P2.197: Optimizing Intensive Health Behavior and Lifestyle Treatment for Children with Obesity: A Hybrid Approach

Purpose/Objectives: Intensive Health Behavior and Lifestyle Treatment (IHBLT) programs play an important role in improving weight status and reducing comorbidities for children with obesity. However, known limitations for participation exist. Frameworks such as Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) address the disconnect between evidence-based research and practical application. This project aimed to explore if a hybrid IHBLT program, containing both face-to-face and virtual components would result in adequate reach and effectiveness.

Design/Methods: Over one year, a single-center quality improvement project was conducted. IHBLT total dosage was intensified by offering a combination of face-to-face and virtual weight management contact hours (Figure 1). Reach evaluated the proportion of eligible patients who participated. Effectiveness evaluated the targeted outcomes of treatment intensity and change in body mass index standard deviation scores (BMIz).

Results: Baseline data from the clinic was reviewed for 8,267 patients demonstrating 34% of patients seen for their annual visit had a BMI ≥85th percentile for age and sex. Of these patients 2.7% were referred to the IHBLT program and 1.4% of the total eligible population participated. BMI was collected at each face-to-face visit. Descriptive statistics quantified the reduction in BMIz; a reduction in BMIz of ≥0.25 is generally believed to be the threshold for a significant reduction in short- and long-term risk of comorbidity. Analysis involved with patients who completed two or more face-to-face visits (24 out of 39 participants) noted a mean reduction in BMIz of 0.09 (SD 0.19). As seen in Figure 2, multivariate analysis of total dosage revealed that for every unit increase in dosage (in hours), the BMIz score decreases by 0.01, holding all other variables constant, however, it is not statistically significant (p-value: 0.495)

Conclusion/Discussion: Reach of the Hybrid IHBLT program was noted to be below goal. Effectiveness as measured by treatment intensity and BMI reduction was consistent with prior evidence supporting that the number of contact hours influenced the degree of reduction in BMI. While a non-significant reduction in BMIz was noted in this project, a recent systematic review found that an average reduction in BMIz of 0.07, while not meeting clinically significant thresholds, still substantially impacted weight-related health behaviors. This evidence suggests that regardless of the magnitude of decrease in BMIz, there are beneficial effects on important health outcomes. Overall project findings support the growing body of evidence for virtual-supported interventions to reduce weight and improve health status.