Abstract
BackgroundImplementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States).MethodsIn a 12-month trial, families of children (age 7–12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions.ResultsThe mean body mass index Z-score declined in both arms (P < 0.01) with no significant difference between the Standard Care Alone (0.12 kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15 kg [SE: 0.03]) arm (P = 0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P = 0.05), low-density lipoprotein cholesterol (P = 0.04), aspartate aminotransferase (P = 0.02), and alanine transaminase (P = 0.03) concentrations.ConclusionsSafety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters.Trial registrationClinicalTrials.gov Identifier: NCT00851201. Registered 23 February 2009.
Highlights
Implementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings
The main study finding was that children in both the Standard Care Alone and Standard Care + Enhanced Program arms achieved a significant decrease in body mass index (BMI) Zscore during the 12-month intervention period in response to an embedding weight management program consistent with the American Academy of Pediatrics overweight/obesity recommendations
Clinical implications Children who are ≥85th BMI percentile for age and sex can be readily identified in public hospital setting using electronic health record (EHR) data, and their families can be recruited to participate in a weight management program in collaboration with primary care providers
Summary
Implementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States). Evidence-based care standards from the American Academy of Pediatrics for the prevention and treatment of obesity in children recommend supporting families to make lifestyle changes, addressing excess body weight in children as a chronic condition, and providing advice about weight-related health risk factors [1,2,3,4]. Little is known about how to integrate family weight management services that address these barriers and minimize dropout in safety-net health care settings. Our practice-based study evaluated the efficacy of novel strategies for embedding weight management services into pediatric ambulatory care in a publically funded safety-net care system
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