Exploring Innovative Approaches and Patient-Centered Outcomes From Positive Outliers in Childhood Obesity

Abstract

Objective New approaches for obesity prevention and management can be gleaned from 'positive outliers', i.e., individuals who have succeeded in changing health behaviors and reducing their body mass index (BMI) in the context of adverse built and social environments. We explored perspectives and strategies of parents of positive outlier children living in high risk neighborhoods. Methods We collected up to five years of height/weight data from the electronic health records of 22,443 Massachusetts children, ages 6-12 years, seen for well-child care. We identified children with any history of BMI ≥95th percentile (n=4007) and generated a BMI z-score slope for each child using a linear mixed effects model. We recruited parents for focus groups from the sub-sample of children with negative slopes who also lived in zip codes where >15% of children were obese. We analyzed focus group transcripts using an immersion/crystallization approach. Results We reached thematic saturation after 5 focus groups with 41 parents. Commonly cited outcomes that mattered most to parents and motivated change were child inactivity, above-average clothing sizes, exercise intolerance, and negative peer interactions; few reported BMI as a motivator. Convergent strategies among positive outlier families were family-level changes, parent modeling, consistency, household rules/limits, and creativity in overcoming resistance. Parents voiced preferences for obesity interventions that include tailored education and support that extend outside clinical settings and are delivered by both health care professionals and successful peers. Conclusions Successful strategies learned from positive outlier families can be generalized and tested to accelerate progress in reducing childhood obesity.

Connect for Health : Design of a clinical-community childhood obesity intervention testing best practices of positive outliers

“…12,13 Several children and parents from these focus groups now participate as ongoing members of our parent and youth advisory board. Leaders and staff of youth-serving community-based organizations, including the YMCA, provided critical input on the ideas and activities we ultimately implemented.…”

“…We have previously published the methods and results of this formative work. 12,13 Parents reported several practices that facilitated their ability to help their child improve their BMI. Among them were: 1) making changes as a family rather than solely for the child; 2) implementing limits and rules around snacking, screen time and activity, and maintaining consistency around those rules; 3) being involved in the decision-making with their health care provider about their child's weight management; 4) using more immediate rather than long-term outcomes of weight management to motivate change, and 5) maximally leveraging community resources to support behavior change.…”

“…The intervention was built upon practices of positive outlier families as well as strategies recommended by a diverse group of stakeholders representing parents, children, pediatric clinicians, and community/public health providers. 12,13 In this paper we summarize the development and methods of Connect for Health .…”

Engaging children in the development of obesity interventions: Exploring outcomes that matter most among obesity positive outliers

“…We have previously suggested that the positive outlier approach may advance progress in childhood obesity by identifying and learning from successful children and families within obesogenic socio-environmental contexts [8]. We have also applied the approach to examine the perceptions and strategies of parents of positive outlier children who have improved their weight status despite living in neighborhoods with high obesity prevalence [9]. …”

Teen, Parent, and Clinician Expectations About Obesity and Related Conditions During the Annual Well-Child Visit

“…6 In pediatrics, patient-centered approaches positively influence parent satisfaction. 4 Prior qualitative studies using focus groups and interviews have examined pediatric screening, care and communication during the well-child visit from the parent [7][8][9][10][11] or the provider perspective. [12][13][14] To our knowledge, none of these included teens in the discussion to improve well-child visit outcomes.…”