FitKids360: Design, Conduct, and Outcomes of a Stage 2 Pediatric Obesity Program

Abstract

This paper describes FitKids360, a stage 2 pediatric weight management program. FitKids360 is a physician-referred, multicomponent, low-cost healthy lifestyle program for overweight and obese youth 5–16 years of age and their families. FitKids360 provides an evidence-based approach to the treatment of pediatric overweight by targeting patients' physical activity, screen time, and dietary behaviors using a family-centered approach. The intervention begins with a two-hour orientation and assessment period followed by six weekly sessions. Assessments include lifestyle behaviors, anthropometry, and the Family Nutrition and Physical Activity (FNPA) survey, which screens for obesogenic risk factors in the home environment. Outcomes are presented from 258 patients who completed one of 33 FitKids360 classes. After completing FitKids360, patients increased moderate to vigorous physical activity by 14 minutes (P = 0.019), reduced screen time by 44 minutes (P < 0.001), and improved key dietary behaviors. Overall, FNPA scores increased by 9% (P < 0.001) and 69% of patients with “high risk” FNPA scores at baseline dropped below the “high risk” range by followup. Patients also lowered BMIs (P = 0.011) and age- and sex-adjusted BMI z-scores (P < 0.001) after completing the 7-week program. We hope this report will be useful to medical and public health professionals seeking to develop stage 2 pediatric obesity programs.

Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions

“…A summary of all included studies is shown in Table 1. Three articles were published in 2007 [13][14][15], two in 2009 [16,17], one in 2010 [11], one in 2011 [18], one in 2013 [19] and one in 2014 [20]. Most of the studies included in the review were interventions conducted in the US, with one study conducted in Australia [15], and one study conducted in Italy [14].…”

“…In three studies, children with BMI of ≥85th percentile were included in the interventions [16,19,20]. The study by Kwapiszewski et al had additional inclusion criteria of children being overweight (BMI > 85th percentile and <95th percentile), obese (BMI > 95th percentile) or at risk for obesity, which considers age as well as corresponding BMI [18].…”

“…One study implemented the FitKids360 intervention which involved a ''healthy counts'' (8-7-6-5-4-3-2-1-0) concept as a part of its curriculum, which recommends: 8-11 h of sleep every night, seven breakfasts in a week, six home-cooked meals in a week, five servings of fruits and vegetables per day, four positive self-messages per day, three servings of low-fat dairy per day, 2 h or less of screen viewing time per day, 1 h or more of physical activity per day and zero sugary drinks per day [20]. The intervention included sessions for physical activity, nutrition education, and behavioural counselling for parents.…”

“…The intervention included sessions for physical activity, nutrition education, and behavioural counselling for parents. In addition, there was also a 'buddy' who would be the case manager or a mentor, who engaged the families in accountability, goal-setting, motivation, and weekly planning [20]. Schwartz et al employed Motivational Interviewing (MI), which focuses on counselling to encourage behaviour changes [13].…”

“…BMI z-scores are defined as the units of standard deviation that a child's BMI was above the average BMI value for the same age group and sex [21]. Three studies found significant decreases in BMI z-scores [16,19,20]; two studies found significant percentage decreases in BMI in the intervention group(s) as compared to the control group [14,18]; while two studies did not find any significant changes in BMI [13,15]. Two studies also evaluated changes in clinical practices after the intervention [11,17].…”