Childhood Obesity

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.

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.

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).

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.

One potential strategy to prevent unhealthy summer weight gain in children is to integrate obesity prevention interventions into the SUN Meals program, where free meals are offered to children from low-income households. The current study gathered insights from parents to (1) identify children’s weight-related health behaviors that need support during the summer, (2) examine potential intervention activities and their relevant barriers and facilitators, and (3) describe the preferred logistics of a summer obesity prevention intervention.

Two rounds of focus groups were conducted virtually between February and April 2025. Participants (n = 26) were parents of elementary school-aged children from low-income families. Data were analyzed using inductive thematic content analysis.

The top five weight-related health behaviors parents identified as priorities for their children were (1) increasing fruit and vegetable intake, (2) getting sufficient sleep, (3) limiting screen time, (4) increasing physical activity, and (5) reducing added sugar intake. Most parents supported a weekly, half-day intervention at the SUN Meals program sites for elementary school-aged children. Activities deemed important included providing engaging nutrition education related to the food served; helping families establish bedtime routines and screen time agreements; and offering physical activities at the program sites. Parents also suggested low- or no-cost half-day programming on-site, complemented by take-home packets and additional follow-ups between sessions to reinforce intervention content at home.

Parents supported the proposed structured summer obesity prevention intervention at SUN Meals program sites, noting its benefits for families’ weight-related health behaviors and offering practical logistical suggestions.

Parents have an important influence on the management of childhood obesity, yet parental priorities for obesity management have not been deeply explored. The purpose of this study was to explore parent-generated preferences for primary care management of childhood obesity across a broad range of child ages.

In this qualitative study, parents of 4- to 17-year-old children with obesity participated in semi-structured virtual interviews about their experiences with and priorities for primary care management of obesity. Inductive thematic analysis was performed using the constant comparative method.

Among 20 participants interviewed, 19 self-identified as female and 17 as White, with average child age of 10.9 years old (SD = 3.6, range 4–17). We identified three themes. Participants preferred that providers (1) reinforce family-based Care Across Contexts, recognizing that several competing factors influence health as children grow in autonomy, (2) prioritize a Need for Sensitivity, focusing on holistic health and avoiding stigmatizing language, and (3) embrace Collaborative Action-Based Approaches, leveraging parental insight and encouraging allied health visits to support parents in managing childhood obesity.

As parents help children navigate increasing autonomy and competing influences on health, obesity management may require providers to take a parent-centered approach to childhood obesity care, specifically reinforcing parent-led healthy habits and equipping parents with skills to mediate obesity management for their children in partnership with allied health providers.

Systemic barriers contribute to challenges in implementing sustainable improvements in early care and education (ECE) health promotion practices, including fragmented state systems, limited organizational capacity, and a lack of accessible, high-quality professional development. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study evaluated the Better Together approach—a multi-level quasi-experimental program aimed at enhancing health promotion practices in ECE programs.

Better Together, developed by Nemours Children’s Health and University of North Carolina Chapel Hill Community Health & Wellness Resource Team, used organizational- and systems-level approaches to improve ECE health promotion practices. Learning collaboratives (organizational level) addressing ECE health practices were delivered by trained consultants. State partners coordinated efforts to impact state systems change using the CDC’s Spectrum of Opportunities 2.0 Framework (systems-level). Surveys and program data were collected to assess reach, effectiveness, adoption, and implementation. Descriptive statistics were used to evaluate RE-AIM outcomes.

Four states implemented Better Together learning collaboratives, reaching 1,078 staff from 533 ECE programs. Across states, ECE program completion of initiative components ranged from 58.0 to 94.7% (adoption). Consultants implemented planned sessions (n = 26; implementation). On average, ECE programs experienced a 15.1% increase in health-promoting practices (range 11.8–17.5%; effectiveness). Partner groups generated 10 state system-level action plans to promote ECE health practices in perpetuity (maintenance).

The RE-AIM evaluation of the Better Together program showed positive results. It reached a significant number of ECE programs, leading to increased health-promoting practices, policies, and environments, as well as initiated state-level ECE systems change to sustain support.

Whether children’s generational status (i.e., immigrant generation based on country of birth) or family structure (i.e., household composition) influences phenotypic obesity severity, or outcomes of its management, remains unclear. We investigated associations of generational status and family structure with phenotypic obesity severity, its change over time, and persistence in a lifestyle-modification program among children with obesity attending a pediatric obesity clinic in Montreal (Canada).

This retrospective longitudinal analysis used medical records from children (2–17 years) who were followed between 2017 and 2023. We compared BMI z-score (BMIz) and clinical obesity prevalence at baseline and program persistence and changes in BMIz and blood pressure (BP) over follow-up, according to generational status and family structure.

Among the 568 included children, 362 (63.7%) had a first- or second-generation immigrant background, and 201 (35.4%) lived in non-two-parent families. At baseline, compared with children of third generation or more, those of first or second generation had lower BMIz (3.33 [95% CI: 3.22, 3.45] vs. 3.62 [95% CI: 3.47, 3.77]; p = 0.02) but a similar prevalence of clinical obesity (47.6% [95% CI: 42.6, 53.2] vs. 53.4% [95% CI: 47.0, 60.7]; p = 0.15). No differences were observed by family structure at baseline. Over follow-up (mean ± SD: 12.7 ± 12.8 months), program persistence and reductions in BMIz and BP were similar across groups.

Although generational status and family structure remain relevant for tailoring counseling, we found no evidence that they are meaningfully associated with phenotypic obesity severity, its change over time, or persistence in this program.

Responsive feeding supports healthy growth and may reduce obesity risk, yet bottle-feeding can promote nonresponsive feeding practices such as pressuring infants to finish their bottle. Because the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves many U.S. infants and bottle-feeding is common, scalable strategies are needed. We tested feasibility, acceptability, and preliminary effectiveness of GrowWell, an automated text-messaging program to support responsive bottle-feeding.

We conducted a 12-week randomized attention-control trial among mothers of bottle-fed infants ≤7 weeks old enrolled in WIC (n = 60; intervention n = 31; control n = 29). Participants received weekly goals, twice-weekly self-monitoring prompts with tailored feedback, and daily skills training; controls received texts focused on infant safety. Feasibility was assessed by response to self-monitoring prompts; acceptability by postintervention satisfaction surveys; and preliminary effectiveness by change in Infant Feeding Style Questionnaire (IFSQ) scores. Intervention participants completed semistructured interviews analyzed using rapid qualitative methods.

Mean response rate to self-monitoring prompts was 71.9% and did not differ by group. Satisfaction survey responses (n = 56, 30 intervention, 26 control) indicated high acceptability (≥80% agreement across items), with consistently higher ratings in the intervention group. Overall changes in IFSQ scores did not differ between groups (n = 58, 31 intervention, 27 control); however, within-group analyses showed reductions in pressuring to finish (p = 0.012) and pressuring to soothe (p = 0.002) among intervention participants at 12 weeks. Exploratory interaction analyses suggested heterogeneity by select sociodemographic characteristics. Interviews among intervention participants (n = 16) indicated high satisfaction, increased awareness of cues, and adoption of responsive practices.

GrowWell was feasible and highly acceptable, with promising preliminary signals for reducing pressuring bottle-feeding practices.

Standardized workflows supporting primary care provider (PCP) detection and management of obesity and its comorbidities are lacking in resource-poor settings. We evaluated the use of technological and visual aids to support PCP documentation, assessment, and management of comorbidities in youth with overweight and obesity.

A prospective electronic medical record (EMR) chart review evaluated the impact of technological (EMR SmartPhrases) and visual (graphic and written reminders) aids, as well as provider training, on standardizing provider documentation and management of overweight- and obesity-related comorbidities during health care maintenance visits. Baseline intervention (T0) and postintervention (T1, T2, and T3) assessments were conducted from March 2022 to June 2023. Patient charts of children aged 5–12 years with overweight and obesity were reviewed for PCP identification of comorbidities, relevant laboratory orders, plans, and 3-month follow-up. T1, T2, and T3 measures were compared with T0 measures using Fisher’s exact test and t-test for categorical and continuous variables, respectively.

Of 100 baseline and 300 postintervention charts reviewed, 3-month follow-up visits increased significantly in patients with overweight and class 1 obesity (3%–27% and 14%–40%, respectively, from T0 to T3; p = 0.02). Planned lifestyle changes increased significantly in patients with class 1 obesity (8% at T0 versus 30% and 40% at T1 and T2; p = 0.02 and p = 0.002), respectively, but not in patients with overweight. Initial increases in the use of aids were not sustained.

Technological and visual aids, along with PCP training, may support the adoption of standardized provider documentation, assessment, and management of weight-related comorbidities in youth with overweight and obesity in resource-poor settings.