Embedding weight management into safety-net pediatric primary care: Randomized controlled trial

Background: Implementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States). Methods: In a 12-month trial, families of children (age 7-12years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n=360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions. Results: The mean body mass index Z-score declined in both arms (P<0.01) with no significant difference between the Standard Care Alone (0.12kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15kg [SE: 0.03]) arm (P=0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P=0.05), low-density lipoprotein cholesterol (P=0.04), aspartate aminotransferase (P=0.02), and alanine transaminase (P=0.03) concentrations. Conclusions: Safety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters. Trial registration:ClinicalTrials.govIdentifier: NCT00851201. Registered 23 February 2009.