Tell me a little about the Choices program.
The project is being developed because, on the whole, physicians don't tend to have many strategies in their pockets to deal with pediatric obesity. And more and more parents now--with all the attention to it in the news and all the obesity--are asking physicians what to do. And the structure of fee-for-service medical care means that normally, it's just one physician seeing a kid once a month, or something like that. But what we're trying to do is called a group office visit, which means you bring a number of people together, and a physician sees them each time and weighs them. You can bill for a minimal office visit. But by having 10 together, it becomes cost-effective to see them every week. So you couldn't really have enough physician time to see children that often, but by putting them all together, it works. And it's better for the kids, we think, and the parents to be coming in groups, anyhow.
This could become a tool for physicians?
We're testing this model of doing it with the physicians involved ... to see if you can build something that could happen in the clinic and can kind of be packaged, so there'd be maybe a 12-session class, and we could have materials all ready to go, so a physician's office could actually do it. ... It's not the way to solve the problem, but you sort of figure that every channel through which the information can come is probably beneficial.
Statistics indicate that Latino children are more likely to be overweight than their white peers. How will your program target the particular needs of Latino children?
The nature of our clinic is that it's a very ethnically diverse clinic, and so this program is being run in a mixture of English and Spanish. We're not really set up for kids who only speak Spanish (monolingual Spanish-speaking parents are OK), but everything else in terms of English and Spanish, we can pretty much handle--as long as kids speak English, we're pretty much OK. Actually, most of our overweight kids are Hispanic, even though only about 40 percent of our clinic population are Hispanic.
What do you have to do to target that population?
Think of two components: So there's the kids' component, and I don't really think that component is much different, because our basic interventions are: chew smaller portions to start with and stop when you're not hungry; don't drink sugared beverages, drink water; and have more fruits and vegetables. That's kind of the dietary thing. And the exercise thing is: Watch less television; play more. Do fun physical-activity things. ... So, I think for kids--white, yellow, red, black, whatever color--those messages are going to be pretty much the same.
What about the parents and families?
I think the difference comes in the family component, which Mary is going to lead. We're dealing across a pretty broad socioeconomic spread in our clinic, so this isn't an upper-middle-class, white, organic-food-driven, highly educated group. It's probably going to be more working-class people, who may have less access to Prevention magazine and all these other sorts of things that they can have. I think there's going to be more education; it's going to be in a mixture of English and Spanish, and it's going to include issues about a lot of the foods that are more typically Hispanic--but here in Tucson, everybody eats tortillas and all that kind of stuff. So, I think maybe that's a difference compared to some of the stuff that's on the market and widely available, which is sort of more targeted at the high end.