This study was a randomized controlled trial to review the effects of two interventions for children with obesity or who are overweight. The primary outcomes of this study were children’s changes in BMI, parent-reported empowerment related to resources available for their children’s weight management, and children’s health-related quality of life.

Researchers randomly assigned 721 patients into one of two arms:

• Enhanced primary care, which included electronic alerts and clinical decision-support tools for pediatric weight management for clinicians as well as educational materials, a neighborhood resource guide, and monthly text messages promoting behavior change for patients.
• Enhanced primary care that included the same components described above, plus contextually tailored health coaching. The health coaching comprised twice-weekly text messages and six sessions by telephone or videoconference or in person with a trained health coach.

The children were ages 2–12 years, with a BMI at or above the 85th percentile, from six primary care practices affiliated with Atrius Health in Massachusetts.

Researchers developed the interventions with input from parents, children, pediatric clinicians, and community health providers.

Researchers obtained height and weight measurements for study participants from electronic medical records at baseline and at one year. They used these measurements to calculate BMI z-scores, which represent age- and sex-specific measures of BMI. BMIs fell into four categories: normal (≥5th to <85th percentile), overweight (≥85th percentile to <95th percentile), obese (95th percentile to <120% of the 95th percentile), and severely obese (≥120% of the 95th percentile). Approximately 21% of study participants had severe obesity at the study outset.

In telephone surveys with researchers at baseline and one year, parents reported their perceived resource empowerment and their children’s health-related quality of life by responding to questionnaires. Investigators documented the children’s race or ethnicity, parents’ educational attainment, household income, and parental satisfaction with the program.

For intent-to-treat analysis, the research team examined the effect of the intervention on the BMI z-score, parental resource empowerment score, and children’s health-related quality of life using linear mixed-effects repeated-measure models.

Results

The addition of health coaches did not improve children’s BMI, increase parental resource empowerment, or improve children’s health-related quality of life more than enhanced primary care alone.

Compared with baseline scores, after one year, BMI z-scores improved significantly both for children who received enhanced primary care (p<0.01) and children who received enhanced primary care plus health coaching (p<0.01). In addition, compared with the beginning of the study, more children who received enhanced primary care (p<0.02) and enhanced primary care plus health coaching (p<0.01) had BMI percentiles in lower categories at the end of the study. However, neither intervention significantly decreased the proportion of children with severe obesity.

After one year, parents of children who received enhanced primary care (p<0.01) and enhanced primary care plus health coaching (p<0.01) reported increased parental empowerment relative to baseline.

Parents of children who received enhanced primary care plus health coaching reported significant improvements in their children’s health‐related quality of life from the beginning of the study to the conclusion of the study (p<0.01). Parents of children who received enhanced primary care alone did not report this improvement.

Limitations

This study took place in a large, multisite pediatric practice in Massachusetts; findings may not be generalizable to smaller practices or in other locations. Post hoc analysis revealed an increase in BMI z-score during the year prior to enrollment in both groups. The research team could not determine whether the interventions alone were successful in reversing the previous upward trend in BMI z-scores or whether the decrease in BMI occurred independently as a natural response to the prior increase.

Conclusions and Relevance

This study found that both enhanced primary care and enhanced primary care plus health coaching improved children’s BMI z-scores and reduced elevated BMIs. Neither of the interventions reduced the percentage of children with severe obesity. Both interventions also improved parental resource empowerment. However, only parents of children who received enhanced primary plus health coaching reported significant improvements in their children’s health-related quality of life.

Future Research Needs

Future research could compare these interventions in different settings, such as smaller pediatric practices, or among populations of different ethnicities and family incomes. Future research could also examine ways to address weight management in children with severe obesity; these children have the highest prevalence of comorbidities and may require more intensive intervention than the enhanced primary care interventions used in this study.