Childhood Obesity Research Demonstration (CORD) 2.0

Photo: Mother serving fresh healthy salad to her son

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

CORD 2.0 (funding period 2016–2018) focused on clinical and weight management interventions to improve nutrition and physical activity behaviors of children who are struggling with overweight and obesity. Projects built on 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 focused on children aged 6 to 12 years from working families with lower incomes.

The programs were designed to help 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 evaluated if these interventions affected parents and other family members at risk of obesity.

CORD 2.0 grantees worked with state and community partners—such as state Medicaid offices—to make sure these programs were easy for families to access. The partners also collaborated to identify payment models that balanced care and costs.

CORD 2.0 grantees assessed healthy weight program costs and identified program strengths and weaknesses from the perspective of providers, attendees and other partners, including state Medicaid offices. This information will be used to determine how similar programs may be sustained and disseminated across primary care practices in the state.

For more information, see CORD 1.0 and CORD 3.0.

In 2017, the U.S. Preventive Services Task Force (USPSTF)external icon found that clinicians should 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 (Grade B Recommendation). However, may children and families face barriers in getting to healthy weight programs.

Project Emphasis

CORD 2.0 recipients focused on the role of health care providers, other health care team members, and community partners for management of childhood obesity in the health care and community settings such as the YMCA. Grantees:

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

Publications updated 3/23/2021

Title: Effects of the Family Check‑Up 4 Health on Parenting and Child Behavioral Health: A Randomized Clinical Trial in Primary Care
Authors: Berkel C, Fu E, Carroll AJ, Wilson C, Tovar‑Huffman A, Mauricio A, Rudo‑Stern J, Grimm KJ, Dishion TJ, Smith JD.
Journal: Prev Sci
Released: February 2021
Link to abstract:  https://rdcu.be/cgKZ3external icon

Title: The Family Check-Up 4 Health: Study protocol of a randomized type II hybrid effectiveness–implementation trial in integrated primary care (the healthy communities 4 healthy students study)
Authors: Berkel C, Smith JD, Bruening MM, Jordan N, Fu E, Mauricio AM, Grimm KJ, Winslow E, Ray K, Bourne A, Dishion TJ.
Journal: Contemp Clin Trial
Released: September 2020
Link to abstract:  https://pubmed.ncbi.nlm.nih.gov/32707101/external icon

Title: Translating evidence‐based parenting programs for primary care: Stakeholder recommendations for sustainable implementation
Authors: Berkel C, Rudo-Stern J, Abraczinskas M, Wilson C, Lokey F, Flanigan E, Villamar JA, Dishion TJ, Smith JD.
Journal: J Community Psychol
Released: January 2020
Link to abstract:  https://pubmed.ncbi.nlm.nih.gov/31951291/external icon

Title: Parenting and social-ecological correlates with children’s health behaviors: A latent profile analysis
Authors: Fu E,  Grimm KJ, Berkel C, Smith JD.
Journal: Pediatric Obesity
Released: September 2020
Link to abstract:  https://onlinelibrary.wiley.com/doi/full/10.1111/ijpo.12721external icon

Title: Unmet Social Needs and Adherence to Pediatric Weight Management Interventions: Massachusetts, 2017-2019
Authors: Atkins M , Castro I , Sharifi M , Perkins M , O’Connor G , Sandel M , Taveras EM, Fiechtner L.
Journal: Am J Public Health. 2020 Jul;110(S2):S251-S257. doi: 10.2105/AJPH.2020.305772.
Released: July 2020
Link to abstract: https://pubmed.ncbi.nlm.nih.gov/32663093/external icon

Title: Motivational Interviewing and Caregiver Engagement in the Family Check-Up 4 Health.
Authors: Berkel C, Mauricio AM, Rudo-Stern J, Dishion TJ, Smith JD.
Journal: Prev Sci. 2020 Jun 3. doi: 10.1007/s11121-020-01112-8.
Released: June 2020
Link to abstract: https://pubmed.ncbi.nlm.nih.gov/32488687/external icon

Title: Costs of Preparing to Implement a Family-Based Intervention to Prevent Pediatric Obesity in Primary Care: a Budget Impact Analysis.
Authors: Jordan N, Graham AK, Berkel C, Smith JD.
Journal: Prevention Science
Released: January 2019
Link: https://www.ncbi.nlm.nih.gov/pubmed/30613852external icon

Title: Rationale and Design of the Clinic and Community Approaches to Healthy Weight Randomized Trial.
Authors: Fiechtner L, Perkins M, Biggs V, Langhans N, Sharifi M, O’Connor G, Price S, Locascio J, Kuhlthau K, Kwass JA, Nelson C, Land T, Longjohn M, Lawson V, Hohman K, Taveras EM.
Journal: Contemporary Clinical Trials.
Released: April 2018
Link: https://www.ncbi.nlm.nih.gov/pubmed/29330083external icon

Title: An Individually Tailored Family-Centered Intervention for Pediatric Obesity in Primary Care: Study Protocol of a Randomized Type II Hybrid Effectiveness–Implementation Trial (Raising Healthy Children study).
Authors: Smith JD, Berkel C, Jordan N, Atkins DC, Narayanan SS, Gallo C, Grimm KJ, Dishion TJ, Mauricio AM, Rudo-Stern J, Meachum MK, Winslow E, Bruening MM.
Journal: Implementation Science.
Released: January 2018
Link: https://pubmed.ncbi.nlm.nih.gov/29334983/external icon

Publications updated 3/23/2021

Arizona State University

The Arizona-CORD (AZ CORD) adapted and implemented an existing parenting program called the Family Check-Up (FCU) to address overweight and obesity in young people. The AZ-CORD team worked with three primary care clinics and other providers across the state to implement and test Family Checkup 4 Health (FCU4Health).

Massachusetts Department of Health

Massachusetts CORD 2.0 (MA-CORD 2.0) built on experiences in CORD 1.0 to optimize and test the clinical care of children with a body mass index (BMI) greater than the 85th percentile for their age and gender. The children were from families with low incomes.