Despite recent progress in obesity prevention, the prevalence of overweight and obesity in the US remains at historically high levels and racial/ethnic and socioeconomic disparities persist. Many factors contribute to the intractability of obesity but promising approaches for prevention and reduction are emerging including multi- sector, collaborative interventions across settings where children spend their time. Members of our research team at the Massachusetts Department of Public Health (MDPH) and the Massachusetts General Hospital have been at the forefront of innovation in childhood obesity prevention and management using clinical, community, and environmental approaches. We now seek to build on these innovative strategies to specifically optimize the care of low-income children with a body mass index (BMI) ? 85th percentile and in whom far greater energy deficits will be necessary to achieve improvements in BMI than those that can be achieved with community and environmental approaches alone. To achieve this goal, we propose a new clinical-community intervention, theoretically grounded in the Integrated Clinical and Community Systems of Care Model, to address obesity through optimized screening and management known to be effective in the STAR trial, e- Referrals developed by MDPH, Healthy Weight Clinics tested in the Massachusetts Childhood Obesity Research Demonstration project, and the YMCA's Healthy Weight and Your Child weight management program (originally known as MEND). We will aim to implement a model of high quality care for addressing overweight and obesity among 6-12 year old children that includes (a) computerized point-of-care decision supports to primary care providers to improve obesity screening and counseling; (b) educational materials and interactive text messages for self-guided behavior change support; (c) links to community resources to support behavior change; and (d) EHR-referral based, structured pediatric weight management. In a nested, randomized controlled trial we will also examine the comparative effects of a pediatric weight management program delivered in a Healthy Weight Clinic vs. the YMCA's Healthy Weight and Your Child program. Our study will examine outcomes for children that matter most to a broad group of stakeholders including parents, clinicians, and public health practitioners as well as inform the care of >7 million children with overweight or obesity covered by the Children's Health Insurance Program or Medicaid. To achieve these aims, we have assembled a multidisciplinary team with extensive expertise in implementation and evaluation of paradigm- shifting, clinical and community weight management programs as well as the use of health information technology to connect clinical delivery systems with community resources to improve health outcomes. Collaboration with Medicaid will ensure the sustainability of the program, which if successful, may provide a new model of obesity care for the very segment of the population who need it most.
Despite recent evidence of progress, overall rates of childhood overweight and obesity remain at historically high levels and racial/ethnic and socioeconomic disparities persist. Community and environmental approaches can be effective in preventing overweight but far greater energy deficits will be needed for children who already have a body mass index ? 85th percentile. The overall goals of this study are to optimize the care of low- income children with overweight or obesity and to test the comparative effectiveness of clinic- and community- based pediatric weight management programs in improving obesity-related outcomes.
| Fiechtner, Lauren; Perkins, Meghan; Biggs, Vincent et al. (2018) Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial. Contemp Clin Trials 67:16-22 |
