Community partnerships boost success of youth obesity treatment

Strategic partnerships between healthcare systems and community organizations, such as public parks and recreation (P&R) centres, represent a promising strategy for tackling youth obesity, helping increase access to health behaviour and lifestyle interventions and improve weight outcomes.

“P&R centres provide low-cost or free access to physical activity and are accessible to diverse populations. Access to P&R facilities is associated with higher levels of physical activity among children and adults,” according to researchers. [Pediatrics 2006;117:417-424; Prev Med 2006;43:437-441]

“We have previously developed a model of paediatric obesity treatment called Fit Together that pairs healthcare organizations with local P&R providers to deliver intensive health behaviour and lifestyle treatment (IHBLT). In the Fit Together model, healthcare partners screen for obesity, provide counselling, and treat comorbidities, while P&R partners provide IHBLT in the community setting,” they added. [Implement Sci 2023;18:6; Pediatrics 2018;141:e20171444]

In a randomized controlled trial, the Fit Together intervention (intervention group) led to a significant reduction in BMI after 6 months, with a mean difference of 3.32 (95 percent confidence interval [CI], −5.69 to −0.96; p=0.006) relative to the waitlist control (control group). BMI was standardized to the 95th percentile for age and sex. [Pediatrics 2025;doi:10.1542/peds.2024-068427]

As the trial was affected by COVID-19 disruptions, subgroup analyses were conducted and indicated that that significant BMI reductions with the intervention vs control were observed only among participants who were not affected by the disruptions (β, −3.05, 95 percent CI, −5.08 to −1.01; p=0.003).

However, no significant effect was seen on cardiorespiratory fitness, with the 4-min heart rate being similar between the intervention and control groups (β, −7.18, 95 percent CI, −16.12 to 1.76) among participants not affected by COVID-19 disruptions.

Engagement hours for intervention participants overall averaged 8.9 hours, ranging from 0 to 80 hours, and were higher among participants unaffected vs affected by COVID-19 disruptions (mean 11.5 vs 5.4 hours).

“Although findings were in the expected direction, there was no significant effect of Fit Together on youth cardiorespiratory fitness. The most likely reason is insufficient power because of discontinuation of the fitness assessment during the COVID-19 pandemic,” the researchers said.

“Additionally, it is likely that youths who experienced reductions in BMI also made dietary changes that contributed to reductions in weight, which may explain the reduction in BMI without changes in fitness,” they noted.

Overall, the findings suggest that the Fit Together model may provide an avenue to implement IHBLT and achieve BMI reductions in young people with obesity, according to the researchers. However, they acknowledged that only a few participants in the trial met the 26-hour IHBLT recommendation, which highlights a need to further investigate the dose-response relationship and heterogeneity in treatment response within IHBLT interventions.

A total of 255 children (47.8 percent male, 38.8 percent Hispanic) with a mean age of 10.0 years participated in the trial. More than half of the participants had class I obesity (54.5 percent), 29.4 percent had class II obesity, 8.2 percent had class III obesity, and 7.8 percent were overweight. A total of 44 percent were affected by COVID-19 disruptions to study protocols.

Of the participants, 131 were randomly allocated to the intervention group and 124 to the control group. In the intervention group, 10 percent of the participants received a high-intensity dose (ie, ≥26 hours) and nearly one-third (30 percent) received a moderate-intensity dose (ie, 5–25 hours). No adverse events related to the study protocol were documented.