Starting Right Initiative

Obesity has become our nation’s fastest growing health problem. Currently there are more than twice as many obese children and three times as many obese adolescents in the US as there were 30 years ago. The epidemic rise in pediatric overweight has brought with it multiple health risks for children and adolescents, including type 2 diabetes (T2DM) and cardiovascular disease.

Poor and minority children are most vulnerable, experiencing higher prevalence and worse health outcomes. The South Bronx community has one of the highest rates of obesity in NYC. More than one in four adults (27%) are considered obese. Our review of a random sample of pediatric medical charts in 2004 showed that 44% of school-aged children at Children's Health Fund’s South Bronx Health Center for Children & Families are at risk of health problems associated with overweight and obesity.

Starting Right is a multi-faceted initiative designed to create and implement a new model of pediatric primary care for medically underserved populations and to increase awareness of the risks of obesity including T2DM. The initiative has focused on:

• Developing pediatric-specific screening and diagnostic protocols, in affiliation with the Children's Hospital at Montefiore;
• Training providers about pediatric obesity and appropriate screening and referral protocols;
• Enhancing the level of pediatric primary care to include the new screening protocols to identify children at high risk and include targeted health education messages in the primary care visit;
• Implementing intervention and prevention strategies that work with families and communities to promote healthy diet, physical activity, weight, and other lifestyle choices; and
• Developing culturally and linguistically appropriate health education materials to support and expand the reach of this aspect of the initiative.

Starting Right has begun a health and fitness group that combines health education with opportunities for physical activity at the local Police Athletic League. The impact of the program on the knowledge, attitude and behavior of participating children is being assessed in partnership with the Mailman School of Public Health, Columbia University. A strong public policy and advocacy component of Starting Right is focused on facilitating health insurance reimbursement for nutrition counseling for high risk children before they are diagnosed with T2DM or a similarly preventable condition.