Primary Care Practice-Based Framework for Childhood Obesity Treatment Utilizing Health Coaching and a Behavioral Screening Tool: the My Health, My Way! Randomized Controlled Pilot Trial

Abstract

Background: Childhood obesity treatment recommendations promote utilization of screening tools, motivational interviewing, and support staff to facilitate lifestyle behavior change with children and families through a staged approach. While these recommendations are evidence-based and have been in place for over a decade, little research has been done to explore the utilization and effectiveness of the framework in real-world primary care settings. Objective: The purpose of the My Health, My Way! (MHMW) pilot study was to determine the effectiveness of a primary care practice-based framework for childhood obesity treatment on behaviors related to nutrition, physical activity, sleep, and screen time. Methods: Families of pediatric patients at a primary care practice in the Midwest were invited to participate if the child was 5-12 years of age and had a body mass index (BMI) ≥ 85th percentile. Participants were randomized to standard of care (control) or a six-month intervention, which involved monthly health coaching sessions utilizing the Family Nutrition and Physical Activity (FNPA) screening tool. Outcome measures included FNPA score, BMI percentile, and BMI z-score. Results: Thirty-five participants enrolled and 28 completed baseline measures. Participants in the intervention group had greater increases in FNPA scores than the control group for those that completed the study, though not significantly different (4.86 ± 6.28 versus 0.38 ± 4.6; p = 0.135). However, the effect size (d = 0.88) is considered to be large. There was a significantly greater mean change score on the FNPA subscale of family eating practices (intervention 0.57 ± 0.54, control -0.13 ± 0.41; p = 0.041). Conclusions: A primary care practice-based framework for childhood obesity treatment utilizing health coaching and a behavioral screening tool may be effective for facilitating lifestyle behavior change with children and families. Additional study is needed to examine retention strategies in real-world primary care interventions.