Left to right: Paul Estabrooks, Julie Lucero, Guilherme del Fiol, and David Wetter, who are the director, deputy director, and two co-directors of the PRC, respectively.
News — In the past four decades, the rate of childhood obesity has quadrupled, increasing kids’ risk of serious conditions, including type 2 diabetes and high blood pressure. This is a profoundly unequal public health crisis. Often driven by food insecurity or lack of access to organized physical activities, obesity is far more common in kids in low-income families or from rural areas.
The Mountain West Prevention Research Center (MW-PRC), launching with $5 million in federal funding from the Centers for Disease Control and Prevention, aims to address this crisis. Based at University of Utah Health, the center will collaborate with local organizations across the state and throughout Montana, Idaho, Nevada, Wyoming, and New Mexico. Its ultimate goal is to find ways to reduce childhood obesity, especially in rural communities that often lack the health care infrastructure of bigger cities.
Health promotion and other lifestyle interventions face particular challenges in the Mountain West, says associate professor in health and kinesiology in the College of Health at the University of Utah, who will be the deputy director of the center. "The states that we’re going to be working with are all often overlooked,” Lucero says. “They’re very rural, and there are a lot of people that have been forgotten in these areas.” With the launch of the PRC, U of U Health will be ideally positioned to work with community partners and make a difference in these regions, according to Lucero.
She hopes that, in addition to helping families adopt healthier behaviors, the center will provide data on kids’ health throughout the study region that can be used to drive meaningful change. She emphasizes that some factors, like the nutritional value (or lack thereof) of free or reduced-cost school lunches, are large-scale issues that will require top-down policy or funding changes, which the center’s work may inform.
Digital outreach, personal impact
The center’s core project will test different strategies to enroll people in a science-backed family healthy weight program designed for rural communities. The (BHF) program, originally developed by Kate Heelan, PhD, chair of exercise science and her team at University of Nebraska-Kearney, offers classes on lifestyle changes that support healthful nutrition and physical activity. Families also set goals and track behavior changes together.
The BHF program is known to lead to healthier behaviors and reduced weight for both children and adults. But identifying, inviting, and enrolling families in BHF can be difficult, and busy rural clinics often lack the time to regularly refer families to the program.
The PRC’s core research project will test a digital health approach that will identify families with children with obesity, then recruit them to the family healthy weight program through text messaging, alone or together with follow-up calls from community partners.
professor and vice-chair for research in biomedical informatics in the Spencer Fox Eccles School of Medicine, a principal investigator for the core project and co-director of the center, says that this text-based method was designed for rural residents, who often have limited access to internet or phone data but can usually access voice and text services. Additionally, automated reminders take the burden of referral off of busy local clinics and organizations, which may make the program more sustainable.
While participants will be recruited using digital technology, the healthy weight program itself is in person. professor of health and kinesiology in the College of Health, director of the center, and a principal investigator for the core project, says that the social aspect of the intervention is crucial. “We’ve found in our earlier research that bringing people together on a weekly basis, even in rural areas, creates an excellent social network that results in sustained health behavior changes and obesity reduction,” Estabrooks says.
While sending reminder texts may seem simple, Del Fiol emphasizes that it can have powerful results, citing a previous health intervention focused on at-home COVID testing in which automated texts engaged more people than “actual human” phone calls. “The simplest intervention was the most effective,” Del Fiol says.
The importance of community
Partnerships with community organizations will be critical to the project’s success, Estabrooks says, due to local health workers’ deep connection to their communities. The center’s work will be guided by a community advisory board composed of members from every partner state.
“Rural communities have their own culture,” Estabrooks explains. “And one of the best ways to make something culturally relevant is to rely on local strengths and develop capacity to sustain program implementation. Having people that have knowledge of the community is a necessity to having the impact that we're hoping to achieve.” Accordingly, the center aims to support connections between local community health centers and other community-based organizations such as local health departments, cooperative extensions, and parks and recreation. Such connections are key to engaging families with community organizations delivering BHF.
professor of population health sciences, director of the Center for HOPE at Huntsman Cancer Institute, and co-director of the PRC, adds, “We have been incredibly fortunate to create robust partnerships with community health centers, the federally designated primary care association, and the state department of health and human services in Utah. The PRC provides an outstanding opportunity to create similar partnerships throughout the entire Mountain West.”
The center will also provide a forum for health workers and intervention researchers to learn from their peers across communities, through an approach developed by associate professor in population health sciences and investigator on the core research project.
Once the program is established, other researchers at U of U Health will be able to apply to develop other prevention research projects in collaboration with the existing network of community partners. In turn, the center itself will be able to draw on lessons learned from 19 other PRCs across the nation.
Lucero hopes that the center will ultimately help bring the family healthy weight program to kids and parents across a huge swath of the country. “Maybe in five years we’ll have Building Healthy Families available in the Western states, and then we’re just going to be growing it from there,” she says. “This is huge.”
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