Facilitating lifestyle behavior change in the primary care setting with a staged approach to childhood obesity treatment

Childhood obesity treatment has become a priority due to the increasing prevalence of obesity in the United States. Evidence-based recommendations have been developed to guide treatment using a staged approach, where the first two levels of treatment occur in primary care with a focus on lifestyle behavior change. The purpose of this dissertation is to explore lifestyle behavior change in the primary care setting using the staged approach for childhood obesity treatment by: (1) examining primary care providers’ (PCPs) current practices, barriers and needed improvements; (2) determining the effectiveness of an intervention for treatment using a lifestyle behavior screening tool and health coaching; and (3) examining action plans and experiences of families participating in the intervention. The first study found that 63% of surveyed PCPs always/often use a screening tool to assess patients’ eating and physical activity behaviors, but only 41% always/often track these behaviors. PCPs identified their top treatment barrier as limited time and identified needing better counseling tools. The second study found that after a six-month intervention using a lifestyle behavior screening tool and health coaching, participants in the intervention group had greater improvements in lifestyle behavior change measured by the Family Nutrition and Physical Activity screening tool compared to the control group, but the difference was not significant (intervention: 4.86 ñ 6.28; control: 0.38 ñ 4.6; p = 0.135). However, the effect size (d = 0.88) is considered to be large. The third study identified that the key differences among action plans of intervention participants were related to the relationship to a particular lifestyle behavior, as well as the contextual detail in an action plan. Common themes identified in participant interviews included accountability, an interest in experiential learning and resources, and perceived program benefit. Findings of this dissertation support the need for additional research on behavior change interventions in primary care that promote self-management of health more broadly, as well as to explore other factors in lifestyle behavior change (e.g., cognitive skills) that aren’t routinely addressed in current approaches to treatment