grow up.