Topic: Obesity, Nutrition/Diet, Physical Activity
Target Population: Early Childhood, Parents
Sector: Medical Setting
This program is for youth who are 2 to 6 years old and whose body mass index (BMI) exceeds the recommendations for their age and gender and their parents.
High Five for Kids, a clinically based program, is designed to improve the dietary habits of participants in order to reduce obesity.
A randomized controlled trial was conducted in 10 pediatric practices in Massachusetts. After 1 year of program implementation, no significant differences between the intervention and control groups were observed for BMI measurements, fast food intake, or sugar-sweetened beverage consumption. However, youth in the intervention group significantly decreased their TV and video viewing compared to the control group. At 2 years post implementation, the differences in TV viewing between the two groups were no longer significant.
High Five for Kids was created for pediatric primary-care offices and combines restructuring of patient care and motivational interviewing during primary-care visits to teach families about obesity and encourage them to overcome challenges in adopting and practicing healthy habits.
Pediatric nurse practitioners deliver motivational interviewing counseling sessions to parents and their children. These sessions include educational modules on the six behaviors associated with obesity. Nurse practitioners follow a printed script that is matched to each family’s stage of readiness to change and encourage parents to set and achieve the following goals for their children:
Families are encouraged to choose one or more of the six behaviors to focus on changing. They receive printed handouts for each in-person session and electronic tools for self-management between in-person visits and follow-up telephone calls; lists of local community resources for regular physical activity; and an interactive High Five for Kids website that includes educational materials, recipes, and other features that can be accessed from home. Families receive small incentives, such as water bottles and snack containers, and an electronic television-monitoring device to help with the goal of reducing daily television viewing. In addition, primary-care physicians use brief, motivational interviewing-based, negotiation skills at all routine well-child visits to encourage family behavior change.
Changes to the medical practice include enhancing the existing electronic medical-record system with tools to help clinicians with decision support, patient tracking, follow up, scheduling, and billing. In addition, an online toolkit is included that includes a poster to be placed in the patient waiting room that outlines the six target behaviors.
The program has been tested in 445 youth who received pediatric care at Harvard Vanguard Medical Associates from 2006 to 2008. The extent to which the program has been used outside of this is unknown.
This program is delivered by nurse practitioners and physicians, and a 2-day training is required for these individuals. In addition, the Implementation Guide includes information needed for delivery of the program. Please use details in the Contact section to learn more.
Considerations for implementing this program include acquiring buy-in from pediatric healthcare providers, ensuring families are committed to attending more clinic visits than are typical, working with health insurance providers to cover the additional clinic visits for youth who participate in the program, understanding that program implementation may be costly, and ensuring the program components are delivered with fidelity.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing High Five for Kids, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
The program consists of a 1-year intensive implementation phase followed by a 1-year less intensive maintenance phase. There are seven motivational interviewing counseling sessions (four 25-minute in-person sessions and three 15-minute telephone sessions). Primary care physicians conduct a 5- to 10-minute interview at the annual well-child care visit. A medical assistant spends 4 to 5 minutes at each well-child care visit and in-person counseling visit to collect anthropometric measurements.
According to Wright et al. (2014), total costs for the intervention group in the first year of a randomized trial of the program were $65,643. The mean costs for the intervention were $259 per child. Please visit https://ebccp.cancercontrol.cancer.gov/productDownloads.do?programId=2539629 to preview the Implementation Guide, and contact Sarah Price by email snprice@mgh.harvard.edu to obtain program materials.
To move High Five for Kids to the Effective category on the Clearinghouse Continuum of Evidence at least one external evaluation must be conducted that demonstrates sustained, positive outcomes. This study must be conducted independently of the program developer.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact Sheryl Rifas-Shiman by phone 1-617-867-4824 or email sheryl_rifas@harvardpilgrim.org
https://ebccp.cancercontrol.cancer.gov/programDetails.do?programId=2539629, Rifas-Shiman et al. (2017), Taveras et al. (2011), and Wright et al. (2014).
Cespedes, E. M., Horan, C. M., Gillman, M. W., Gortmaker, S. L., Price, S., Rifas-Shiman, S. L., … Taveras, E. M. (2014). Participant characteristics and intervention processes associated with reductions in television viewing in the High Five for Kids study. Preventive Medicine, 62, 64-70. https://doi.org/10.1016/j.ypmed.2014.02.005
Rifas‐Shiman, S. L., Taveras, E. M., Gortmaker, S. L., Hohman, K. H., Horan, C. M., Kleinman, K. P., … Gillman, M. W. (2017). Two‐year follow‐up of a primary care‐based intervention to prevent and manage childhood obesity: The High Five for Kids study. Pediatric Obesity, 12(3), e24-e27. https://doi.org/10.1111/ijpo.12141
Taveras, E. M., Gortmaker, S. L., Hohman, K. H., Horan, C. M., Kleinman, K. P., Mitchell, K., … Gillman, M. W. (2011). Randomized controlled trial to improve primary care to prevent and manage childhood obesity the High Five for Kids study. Archives of Pediatrics & Adolescent Medicine, 165(8), 714-722. https://doi.org/10.1001/archpediatrics.2011.44
Martínez-Andrade, G. O., Cespedes, E. M., Rifas-Shiman, S. L., Romero-Quechol, G., González-Unzaga, M. A., Benítez-Trejo, M. A., … Gillman, M. W. (2014). Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City. BMC Pediatrics, 14(1), 77-77. https://doi.org/10.1186/1471-2431-14-77
Hohman, K. H., Price, S. N., Rifas-Shiman, S. L., Taveras, E. M., & Gillman, M. W. (2008). Abstract PS1-13: High Five for Kids: Predictors of participation in a clinically-based obesity prevention intervention. Clinical Medicine & Research, 6(3-4), 133-133. https://doi.org/10.3121/cmr.6.3-4.133-a
Killedar, A., Lung, T., Taylor, R. W., & Hayes, A. (2023). Modelled distributional cost-effectiveness analysis of childhood obesity interventions: A demonstration. Applied Health Economics and Health Policy, 21(4), 615-625. https://doi.org/10.1007/s40258-023-00813-9
Sonneville, K. R., Rifas-Shiman, S. L., Haines, J., Gortmaker, S., Mitchell, K. F., Gillman, M. W., & Taveras, E. M. (2013). Associations of parental control of feeding with eating in the absence of hunger and food sneaking, hiding, and hoarding. Childhood Obesity, 9(4), 346-349. https://doi.org/10.1089/chi.2012.0149
Sonneville, K. R., Rifas‐Shiman, S. L., Kleinman, K. P., Gortmaker, S. L., Gillman, M. W., & Taveras, E. M. (2012). Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial. Obesity, 20(7), 1449-1454. https://doi.org/10.1038/oby.2012.43
Taveras, E., Gortmaker, S., Kleinman, K., Mitchell, K., Price, S., Prosser, L., ... Gillman, M. (2010). C-C2-02: The High Five for Kids study: An intervention to improve primary care to prevent childhood obesity. Clinical Medicine & Research, 8(3-4), 204-204. https://doi.org/10.3121/cmr.2010.943.c-c2-02
Taveras, E. M., Hohman, K. H., Price, S. N., Rifas‐Shiman, S. L., Mitchell, K., Gortmaker, S. L., & Gillman, M. W. (2011). Correlates of participation in a pediatric primary care-based obesity prevention intervention. Obesity, 19(2), 449-452. https://doi.org/10.1038/oby.2010.207
Woo Baidal, J. A., Price, S. N., Gonzalez-Suarez, E., Gillman, M. W., Mitchell, K., Rifas-Shiman, S. L., … Taveras, E. M. (2013). Parental perceptions of a motivational interviewing–based pediatric obesity prevention intervention. Clinical Pediatrics, 52(6), 540-548. https://doi.org/10.1177/0009922813483170
Wright, D. R., Taveras, E. M., Gillman, M. W., Horan, C. M., Hohman, K. H., Gortmaker, S. L., & Prosser, L. A. (2014). The cost of a primary care-based childhood obesity prevention intervention. BMC Health Services Research, 14(1), 44-44. https://doi.org/10.1186/1472-6963-14-44
