Neighborhood-Level Variation in the Effectiveness of Intensive Health Behavior and Lifestyle Treatment for Pediatric...

This study assessed variation in BMI change by neighborhood characteristics of participants in Bright Bodies, a family-based intensive health behavior and lifestyle treatment for pediatric obesity.

For first-time participants (2008-2018) with initial BMI ≥ 85th percentile, we geocoded addresses and assigned Child Opportunity Index (COI) and COI-Healthy Environment (COI-HE) scores (Low/Moderate/High). Using multivariable mixed effect linear regression, we assessed monthly change in BMI percent of the 95th percentile (%BMIp95) and extended BMI z score by COI and COI-HE.

Of 391 youth (mean ± SD age 11.7 ± 2.8 years, 60.1% female), 80.8% resided in Low COI and 66.5% in Low COI-HE neighborhoods. Monthly %BMIp95 change differed by COI (p = 0.039 for interaction) and COI-HE (p = 0.004). Mean %BMIp95 decreased in all subgroups; greatest reductions were in High COI (-1.86 [95% CI: -2.40, -1.33]) and High COI-HE groups (-2.32 [-2.78, -1.85]) and lowest in Moderate COI (-1.17 [-1.59, -0.75]) and Low COI-HE groups (-1.53 [-1.75, -1.32]). Change in extended BMI z score differed significantly between COI-HE subgroups only (p < 0.001).

Bright Bodies participation was associated with BMI reduction among all COI/COI-HE subgroups, but the highest COI/COI-HE groups had the greatest reductions. Modifications to intensive health behavior and lifestyle treatments should address inequities in access to built environments that facilitate healthy, active living.