Assessing Pediatric Obesity Intervention in Urban Primary Care Clinics Network

Thesis Abstract

Pediatric obesity remains a pressing public health challenge in urban settings, where sociodemographic diversity, food environments, and access to preventive services converge to influence weight trajectories in children. This study investigates how an urban network of primary care clinics delivers obesity intervention programs to children aged 6–12 years, examining implementation processes, clinical outcomes, and organizational determinants within a real-world health system. The aim is to evaluate the effectiveness, feasibility, and equity of multidisciplinary obesity interventions and to identify mechanisms that strengthen routine care in primary settings. Specific objectives are to (1) assess the reach and fidelity of structured obesity interventions across clinics, (2) quantify changes in adiposity indicators (BMI z-scores, waist circumference) and lifestyle behaviors (physical activity, dietary patterns) over 12 months, (3) explore clinicians’ adherence to evidence-based guidelines and perceived barriers to implementation, (4) examine parent–child engagement and satisfaction with services, and (5) develop a transferable model of urban primary care obesity intervention suitable for scaling. The study adopts a mixed-methods design, integrating a quasi-experimental, multi-site cohort with a concurrent qualitative component. The population comprises 8 urban primary care clinics within a metropolitan network, with an intervention cohort of 320 children and a matched usual-care control group of 320 children, followed prospectively for 12 months. Quantitative data are sourced from electronic health records (EHRs), clinic intake forms, and standardized parent-reported surveys, supplemented by objective physical activity data via wearable accelerometers (n=200) and validated dietary recalls (n=250). Instrument validity and reliability are established through prior validation studies and pilot testing within the network. Quantitative analyses employ multilevel linear and logistic regression to assess changes in BMI z-scores, waist circumference, and health behaviors, adjusting for clustering by clinic and potential confounders. Time-series analyses examine trends in program uptake and adherence, while subgroup analyses explore differential effects by age, sex, socioeconomic status, and language preference. The qualitative component uses thematic analysis of semi-structured interviews with 40 clinicians, 60 parents, and 20 administrators to elucidate implementation fidelity, perceived facilitators and barriers, and cultural considerations in care delivery. The study integrates quantitative and qualitative findings through a convergent mixed-methods framework, triangulating outcomes to interpret causal inferences and contextualize variability in intervention effectiveness. Expected findings include moderate improvements in BMI z-scores and reductions in waist circumference among intervention participants, with greater gains among families engaged in structured goal-setting and family-based counseling. Clinician adherence to guidelines is anticipated to be high in clinics with integrated care teams and robust data feedback mechanisms, whereas gaps may persist in time-constrained visits and language-discordant communications. The analysis is informed by Social Cognitive Theory and the Ecological Systems Theory, enabling interpretation of behavioral change within individual, interpersonal, organizational, and community contexts. The study contributes to knowledge by providing granular, real-world evidence on the effectiveness, feasibility, and equity of pediatric obesity interventions embedded in urban primary care networks, and by deriving a pragmatic scalability framework for diverse metropolitan settings. Implications include informing policy decisions on resource allocation, refining EHR-embedded prompts for obesity risk assessment, and enhancing training curricula for multidisciplinary teams. The principal conclusion is that urban primary care clinics can achieve meaningful, sustained improvements in pediatric obesity outcomes when interventions are integrated into routine care, guided by data-driven feedback loops, culturally competent family engagement, and organizational supports for care coordination. Recommendations emphasize strengthening data infrastructure, expanding family-centered approaches, ensuring interpreter services and culturally tailored counseling, and adopting a scalable implementation model that can be adapted across comparable urban health systems. Further research should investigate long-term maintenance beyond 12 months, cost-effectiveness analyses, and the impact of broader environmental interventions on weight trajectories.