Embedding weight management into safety-net pediatric primary care: randomized controlled trial

Area of Science:

• Pediatric Endocrinology
• Public Health
• Clinical Trial Research

Background:

• Implementing evidence-based pediatric overweight and obesity treatment is difficult in low-resource settings.
• A randomized controlled trial was conducted in a safety-net pediatric primary care clinic in Bronx, New York.
• The study evaluated standard care versus standard care plus an enhanced program for treating pediatric overweight/obesity.

Purpose of the Study:

• To assess the effectiveness of an enhanced program in improving pediatric weight management outcomes.
• To determine if an enhanced program offers benefits beyond standard care in a safety-net setting.
• To evaluate the impact on body mass index (BMI) Z-score and metabolic parameters.

Main Methods:

• A 12-month randomized controlled trial involving 360 children aged 7-12 years with BMI at or above the 85th percentile.
• Participants were assigned to either Standard Care Alone (quarterly pediatrician visits) or Standard Care + Enhanced Program (additional skill-building and support sessions).
• The enhanced program utilized bilingual staff for family-based behavioral counseling.

Main Results:

• Both groups showed a significant decline in mean BMI Z-score (P < 0.01), with no significant difference between the two arms.
• The Standard Care + Enhanced Program group demonstrated significantly greater improvements in total cholesterol, low-density lipoprotein cholesterol, aspartate aminotransferase, and alanine transaminase compared to Standard Care Alone.
• These metabolic improvements were statistically significant (P values ranging from 0.02 to 0.05).

Conclusions:

• Safety-net primary care settings can effectively deliver pediatric weight management services.
• Targeted family-based behavioral counseling contributes to modest BMI Z-score improvements in overweight/obese children.
• An intensive lifestyle intervention program shows potential for improving metabolic health parameters in pediatric obesity management.