The proposed project will test an implementation strategy (the "TrailGuide") for delivering an existing model of pediatric obesity treatment ("Fit Together") that has demonstrated ability to meet published recommendations for improving health outcomes of children with obesity.
Evidence-based treatment for childhood obesity exists, yet a fundamental knowledge-to-action gap has significantly limited the uptake of recommendations into clinical practice, particularly in low-income settings. Persistence of this gap represents a large-scale public health threat, as the earliest generation of children living through the obesity epidemic now enters adulthood, they are the first in US history to have a shorter life expectancy than their parents, mainly due to rising rates of obesity-related cancers and cardiovascular disease. A central challenge in delivering recommended treatment is the intensity; ≥26 hours of face-to-face contact are necessary to achieve health benefits and risk reduction. The objective of the proposed project is to develop and test an implementation strategy that pairs primary care pediatric clinics with the municipal Parks and Recreation (P\&R) centers to deliver the current treatment recommendations with high fidelity, while allowing while allowing crucial adaptations for the local and cultural context. Using the Fit Together model, the clinical partner provides standard medical treatment for pediatric obesity, while the community partner (typically parks and recreation) provides space facilitating the activity/nutrition sessions specifically for children referred from the clinic, along with their families. Fit Together will be implemented in two new communities in North Carolina, and we will study implementation outcomes as well as 12-month patient outcomes. We have added a local cohort in Durham, North Carolina, where their local Fit Together model has re-started their community activity program, and we will look at 6-month patient outcomes.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
400
Fit Together intervention follows a clinic and community partnership model for childhood obesity treatment. Children with obesity will receive standard of care obesity treatment from their usual provider and will also receive a referral to an activity program run out of the local community center. Each session delivers a combination of high-intensity individual exercises, sports and games, and unstructured playtime to help children reach the US Physical Activity guidelines of 60min moderate-to-vigorous physical activity daily. There will also be a nutrition activity session offered regularly.
Participants will receive a child-friendly cooking magazine mailed quarterly and a local Parks and Recreation program guide.
Michael Jordan Family Medical Clinic (Freedom Drive Location) (NHPMCF)
Charlotte, North Carolina, United States
NOT_YET_RECRUITINGWaughtown Pediatrics (NHFMCF)
Winston-Salem, North Carolina, United States
RECRUITINGChange in percent of the 95th percentile for BMI Collected from clinic records.
Change in child's BMI, based on percent of the 95th percentile, measured using height and weight collected from clinic/medical records
Time frame: Baseline, 6 months, and 12 months
Proportion of children with 26 hours or more of intervention contact
Measured by program attendance
Time frame: Up to 12 months
Change in number of combined minutes per day of moderate and vigorous physical activity, as measured by Garmin vivofit4 fitness tracker
Change in physical activity measured by Garmin vivofit4 fitness tracker
Time frame: Baseline up to 12 months
Change in self-report physical activity
Measured by the Evaluation of Activity Surveys in Youth (EASY); Scoring: range 0-88, higher scores indicate more activity
Time frame: Baseline, 6 months, and 12 months
Change in quality of life
Measured by Sizing Them Up; Scoring: range 0-100, higher scores indicate better health-related quality of life
Time frame: Baseline, 6 months, and 12 months
Unintended Consequences as measured by adverse events
Measured by collecting adverse events throughout participation
Time frame: Up to 12 months
Patient Satisfaction at 6 months
Measured by satisfaction survey; Scoring: ranging 5-25, higher scores indicate higher satisfaction
Time frame: 6 months
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Patient Satisfaction at 12 months
Measured by satisfaction survey; Scoring: ranging 5-25, higher scores indicate higher satisfaction
Time frame: 12 months
Change in diet quality
Measured by the Dietary Screener Questionnaire (DSQ)
Time frame: Baseline, 6 months, 12 months
Healthcare utilization
Measured by electronic health records
Time frame: Up to 12 months
Cost effects
Cost impact (summative or incremental) to the unit or organization resulting from changes in health care utilization and efficiency. Fixed and variable costs; offsets of the cost of implementation. Collected as project administrative data, surveys with clinics and P\&R sites to assess additional costs.
Time frame: Throughout program implementation duration (approx. 30 months)