Editor’s Note: Dr. Elif Ozdogan (she/her) is a resident physician in Pediatrics at The Boston Combined Residency Program at Boston Children's Hospital and Boston Medical Center. She is interested in quality improvement and computational research and hopes to pursue further training in Transplant Medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
In the US, obesity affects 1 in every 5 children and adolescents. Obesity in children is medically defined as having a body mass index (BMI) greater than that of 95% of the population, where BMI is a measure of one’s weight in relation to their height. Most children and adolescents who are obese go on to become adults who are obese, with many associated health risks, from heart disease to diabetes to even some cancers.
In early 2023, American Academy of Pediatrics released their first clinical practice guideline for evaluation and management of children and adolescents with obesity, which highlighted obesity as a condition highly shaped by health inequities. Not every family has access to robust lifestyle treatments, which have been shown in some trials to require at least 26 hours of engagement for effectiveness. Currently, most health systems do not have the capacity to incorporate such intensive modifications into their practice.
In the article entitled “Using Parks and Recreation Providers to Enhance Obesity Treatment: A Randomized Controlled Trial,” being early released this week in Pediatrics, Sarah Armstrong, MD, Cody Neshteruk, PhD, and colleagues from Duke University and Johns Hopkins University offer a promising solution (10.1542/peds.2024-068427).
This randomized clinical trial builds on years of work by the same group to establish a partnership with the local parks and recreation department. They enrolled 255 children and adolescents with BMI > 95th percentile. The average age was 10 years, and children were from Hispanic, non-Hispanic Black, and White backgrounds.
Those in the intervention group were enrolled in Fit Together, involving 6 months of clinic visits and lifestyle sessions at a local parks and recreation center. The control group received standard clinic visits and follow-up at the discretion of the pediatrician.
The authors then looked at changes in BMI percentile and cardiorespiratory fitness as measured by submaximal 3-minute step test: children stepped up and down on a platform for 3 minutes, at a pace of 96 beats per minute, and heart rate was measured before, immediately after, and 1 minute after the exercise.
Participants in the intervention group had average engagement of 8.9 hours (each clinic visit was counted as 1 engagement hour, and each parks and recreation visit was counted as 2 engagement hours). They also had a significant decrease in BMI percentile compared to the control, but there was no difference in submaximal heart rate between two groups.
In the accompanying commentary, “Embedding Pediatric Obesity Treatment in Community-Based Settings: Opportunities and Challenges,” Drs. Sarah Maxwell and Amy Beck from University of California San Francisco give other examples of successful partnerships but also discuss the barriers to widespread implementation (10.1542/peds.2024-069092). If community partnerships are key to delivering high-quality and accessible lifestyle interventions, structural reforms are necessary to allow sustainable funding and growing access.
Childhood obesity is common and has long-lasting implications. This trial reveals that the lifestyle counseling should and can go beyond the walls of the pediatrician’s office and integrate into the community. The success of this trial highlights a promising path forward. However, it also emphasizes the urgent need for systemic changes to scale such partnerships and support healthier futures for all children.
