Kids N Fitness: A Group-based Pediatric Weight Management Curriculum Adapted for a Clinical Care Model

Research Article

J Pediatr & Child Health Care. 2020; 5(1): 1028.

Kids N Fitness: A Group-based Pediatric Weight Management Curriculum Adapted for a Clinical Care Model

Manzanarez B1, Lopez K1, Lipton-Inga M1, Fink C1, Radzik M2, Buxton R3, Gonzalez J1, Davis C1 and Vidmar AP1*

1Diabetes and Obesity Program, Center for Endocrinology, Diabetes and Metabolism, Children’s Hospital Los Angeles and Keck School of Medicine of USC, USA

2Diabetes & Obesity Program and Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles and Keck School of Medicine of USC, USA

3Physical Therapy and Rehabilitation Services, Children’s Hospital Los Angeles and Keck School of Medicine of USC, USA

*Corresponding author: Alaina Vidmar, Department of Pediatrics, Center for Endocrinology, Diabetes & Obesity Program, Diabetes and Metabolism, Children’s Hospital Los Angeles and Keck School of Medicine of USC, 4650 Sunset Boulevard, Mailstop #61, Los Angeles, CA 90027, USA

Received: December 23, 2019; Accepted: January 28, 2020; Published: February 04, 2020


Background: The current AAP clinical practice guidelines for the management of pediatric obesity recommend a structured, comprehensive, multi-disciplinary clinical intervention. However, there is a gap in the current literature on standardized curriculums for implementation of such programs. The objective of the present study is to adapt an evidenced-based, familycentered, weekly, weight management curriculum that addresses nutritional, physical activity and behavioral topics for a clinical care model at a tertiary care children’s hospital.

Methods: The curriculum was adapted for use in six individual sessions offered monthly by a multidisciplinary team, including a health educator, physician, dietitian, physical therapist and psychologist. Each provider offered specific feedback and curriculum adaptation based on their specialty. All team members completed training with scheduled treatment fidelity monitoring during implementation. To evaluate the effectiveness of the adapted curriculum, 60 adolescents, ages 14-18 years, with overweight or obesity, and at least one family member, will complete the six month intervention. The primary outcome is mean change in zBMI and %BMIp95 at six month and 18 months. Secondary outcomes include retention, satisfaction, effect on metabolic factors and activity level.

Conclusion: There is a paucity of literature on utilizing a standard curriculum in clinical weight management programs. Drawing from evidencedbased curriculum to strengthen clinical care creates an opportunity to improve existing clinical programs and potentially increase access and implementation of the current treatment recommendations for this high risk population.

Keywords: Obesity; Pediatrics; Weight Loss; Weight Management; Curriculum


Body mass index (BMI); Body mass index Z-score (zBMI); Percent over the 95th percentile (%BMIp95); Alanine aminotransferase (ALT); Coefficient (coef); Confidence Interval (CI); Quality-adjusted life years (QALY)


Pediatric obesity remains a major public health concern [1]. Recent NHANES data indicates that 18.5% of children and adolescents are obese, including 13.9% of 2- to 5-year-olds, 18.4% of 6 - to 11-year-olds, and 20.6% of 12 - to 19 year-olds [2]. In our population of lower income minority patients in Southern California, 1 in 3 adolescents have obesity or severe obesity, and of those, 30- 50% go on to develop pre-diabetes or type 2 diabetes as young adults [3]. These striking findings reinforce the need to identify innovative, effective, and replicable interventions that target children and their families specifically and determine the best way to replicate these interventions across clinical practices and providers [2, 3]. The pediatric population is at high risk of poor health outcomes and therefore requires thoughtful study of the most effective treatment strategies to promote stabilization of their BMI trends [4].

The recent consensus guideline for the treatment of pediatric obesity recommends comprehensive, multi-disciplinary, familybased interventions with 26 contact hours over a 6 month period [4,5]. Interestingly, there is a paucity of literature discussing the use of a standardized, structured weight management curriculum to implement these interventions in a tertiary care setting [6]. Multiple group-based curriculums have been developed to date as intervention strategies for the management of pediatric obesity [7,8]. However, few have been adapted for individualized implementation and studied in a clinical setting. Therefore, the current study aims to investigate the adaptation of an evidence based, family-centered, group weight management curriculum to be implemented by a multi-disciplinary provider team in a clinical setting in a tertiary care center.

Kids N Fitness© (KNF) is an evidence-based, weight management program for children with overweight and obesity and their families [9,10]. KNF was developed at Children’s Hospital Los Angeles (CHLA) in 2000 by a team of pediatric endocrinologists (MD), Registered Dietitian Nutritionist (RDN), social workers, Psychologists (PSY), and Physical Therapists (PT). The objectives of KNF are to: 1) reduce weight gain in youth with overweight and obesity, 2) promote healthier eating habits, more frequent exercise, and a reduction in the behaviors that encourage weight gain, and 3) provide ongoing support to help sustain healthy behaviors. The program empowers families to make healthy lifestyle changes by providing digestible, interactive nutrition education for the entire family. Each class consists of nutrition education, physical activity, and parent support sessions.

The goal-setting objectives of the present study are twofold: 1) To adapt the KNF curriculum to be implemented by a multidisciplinary provider team in a clinical setting and 2) To evaluate how baseline demographics or clinical characteristics of treatmentseeking youth or their parents predict treatment outcomes, across BMI status metrics in this high risk population. This curriculum adaptation was created as part of a larger Randomized Controlled Trial (RCT) that is set to test the efficacy of an interactive addiction mobile health (mHealth) weight-loss intervention with personalized phone-coaching (App+Coach) compared to: 1) interactive addiction model based mHealth weight-loss intervention alone (App) or 2) multidisciplinary in-clinic weight management program (Clinic) [9].


Overview of study design

The present study will describe the development of a multidisciplinary in-clinic weight management program that was developed as one of the intervention arms for a three-arm multicenter (n=180) RCT of a mHealth weight loss intervention plus personalized coaching (App+Coach) compared to: 1) mHealth intervention alone (App) and 2) multidisciplinary in-clinic weight management program (Clinic) [11]. The specific details of the RCT design and process have been described by Vidmar et al [11].

Participant recruitment and eligibility criteria

Study procedures were approved by the Children’s Hospital Los Angeles (CHLA) Institutional Review Board and are in accordance with the Helsinki Declaration of 1975, as revised in 2008. The study will be reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement for randomized trials of no pharmacological treatments and is registered with (NCT03500835). Youth interested in participating will be scheduled for a visit and informed consent will be obtained. Eligible participants will be adolescents, ages 14-18 years with BMI =85th percentile for age and sex with at least one family member willing to participate in the six-month intervention followed by 12-month maintenance period. Youth will be excluded if they: are currently participating in an alternative weight loss intervention; have a self- reported diagnosis of blood pressure > 99th percentile for age, gender, and height, and/or severe developmental delay in which they are unable to autonomously interact with the interventions; or are unable to read English. Participants will be recruited from: 1) four Southern California-based hospitals (CHLA, Los Angeles Biomedical Research Institute at Harbor-UCLA (LA Biomed), Mattel Children’s Hospital of the University of California Los Angeles, and Cedars Sinai Medical Center) and 2) direct mailing campaign. A direct mailing campaign will be utilized to send 10,000 recruitment letters to families with adolescents’ ages 14-18 years across 40 neighborhoods in Los Angeles County.

Session Design and Layout: Participants randomized to the in-clinic arm will be given an appointment to come to CHLA for a 1.5-2 hour visit once per month (+/-2 weeks) for six sessions over a six-month period. The research team consists of a physician (MD), Registered Dietitian Nutritionist (RDN), Psychologist (PSY), Physical Therapist (PT) and/or health educator (HE). Each visit will consist of five components: 1) nutrition education for the entire family, 2) physical activity for the teen, 3) a parent support session, 4) SMART (Specific, Measurable, Attainable, Relevant and Timely) goal setting, and 5) a healthy snack. Interspersed throughout the six sessions will be a facilitated discussion based on the socioecological model around barriers and strategies to health, sustained habit change and lifestyle redesign. The adaptation is designed for the RDN and/or HE to meet with the family at all six sessions and provide continuity between visits. The intention is that the MD will meet with the family twice, ideally at sessions one and six, and for the PSY to meet with the parent at sessions one and six twice and with the teen alone at session three independent of the parent once. The PT will meet with the teen on session one and provide an orientation and do an initial assessment, and make recommendations.

Randomization: Randomization will be at the level of the youth utilizing block randomization to ensure the groups are balanced in terms of number of subjects and the distribution of potential confounding variables. Youth (n=180) will be randomly assigned to one of the intervention arms. Investigators and study staff will be blinded to block size.

Intervention Components

Table 1 outlines the components of the multi-disciplinary curriculum.