Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention

R T Bartee; K A Heelan; C A Golden; J L Hill; G C Porter; B A Abbey; K George; N Foster; P A Estabrooks

doi:10.1007/s11121-023-01557-7

Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention

Prev Sci. 2024 Apr;25(Suppl 1):72-84. doi: 10.1007/s11121-023-01557-7. Epub 2023 Jul 21.

Authors

R T Bartee¹, K A Heelan², C A Golden³, J L Hill³, G C Porter⁴, B A Abbey², K George², N Foster⁵, P A Estabrooks⁶

Affiliations

¹ Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA. barteet2@unk.edu.
² Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA.
³ School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA.
⁵ Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA.
⁶ Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA.

Abstract

Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.

Keywords: Adaptations; Child obesity; Implementation outcomes.

MeSH terms

Child
Evidence-Based Practice
Female
Humans
Male
Pediatric Obesity* / prevention & control
Pediatric Obesity* / therapy
Weight Reduction Programs