An Integrated Clinic-Community Partnership for Child Obesity Treatment: A Randomized Pilot Trial

• Published in: Pediatrics (Evanston) 2018-01, Vol.141 (1), p.1
• Main Authors: Hoffman, Jessica, Frerichs, Leah, Story, Mary, Jones, Jason, Gaskin, Kiah, Apple, Annie, Skinner, Asheley, Armstrong, Sarah
• Format: Article
• Language: English
• Subjects: Ambulatory Care - organization & administration; Analysis; Body mass; Body Mass Index; Care and treatment; Child; Child Welfare; Child, Preschool; Childhood obesity; Children; Clinical trials; Community Health Services - organization & administration; Delivery of Health Care, Integrated - organization & administration; Demographic aspects; Exercise - physiology; Feasibility; Feasibility studies; Female; Follow-Up Studies; Health behavior; Healthy Diet; Humans; Life Style; Male; Medical treatment; Obesity; Obesity in children; Parks; Patient Compliance - statistics & numerical data; Pediatric Obesity - prevention & control; Pediatric Obesity - therapy; Pediatrics; Physical activity; Physical fitness; Pilot Projects; Poverty; Prospective Studies; Quality of Life; Recreation; Recreational facilities; Risk Assessment; Socioeconomic Factors; System effectiveness; Treatment outcome; United States; Weight Loss
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2017-1444

Effective treatment of childhood obesity remains elusive. Integration of clinical and community systems may achieve effective and sustainable treatment. However, the feasibility and effectiveness of this integrated model are unknown. We conducted a randomized clinical trial among children aged 5 to 11 presenting for obesity treatment. We randomized participants to clinical care or clinical care plus community-based programming at a local parks and recreation facility. Primary outcomes were the change in child BMI at 6 months and the intensity of the program in treatment hours. Secondary outcomes included health behaviors, fitness, attrition, and quality of life. We enrolled 97 children with obesity, and retention at 6 months was 70%. Participants had a mean age of 9.1 years and a mean baseline BMI score of 2.28, and 70% were living in poverty. Intervention participants achieved more treatment hours than controls (11.4 vs 4.4, SD: 15.3 and 1.6, respectively). We did not observe differences in child BMI score or percent of the 95th percentile at 6 months. Intervention participants had significantly greater improvements in physical activity ( = .010) and quality of life ( = .008). An integrated clinic-community model of child obesity treatment is feasible to deliver in a low-income and racially diverse population. As compared with multidisciplinary treatment, the integrated model provides more treatment hours, improves physical activity, and increases quality of life. Parks and recreation departments hold significant promise as a partner agency to deliver child obesity treatment.