Testing Implementation Strategies for a Family Healthy Weight Program: Results From the Nebraska Childhood Obesity Research Demonstration 3.0 Pilot Trial
Restricted accessResearch articleFirst published online June, 2026
Testing Implementation Strategies for a Family Healthy Weight Program: Results From the Nebraska Childhood Obesity Research Demonstration 3.0 Pilot Trial
Building Healthy Families (BHF) is an adapted family healthy weight program (FHWP) designed for and implemented in rural areas. To increase the likelihood of the broad dissemination and implementation of BHF to other rural communities, the Nebraska Childhood Obesity Research Demonstration 3.0 project developed the BHF Online Training Resources and Program Package (BHF Program Resources). The BHF Program Resources is a “turn-key” online platform that includes a train-the-trainer system, program materials, and a data portal for use by community-based implementation teams.
Methods:
A community-randomized type 3 hybrid effectiveness-implementation pilot study tested the BHF Program Package only (BHF-PO) with and without an action learning collaborative (BHF-LC) to determine relative implementation fidelity and effectiveness among community-based implementation teams. RE-AIM was used for planning and reporting outcomes.
Results:
The BHF-LC communities demonstrated higher implementation fidelity during the core sessions (90.6% vs. 75.8%, p = 0.076), with greater contact hours (17.8 vs. 14.8, p = 0.096). Adoption and Maintenance were successfully achieved but did not differ by the study condition. Children in the BHF-LC communities attended significantly more sessions (79% vs. 69%, p < 0.05, Reach) and showed a greater change in the BMI z-score (−0.15 ± 0.14 vs. −0.08 ± 0.16, p < 0.05, Effectiveness) by 3 months.
Conclusions:
Rural communities can implement the BHF program with fidelity using online resources; however, adding a learning collaborative may improve early implementation quality and child engagement. These findings warrant further testing in a larger trial.
OgdenCL, FryarCD, MartinCB, et al.Trends in obesity prevalence by race and Hispanic origin-1999–2000 to 2017–2018. JAMA, 2020; 324(12):1208–1210.
2.
HuK, StaianoAE. Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020. JAMA Pediatr, 2022; 176(10):1037–1039.
3.
LangeSJ, KompaniyetsL, FreedmanDS, et al.; DNP3. Longitudinal trends in body mass index before and during the COVID-19 pandemic among persons aged 2–19 years—United States, 2018-2020. MMWR Morb Mortal Wkly Rep, 2021; 70(37):1278–1283.
4.
WangML, GagoCM. Shifts in child health behaviors and obesity after COVID-19. JAMA Pediatr, 2024; 178(5):427–428.
5.
JohnsonJA, JohnsonAM. Urban-rural differences in childhood and adolescent obesity in the United States: A systematic review and meta-analysis. Child Obes, 2015; 11(3):233–241.
6.
FarriganT, GenetinB, SandersA, et al.Rural America at a glance2024. edition ed. United States Department of Agriculture, Economic Research Service: Washington, D.C; 2024.
7.
EpsteinLH, WingRR, KoeskeR, ValoskiA. Long-term effects of family-based treatment of childhood obesity. J Consult Clin Psychol, 1987; 55(1):91–95.
8.
GolanM, WeizmanA. Familial approach to the treatment of childhood obesity: Conceptual mode. J Nutr Educ, 2001; 33(2):102–107.
9.
WolfendenL, WiggersJ, Tursan d’EspaignetE, BellAC. How useful are systematic reviews of child obesity interventions? Obes Rev, 2010; 11(2):159–165.
10.
ReinehrT. Effectiveness of lifestyle intervention in overweight children. Proc Nutr Soc, 2011; 70(4):494–505.
11.
AltmanM, WilfleyDE. Evidence update on the treatment of overweight and obesity in children and adolescents. J Clin Child Adolesc Psychol, 2015; 44(4):521–537.
12.
WilfleyDE, StaianoAE, AltmanM, et al.; Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment Conference Workgroup. Improving access and systems of care for evidence-based childhood obesity treatment: Conference key findings and next steps. Obesity (Silver Spring), 2017; 25(1):16–29.
13.
HendersonM, MooreSA, Harnois-LeblancS, et al.; Steering Committee for Updating Canada’s Clinical Practice Guideline for Managing Pediatric Obesity. Effectiveness of behavioural and psychological interventions for managing obesity in children and adolescents: A systematic review and meta-analysis framed using minimal important difference estimates based on GRADE guidance to inform a clinical practice guideline. Pediatr Obes, 2025; 20(3):e13193.
14.
HamplSE, HassinkSG, SkinnerAC, et al.Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics, 2023; 151(2):e2022060641.
15.
JanickeDM, SallinenBJ, PerriMG, et al.Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: Outcomes from project STORY. Arch Pediatr Adolesc Med, 2008; 162(12):1119–1125.
16.
EpsteinLH, PaluchRA, RoemmichJN, BeecherMD. Family-based obesity treatment, then and now: Twenty-five years of pediatric obesity treatment. Health Psychol, 2007; 26(4):381–391.
17.
GolanM, KaufmanV, ShaharDR. Childhood obesity treatment: Targeting parents exclusively v. parents and children. Br J Nutr, 2006; 95(5):1008–1015.
18.
GolanM, CrowS. Targeting parents exclusively in the treatment of childhood obesity: Long-term results. Obes Res, 2004; 12(2):357–361.
19.
EpsteinLH, WingRR, KoeskeR, et al.Child and parent weight loss in family-based behavior modification programs. J Consult Clin Psychol, 1981; 49(5):674–685.
20.
EpsteinLH, McCurleyJ, WingRR, ValoskiA. Five-year follow-up of family-based behavioral treatments for childhood obesity. J Consult Clin Psychol, 1990; 58(5):661–664.
21.
EpsteinLH, ValoskiA, WingRR, McCurleyJ. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol, 1994; 13(5):373–383.
22.
RuebelML, HeelanKA, BarteeT, FosterN. Outcomes of a family based pediatric obesity program—Preliminary results. Int J Exerc Sci, 2011; 4(4):217–228.
23.
BarteeRT, HeelanKA, GoldenCA, et al.Adaptations of an effective evidence-based pediatric weight management intervention. Prev Sci, 2024; 25(Suppl 1):72–84.
24.
AbbeyBM, HeelanKA, BarteeRT, et al.Building healthy families: Outcomes of an adapted family healthy weight program among children in a rural mid-western community. Child Obes, 2024; 20(7):468–475.
25.
JanickeDM, SallinenBJ, PerriMG, et al.Comparison of program costs for parent-only and family-based interventions for pediatric obesity in medically underserved rural settings. J Rural Health, 2009; 25(3):326–330.
26.
JanickeDM, SallinenBJ, PerriMG, et al.Sensible Treatment of Obesity in Rural Youth (STORY): Design and methods. Contemp Clin Trials, 2008; 29(2):270–280.
27.
HillJL, HeelanKA, BarteeRT, et al.A type III hybrid effectiveness-implementation pilot trial testing dissemination and implementation strategies for a pediatric weight management intervention: The Nebraska childhood obesity research demonstration project. Child Obes, 2021; 17(S1):S70–S78.
28.
HeelanKA, AbbeyBM, BarteeRT, et al.Packaging of a pediatric weight management intervention and implementation blueprint for rural and micropolitan communities: The Nebraska CORD 3.0 project. Child Obes, 2021; 17(S1):S62–S69.
29.
GoldenCA, HillJL, HeelanKA, et al.A dissemination strategy to identify communities ready to implement a pediatric weight management intervention in medically underserved areas. Prev Chronic Dis, 2021; 18:E10.
30.
GoldenCA, EstabrooksPA, HeelanKA, et al.Developing an implementation fidelity measure for a family healthy weight program. Int J Behav Nutr Phys Act, 2025; 22(1):53.
31.
GlasgowRE, HardenSM, GaglioB, et al.RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Front Public Health, 2019; 7:64.
32.
HarveyG, KitsonA. PARIHS revisited: From heuristic to integrated framework for the successful implementation of knowledge into practice. Implementation Sci, 2015; 11(1):13.
33.
KitsonAL, Rycroft-MaloneJ, HarveyG, et al.Evaluating the successful implementation of evidence into practice using the PARiHS framework: Theoretical and practical challenges. Implement Sci, 2008; 3:1.
34.
FreedmanDS, DaviesAJG, KompaniyetsL, et al.A longitudinal comparison of alternatives to body mass index Z-Scores for children with very high body mass indexes. J Pediatr, 2021; 235:156–162.
35.
HagerER, QuiggAM, BlackMM, et al.Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 2010; 126(1):e26–e32.
36.
LeeEC, WhiteheadAL, JacquesRM, JuliousSA. The statistical interpretation of pilot trials: Should significance thresholds be reconsidered? BMC Med Res Methodol, 2014; 14(1):41.
37.
NadeemE, OlinSS, HillLC, et al.A literature review of learning collaboratives in mental health care: Used but untested. Psychiatr Serv, 2014; 65(9):1088–1099.
38.
HillJE, StephaniAM, SappleP, CleggAJ. The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: A systematic review. Implement Sci, 2020; 15(1):23.
39.
NadeemE, WeissD, OlinSS, et al.Using a theory-guided learning collaborative model to improve implementation of EBPs in a state children’s mental health system: A pilot study. Adm Policy Ment Health, 2016; 43(6):978–990.
40.
HillJL, ZoellnerJM, YouW, et al.Participatory development and pilot testing of iChoose: An adaptation of an evidence-based paediatric weight management program for community implementation. BMC Public Health, 2019; 19(1):122.
41.
O’ConnorEA, EvansCV, BurdaBU, et al.Screening for obesity and intervention for weight management in children and adolescents: Evidence report and systematic review for the US preventive services task force. JAMA, 2017; 317(23):2427–2444.
42.
EconomosCD, HyattRR, GoldbergJP, et al.A community intervention reduces BMI z-score in children: Shape UP Somerville first year results. Obesity (Silver Spring), 2007; 15(5):1325–1336.
43.
PerryRA, GolleyRK, HartleyJ, MagareyAM. The adaptation and translation of the PEACH™ RCT intervention: The process and outcomes of the PEACH™ in the community trial. Public Health, 2017; 153:154–162.
44.
KolsgaardML, JonerG, BrunborgC, et al.Reduction in BMI z-score and improvement in cardiometabolic risk factors in obese children and adolescents. The Oslo adiposity intervention study—A hospital/public health nurse combined treatment. BMC Pediatr, 2011; 11:47.
45.
SamuelsSL, HuP, MaciejewskiKR, et al.Real-world effectiveness of the bright bodies healthy lifestyle intervention for childhood obesity. Obesity (Silver Spring), 2023; 31(1):203–213.
46.
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.
47.
ButtonA, HolstonD, FreightmanJ, et al.Family weight management in rural U.S. communities: A mixed methods study of parent and child perspectives. BMC Public Health, 2025; 25(1):2089.
