A Novel Healthcare-Community Partnership for Childhood Obesity Treatment: A Randomized Pilot Study

Prevention strategies have made important strides to stabilize obesity prevalence, however US childhood obesity prevalence remains high (17%) and effective treatment has been elusive. Furthermore, children with severe obesity continues to increase, especially among Hispanics and African Americans. These children have increased cardio-metabolic risks and comorbidities, and healthcare costs are concentrated among them. It is critical to identify effective interventions that can be made widely available for low-income, diverse populations in order to mitigate economic and societal costs.

High-intensity behavioral treatment interventions in specialized clinical research settings have been shown to be modestly effective.Effects tend to be small, short-term, and difficult to replicate in "real-world" clinical settings. Community-based settings (e.g., recreation centers) offer an attractive setting to deliver treatment. Community centers are locally accessible, can offer activities during evenings and on weekends, and provide relaxed environments that support social interaction. However, community-based interventions cannot provide the patient-centered medical care and individual nutrition counseling currently recommended for obesity treatment. New recommendations encourage linking clinical treatment with community resources, yet evidence demonstrating the feasibility and efficacy of such interventions is limited.

Locally, the investigators have developed both a specialized clinical obesity treatment program as well as a community based treatment program, and have linked the two via a shared use agreement. The innovative model provides multidisciplinary, individualized behavioral modification counseling and support through the clinic-based Healthy Lifestyles program, and higher intensity social and environmental support to reinforce behavior change through Bull City Fit programming.

The clinical program, Duke Children's Healthy Lifestyles (HL), is a comprehensive (AAP Stage 2-4) childhood obesity treatment program that has served primarily low-income African American and Hispanic families since 2006. In short, children aged 22 years and under with BMI ≥ 95th percentile (i.e., obese) are referred by their primary physician to the multidisciplinary Healthy Lifestyles clinic for treatment of obesity and related co-morbidities. The intervention involves monthly visits for one year to meet with medical, dietary, exercise and behavior specialists all certified in Motivational Interviewing. Similar to other interventions delivered through primary care settings, the Healthy Lifestyles model alone leads to measurable but not clinically significant decreases in body mass index.

The community-based program, Bull City Fit (BCF), was developed in 2012 by HL staff to increase intensity of the clinical intervention. The community center is a Durham Parks and Recreation (PR) facility. The investigators chose this municipal partner due to potential scalability of the intervention; over 5,000 PR facilities exist nationwide and every American lives within a 20 mile radius of a PR facility (DPR.gov). Bull City Fit provides free access to Edison Johnson Community Center, including 2 hours of staffed programming six days a week designed specifically for Healthy Lifestyles patients aged 2-18 and their families. This includes sports, games, cooking classes, gardening, parent support groups, teen support groups, and developmentally appropriate activities for all ages. With guidance from Healthy Lifestyles clinic providers, Bull City Fit programming is run by trained volunteers who are primarily Duke University students, pediatric residents, and community members invested in the wellness of families in their city.