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CDC’s Childhood Obesity Research Demonstration (CORD) Project 2.0

Improving Access to Childhood Healthy Weight Programs

The foundation of childhood obesity treatment is lifestyle modification. Through visits with medical, nutrition, and behavioral specialists, families enrolled in healthy weight programs learn the skills and knowledge needed to a live a life of healthy eating and active living.

In 2017, the U.S. Preventive Services Task Force (USPSTF) found that clinicians screen children ages 6 and over for obesity (using body mass index (BMI)) and offer or refer them to family-centered comprehensive intensive behavioral interventions as these can result in improvements in weight status for up to 12 months (Grade B Recommendation).  In general, weight management programs that provided moderate to high intensity (defined as 26-75 hours of contact time over a 6 month period) were found to be more effective. Several examples of family-centered obesity interventions are found in the USPSTF review.  An example of an evidence-based program that works for managing childhood obesity and is readily adaptable is the Mind, Exercise, Nutrition, Do It (MEND) program.  The MEND program was used by grantees in both CORD 1.0 and 2.0.

CORD 2.0

CORD 2.0 (Funding Period 2016–2018) builds off of research findings from CORD 1.0 [CORD 2.0 specifically focuses on clinical and weight management program interventions to improve nutrition and physical activity behaviors of children in working families who are struggling with overweight and obesity.]. Projects will strengthen clinical-community collaborations to improve obesity screening and counseling services for children in select communities, and when appropriate, refer them to community-based healthy weight programs.

CORD 2.0 focuses on low income children aged 6 to 12 years. The two project grantees are

  • The Massachusetts Department of Public Health in collaboration with Massachusetts General Hospital.
  • Arizona State University-Tempe.

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Project Emphasis

CORD 2.0 grantees will focus on the role of health care providers, other health care team members, and community partners for management of childhood obesity in the health care setting and the community settings such as the YMCA. Grantees will

  • Implement body mass index screening and quality nutrition and physical activity counseling for all children.
  • Use electronic health systems to enroll children who are overweight and children who have obesity in healthy weight programs.
  • Deliver evidence-based structured behavioral programs (healthy weight programs) that support improved obesity-related behaviors. This includes working with parents to provide skills that will support their children who are overweight or who have obesity.

CORD 2.0 builds on the 2017 USPSTF recommendations by supporting providers to screen children aged 6 years or older for obesity, and referring those with overweight or obesity to intensive lifestyle modification programs. The lifestyle modifications programs used in CORD 2.0 are consistent with program intensity recommendations from USPSTF.

These programs, if effective, will help low-income children improve their obesity-related behaviors, reduce their weight gain, and reduce their risk of developing sleep apnea, joint problems, and diseases such as fatty liver and type 2 diabetes. The projects also will evaluate if these interventions affect parents and other family members at risk of obesity.

CORD grantees are working with state and community partners—such as state Medicaid offices—to assess how local childhood healthy weight programs are offered. CORD grantees will work to make sure these programs are easy to access by low-income families, and identify payment models that balance care and costs.

CORD 2.0 grantees will evaluate their interventions, providing needed information on how value-based childhood healthy weight interventions can be effectively carried out for children from lower income families. Grantees will assess healthy weight program costs as well as identify program strengths and weaknesses from the perspective of providers, attendees and other stakeholders, including state Medicaid offices. This information will be used to determine how similar programs may be developed in a sustainable way and disseminated across primary care practices in the state.

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Arizona State University

The Arizona-CORD (AZ CORD) work builds off an existing intervention called the Family Check-Up (FCU). FCU is an evidence-based parenting program that uses motivational interviewing to improve family management skills, and helps link families to appropriate services. The AZ-CORD team will use an adaptation of the FCU, called the Family Checkup 4 Health (FCU4Health) to target health behavior change in young people with overweight and obesity. FCU4Health is an assessment-driven approach that tailors services to meet the needs of families and works to increase motivation to address the behavioral risk factors related to overweight and obese children and their families. AZ-CORD will conduct a randomized trial (n=350) to test the effects of the FCU4Health program in 3 primary care clinics that predominantly serve Medicaid patients and have a large population of families of Mexican American and American Indian decent. AZ-CORD will use electronic health data, behavioral observation, questionnaires, and interviews to assess the effect of the FCU4Health on overweight and obesity, child health behaviors, and parenting skills. CORD-AZ will also conduct a process evaluation that will assess key process outcomes, such as acceptability, feasibility, and fidelity, along with a cost evaluation, which will provide actionable information for sustainability.

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Massachusetts Department of Health

Massachusetts CORD 2.0 (MA-CORD 2.0) will build on innovative strategies to optimize the care of low-income children with a body mass index (BMI) ≥ 85th percentile for age and gender through a model that includes

  • Obesity-related clinical decision supports in electronic health records (EHR) for primary care providers.
  • Educational materials and interactive text messages for self-guided behavior change support.
  • Links to community resources to support behavior change.
  • EHR-referral based, structured pediatric weight management.

This nested randomized controlled trial will examine the comparative effects of two pediatric weight management programs. The first is the Healthy Weight Clinics that was tested in the MA-CORD 1.0 project in two primary care clinics. The second is the YMCA’s Healthy Weight and Your Child weight management program. Each of the two intervention groups will receive an intensive 6-month intervention, followed by a 6-month maintenance period that delivers ≥ 27 hours of contact time. MA-CORD 2.0 builds on prior research and implementation activities across several health care systems and communities and will use health information technology to connect clinical delivery systems with community resources to improve health outcomes. Collaboration with the state Medicaid office will ensure the sustainability of the program, which if successful, may provide a new model of obesity care for the population who carries the highest burden of this disease.

For additional CORD resources and information, please see CORD 1.0.

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