P0782 - Implementing Obesity Treatment through Clinic and Community Partnerships

Background/Purpose: Current recommendations suggest effective obesity treatment requires 26 or more hours of comprehensive lifestyle modification over 6-12 months. However, implementing this level of care is difficult, particularly in rural and low-income communities. One model of clinic-community partnerships joins primary care pediatricians with parks and recreation programs, providing both needed clinical care and family-based activity opportunities. We examined an implementation strategy that developed partnerships between primary care clinics and parks and recreation programs for delivery of child obesity treatment.

Methods: Using a mixed-methods, hybrid type 3 implementation-effectiveness study, we selected eight North Carolina counties representing a range of geographic and demographic factors. Between January 2016 and December 2019, we provided curriculum and technical support to create a community partnership. We measured program referrals, attendance, engagement, fidelity, and adaptation, and individual-level behavior and health changes, using program data and individual survey responses (n=139).

Results: All eight sites successfully implemented their partnership, with 1,193 patients referred to the programs (mean age 12 years). The programs reached high-needs populations: 63% had severe obesity (30% class II, 33% class III); 47% of survey respondents were Black and 9% other race; 32% identified as Hispanic, 43% reported food insecurity. Of referred patients (n=241), 20% attended a community program session at least once (n=241 children), with 85% of these continuing attendance. Among engaged participants (those attending 2+ sessions), 32% met the target recommendation of 26 hours. Programs had a mean of 16.5 total participants (5.7 patients, 6.1 parents, and 5.3 siblings) each session, and delivered a variety of indoor and outdoor activities, as well as nutrition programming.

Conclusion: A clinic-community partnership can effectively deliver recommended obesity treatment and engages a wide range of populations. Programs are consistently able to meet the USPSTF recommendations for treatment contact time. A comprehensive implementation strategy can support the development of clinic-community partnerships in rural and underserved communities lacking specialty care.