Project Summary

Children from rural communities and minority populations have the highest rates of obesity yet the lowest access to obesity treatment interventions. In the United States, 13.4 million children live in rural communities and nearly 37 million children are underrepresented minorities. These populations are impacted by health disparities in the prevalence of childhood obesity: compared to 14 percent of White children with obesity, 22 percent of Latino children, 20 percent of African American children and 22 percent of children who live in rural areas have obesity. Obesity treatment during early childhood is important because early childhood growth patterns have implications for future health. For example, the long-term consequences of childhood obesity, including type 2 diabetes mellitus, hypertension and coronary heart disease, have their beginnings in early childhood.

A main contributor to the unequal rates of childhood obesity is unequal access to evidence-based obesity interventions among underserved communities. Even when interventions are available, they are often difficult to attend and sometimes insurance companies do not pay for those services. The current recommendation for children with obesity is that they receive an intensive behavioral intervention of 26 hours over six months—an average of one hour per week. During the stakeholder engagement process for developing study, the research team spoke with families who agreed to the need for less-intensive intervention strategies to meet the demands of their schedules. 

There is conflicting evidence about the optimal dose of behavioral interventions for childhood obesity treatment. It is unclear whether clinically meaningful weight loss can be achieved with fewer than 26 hours of intensive intervention. The goal of this study is to answer the question: Is the burden of 26 hours worth it? Or can we achieve equal weight loss for children with obesity from rural and minority populations by implementing a more feasible 13-hour intervention? 

The study has the following aims: 

  • Aim 1: Conduct a randomized trial to test the effect of a variety of lower-intensity behavioral interventions versus a behavioral intervention with 26 contact hours on changes in child body mass index 
  • Aim 2: Evaluate the effectiveness of each intervention arm among prespecified population subgroups 
  • Aim 3: Evaluate the potential dissemination and implementation of both intervention arms among providers and patients 
  • Aim 4: Evaluate whether each intervention arm is better than no intervention by comparing each study arm to a control group using electronic health record data 

The study team will conduct a randomized trial that tests whether the reduced-intensity arms are equivalent to a 26-hour intervention. Researchers will recruit 900 children ages 5-17 from rural and minority communities in Tennessee and Louisiana, where rates of childhood obesity are among the highest in the country. Eligible children will have obesity. The study will enroll participants from urban, suburban and rural communities who speak English or Spanish. The intervention is designed to apply health behavior change theory to improve child obesity and is delivered by pediatric healthcare providers, clinical nutritionists and social workers. The primary outcome is a change in a child’s weight over 12 months. Secondary outcomes include changes in child diet, physical activity, sleep, media use and quality of life. Researchers will also assess reach, feasibility and accessibility of this approach for both participants and providers. 

The study team’s engagement approach includes involvement of stakeholders from both rural and urban settings across middle Tennessee and southern Louisiana, including: 

  • Academic and community pediatricians
  • Community leaders 
  • Insurance companies (to facilitate sustainability) 
  • Parents (both English- and Spanish-speaking families) 
  • Leaders from the United States Preventive Services Task Force and the American Academy of Pediatrics 

Each of these stakeholder groups has reviewed the study, providing input into study design, intervention content and feasibility, and potential for long-term sustainability. 

The expected impact of this work is to: 

  • Inform national practice guidelines for childhood obesity management
  • Expand access to obesity treatment in limited-resource settings, especially rural communities 
  • Build linkages between local healthcare providers and community resources to support child health 
  • Support families by creating intervention strategies that are feasible and effective to reduce childhood obesity

Project Information

William Heerman, M.D., MPH
Amanda Staiano, Ph.D., MPP
Vanderbilt University Medical Center
$13,855,636 *

Key Dates

66 months *
November 2023

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.


Award Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 24, 2024