Feedback Following a Family-Focused Pediatric Weight Management Intervention: Experiences from the New Impact Program

Introduction: New Impact is a family-centered pediatric weight management program for children and adolescents with a BMI percentile >85%, offered through a hospital system specialty clinic. New Impact’s interdisciplinary treatment team began with a registered dietitian, a psychologist, a pediatrician and an exercise specialist (later replaced with a reduced-cost YMCA membership). The team, trained in motivational interviewing, engaged children and their families in lifestyle changes for weight management over one year. Program participants received a clinical assessment, psychological assessment, nutrition education, access to physical activity programs, and assistance with setting individual and family goals for nutrition and physical activity behaviors. Purpose: The purpose of this study was to explore parent and child feedback following an intensive obesity treatment program, and to determine which patient and program characteristics influence a patient’s perceived and actual success. Methods: Telephone interviews were conducted with 20 child/family units; phone calls included patients and parents where age-appropriate. Interviews were then transcribed and a team of four researchers developed a qualitative codebook. Using inductive and deductive coding methods, researchers applied codes to all transcripts and Atlas.ti was used to extract coded participant responses. Results: New Impact used the “Let’s Go! 5-2-1-0”, “Go Slow Whoa”, and “My Plate” programs to structure nutrition education and anchor goal setting. Most parents and teenagers remembered the “Go, Slow, Whoa” and “My Plate” program elements, however only two parents remembered specific components of the “Let’s Go! 5-2-1-0” program. Many interviewees described individual and family changes they initiated as part of the program. Interviewees discussed changes that aligned with New Impact goal setting techniques, focusing on setting small incremental goals designed to lead to more substantial changes over time. Interviewees who emphasized program incentives, logistical barriers, a need for external accountability, or assistance with goal setting were less likely to complete the program or to continue with healthy changes after completing the program. As an example, one participant stated, “The program is great and when you’re going over there, it’s really easy to get with it, but as soon as you leave, the motivation at home is different.” Conversely, interviewees who described how they enjoyed the lifestyle changes, increased their confidence or competence in related behaviors, felt like the providers were empathetic to their situation, or could find ways to make the changes fit in their current family dynamics, were more likely to continue with behavior changes after the program. Conclusion: Pediatric weight management programs should consider patient and family readiness, structured implementation adaptations to address barriers, intentional efforts to move from external reward to internal motivation, and how to help families develop skills to address barriers in order to develop self-efficacy with achievable healthy behaviors that will impact a participant’s obesity.