Moving Pediatric Healthy Weight Interventions into Real-World Settings, Using Implementation Science to Address Access, Flexibility, and Sustainability

Abstract

ourteen million US children are affected by obesity, including 4.4 million with severe obesity. 1,2 Excess weight can put children and adolescents at risk for serious and costly short-and long-term adverse health outcomes, including, but not limited to, cardiovascular disease, type 2 diabetes mellitus, and nonalcoholic fatty liver disease. 3,4 Disparities in prevalence of obesity exist among different populations of children and adolescents. From 2015 to 2018, non-Hispanic black children and Mexican American youth 6-11 years of age had a higher prevalence of obesity (22.7% and 28.2%, respectively) than non-Hispanic white children (15.5%). 5 These disparities are often related to contextual differences and social determinants of health, including poverty and socioeconomic status, parental education, early adverse childhood events, and access to healthier food options and safe and affordable physical activity opportunities. [6][7][8][9] Childhood obesity is a multifactorial condition that requires multifaceted systemic approaches to address (1) the root causes of unhealthy weight and related chronic conditions, (2) barriers to access to healthy nutrition, active living, and effective treatment, and (3) disparate prevention and treatment efforts. Major advances in effective treatment of pediatric obesity have occurred over the past decade. 10 Many research trials show that pediatric weight management interventions (PWMIs), with a minimum of 26 hours of comprehensive family-based intervention delivered for a period of 2-12 months, are effective in improving health outcomes, including body mass index.

Children's rates of BMI change during pre‐pandemic and two COVID‐19 pandemic periods, IQVIA Ambulatory Electronic Medical Record, January 2018 Through November 2021

“…Our findings underscore the importance of ongoing obesity prevention efforts as well as increasing access to effective treatments, such as obesity medications for adolescents and family‐centered healthy weight programs that meet US Preventive Services Task Force recommendations [17]. Spread and scale of these comprehensive lifestyle programs, as well as insurance coverage and reimbursement, are important to ensure equitable access to evidence‐based care for children and families struggling with obesity [18].…”

Evaluating the Implementation of the Connect for Health Pediatric Weight Management Program

“…The frameworks allow for an understanding of barriers and facilitators so that programs and implementation strategies can be adapted to suit local contexts. 7,37 During program implementation, the health care organizations faced barriers and challenges.…”

“…Progress in reducing obesity prevalence and eliminating disparities can be achieved by implementing effective childhood obesity management interventions in primary care settings. 7,8 Connect for Health helps to fill that gap by delivering an evidence-based pediatric weight management program for systemwide delivery that leverages community and clinical resources to improve the quality of clinical care for childhood obesity. [9][10][11] In a randomized clinical trial (RCT), Connect for Health improved child body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and family-centered outcomes, including child health-related quality of life and parental empowerment.…”

“…10,11 Despite programs that have shown effectiveness, few programs have been implemented and studied in primary care settings due to a myriad of barriers, including shortage of resources, insurance coverage and reimbursement, program sustainability, and low prioritization of child health, which is critical to moving evidence from an RCT to routine practice to improve care for children and mitigate disparities. 7,12 This study aims to promote and facilitate the uptake of research evidence generated by the Connect for Health trial in 3 health care organizations with substantially high numbers of children living in low-income communities. We aimed to examine the extent to which our implementation strategies supported the implementation of the Connect for Health program at participating health care organizations using the Reach-Adoption-Effectiveness-Implementation-Maintenance (RE-AIM)…”

Five Priority Public Health Actions to Reduce Chronic Disease Through Improved Nutrition and Physical Activity

“…Researchers developed curriculum, training modalities, and implementation science metrics such as acceptability, fidelity, and maintenance so that packaged interventions can spread and scale and be delivered by a variety of professionals with fidelity. This will further the reach of family healthy weight programs across more health care, community, and public health organizations that serve children from low-income families (Goodman et al, 2021). DNPAO has also engaged state primary care associations and supported federally qualified health centers in five states through learning communities to help centers bring these programs into their existing workflows to support families.…”