Staged Treatment for Childhood Obesity in a Medical Home: A Feasibility Study

Introduction: In 2007, a committee of experts made evidence-informed recommendations for the treatment of childhood obesity that proposed a stepwise approach to treatment of overweight and obese children. The aim of this study is to assess the feasibility and efficacy of a staged intervention for obese and overweight children in a large medical home.

Methods: A staged intervention approach to treating childhood obesity was implemented for patients enrolled in a large Medicaid managed care organization in Houston, Texas. Patients were eligible if they were between the ages of 7 and 13 years and had a BMI greater than the 85th percentile. After one year, patients EMR was reviewed to compare final & initial BMI as well as patient participation.

Results: 51 children were enrolled over a period of 3 months. Participation was low with only 18% of all completed problem-oriented visits focusing on healthy weight counseling (stage 1). Despite a high acceptance rate for enrollment into the Keep Fit classes (stage 2), patients did not continue to attend classes over the course of the year, on average attending only 21% of scheduled classes. The stage 3 group program was not offered. There was no improvement in BMI status and no relationship between the frequency of documented weight counseling and BMI change.

Discussion: Exposure to the planned program was low and thus we were unable to ascertain the efficacy of a staged intervention for childhood obesity. In assessing feasibility, there are several reasons that could explain the high rate of attrition, including scheduling conflicts, lack of transportation, and poor motivation.