Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention.

Area of Science:

• Public Health
• Pediatrics
• Behavioral Science

Background:

• Existing childhood obesity interventions often fail to reach medically underserved populations or adapt to settings lacking full interdisciplinary teams.
• Community-academic partnerships are crucial for developing and implementing effective pediatric weight management interventions (PWMI) in diverse settings.

Purpose of the Study:

• To adapt Epstein's Traffic Light Diet (TLD) into a community-placed, evidence-based PWMI called Building Healthy Families (BHF).
• To evaluate the effectiveness of the adapted BHF program in reducing BMI z scores among children aged 6-12 years with obesity.
• To document and classify adaptations made to the intervention using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME).

Main Methods:

• A community-academic partnership iteratively adapted the TLD into the BHF program for nine cohorts of families.
• The FRAME guided the documentation of planned, stakeholder-driven adaptations, including adding family-based approaches, removing calorie counting, and substituting physical activity metrics.
• The study evaluated changes in BMI z scores at 6-month follow-up for children who completed the 12-week BHF program.

Main Results:

• Across nine cohorts, 69 out of 84 initiating families completed the 12-week BHF program, with 45 attending 6-month follow-up.
• The BHF program resulted in a significant reduction in children's BMI z score by 0.31 ± 0.17 at 6 months.
• Adaptations varied in effectiveness, with BMI z score reductions ranging from 0.41 in cohort 4 to 0.13 in cohort 5.

Conclusions:

• Iterative adaptations improved the fit of the BHF program to its specific community setting and participants.
• The adapted BHF program represents a sustained, community-placed PWMI that maintains core evidence-based principles.
• Monitoring adaptations and their impact on outcomes is vital for the long-term sustainability and effectiveness of community-based interventions.