Family-Based Behavioral Treatment for Childhood Obesity Adapted to Align with the MOHealthNet Medicaid Benefit: Results of the Missouri Childhood Obesity Research Demonstration Study
Restricted accessResearch articleFirst published online 2026
Family-Based Behavioral Treatment for Childhood Obesity Adapted to Align with the MOHealthNet Medicaid Benefit: Results of the Missouri Childhood Obesity Research Demonstration Study
This study leveraged a novel Missouri Medicaid (MOHealthNet) benefit to adapt and implement evidence-based family-based behavioral treatment (FBT) within health care settings in alignment with policy requirements.
Methods:
In a nonrandomized matched-comparison trial, 108 parent–child dyads participated in FBT, and 92 dyads attended at least one session. Licensed Clinical Social Workers or Registered Dietitian Nutritionists offered 26–33 FBT hours delivered virtually over 6–12 months to Medicaid-insured patients in an urban and rural pediatric health system in Missouri. The matched-comparison group included 186 participants. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) framework was used to evaluate effectiveness (primary) and reach (secondary) and explore adoption, implementation, and maintenance.
Results:
Children in the FBT group reduced their percent over median body mass index (BMI) compared with the matched comparison group (mean reduction: −3.9 ± 1.4, d = −0.42). Within the FBT group, participants also demonstrated improvements in coping with teasing, health-related quality of life, and family health habits (all p < 0.05). Families rated the program as highly acceptable. Reach data indicated enrolled patients had similar BMI, sex, and ethnic backgrounds compared with eligible but non-enrolled patients (ps > 0.301).
Conclusions:
Data demonstrate the feasibility of adopting and implementing FBT within health care systems and inform efforts to support maintenance. FBT reached a diverse population of families receiving Medicaid in pediatric primary care settings and was associated with greater improvements in youth weight outcomes compared with a matched comparison group. Adaptations made to align with the benefit may have reduced the magnitude of effects; however, this policy provides an opportunity to deliver FBT within primary care settings and expand access.
HamplSE, HassinkSG, SkinnerAC, et al.Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity. Pediatrics2023;151(2):e2022060641.
2.
EpsteinLH, PaluchRA, WrotniakBH, et al.Cost-effectiveness of family-based group treatment for child and parental obesity. Child Obes2014;10(2):114–121.
3.
EpsteinLH, WilfleyDE, KilanowskiC, et al.Family-based behavioral treatment for childhood obesity implemented in pediatric primary care: A randomized clinical trial. JAMA2023;329(22):1947–1956.
4.
WilfleyDE, SteinRI, SaelensBE, et al.Efficacy of maintenance treatment approaches for childhood overweight: A randomized controlled trial. JAMA2007;298(14):1661–1673.
5.
EpsteinLH, ValoskiA, WingRR, McCurleyJ. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol1994;13(5):373–383.
6.
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. JAMA2024;332(3):226–232.
7.
DavisonGM, MonocelloLT, LipseyK, WilfleyDE. Evidence base update on behavioral treatments for overweight and obesity in children and adolescents. J Clin Child Adolesc Psychol2023;52(5):589–603.
8.
EpsteinLH, PaluchRA, RaynorHA. Sex differences in obese children and siblings in family‐based obesity treatment. Obes Res2001;9(12):746–753.
9.
CheslaCA, FisherL, SkaffMM, et al.Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes. Fam Process2003;42(3):375–390.
10.
FisherL, CheslaCA, ChunKM, et al.Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes. J Fam Psychol2004;18(2):302–310.
11.
BockDE, RobinsonT, SeabrookJA, et al.The Health Initiative Program for Kids (HIP Kids): effects of a 1-year multidisciplinary lifestyle intervention on adiposity and quality of life in obese children and adolescents-a longitudinal pilot intervention study. BMC Pediatr2014;14:296–299.
12.
ButtonAM, StaianoAE, SeligmanHK. Closing the gap between evidence and practice for childhood obesity treatment. Child Obes2024;20(6):376–377.
13.
Missouri Department of Health and Senior Services. Biopsychosocial treatment for youth and adults. MO HealthNet Division. Available from: https://health.mo.gov/
14.
GlasgowRE, HardenSM, GaglioB, et al.RE-AIM planning and evaluation framework: Adapting to new science and practice with a 20-year review. Front Public Health2019;7:64.
15.
GlasgowRE, VogtTM, BolesSM. Evaluating the public health impact of health promotion interventions: The RE-AIM framework. Am J Public Health1999;89(9):1322–1327.
16.
CurranGM, BauerM, MittmanB, et al.Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care2012;50(3):217–226.
17.
WilfleyDE, FowlerLA, HamplSE, et al.; MO-CORD Study Group. Implementation of a scalable family-based behavioral treatment for childhood obesity delivered through primary care clinics: Description of the Missouri Childhood Obesity Research Demonstration study protocol. Child Obes2021;17(S1):S39–S47.
HalesCM, FreedmanDS, AkinbamiL, et al.Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts. National Center for Health Statistics. Vital Health Stat2022;2(197); doi: 10.15620/cdc:121711
FowlerLA, HamplSE, Dreyer GilletteML, et al.; MO-CORD Study Group. Translating family-based behavioral treatment for childhood obesity into a user-friendly digital package for delivery to low-income families through primary care partnerships: The MO-CORD study. Child Obes2021;17(S1):S30–S38.
22.
PowellBJ, WaltzTJ, ChinmanMJ, et al.A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci2015;10(1):21.
23.
StaianoAE, ButtonAM, BakerA, et al.; TEAM UP Research Group. A pragmatic trial of a family-centered approach to childhood obesity treatment: Rationale and study design. Contemp Clin Trials2024;138:107459.
24.
StirmanSW, BaummanAA, MillerCJ. The FRAME: An extended Framework for Reporting Adaptations and Modifications to evidence-based interventions. Impl Sci2019;14(58).
25.
EpsteinLH, SchechtmanKB, KilanowskiC, et al.Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. Contemp Clin Trials2021;109:106497.
HalesCM, FreedmanDS, AkinbamiL, et al.Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts. Vital Health Stat 12022;1(197):1–42.
29.
Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Protocol. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, MD; 2007.
30.
HarrisPA, TaylorR, MinorBL, et al.; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform2019;95:103208.
31.
HarrisPA, TaylorR, ThielkeR, et al.Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform2009;42(2):377–381.
32.
ModiAC, ZellerMH. Validation of a parent‐proxy, obesity‐specific quality‐of‐life measure: Sizing them up. Obesity2008;16(12):2624–2633.
33.
MurphyJM, BergmannP, ChiangC, et al.The PSC-17: Subscale scores, reliability, and factor structure in a new national sample. Pediatrics2016;138(3):e20160038.
34.
FaithMS, LeoneMA, AyersTS, et al.Weight criticism during physical activity, coping skills, and reported physical activity in children. Pediatrics2002;110(2 Pt 1):e23.
35.
IhmelsMA, WelkGJ, EisenmannJC, NusserSM. Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool. Int J Behav Nutr Phys Act2009;6(1):14.
36.
AccursoEC, HawleyKM, GarlandAF. Psychometric properties of the Therapeutic Alliance Scale for caregivers and parents. Psychol Assess2013;25(1):244–252.
37.
EpsteinLH, PaluchRA, RoemmichJN, BeecherMD. Family-based obesity treatment, then and now: Twenty-five years of pediatric obesity treatment. Health Psychol2007;26(4):381–391.
38.
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 Rep2021;70(37):1278–1283.
39.
KumarS, KingEC, ChristisonAL, et al.; POWER Work Group. Health outcomes of youth in clinical pediatric weight management programs in POWER. J Pediatr2019;208:57–65.e4.
40.
ShieldJ. What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Med Health Sci2010; doi: 10.1136/ADC.2009.165340
41.
ReihnehrT, LassN, ToschkeC, et al.Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children? J Clin Endocrinol Metab2016;101(8):3171–3179.
42.
WilfleyDE, TibbsTL, Van BurenD, et al.Lifestyle interventions in the treatment of childhood overweight: A meta-analytic review of randomized controlled trials. Health Psychol2007;26(5):521–532.
43.
WilfleyDE, SaelensBE, SteinRI, et al.Dose, content, and mediators of family-based treatment for childhood obesity: A Multisite Randomized Clinical Trial. JAMA Pediatr2017;171(12):1151–1159; doi: 10.1001/jamapediatrics.2017.2960
44.
PutriRR, DanielssonP, EkströmN, et al.Effect of pediatric obesity treatment on long-term health. JAMA Pediatr2025;179(3):302–309.
45.
BrownellKD, KelmanJH, StunkardAJ. Treatment of obese children with and without their mothers: Changes in weight and blood pressure. Pediatrics1983;71(4):515–523.
46.
GoldfieldGS, EpsteinLH, KilanowskiCK, et al.Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes Relat Metab Disord2001;25(12):1843–1849.
47.
HayesJF, AltmanM, CoppockJH, et al.Recent updates on the efficacy of group-based treatments for pediatric obesity. Curr Cardiovasc Risk Rep2015;9(4):16.
48.
ImoisiliOE, GoodmanAB, DooyemaCA, et al.Referrals and management strategies for pediatric obesity—DocStyles Survey 2017. Front Pediatr2018;6:367.
49.
DarlingKE, WarnickJ, GuthrieKM, et al.Referral to adolescent weight management interventions: Qualitative perspectives from providers. J Pediatr Psychol2023;48(10):815–824.
50.
SkjåkødegårdHF, ConlonRP, HystadSW, et al.Family‐based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial. Clin Obes2022;12(3):e12513.
51.
ForsethB, AppelhansBM, DavisAM. Considerations for interpreting childhood obesity treatment trials from the COVID-19 pandemic era. Child Obes2024;20(8):551–552.
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