The Role of Primary Care-based Initiatives in Childhood Obesity Prevention Intervention
Introduction
While most Western countries have identified the high prevalence of childhood obesity,
controversy still surrounds the issue as to which are the most effective intervention initiatives to
be adopted to manage the risks (Kerkez et al., 2013). Numerous studies have demonstrated the
strong association of physical activity and obesity, while others identify physical fitness, as a
closely related to obesity. Prevention and management interventions are likely to be effective
when the target is primary interventions integrated with increased physical activity, nutrition
education, and decreased sedentary behaviors. Therefore, it is imperative to investigate the most
effective intervention initiatives that can be adopted to comprehensively address these issues.
The study reviews the role of primary care-based initiatives in childhood obesity intervention.
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), 1-16.
The authors, Wright, et al., (2014), contend that their research was motivated by the need
to establish the cost of health interventions as a basis for decision makers such as health
practitioners, to assess its affordability and prioritize resources among other competing
programs. The application of the techniques cannot, however, be decided upon without first
assessing the financial and time resources needed to implement them. The study used the high
five kids intervention method in which a cluster-randomized trial was undertaken from 2006-
2008 across 10 non-profit pediatric offices in Massachusetts. The intervention used was based on
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the Chronic Care Model, which holds that all members of the pediatric care practice team ought
to participate actively in an intervention to change the patient’s behavior successfully, and
improve health outcomes. Parent time costs and out-of-pocket costs for visits were then valued.
Intervention costs were found to be higher than usual care costs obtained in the base case
analysis. The cost was $258per kid as per the base case analysis compared with $63 per child in
usual care. This implies that the economic burden of one of primary care-based intervention is
quite high.
Data on direct medical costs and training costs are of particular interest to medical
providers planning to implement. The research is instrumental and effective in providing the
potential costs involved in primary care-based interventions. However, to get sense of the real
value of these interventions in terms of gain in health or outcomes relative to dollars spent
requires a cost-effective analysis. The study also used a small population of practices which
leads to concern about the generalization of the findings of the study to other practices.
Ilker Kerkez, F., Tutal, V., & Akcinar, F. (2013). Malnutrition / Obesity Prevalence in Children
between The Ages 3 And 6 And Mother – Child Bmi Relation. International Journal Of
Academic Research, 5(5), 202-205.
The study by Kerkez et al. (2013) was conducted to establish obesity and malnutrition
prevalence among children of ages 3 to 6 years, as well as the mother child, Body Mass Index
(BMI) relation. It involved 675 children registered in 11 preschool institutions among them 346
males and 311 females and their mothers. The study identified that 14% of the children were
thin, 10.4% risky fat while 8.2% were considered obese. Consequently, 1.6% of mothers were
found to be thin, 38.3% were risky fat and 16.4% being obese. Obese prevalence was to be
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higher in boys than in girls. Positive correlations were established between the BMI of mothers
and children. The study, therefore, identified obesity among children between the ages of 3 to 6
years as a health problem related to BMI of mothers and children. The condition should be
fought against by monitoring the nutrition and weight of mothers starting from the pregnancy
period and providing healthy nutrition and physical activity and lifestyle habits for the children.
The results of the Kerkez et al. (2013) were compliant with similar studies conducted
previously. However, the study was limited in the monitoring of weight and nutrition for long-
term and continuous status in this cross sectional scanning model of study. Basically, more study
is required to determine overweight and shortness during the preschool period.
Galavíz, K. I., Tremblay, M. S., Colley, R., Jáuregui, E., López y. Taylor, J., & Janssen, I.
(2012). Associations between Physical Activity, Cardiorespiratory Fitness, and Obesity in
Mexican Children. Salud Pública De México, 54(5), 463-469.
Galaviz et al. (2012) conducted a study to examine the relation of physical activity and
the cardio-respiratory fitness with measures of obesity. The participants involved were 193
children from Guadalajara in the 5 th and 6 th grade. Measurement of the number of skin folds,
BMI, and the weight circumference were taken. Physical activity was measured over a period of
four days using a pedometer while fitness was measured using a 20 meter shuttle-run test.
Physical activity and fitness were found to be negatively correlated to the obesity measures in
both girls and boys. The study concluded that fitness strongly correlates and predicts obesity than
physical activity. This analysis is important in the sense that it can be used to guide future health
initiatives aimed at countering childhood obesity through a primary care-based approach. Future
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research concerning further analysis of associations should involve larger, more representative
population samples.
Reynolds, M. A., Jackson Cotwright, C., Polhamus, B., Gertel-Rosenberg, A., & Chang, D.
(2013). Obesity Prevention in the Early Care and Education Setting: Successful Initiatives across
a Spectrum of Opportunities. Journal of Law, Medicine & Ethics, 418-18.
The study by Reynolds et al. (2013) Early Care and Education (ECE) study focused on
demonstrating the innovative community, state, national obesity prevention efforts. It was
organized around a variety of spectrum of opportunities for the prevention of obesity in ECE.
The authors have outlined a set of opportunities capable of enhancing the ECE situation in regard
to physical activity, nutrition, breast feeding, and screen time. These areas according to this study
are all important for prevention of obesity for young children. The authors note that with over
28% of 2-6year olds in U.S. obese or overweight, preventive efforts that address the issue are
important. In this regard, they contend that the best places to reach the young children are the
ECE setting, including day care homes, child care centers, and preschools. They base this
preposition on the fact that, over 61% of children, less than 6 years are deemed to be in non-
parental care on a weekly basis. Also, about 11 million spend an average of 32 hours per week in
non-parental care.
The argument championing for the use of ECE settings in obesity management
interventions is strong and is based on substantially convincing facts to present the need for
health interventions to be initiated in ECE centers. The evidence presented by the analysis is
sufficient to form a strong basis for informed decision making. Future efforts should be focused
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on equipping ECE providers with the necessary training, resources, and technical assistance to
facilitate implementation of obesity prevention programs.
Gollust, S. E., Niederdeppe, J., & Barry, C. L. (2013). Framing the Consequences of Childhood
Obesity to Increase Public Support for Obesity Prevention Policy. American Journal of Public
Health, 103(11),
Gollust et al, (2013) examined the implications of messages describing the effects of
childhood obesity on the attitudes of the public concerning obesity prevention policy. They
collected data from two surveys from two nationally representative surveys on the internet where
2494 respondents were involved. The respondents perceived messages about health
consequences of childhood obesity to be strongest rationale for government action. This implies
that Americans assign the primary responsibility for reducing childhood obesity to the parents
rather than the government, food beverage, or schools. In this regard, this study offers new
knowledge that messages contextualizing obesity in broader societal terms such as schools, food
industry, and community other than just parents and children may be effective in increasing the
public support for and consequently the government feasibility of the obesity policies.
Preschool Staff Members’ Perceptions of the Implementation of a Grant-Funded Intervention
Program Designed To Combat Childhood Obesity: A Phenomenological Approach.
(2013). Education, 134(2), 255-265.
The study championed the analysis of preschool staff members’ perception of obesity
prevention program grant-funded and implemented within a preschool setting in which 50% of
the kids were classified as obese. It involved eight preschool employees who made substantial
changes in their daily routine to meet the requirements of this new health activity program. Each
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respondent reported a positive feeling making a change for the wellbeing of the children. The
findings of this study reflect previous studies that suggest that extensive intervention efforts
would be effective at interrupting the patterns of childhood obesity. It was also effective in its
recommendation for comprehensive physical and health education starting on curriculum, be
implemented at all levels of school grades starting with preschool. However, the small
population sample population used in the study presents the challenge of using the same as a
basis for more generalized postulations for the greater population.
Gorin, A. A., Wiley, J., McCauley Ohannessian, C., Hernandez, D., Grant, A., & Cloutier, M. M.
(2014). Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program
for young children. BMC Public Health, 14(1), 1-20.
The 12 month study by Gorin et al. (2014) recruited 150 mother-child dyads and BMC
offered by nurses and clinicians. Gorin et al. (2014) seeks to demonstrate repeated doses for
motivational interviewing coupled with specific core behavioral strategies such as screen time,
physical activity, and milk consumption. The study identified pediatric primary case clinicians
the most significant health problem facing most families today. The concern is that it is normally
not addressed as a part of the routine care. Although numerous calls have been made for the
primary care providers and programs to expand their role in preventing obesity, there has been
identified time, resource, training shortage in obesity management. The study is also innovative
in its primary focus on very young children, testing of reversal obesity, and the use of routine
clinic visits in analyzing obesity management.
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Sola, K., Brekke, N., & Brekke, M. (2010). An Activity-Based Intervention For Obese And
Physically Inactive Children Organized In Primary Care: Feasibility And Impact On Fitness and
BMI. Scandinavian Journal of Primary Health Care, 28(4), 199-204.
Sola et al. (2010) set out to investigate the feasibility and effect on physical fitness and
BMI of an intervention for inactive and obese children based on physical activity and undertaken
in primary health care. A total of 64 physically inactive children of ages ranging from 6-14 years
were involved in a 40 week structured intervention based on physical training and lifestyle
advice for one parent and the obese child. A total of 32 out of the 64 children completed the
training. The activity-based intervention for the inactive and obese children in primary health
care succeeded in increasing the physical fitness and cardiovascular capacity combined with
reduced BMI. This study confirms other related studies that demonstrate that physical inactivity
contributes significantly to the present obesity epidemic in the Western world. The study lacked
a control group and a distinction between the boys and girls.
McCallum, Z. Z., Wake, M. M., Gerner, B. B., Baur, L. A., Gibbons, K. K., Gold, L. L., & …
Waters, E. E. (2009). Outcome Data from the LEAP (Live, Eat and Play) Trial: A Randomized
Controlled Trial of a Primary Care Intervention for Childhood Overweight/Mild
Obesity.International Journal Of Obesity, 31(4), 630-636.
McCallum et al. (2009) sought to reduce the gain in BMI in overweight, obese children in
the primary case setting through a randomized controlled trial within a baseline cross-sectional
survey. A total of 2112 children were involved in the study ages 5 to 10 years. Their study was a
post randomized parent-reported health status, child nutrition, and physical activity and child-
reported body satisfaction, health status and self-worth. They found a relative improvement in
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the nutrition scores, in the intervention and a weak evidence of an increase in physical activity in
the intervention arm. They came to conclusion that intervention did not lead to a sustained BMI
reduction. The brief individualized focused solution or training may not have been effective to
childhood obesity. Increasing either would result in a significant implication in terms of cost and
resources. The study’s major strength was the use of the randomized design and the high uptake
by families. The retention rate and period of study, one year, were also high rating. However, for
variant results future studies should focus on primary are consultations and the use of techniques
such as simulated patients reporting on their experiences.
McKee, M., Maher, S., Deen, D., & Blank, A. E. (2010). Counseling to Prevent Obesity among
Preschool Children: Acceptability of a Pilot Urban Primary Care Intervention. Annals Of Family
Medicine, 8(3), 249-255.
McKee et al. (2010) survey was aimed at helping design primary-based interventions.
They explored the reactions of urban parents towards a pilot and feasibility study which was
designed to address obesity risk behaviors among preschool children. Their study involved 3
focus groups with participants exploring the acceptability of the intervention components and the
fidelity of the intervention delivery. They found out that parents expressed desire to change
behaviors and achieve healthier families. The parents were found to be more accepting of
nutrition discussions than the physical activity and cited a lack of safe outdoor space. Parent’s
contact with lifestyle counselors was identified as empowering. This study was instrumental in
raising the awareness of the need for physicians to help deliver health behavior change messages
effectively. In addition, the study revealed the overall acceptability of approaches that integrate
health behavior change with preventive care for preschool children. The study was limited in its
restriction on family recruitment that made visits and agreed to fill the screening questionnaire.
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Sivertsen, L. M., Woolfenden, S. R., Woodhead, H. J., & Lewis, D. (2008). Diagnosis and
Management Of Childhood Obesity: A Survey of General Practitioners in South West
Sydney. Journal Of Paediatrics & Child Health, 44(11), 622-629.
The study by Sivertsen et al., (2008) sought to describe the general practitioners’
diagnosis and management of obesity in children, attitudes concerning obesity, and awareness of
clinical practice guidelines. The researchers used a cross-sectional survey of 137 members of the
General Practice Division in Liverpool. Most of the respondents prescribed correct interventions
but with variability in complications screening. Only 8% used BMI charts to correctly diagnose
childhood obesity. Barriers to treatment of obesity reported were lack of community supports
and parental denial. The study identified the motivation awareness of the need for managing the
childhood obesity among general practitioners. However, as the study, revealed primary care
approach requires support through greater community awareness of the impact of childhood
obesity. The study was a major insight into the underlying factors surrounding the issue of
childhood obesity where different people and communities hold diverse cultural beliefs about
obesity which may have direct impacts on their perception towards primary care intervention.
Campbell, K. J., & Hesketh, K. D. (2008). Strategies which Aim to Positively Impact on Weight,
Physical Activity, Diet and Sedentary Behaviors in Children From Zero to Five Years. A
Systematic Review of the Literature. Obesity Reviews, 8(4), 327-338.
The authors Campbell and Hesketh (2008) reviewed different literature on childhood
obesity prevention interventions targeting obesity-preventing behaviors such as sedentary
behaviors and physical activity. The focus was on children under the age of 5 years
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interventions, and nine studies from U.S.A were used in the review. The researchers identified
some common themes across the studies which could form the basis for the most effective
strategies to achieve healthy weight outcomes in young children. Most of the studies
demonstrated success in changing of some behaviors in children in, for example, reduction in
television viewing and fat intake. The review was, however, challenged the limited number of
studies that have been done and published in this area. The study supported previous empirical
studies that families can be supported to provide effective changes to influence the propensity for
overweight in their children. Most of the health interventions can be classified as the high-
intensity interventions in which parents were involved several times and in a range of contexts
by their health providers.
English Composition II – Task 2
Introduction
The discussion has established existence of high prevalence of childhood obesity around
the world. The study has reviewed numerous literature on the use of primary care-based
initiatives in managing the risks of obesity among children. Several studies have demonstrated
the strong association of physical activity and obesity while other identify physical fitness as a
closely related to obesity. These two factors coupled with nutrition no doubt independently affect
adiposity through different mechanisms. Therefore, it is imperative to investigate the most
effective intervention initiatives that can be adopted to comprehensively address these issues.
The study reviews the role of primary care-based initiatives in childhood obesity intervention.
Several issues were also identified as crucial contributing factors to the success of the
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implementation of primary care initiatives such as perceptions of mothers, communities, health
practitioners, and cost.
Childhood Obesity Prevalence Rates
According to Wright et al., (2014) the government and other agencies have identified the
need for comprehensive management initiatives. For instance, the Pertinent Protection and
Affordable Care Act of 2010 promotes the use of preventive care and mandates insurers to cover
obesity counseling and screening services as part of their policies. In 2007, an expert committee
in the U.S. recommended that obesity counseling be done in a primary care setting. The
utilization of motivational interviewing techniques in these settings has been proven to be
programmatically effective and feasible in improving health behaviors. A study by Kerkez et al.
(2013) identified that 14% of the children were thin, 10.4% risky fat while 8.2% were considered
obese. Positive correlations were established between the BMI of mothers and children. The
study, therefore, identified obesity among children between the ages of 3 to 6 years as a health
problem related to BMI of mothers and children. The problem of obesity among children is
associated with sedentary leisure activities and reduced daily physical activity. Studies have
demonstrated the role of regular physical activity in reducing risk of mortality and improving
health.
Literature review of different studies on childhood obesity prevalence in the USA and
across the world reveal high rates and recommendations champion for the adoption of
comprehensive programs that involve different levels of participation from parents, community,
children, food industries, and schools. The studies identified that, over 26% adults as obese, 36%
overweight, and 28% 0f 2-6year olds across the U.S. are obese or overweight. This demonstrates
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just how preventive efforts that address the issue are necessary (Campbell & Hesketh, 2008). The
challenge for health promotion and public health practitioners is, therefore, how to engage
effectively individuals in behaviors which can manage, reduce, or prevent obesity. The most
vulnerable population being children of age 6 years and below since they require other people to
make such healthy decisions for them and to see them through each stage of such initiatives.
Simplistic messages of eat less-exercise more; seem to have limited impact on changing
people’s behaviors. Furthermore, public health related warning messages on the risks related to
obesity appear everywhere on industry marketing campaigns with limited impact. Many activists
of obesity preventive programs have suggested the use of a range of promotional techniques and
approaches including social marketing. News articles and policy reports often frame the problem
and challenge of childhood obesity by emphasizing the consequences it has on medical costs,
health, and some other nonmedical outcomes. Such concerns are postulated with the aim to
heighten policy maker and public attention to obesity and to engage sectors who would otherwise
be uninterested.
Primary Care-based Behavior Change Interventions
Kerkez et al. (2013) study on obesity and malnutrition prevalence among children
identified a positive correlation between the BMI of mothers and children. Obesity among
children between the ages of 3 to 6 years is a health problem that calls for initiatives such as
monitoring the nutrition and weight of mothers starting from the pregnancy period and providing
healthy nutrition and physical activity and lifestyle habits for the children. Fitness strongly
correlates and predicts obesity than physical activity (Galaviz et al., 2012). This analysis is
ENGLISH COMPOSITION 2 13
important in the sense that it can be used to guide future health initiatives aimed at countering
childhood obesity through a primary care-based approach.
In addition, studies organized around a variety of spectrum of opportunities for the
prevention of obesity in ECE such as physical activity, nutrition, breast feeding, and screen time.
These areas are all important for the prevention of obesity among young children. The best
places to reach the young children are the ECE setting, including day care homes, child care
centers, and preschools. This argument is based on the argument that over 61% of children less
than 6 years old are deemed to be in non-parental care on a weekly basis. Also, about 11 million
spend an average of 32 hours per week in non-parental care (Reynolds et al., 2013). This
argument is strong and is based on substantially convincing facts to present the need for health
interventions to be initiated in ECE centers. The evidence presented by the analysis is sufficient
to form a strong basis for informed decision making. Future efforts should be focused on
equipping ECE providers with the necessary training, resources, and technical assistance to
facilitate implementation of obesity prevention programs.
Another approach to the problem of childhood obesity is the use of repeated doses for
motivational interviewing coupled with specific core behavioral strategies such as screen time,
physical activity, and milk consumption (Gorin et al., 2014). The concern is that obesity is
normally not addressed as a part of the routine care. Although concerns have been raised for the
primary care providers and programs to expand their role in preventing obesity, there is a
challenge of shortage of time, resource, and training in obesity management. Sola et al. (2010)
study on the feasibility and effect of an intervention for inactive and obese children on physical
fitness and BMI confirmed the effectiveness of such initiatives as physical fitness in improving
cardiovascular capacity and reducing IBM. This study confirms other related studies that
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demonstrate that physical inactivity contributes significantly to the present obesity epidemic in
the Western world. The success of primary care interventions to a great extent depends on
collaborations across the different sectors to develop a comprehensive integration.
Cross-cutting Issues in Primary Care-based Interventions
Consequently, the implementation of primary care interventions is highly dependent on
the cost-effectiveness of the program. Data on direct medical costs and training costs are of
particular interest to medical providers and other interested parties planning to implement the
projects. In addition, studies have also demonstrated that Americans assign the primary
responsibility for reducing childhood obesity to the parents rather than the government, food
beverage, or schools (Gollust et al., 2013). This implies that messages contextualizing obesity in
broader societal terms such as schools, food industry, and community other than just parents and
children may be effective in increasing the public support for and consequently the government
feasibility of the obesity policies. Primary care programs would work best when implemented as
comprehensive physical and health education at all level grades starting with preschool. They
must be comprehensive in the sense that the educators of the children, who spend more time per
week with them, are involved as well as the medical practitioners who are instrumental in the
measurement for obesity and offering lifestyle counseling. In addition, parents and children
should also play an integral role in addressing the childhood obesity by monitoring diets,
exercise, and inactivity in children. The government’s participates in drafting policies that
support primary care interventions and awareness across the community.
Conclusion
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The discussion has demonstrated that childhood obesity is currently epidemic across the
world, and especially in the Western nations. The need for effective intervention strategies for
obese and overweight children stands the best chance of preventing severe physical and
psychosocial morbidity. The problem of obesity among children is associated with sedentary
leisure activities and reduced daily physical activity. This calls for immediate response through
cooperation by medical practitioners, government agencies, communities, parents, and other
stakeholder to tackle this issue. Suggestions on the most effective approach greatly point to
primary care-based interventions, for a number of reasons. Basically, the contemporary lifestyle
demands that parents do not spend most of their time with children leaving them under child-care
and school setups. Additional factors likely to influence the success of primary based
interventions were also identified, for instance, perceptions of mothers, communities, health
practitioners, and cost. Preventing childhood obesity is an international health priority with data
showing that the weight increases begin right early in childhood. Obesity and overweight are
known to have numerous negative effects on children’s wellness and health during their
childhood and even later in their adulthood. Prevention measures are poorly understood and yet
of paramount importance. Preventive and management behaviors learnt during early childhood
establish lifestyles and behaviors that track throughout individual’s lifespan.
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References
Campbell, K. J., & Hesketh, K. D. (2008). Strategies Which Aim to Positively Impact on
Weight, Physical Activity, Diet and Sedentary Behaviours in Children From Zero To
Five Years. A Systematic Review of the Literature. Obesity Reviews, 8(4), 327-338.
Galavíz, K. I., Tremblay, M. S., Colley, R., Jáuregui, E., López y. Taylor, J., & Janssen, I.
(2012). Associations Between Physical Activity, Cardiorespiratory Fitness, and Obesity
in Mexican Children. Salud Pública De México, 54(5), 463-469.
Gollust, S. E., Niederdeppe, J., & Barry, C. L. (2013). Framing the Consequences of Childhood
Obesity to Increase Public Support for Obesity Prevention Policy. American Journal Of
Public Health, 103(11),
Gorin, A. A., Wiley, J., McCauley Ohannessian, C., Hernandez, D., Grant, A., & Cloutier, M. M.
(2014). Steps to Growing Up Healthy: A Pediatric Primary Care Based Obesity
Prevention Program for Young Children. BMC Public Health, 14(1), 1-20.
Ilker Kerkez, F., Tutal, V., & Akcinar, F. (2013). Malnutrition / Obesity Prevalence in Children
between the Ages 3 and 6 And Mother – Child Bmi Relation. International Journal of
Academic Research, 5(5), 202-205.
McCallum, Z. Z., Wake, M. M., Gerner, B. B., Baur, L. A., Gibbons, K. K., Gold, L. L., & …
Waters, E. E. (2009). Outcome Data from the LEAP (Live, Eat and Play) Trial: A
Randomized Controlled Trial of a Primary Care Intervention for Childhood
Overweight/Mild Obesity.International Journal of Obesity, 31(4), 630-636.
ENGLISH COMPOSITION 2 17
McKee, M., Maher, S., Deen, D., & Blank, A. E. (2010). Counseling to Prevent Obesity among
Preschool Children: Acceptability of a Pilot Urban Primary Care Intervention. Annals Of
Family Medicine, 8(3), 249-255.
Preschool Staff Members’ Perceptions of the Implementation of a Grant-Funded Intervention
Program Designed to Combat Childhood Obesity: A Phenomenological Approach.
(2013). Education, 134(2), 255-265.
Reynolds, M. A., Jackson Cotwright, C., Polhamus, B., Gertel-Rosenberg, A., & Chang, D.
(2013). Obesity Prevention in the Early Care and Education Setting: Successful
Initiatives across a Spectrum of Opportunities. Journal Of Law, Medicine & Ethics, 418-
18.
Sivertsen, L. M., Woolfenden, S. R., Woodhead, H. J., & Lewis, D. (2008). Diagnosis and
management of childhood obesity: A survey of General Practitioners in South West
Sydney. Journal Of Paediatrics & Child Health, 44(11), 622-629.
Sola, K., Brekke, N., & Brekke, M. (2010). An Activity-Based Intervention for Obese And
Physically Inactive Children Organized in Primary Care: Feasibility and Impact on
Fitness and BMI. Scandinavian Journal Of Primary Health Care, 28(4), 199-204.
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), 1-16.