Do Weight Management Programs Involving Health Coaches Improve Body Mass Index and Parent Empowerment for Children with Obesity or Who Are Overweight? [Internet]

Excerpt

Background: Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes.

Objective: To examine the extent to which 2 clinical-community interventions improved child BMI z-score, parent sense of empowerment, and child health-related quality of life (HR-QoL).

Methods: We conducted a 2-arm, randomized controlled trial from June 2014 to June 2016 with measures at baseline and 1 year. We enrolled 721 children ages 2 to 12 years with a BMI ≥85th percentile from 6 primary care practices of Atrius Health. Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, electronic alerts and clinical decision support tools for pediatric weight management, educational materials, a Neighborhood Resource Guide, and monthly text messages promoting behavior change) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and 6 telephone or video contacts) to support behavior change and link families to community resources. In intent-to-treat analyses, we used multiple imputation and linear repeated measures models to examine 1-year changes in age- and sex-specific BMI z-score, HR-QoL as measured by the Pediatric Quality of Life Inventory (PedsQL) version 4.0, and parent sense of empowerment.

Results: At 1 year, we obtained BMI z-scores from 664 children (92%) and parent-reported outcomes from 657 parents (91%). Baseline mean (SD) child age was 8.0 (3.0) years; 35% were White, 33% Black, 22% Hispanic, and 10% other; 44% lived in households with annual incomes <$50 000. We observed significant improvements in BMI z-score in both the enhanced primary care group (−0.06 units; 95% CI, −0.10 to −0.02) and the enhanced primary care plus coaching group (−0.09 units; 95% CI, −0.13 to −0.05) but no statistically significant difference between the 2 arms (−0.02 units; 95% CI, −0.08 to 0.03). Both intervention arms also significantly improved parent sense of empowerment. Parents in the enhanced primary care plus coaching group, but not in the enhanced care group, reported improvements in their child's HR-QoL (1.53 units; 95% CI, 0.51-2.56). However, there were no significant differences between the arms in either family-centered outcome.

Conclusions: Two interventions that included high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI from baseline to 1 year, but there were no significant differences between the 2 interventions.