By Geraldine A. Collier CORRESPONDENT
Wednesday, April 30, 2014 — Sixteen-year-old Kwabena Adwetewabadu wouldn’t put a piece of broccoli in his mouth even if he was starving, but his mother buys the vegetable anyway and sneaks it into dishes she cooks up.
Twin sister Abena loves all fruits and vegetables and chops them up every morning to take in her lunch to school as well as for her dad to take with him to work.
As for exercise, Abena plays soccer in the fall, basketball in the winter and tennis during the spring at South High School. “During the summer, I train for all of them,” she added.
Twin brother Kwabena’s exercise is found on the tennis court, but he also rides a bike and walks. And, both he and his sister carry water bottles to school and practice, instead of drinking sugary or energy boosting drinks.
Neither one finds it very difficult to follow the “Let’s Go! 5-2-1-0 Healthy Habits program they and their mother learned about on a visit to the office of their pediatrician, Dr. Jennifer Bram at the UMass Memorial Pediatric Primary Care Medical Group.
Colorful posters on the clinic’s walls proclaim 5-2-1-0, acting as a simple aid that reminds families of the different paths that, taken together, can lead youngsters toward living a healthier life:
5 or more fruits or vegetables
2 hours or less recreational screen time (television, video games, computers, etc.)
1 hour or more of physical activity
0 sugary drinks, more water, and low-fat milk
And a brief 5-2-1-0 Healthy Habits questionnaire filled out by children and their parents helps to involve both the parent and the pediatrician in an ongoing discussion about healthy choices.
“The nice thing about the questionnaire that we use is that it focuses the conversation on behaviors and not so much weight,” said Dr. Bram. “You start talking about a child’s weight and people get defensive; they feel judged, and that’s not really productive in terms of trying to help families make good choices.
“So, it opens up the conversation to what kinds of things would make a positive change. And it’s meant to engage the parents in working with their child as opposed to talking at them,” said Dr. Bram. “It’s really important that the whole family does it together.”
With financial backing from the Harvard Pilgrim Health Care Foundation, the Let’s Go! program has expanded out from Maine, where it’s been active since 2006, into New Hampshire and Central Massachusetts.
Let’s Go! fights obesity by “getting children up and moving and getting them eating healthy,” said Dr. Tory Rogers, program director. “We work wherever kids live, learn, work and play.”
The Harvard Pilgrim Health Care Foundation pays for technical support and printed materials as well as for the time of Dr. Bram, who has recruited the group’s 10 doctors and two nurse practitioners to be Let’s Go! champions, and Dr. Martha Waite, a pediatrician with the Reliant Medical Group, who has introduced the program to other pediatricians at the eight Reliant pediatric sites in Central Massachusetts.
All patients in these pediatric practices are eligible to be involved in the Let’s Go! program, not just the children insured by Harvard Pilgrim Health Care.
“Data tells us that the sooner we get healthy habits incorporated into the lifestyle of a child, the more likely they are to continue those healthy habits as an adult,” said Dr. Rogers. “That’s why we spend a lot of time working on creating healthy environments in early childhood.”
According to a study published in the New England Journal of Medicine, one out of four Massachusetts school-age children are overweight or obese.
“There were always a few children who were overweight or obese, but I think it has gotten worse in the last few years,” said Dr., Waite, who had already started using the Let’s Go! program in her pediatric practice some time ago, after hearing about it at a medical conference.
A great many families realize that it’s a bad thing for their children to be fat, but “they really don’t know what to do to stop it,” said Dr. Waite. “I can point to this poster and say: ‘well here’s a couple of easy ideas. Do you do any of these?’ If they look at the fruit and vegetables and say they do one. I can then say, ‘well can you do two or three of these’ — setting that as a goal.”
As far as exercise goes, Dr. Waite recalls one family where she figured out with the parents that if the child walked to school and back every day — well, that’s half a mile there and a half mile back. And the child ends up walking a mile a day.”
Dr. Waite often finds the 5-2-1-0 program tends to change not only the habits of the child, but the whole lifestyle of the family. “It’s something parents look at and say ‘well I probably could do that too.’ ”
A child may be overweight or even obese and may not seem to experience any more health problems than the average child, but there’s a real difference in years to come, if something isn’t done now.
“If you can prevent weight gain while a child is growing up, you can actually help them to escape a future of chronic diseases: heart disease, cancer, diabetes, any number of things which will be really expensive for all of us,” said Karen Voci, president of the Harvard Pilgrim Health Care Foundation.
“And as a health plan, we care about health costs,”
Of course, there can be obstacles to families and their children changing habits, especially if the family is a low-income one.
Supermarkets and farmers markets may not be accessible, and vegetables and fruit can be very expensive to buy. Families can also live in neighborhoods where there are no yards in which children can play or where it can be unsafe for children to play outside.
The problem acquiring fruits and vegetables may have some solution, even if it is a temporary one. Separate from the Let’s Go! program, the Harvard Pilgrim Health Care Foundation is sponsoring a Veggie Mobile that, beginning in June, will travel a set schedule around Worcester, with stops at community health centers, subsidized family housing and elderly projects.
The mobile staff will speak languages common to most of their customers, will demonstrate how to use the food, even allowing customers to taste different things, according to Voci. Food stamps will be accepted.
In an effort to expand the 5-2-1-0 program, the Reliant Medical Group applied for and was given a grant by the Reliant Medical Group Foundation to work with the Central YMCA on a nutrition and exercise program for some of their heaviest patients and their families.
Patients go once a week for eight weeks and meet with both a nutritionist and a personal trainer who will instruct them in physical activities they can do at home, according to Dr. Waite.
“It’s really been fun and it has been great to see some of our children and their families who have really benefited from it,” said Dr. Waite.