Dissemination of evidence-based intensive health behavior and lifestyle treatments (IHBLTs) to families from low-income communities was the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) 3.0 projects. The goal of RI CORD 3.0 was to adapt and test the effectiveness and context for remote implementation of an IHBLT, JOIN for ME.
Methods:
Children aged 6–12 years with body mass index (BMI) >85th percentile and a caregiver (N = 111) were recruited through a federally qualified health center (FQHC) or community setting and participated in an immediate or 4-month delay condition. Child and caregiver weight status, Family Nutrition and Physical Activity (FNPA), and child weight-related quality of life were assessed at baseline, 4 months, and at the end of the 10-month remotely delivered intervention. Program acceptability and intervention fidelity were assessed to inform subsequent implementation.
Results:
Analyses comparing active and delayed treatment groups at 4 months showed significant improvements in FNPA for the active treatment group compared with delayed group. Groups did not differ significantly on child or caregiver weight status. Ten-month treatment effects in the combined sample showed significant effects of time on child relative weight status, with children who initiated the program demonstrating decreases of 2.90% median BMI, 3.89%BMIp95, and 0.16 zBMI units. Session attendance and food security at baseline were related to greater changes in weight status.
Conclusions:
The adapted version of the JOIN for ME was successfully implemented and shown to be associated with significant, modest changes in child weight status.
DrozdzD, Alvarez-PittiJ, WójcikM, et al.Obesity and cardiometabolic risk factors: From childhood to adulthood. Nutrients, 2021; 13(11):4176.
2.
UmerA, KelleyGA, CottrellLE, et al.Childhood obesity and adult cardiovascular disease risk factors: A systematic review with meta-analysis. BMC Public Health, 2017; 17(1):683.
3.
FinkelsteinEA, GrahamWCK, MalhotraR. Lifetime direct medical costs of childhood obesity. Pediatrics, 2014; 133(5):854–862.
4.
GuoSS, RocheAF, ChumleaWC, et al.The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr, 1994; 59(4):810–819.
5.
GuoSS, WuW, ChumleaWC, et al.Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr, 2002; 76(3):653–658.
6.
HamplSE, HassinkSG, SkinnerAC, et al.Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 2023; 151(2):e2022060641.
7.
HoelscherDM, KirkS, RitchieL, et al.; Academy Positions Committee. Position of the Academy of Nutrition and Dietetics: Interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet, 2013; 113(10):1375–1394.
8.
CunninghamSA, KramerMR, NarayanKMV. Incidence of childhood obesity in the United States. N Engl J Med, 2014; 370(5):403–411.
9.
KumanyikaSK. A framework for increasing equity impact in obesity prevention. Am J Public Health, 2019; 109(10):1350–1357.
10.
ResnicowK, McMasterF, BocianA, et al.Motivational interviewing and dietary counseling for obesity in primary care: An RCT. Pediatrics, 2015; 135(4):649–657.
11.
TaverasEM, MarshallR, KleinmanKP, et al.Comparative effectiveness of childhood obesity interventions in pediatric primary care: A cluster-randomized clinical trial. JAMA Pediatr, 2015; 169(6):535–542.
12.
TaverasEM, MarshallR, SharifiM, et al.Connect for Health: Design of a clinical-community childhood obesity intervention testing best practices of positive outliers. Contemp Clin Trials, 2015; 45(Pt B):287–295.
13.
NicholsonWK, SilversteinM, WongJB, et al.; US Preventive Services Task Force. Interventions for high body mass index in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA, 2024; 332(3):226–232.
14.
CzepielKS, PerezNP, Campoverde ReyesKJ, et al.Pharmacotherapy for the treatment of overweight and obesity in children, adolescents, and young adults in a large health system in the US. Front Endocrinol (Lausanne), 2020; 11:290.
15.
SkinnerAC, StaianoAE, ArmstrongSC, et al.Appraisal of clinical care practices for child obesity treatment. Part I: Interventions. Pediatrics, 2023; 151(2):e2022060642.
16.
LobsteinT, NeveuxM, BrownT, et al.; STOP project consortium. Social disparities in obesity treatment for children age 3–10 years: A systematic review. Obes Rev, 2021; 22(2):e13153.
17.
DavisonGM, FowlerLA, RamelM, et al.Racial and socioeconomic disparities in the efficacy of a family‐based treatment programme for paediatric obesity. Pediatr Obes, 2021; 16(10):e12792.
18.
SmithJD, BerkelC, CarrollAJ, et al.Health behaviour outcomes of a family based intervention for paediatric obesity in primary care: A randomized type II hybrid effectiveness-implementation trial. Pediatr Obes, 2021; 16(9):e12780.
19.
FosterG, SundalD, McDermottC, et al.Feasibility and preliminary outcomes of a scalable, community-based treatment of childhood obesity. Pediatrics, 2012; 130(4):652–659.
20.
JelalianE, EvansE, RancourtD, et al.JOIN for ME: Testing a scalable weight control intervention for adolescents. Child Obes, 2020; 16(3):192–203.
21.
TrostSG, SundalD, FosterGD, et al.Effects of a pediatric weight management program with and without active video games: A randomized trial. JAMA Pediatr, 2014; 168(5):407–413.
22.
JelalianE, EvansW, DarlingKE, et al.Protocol for the Rhode Island CORD 3.0 Study: Adapting, testing, and packaging the JOIN for ME family-based childhood obesity program in low-income communities. Childhood Obesity, 2021; 17(S1):S-11–S-21.
23.
DarlingKE, HayesJF, EvansEW, et al.Implementation of the JOIN for ME Program for families from low-income backgrounds: The use of theory-driven formative evaluation: Rhode Island CORD 3.0. Childhood Obesity, 2021; 17(S1):S-22–S-29.
24.
DarlingKE, HayesJF, EvansEW, et al.Engaging stakeholders to adapt an evidence-based family healthy weight program. Transl Behav Med, 2023; 13(7):423–431.
25.
ProctorE, SilmereH, RaghavanR, et al.Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health, 2011; 38(2):65–76.
26.
ProctorEK, LandsverkJ, AaronsG, et al.Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health, 2009; 36(1):24–34.
27.
BrannonE, KuhlE, BolesR, et al.Strategies for recruitment and retention of families from low-income, ethnic minority backgrounds in a longitudinal study of caregiver feeding and child weight. Child Health Care, 2013; 42(3):198–213.
28.
BuscemiJ, BlumsteinL, KongA, et al.Retaining traditionally hard to reach participants: Lessons learned from three childhood obesity studies. Contemp Clin Trials, 2015; 42:98–104.
29.
Cason-WilkersonR, GoldbergS, AlbrightK, et al.Factors influencing healthy lifestyle changes: A qualitative look at low-income families engaged in treatment for overweight children. Child Obes, 2015; 11(2):170–176.
30.
CuiZ, SeburgE, SherwoodN, et al.Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: A review of the clinical trials registration database. Trials, 2015; 16:564.
31.
DhaliwalJ, NosworthyN, HoltN, et al.Attrition and the management of pediatric obesity: An integrative review. Child Obes, 2014; 10(6):461–473.
32.
CurranGM, BauerM, MittmanB, et al.Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care, 2012; 50(3):217–226.
33.
SmithSN, LiebrechtCM, BauerMS, et al.Comparative effectiveness of external vs blended facilitation on collaborative care model implementation in slow-implementer community practices. Health Serv Res, 2020; 55(6):954–965.
34.
NewmanSD, AndrewsJO, MagwoodGS, et al.Community advisory boards in community-based participatory research: A synthesis of best processes. Prev Chronic Dis, 2011; 8(3):A70.
35.
KaiserBL, ThomasGR, BowersBJ. A case study of engaging hard-to-reach participants in the research process: Community Advisors on Research Design and Strategies (CARDS)(R). Res Nurs Health, 2017; 40(1):70–79.
36.
Coleman-JensenA, NordM, SinghA. Household Food Security in the United States in 2012. ERS., editor. U.S. Department of Agriculture; 2013.
37.
KumarS, KingEC, ChristisonAL, et al.; POWER Work Group. Health outcomes of youth in clinical pediatric weight management programs in POWER. J Pediatr, 2019; 208:57–65.e4.
38.
PaluchRA, EpsteinLH, RoemmichJN. Comparison of methods to evaluate changes in relative body mass index in pediatric weight control. Am J Hum Biol, 2007; 19(4):487–494.
39.
IhmelsMA, WelkGJ, EisenmannJC, et al.Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool. Int J Behav Nutr Phys Act, 2009; 6:14.
40.
PeyerKL, Bailey-DavisL, WelkG. Development, applications, and refinement of the Family Nutrition and Physical Activity (FNPA) child obesity prevention screening. Health Promot Pract, 2021; 22(4):456–461.
41.
ZellerMH, ModiAC. Development and initial validation of an obesity-specific quality-of-life measure for children: Sizing Me Up. Obesity (Silver Spring), 2009; 17(6):1171–1177.
42.
ModiAC, ZellerMH. Validation of a parent-proxy, obesity-specific quality-of-life measure: Sizing them up. Obesity (Silver Spring), 2008; 16(12):2624–2633.
43.
RosenbergD, DingD, SallisJF, et al.Neighborhood Environment Walkability Scale for Youth (NEWS-Y): Reliability and relationship with physical activity. Prev Med, 2009; 49(2–3):213–218.
44.
ScottMM, EvensonKR, CohenDA, et al.Comparing perceived and objectively measured access to recreational facilities as predictors of physical activity in adolescent girls. J Urban Health, 2007; 84(3):346–359.
45.
DuntonGF, JamnerMS, CooperDM. Assessing the perceived environment among minimally active adolescent girls: Validity and relations to physical activity outcomes. Am J Health Promot, 2003; 18(1):70–73.
46.
CaspiCE, KawachiI, SubramanianSV, et al.The relationship between diet and perceived and objective access to supermarkets among low-income housing residents. Soc Sci Med, 2012; 75(7):1254–1262.
47.
CaldwellEM, Miller KobayashiM, DuBowWM, et al.Perceived access to fruits and vegetables associated with increased consumption. Public Health Nutr, 2009; 12(10):1743–1750.
48.
HoffmanJ, FrerichsL, StoryM, et al.An integrated clinic-community partnership for child obesity treatment: A randomized pilot trial. Pediatrics, 2018; 141(1):e20171444.
49.
JelalianE, FosterGD, SatoAF, et al.Treatment adherence and facilitator characteristics in a community based pediatric weight control intervention. Int J Behav Nutr Phys Act, 2014; 11:17.
50.
DavisA, LancasterB, FlemingK, et al.Effectiveness of a paediatric weight management intervention for rural youth (iAmHealthy): Primary outcomes of a cluster randomised control trial. Pediatr Obes, 2024; 19(3):e13094.
51.
DavisAM, DardenP, LancasterB, et al.A family-based behavioral group obesity randomized control feasibility trial across a clinical trials network: A focus on contact hours. J Pediatr Psychol, 2025; 50(3):280–288.
52.
AfulaniP, HermanD, Coleman-JensenA, et al.Food insecurity and health outcomes among older adults: The role of cost-related medication underuse. J Nutr Gerontol Geriatr, 2015; 34(3):319–342.
53.
BrownAG, ShiS, AdasS, et al.A decade of nutrition and health disparities research at NIH, 2010–2019. Am J Prev Med, 2022; 63(2):e49–e57.
54.
GregoryCA, Coleman-JensenA. Food insecurity, chronic disease, and health among working-age adults. USDA, 2017.
55.
Hartline-GraftonH, HassinkSG. Food insecurity and health: Practices and policies to address food insecurity among children. Acad Pediatr, 2021; 21(2):205–210.
56.
SeligmanHK, BindmanAB, VittinghoffE, et al.Food insecurity is associated with diabetes mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002. J Gen Intern Med, 2007; 22(7):1018–1023.
57.
HayesJF, FowlerLA, BalantekinKN, et al.Child and family predictors of relative weight change in a low-income, school-based weight management intervention. Fam Syst Health, 2021; 39(2):316–326.
58.
TesterJM, XiaoL, Tinajero-DeckL, et al.Food insecurity influences weight trajectory in children with obesity. Child Obes, 2022; 18(7):437–444.
59.
PersaudA, EvansEW, PerkinsM, et al.The association of food insecurity on body mass index change in a pediatric weight management intervention. Pediatr Obes, 2023; 18(11):e13075.
60.
DarlingKE, EvansEW, ElwyAR, et al.Scaling and sustaining research tested interventions: Lessons learned from Rhode Island Childhood Obesity Research Demonstration 3.0. Transl Behav Med, 2024; 14(8):472–478.
