Neighborhood-Level Variation in the Effectiveness of Intensive Health Behavior and Lifestyle Treatment for Pediatric Obesity.

Abstract

This study assessed variation in BMI change by neighborhood characteristics of participants in Bright Bodies, a family-based intensive health behavior and lifestyle treatment for pediatric obesity. For first-time participants (2008-2018) with initial BMI ≥ 85th percentile, we geocoded addresses and assigned Child Opportunity Index (COI) and COI-Healthy Environment (COI-HE) scores (Low/Moderate/High). Using multivariable mixed effect linear regression, we assessed monthly change in BMI percent of the 95th percentile (%BMIp95) and extended BMI z score by COI and COI-HE. Of 391 youth (mean ± SD age 11.7 ± 2.8 years, 60.1% female), 80.8% resided in Low COI and 66.5% in Low COI-HE neighborhoods. Monthly %BMIp95 change differed by COI (p = 0.039 for interaction) and COI-HE (p = 0.004). Mean %BMIp95 decreased in all subgroups; greatest reductions were in High COI (-1.86 [95% CI: -2.40, -1.33]) and High COI-HE groups (-2.32 [-2.78, -1.85]) and lowest in Moderate COI (-1.17 [-1.59, -0.75]) and Low COI-HE groups (-1.53 [-1.75, -1.32]). Change in extended BMI z score differed significantly between COI-HE subgroups only (p < 0.001). Bright Bodies participation was associated with BMI reduction among all COI/COI-HE subgroups, but the highest COI/COI-HE groups had the greatest reductions. Modifications to intensive health behavior and lifestyle treatments should address inequities in access to built environments that facilitate healthy, active living.