Addressing social determinants of health in child obesity treatment using community health workers: the role of parental bandwidth in treatment effectiveness - feasibility study for full - scale RCT - PROJECT ABSTRACT Childhood obesity remains a significant problem which impacts children’s health. Family-focused child obesity treatment is efficacious but unfortunately not all children receive the same benefit, especially racial and ethnic minority groups, those on Medicaid and those with insecure housing. Adverse social determinants of health, social risk factors (SRF), are key factors influencing child obesity treatment outcomes. Some challenges are logistical (e.g., lack of transportation). Yet, juggling scarce resources (e.g., money, food) also takes physical, emotional, and mental energy. Bandwidth is our capacity to allocate and use our limited cognitive resources effectively and is impacted by scarcity of time or resources. Lack of bandwidth can lead to poor food choices, weight gain and difficulty learning. Intervening on SRF may have a significant impact on parent bandwidth, allowing parents and children to benefit more fully from child obesity interventions. A community health worker (CHW) can be used to connect families to resources to address SRF and support their ability to engage in child obesity treatment. The long-term goals of this work are to test whether child obesity treatment outcomes can be improved by systematically addressing SRF and whether bandwidth is an important mediator. This proposal will complete a pilot in preparation for a larger trial. The specific aims of this project are 1. To test the feasibility and acceptability of a trial comparing families with SRF receiving CHW support plus a child obesity treatment intervention (CHW+PHIT Kids) and those receiving one-time resource referrals and the obesity intervention (PHIT Kids). We will look at recruitment, retention, satisfaction with CHW intervention and PHIT Kids, and other implementation outcomes. 2. To compare outcomes between CHW+PHIT Kids and PHIT Kids and gather effect sizes on outcome measures to guide a future full-scale trial. Outcomes to be examined over 6 months include1) BMI z-score (primary), 2) child dietary intake (24-hour diet recalls: servings of fruits and vegetables, sugar-sweetened beverages, and high-sugar/high fat foods), 3) child moderate-to-vigorous physical activity (accelerometer, minutes per day) and 4) parent weight. 3. To explore the role of parents’ bandwidth as a potential mediator for the implementation and treatment outcomes. The project will recruit 60 families with an 8- to 12-year-old child with obesity or overweight and a positive SRF screen. Families will be randomized to 1) assistance obtaining needed resources using an existing scalable CHW intervention or 2) a one-time standard of care referral to resources. At three months all families will receive a virtually delivered 3-month child obesity treatment intervention. Data will be collected at baseline, 3, 6, and 12 months. This research is significant as it will give insight into how to improve the efficacy of child obesity treatment interventions for our most vulnerable children by systematically attending to SRF and innovative in exploring bandwidth as a mediator of this relationship. This research will provide the necessary data to support a full-scale clinical trial. This work could significantly alter the way providers deliver obesity treatment and improve health equity.
