A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial

Area of Science:

• Pediatric primary care
• Obesity prevention
• Public health interventions

Background:

• Pediatric obesity is a growing concern, with limited provider time and treatment access in primary care settings.
• The American Academy of Pediatrics recommends lifestyle change interventions for improving Body Mass Index (BMI) in children.
• Effective, scalable interventions are needed to support families in managing pediatric BMI within primary care.

Purpose of the Study:

• To compare the effectiveness of two pediatric practice-based referral interventions for reducing children's BMI.
• To evaluate telephonic coaching versus a mailed workbook intervention for pediatric weight management.
• To assess the impact of these interventions on BMI percentile and z score in children aged 8-12 years.

Main Methods:

• A cluster-randomized clinical trial involving 20 pediatric primary care practices.
• Randomization to either telephonic coaching (Fitline Coaching) or a mailed workbook (Fitline Workbook).
• Assessment of 501 children (aged 8-12) with BMI at or above the 85th percentile at baseline, 6, and 12 months.

Main Results:

• Both interventions showed modest improvements in BMI percentile.
• No statistically significant decline in continuous BMI z score was observed in either group at 12 months.
• Telephonic coaching resulted in a clinically significant reduction (≥0.25) in BMI z score for 20.8% of participants, compared to 12.4% in the workbook group (p=0.0415).

Conclusions:

• Both low-intensity interventions were found to be acceptable and yielded modest improvements in BMI percentile.
• Telephonic coaching demonstrated a higher rate of clinically meaningful BMI z score improvement in children.
• Further research is warranted to determine the recommendation of such programs for routine pediatric primary care practice.