Background: The Mind, Exercise, Nutrition … Do it! (MEND) childhood obesity intervention was implemented in British Columbia (B.C.), Canada from April 2013 to June 2017. The study objective was: a) to describe and explore program reach, attendance, satisfaction, acceptability, fidelity, and facilitators and challenges during scale-up and implementation of MEND in B.C. while b) monitoring program effectiveness in improving children's body mass index (BMI) z-score, waist circumference, dietary and physical activity behaviours, and psychological well-being. Methods: This prospective, pragmatic implementation evaluation (Hybrid Type 3 design) recruited families with children and adolescents aged 7-13 with a BMI ≥ 85th percentile for age and sex. The 10-week MEND B.C. program was delivered in 27 sites, throughout all five B.C. health regions (Northern, Interior, Island, Fraser, and Vancouver Coastal) over 4 years. Families attended two weekly in-person group sessions aimed to increase physical activity and promote healthy eating. BMI z-score and waist circumference were measured at baseline and follow-up. Dietary and physical activity behaviours and psychological well-being were measured using validated questionnaires. A mixedmethod approach was used to collect and analyze the data. Results: One hundred thirty-six MEND B.C. programs were delivered over 4 years. The program reached 987 eligible participants. 755 (76.5%) children and adolescents completed the program. The average program attendance was 81.5%. Parents reported the program content was easy to understand, culturally suitable, respectful of family's financial situation, and provided adequate information to build a healthy lifestyle. Children achieved significant positive changes across all four evaluation years in BMI z-score (d = − 0.13), nutrition behaviours (d = 0.64), physical activity levels (d = 0.30), hours of screen time per week (d = − 0.38) and emotional distress (d = − 0.21). Challenges to continued program implementation included: recruitment, resource requirement for implementation, and the need to tailor the program locally to be more flexible and culturally relevant.

IntroductionFamily-based behavioural weight management interventions are efficacious and widely used to address childhood obesity. Curriculum and strategies vary extensively and scale-up often depends on ensuring that the intervention fits the adoption context.Aims and objectivesTo evaluate the impact and implementation of a ‘made in British Columbia’ (BC) family-based early intervention programme (EIP) for 8–12 years old with overweight and obesity and their families.Methods and analysisA randomised waitlist-control trial will assess a 10-week interactive, family-based lifestyle intervention followed by four maintenance sessions, in BC, Canada. We aim to enrol 186 families. The blended intervention includes at least 26 contact hours between participants and programme providers, including interactive activities and educational materials through weekly 90-min group sessions, an online family portal, and self-directed family activities. Curricular content includes information and activities related to healthy eating, physical activity (PA), positive mental health, parenting practices and sleep hygiene. The waitlist control group will receive a modified programme with the same 10-week sessions in the family portal, and four group sessions. Families participate in data collection at baseline, postintervention (week 10) and follow-up (week 18). The primary outcome is to assess changes in child body mass index z-score at 10 weeks between the groups. Secondary outcomes include changes at 10 weeks between the groups in child and parent PA behaviour and skills, healthy eating behaviour, and mental health. Process evaluation will address reach, implementation and maintenance (baseline, 10-week and 18-week) using recruitment tracking forms, parent questionnaire, programme attendance tracking forms, leader feedback surveys, parents and children satisfaction surveys and postprogramme interviews with facilitators, stakeholders and parents. Intention-to-treat analyses will be conducted. Process evaluation will be analysed thematically.Ethics and disseminationStudy procedures were designed to address research and community needs and will follow ethical standards.Trial registration number NCT03643341.

Background The Mind, Exercise, Nutrition…Do it! (MEND) childhood obesity intervention was implemented in British Columbia (B.C.), Canada from April 2013 to June 2017. The study objective was: a) to describe and explore program reach, attendance, satisfaction, acceptability, fidelity, and facilitators and challenges to implementation during scale-up and implementation of MEND in B.C. while b) monitoring program effectiveness in improving children’s body mass index (BMI) z-score, waist circumference, dietary and physical activity behaviours, and psychological well-being.Methods This prospective, pragmatic implementation evaluation (Hybrid Type 3 design) recruited families with children aged 7-13 with a BMI ≥ 85th percentile for age and sex. The 10-week MEND B.C. program was delivered in 27 sites, throughout all five B.C. health regions (Northern, Interior, Island, Fraser, and Vancouver Coastal) over four years. A mixed-method approach was used to collect and analyze the data. Evaluation measures included: program reach, attendance, fidelity, acceptability, satisfaction, facilitators and challenges to implementation, and effectiveness (change in children’s BMI z-score, physical activity, screen-time, eating behaviours, self-esteem and emotional distress).Results 136 MEND B.C. programs were delivered over four years. The program reached 987 eligible children. 755 (76.5%) children completed the program. The average program attendance was 81.5%. Parents reported the program content was easy to understand, culturally suitable for their family, respectful of their family's financial situation and provided adequate information to build a healthy lifestyle. Children achieved significant positive changes across all four evaluation years in BMI z-score, nutrition behaviours, physical activity levels, hours of screen time per week and emotional distress (p<0.05). Challenges to continued program implementation included: recruitment, resource requirement for implementation and the need to tailor the program locally to be more flexible and culturally relevant.Conclusions Scaling up efficacious childhood obesity interventions into real-world settings is critical to combat the obesity epidemic. Future family-based childhood obesity management interventions need to explore strategies to enhance program delivery flexibility while optimizing the use of health care resources.