Virtual Housecalls: Redesigning Pediatric Primary Care Adolescent Obesity Treatment

PROJECT SUMMARY Adolescents experience high prevalence of obesity and associated chronic diseases, such as type 2 diabetes mellitus, with persistent sociodemographic disparities that begin in childhood and affect quality and length of life. Intensive health behavior and lifestyle treatment (IHBLT) is recommended, with improved treatment responses observed with increasing intervention intensity and duration. As such, the US Prevention Services Taskforce and the American Academy of Pediatrics (AAP) both recommend >26 hours of treatment over 3-12 months. Usually, each “dose” occurs via in-person visits. Pediatric primary care is an ideal setting for IHBLT given family familiarity of services and trust with pediatric primary care practitioners (PPCPs). Unfortunately, clinic-based obesity interventions often have insufficient follow-up related to access barriers (e.g., transportation, childcare, inability to leave work or school, practitioner clinic capacity), reducing their effectiveness. Additionally, clinical advice given without knowledge of the family’s home and community environment is often impractical. Based on our extensive formative work, we propose a redesign of pediatric primary care adolescent obesity treatment, called “Virtual Housecalls.” Virtual Housecalls (VHC) augments typical in-person visits to achieve 26 contact hours: 1) with direct-to-patient video telehealth to tailor behavioral counseling to families’ home and community context, 2) that leverages certified behavior coaches as a part of the care team, and 3) that engages adolescents and caregivers in skill building in real-time within the home environment. The current application will test VHC in a pragmatic randomized clinical trial with 250 adolescents ages 12-15 years with class 1 (non-severe) obesity (BMI≥95% and <120% of the 95%) and a participating parent/caregiver. VHC includes 26 hours of treatment, by combining in-person PPCP visits (every 3m) with 6m of virtual visits conducted by a behavior coach (3m weekly, 3m every 2 weeks), and weekly exercise videos. The control arm will receive enhanced treatment as usual (TAU+), which includes usual care by their PPCP, augmented with publicly available education, sent on an attention-matched contact schedule. All PPCPs will receive training on the AAP Clinical Practice Guideline for obesity treatment and reports of participant progress at 3, 6, and 12m. Assessments of anthropometrics, dietary intake, physical activity, parenting and the home environment will be completed at 0, 3, 6 (post-intervention), and 12m (maintenance), with the primary endpoint at 6m. We will evaluate the efficacy of VHC on adolescent change in body mass index (primary outcome) and dietary and physical activity behaviors (secondary outcomes). We will also evaluate how treatment dose impacts BMI reduction. Results will advance NIDDK’s mission to reduce health disparities via a transformative, patient-centered treatment paradigm to address obesity-related health disparities in adolescents.