Assessing Implementation of Clinic–Community Partnerships Treating Pediatric Obesity

Abstract

Background:

Although intensive health behavior and lifestyle treatment (IHBLT) is effective for treating youth obesity, it is not accessible to many. Our objective was to examine the implementation of Fit Together, an evidence-based IHBLT clinic–community model delivered by health care and local parks and recreation.

Methods:

This study used a hybrid type 3 implementation-effectiveness design to examine uptake and implementation of the Fit Together model in eight North Carolina counties from 2016 to 2021. Each Fit Together partnership was provided with an implementation manual, training, technical assistance, and financial support. Implementation outcomes included partnership characteristics and program delivery (e.g., hours, referrals, attendance). Effectiveness outcomes included engagement (dose received), changes in child lifestyle habits, quality of life, and body mass index (BMI). Descriptive statistics described implementation outcomes, and linear regression models examined changes in participant-level outcomes.

Results:

All eight locations implemented Fit Together (range: 5–18 months). A total of 1193 youth with obesity (12 years ± 3.0, 52.4% female) were referred to a Fit Together program. Of referred youth, 20% (241/1193) attended ≥ 1 session, of which 85% (205/241) attended ≥2 sessions. Nearly a third of engaged participants (29%, 70/241) received ≥26 treatment hours. For each additional session attended, BMI percent of the 95^th percentile declined (β = −0.12, p = 0.06).

Conclusions:

The Fit Together model can be delivered in diverse settings, engage priority populations, and deliver IHBLT in a variety of locations. Future work should test scalability and dissemination strategies for clinic–community models of child obesity treatment.