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Prevention Plus Program to Combat Childhood Obesity

At Cherokee Health Systems (CHS), a federally qualified health center which provides integrated primary care to the underserved in East Tennessee, the prevalence of overweight and obesity in children aged 4 to 10 years is approximately 42%. Over 50% of households with children receiving care at CHS are food insecure, lacking in sources for affordable, healthy food. These children are at high risk for experiencing health disparities later in life.

Hollie Raynor


Under the direction of Hollie Raynor, interim assistant dean of research and professor of nutrition, implementing “Prevention Plus” (PP) is recommended for childhood obesity treatment within a primary care setting.

“We have evaluated PP to determine the best combination of energy balance behaviors and frequency and mode of contact over six months, to optimize reductions in standardized body mass index (zBMI) in children aged 4 to10 years,” said Raynor.

The PP program has reduced zBMI to a degree that should improve cardio metabolic health in young children, which is important in addressing health disparities. However, the ability of this program to improve weight status when delivered by primary care providers to underserved children is unknown.

Household food insecurity is prevalent with CHS families. A family-based approach, in which energy balance behavior goals are provided to both caretaker and child, may reduce overall family adherence and program satisfaction. Female caretakers in food insecure households may feel less comfortable meeting their own dietary goals while participating in an intervention for their child. They also may be concerned with the degree of change required in purchasing food perceived as more costly when multiple family members have dietary goals. Not addressing these concerns may reduce overall effectiveness of the program in CHS.

The program will explore the moderating effect of household food security status of participants with and without caretaker goals and will be implemented through the electronic health record (EHR) and delivered by CHS primary care providers, Behavioral Health Consultants.