Two interventions that link clinical care with community resources helped improve key health measures in overweight or obese children at the outset of a study, as reported in JAMA Pediatrics journal.

Developed by investigators at Harvard–affiliated MassGeneral Hospital for Children (MGHfC) and Harvard Vanguard Medical Associates, a practice of Atrius Health, both programs not only improved body mass index (BMI) in participants but also increased parents’ sense that they had the information and resources to address their child’s weight problem.

“More and more we recognize that, if we don’t assist families in tackling the social and environmental conditions that impede their ability to make changes to their obesity–related behaviors, we will not be successful in pediatric weight management,” said Elsie Taveras, chief of general pediatrics at MGHfC, who led the study.

“To help us create our interventions, we looked to families with children who had managed to improve their BMI, often under challenging environmental and social settings. These ‘positive outlier’ families provided guidance on the content of health coaching, available resources in the community, language to use in motivating other families to change, and the importance of building parents’ confidence in taking on the challenge of reducing their child’s excess weight.”

The Connect 4 Health trial was conducted from June 2014 through March 2016 at six Harvard Vanguard pediatric practices in the Boston area and enrolled 721 children, ages 2 through 12, with a BMI in the overweight or obese range. Participants were randomly assigned to one of two interventions – enhanced primary care (EPC) or enhanced primary care plus coaching (EPCPC).

Parents of those in both groups received educational materials focusing on key goals – decreasing screen time and consumption of sugar–sweetened beverages, improving diet quality, increasing moderate or vigorous physical activity, improving the quality and duration of sleep, and promoting social and emotional wellness. The EPC intervention – incorporating practices introduced at Harvard Vanguard in recent years – included a monthly text message to parents with links to publicly available resources to support behavioral change and a Neighborhood Resource Guide listing supportive facilities in their communities.

Parents of children in the EPCPC group were contacted every other month by specially trained health coaches by telephone, via videoconference, or in person. The health coaches provided individualized support through motivational interviewing, discussion of strategies for addressing and managing obesity risk factors, and identification of supportive resources in families’ communities. Parents in the coaching groups also received additional educational materials after each coaching session and twice–weekly text messages or emails. Families were offered a free, one–month family membership in local YMCAs and invited to attend a program on healthy grocery shopping.

Along with comparing participants’ BMI z–scores at the beginning and end of the one–year study period, the investigators surveyed parents regarding their child’s health–related quality of life and their own sense of empowerment in managing their child’s weight.

In general, participants in both groups had improved BMI z–scores at the end of the study period, with slightly greater improvement among those in the EPCPC group. Comparisons with measurements taken a year before the outset of the study indicated that these reductions did not reflect previous trends towards a lower BMI; in fact, both groups had showed trends toward increasing BMI in the year before the study.