Home-Delivered Pediatric Weight Management for Low-Income Families: A Randomized Controlled Trial

Children from lower-income households lose less weight in family-based weight management interventions, likely due to barriers to treatment attendance and adherence. The CHECK randomized controlled trial tested whether delivering pediatric weight management interventions in the home improves weight loss outcomes relative to clinic-delivered intervention.

Enrolled families included 269 children (137 boys) who were aged 6 to 12 years, had overweight/obesity, and lived in lower-income English- or Spanish-speaking households in Chicago, Illinois (2017-2022). All families received a 12-month pediatric weight management intervention with 18 planned in-person sessions and 12 planned telephone contacts. The sole difference between arms was the location (home vs clinic) of in-person intervention sessions. Intention-to-treat analyses compared treatment arms on 12-month change in BMI z-score (zBMI), intervention session attendance and contact time, and secondary clinical outcomes.

Twelve-month zBMI change did not differ (P = .58) between the home-delivered (n = 133; -0.031, SD = 0.26) and clinic-delivered arms (n = 136; -0.002, SD = 0.30). Across both arms, session attendance and total contact time predicted larger decreases in zBMI. Both variables were higher in the home-delivered arm (median = 11 sessions, 500 minutes) than the clinic-delivered arm (median = 6.5 sessions, 315.5 minutes; P values < .001). Post hoc analyses indicated that home-delivered (vs clinic-delivered) intervention led to 0.03 (SE = 0.008, P = .0004) greater zBMI reductions across time points prior to the COVID-19 pandemic, but not after.

Home delivery did not improve overall 12-month weight loss outcomes. Home-delivered intervention did increase session attendance and contact time and may have had beneficial weight loss effects prior to the COVID-19 pandemic.