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Home-based pediatric weight loss programs improved session attendance and contact time, but didn’t outperform clinic care in weight loss for lower-income children.

Family-based pediatric weight management delivered in the home did not improve weight loss outcomes in children from lower-income households more than a traditional intervention in the clinic, but it did increase session attendance and in-person contact time, which were both predictive of better weight loss outcomes.

“The COVID-19 pandemic began midway through this trial, which temporarily affected trial conduct and precipitated a large population-level increase in children’s obesogenic behaviors and weight gain that was particularly pronounced in economically and racially marginalized groups,” the researchers wrote in Pediatrics. “This represents a type of confound known as a history effect.”

The study, conducted by Sumihiro Suzuki, PhD, and colleagues between 2017 and 2022, was a randomized controlled trial that tested a 12-month pediatric weight management intervention in families of 269 children aged 6 to 12 years with overweight or obesity. Participants were from lower-income English- or Spanish-speaking households in Chicago.

Among the families, 133 were randomly assigned to the home intervention and 136 to the clinic intervention. Both consisted of 18 planned in-person sessions and 12 planned phone contacts, with the only difference being where the in-person sessions occurred.

Changes in BMI Z-Score

According to the results, 12-month changes in BMI z-score (zBMI) did not significantly differ between the home-delivered (−0.031) and clinic-delivered (−0.002) intervention arms.

“The percentage of children that demonstrated clinically meaningful weight loss of at least 0.25 zBMI was 13.7% in the home-delivered arm and 8.6% in the clinic-delivered arm, which was not a significant group difference,” Dr. Suzuki and colleagues wrote.

However, session attendance and contact time predicted larger zBMI decreases across both arms, and each was higher in the home-delivered arm. Participants in the home intervention attended a median of 11 sessions and had 500 minutes of contact time compared with a median of 6.5 sessions and 315.5 minutes in the clinic intervention.

In post hoc analyses, the home-delivered intervention led to 0.03 greater zBMI reductions than the clinic-delivered intervention before the COVID-19 pandemic.

“Prepandemic weight loss outcomes were significantly better for children randomized to home-delivered versus clinic-delivered treatment, whereas children in both arms exhibited adiposity increases in the peripandemic phase,” the researchers wrote. “Children participating in the trial after the pandemic lost weight to a similar degree in both arms.”