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CHECK: A randomized trial evaluating the efficacy and cost-effectiveness of home visitation in pediatric weight loss
B M Appelhans1, S A French2, L E Bradley3
1Department of Preventive Medicine, Rush University Medical Center, United States of America; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America.
Insights
Home-based pediatric weight loss treatment may improve access and outcomes for children in low-income families. The Creating Health Environments for Chicago Kids (CHECK) Trial is evaluating this approach compared to clinic-based treatment.
Area of Science:
- Pediatric obesity intervention research.
- Public health and healthcare delivery systems.
- Behavioral science and health psychology.
Background:
- Socioeconomically disadvantaged households exhibit high rates of pediatric overweight/obesity.
- Barriers to accessing traditional healthcare-based weight loss treatments exist for these populations.
- Home-based delivery of family-centered interventions may improve attendance, tailor recommendations, and increase accountability.
Purpose of the Study:
- To evaluate the efficacy of home-based versus clinic-based family-centered weight loss treatment for children in low-income households.
- To assess the cost-effectiveness of home visitation in pediatric weight loss interventions.
- To investigate the mechanisms through which home visitation influences treatment outcomes.
Main Methods:
- The Creating Health Environments for Chicago Kids (CHECK) Trial is a randomized controlled trial with 266 children (ages 6-12) with overweight/obesity in low-income households.
- Participants are randomized 1:1 to receive standard family-based weight loss treatment delivered either at home or in an academic medical center.
- The primary outcome is the change in child BMI z-score at 12 months; cost-effectiveness and treatment mechanisms will also be analyzed.
Main Results:
- This section is not applicable as the abstract describes the trial design and not the results.
- This section is not applicable as the abstract describes the trial design and not the results.
- This section is not applicable as the abstract describes the trial design and not the results.
Conclusions:
- Findings will inform future intervention designs for pediatric weight management in underserved populations.
- Results will guide dissemination strategies for public health agencies and third-party payers.
- The study aims to optimize the delivery of effective and accessible weight loss treatments for children facing socioeconomic disadvantages.
Background:
Socioeconomically-disadvantaged households have a high prevalence of pediatric overweight/obesity, and also face barriers to accessing weight loss treatment in healthcare settings. Delivering family-based pediatric weight loss treatment in the home setting may enhance its efficacy by facilitating treatment attendance, enabling more tailored treatment recommendations informed by observations of the home environment, and increasing accountability. This paper describes the design of the Creating Health Environments for Chicago Kids (CHECK) Trial, which evaluates the efficacy, cost-effectiveness, and mechanisms of home visitation in family-based pediatric weight loss treatment for children in low-income households.
Design:
CHECK is a two-arm, parallel group, randomized controlled trial that is enrolling N = 266 children, ages 6-12 y, who have overweight/obesity (BMI percentile ≥85) and live in a low-income household. Participants are randomized in a 1:1 ratio to either standard of care family-based weight loss treatment delivered in the home, or the identical intervention delivered in an academic medical center. The primary outcome is change in child BMI z-score from baseline to 12 months. Program delivery costs are rigorously documented to enable cost-effectiveness analyses from the societal and payer perspectives. Objectively-documented changes to the home environment and aspects of intervention delivery (e.g., hours of in-person contact received, quantity of behavioral goals set per session) will be tested as hypothesized treatment mechanisms.
Implications:
Findings will inform the design of future interventions, and treatment dissemination decisions by public health agencies and third-party payers.
Trial Registration:
ClinicalTrials.gov identifier: NCT03195790.
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