The prevalence of overweight/obesity among children and adolescents remains a public health priority. A convergence of evidence supports the efficacy of comprehensive family-based lifestyle approaches for the treatment of pediatric obesity, as reflected in the U.S. Preventive Services Task Force (USPSTF) Grade B recommendation for clinicians to refer identified youth to such programs. Despite this call to action, the vast majority of children struggling with obesity do not have access to evidence-based care. The most pressing need is in youth from low-income families, who are at greatest risk of obesity and least likely to have access to care. Delivering interventions through community settings offers one strategy for increasing access. The JOIN for ME program, developed as a collaboration between United HealthGroup and Y-USA, is a pediatric weight management intervention that can be delivered in community settings, with potential for national dissemination. Consistent with empirically supported family-based interventions, the JOIN for Me program includes strong parental involvement, use of effective behavioral strategies such as self-monitoring, and intervention targets that focus on reducing consumption of energy dense, nutrient poor foods and beverages, decreasing sedentary behavior, and increasing physical activity. Findings from an open trial (N=115) and subsequent randomized controlled trial (N=75) demonstrate significant and meaningful reductions in weight status in children 6-12 years of age; 4.3% and 5.5% decrease in percent overweight. We propose to package the JOIN for ME program to increase acceptability and feasibility for delivery in low-income communities and test implementation in two novel settings: the housing authority and the patient- centered medical home. The revised JOIN for ME package will be tested in a rigorous implementation study, the goals of which are to: 1) examine key implementation metrics of program acceptability, feasibility, fidelity, reach, and cost through comprehensive assessment of process measures, qualitative data, and cost analyses and 2) evaluate patient outcomes, including changes in child and parent weight status and health-related quality of life (HRQL). A total of 128 children (ages 6-12 years) with BMI > 85th% from low-income families and a primary caregiver will be enrolled to participate in the JOIN for ME program offered through one of four settings using a delayed treatment onset design. We will evaluate a series of implementation outcomes to examine constructs of reach, acceptability and feasibility through process measures and multi-informant qualitative interviews. It is hypothesized that children who receive the JOIN for ME program first will demonstrate greater decrease in percent over median BMI and greater improvements in HRQL than those in the delayed treatment onset who receive the intervention four months later. Implementation and effectiveness outcomes will be compiled, examined, and reviewed with Community and Payer Advisory Boards to develop a plan for large scale dissemination of the JOIN for ME program.
Relevance: Pediatric obesity is a significant public health concern that disproportionately impacts children from low income backgrounds. Despite the documented efficacy of family-based weight control interventions, very few children have access to such evidence-based programs. The proposed study will test implementation of an evidence-based pediatric weight management intervention, JOIN for ME, through delivering in public housing and the patient-centered medical home.
