“It’s important to provide pediatric weight-management programs that are accessible, acceptable and affordable for the populations that have the greatest need,” said Thomas Robinson, MD, professor of pediatrics and of medicine at the Stanford University School of Medicine and principal investigator on the CDC grant. About two-dozen well-regarded pediatric weight-control programs exist at academic medical centers around the country, he said, but most children and teens don’t live near these centers.
Although pipelines exist for translating medical research into marketable drugs and medical devices, scaling up public health interventions is far less common. “We have an efficacious program,” said Robinson, who also holds the Irving Schulman, MD, Professorship in Child Health. “The challenge is: How do we get it out there?”
Childhood obesity rooted in social inequality
Since the 1970s, pediatric obesity rates have more than tripled, according to the CDC, putting millions of young people at risk for medical problems such as high blood pressure and Type 2 diabetes. Disadvantaged youth, including children and teens who are racial or ethnic minorities or from low-income families, are the most likely to be affected.
“That’s the group at greatest need, and it also tends to be the group that has the least access to effective weight-management programs,” Robinson said. The grant, awarded as part of the CDC’s Childhood Obesity Research Demonstration Project 3.0, is intended to give low-income families access to safe, evidence-based weight-management plans. The Stanford Medicine Pediatric Weight Control Program fits the bill; it has helped more than 80% of participants achieve a healthier weight.
In the program, each child or teen attends six months of weekly group meetings along with a parent, learning about healthy eating habits and exercise while getting support from other families facing similar challenges.
“It has the benefits of a face-to-face model,” Robinson said, noting that it’s important for parents to be supportive players in addressing their child’s weight, and that having a group of peers to empathize with helps, too. “I think that’s part of the secret sauce of why these family-based, group programs have worked.”
Empowering community leaders
The newly packaged curriculum won’t replace face-to-face interactions; instead, it will use technology to help pediatricians and other community leaders deliver effective face-to-face weight-management counseling to groups of families.
“Many primary care providers say they feel very uncomfortable treating childhood obesity,” Robinson said. “They want to be able to do this, but it’s not something they have much training in.”
The Stanford researchers are spending the first two years of the five-year grant developing online teaching materials and instructional tips to help people lead the weight-loss program in varied settings, such as a community center or pediatrician’s office. The package will be designed to be used with minimal training, with most training for group leaders delivered online via a “Weight Control University” interface.
The researchers will also create online materials, such as videos and animations, for the children and parents who are participating in the program.
The third year of the grant will be spent on beta testing and enhancements, and the remaining years on an implementation trial with multiple groups and at least 80 families.
“We want to make it easy for anyone, whether they’re a health care provider, a high school teacher or a youth leader at the YMCA, to be able to deliver the program in a way that maintains fidelity to what we do here at Stanford,” Robinson said.
Leveraging design thinking
In addition to drawing on years of Stanford research in pediatric weight management, the work also incorporates a different area of Stanford expertise: design thinking. Before applying for the CDC grant, Robinson completed the eight-month Stanford Byers Center for Biodesign Faculty Fellowship, which provides advanced training in health-technology innovation, helping faculty members identify and solve problems in medicine, as well as preparing them to bring those solutions to market. Robinson drew on the lessons of the fellowship to create a roadmap for scaling his team’s work.
“We are exploring business models to create a sustainable program for many different provider types,” he said, noting that insurance reimbursement for behavioral obesity treatments is poor, and clinics and providers that work with low-income populations lack resources to launch such programs. “We’re thinking about how to make it both affordable and sustainable over time.”
The fellowship motivated Robinson to move beyond scientific circles. He attended San Francisco start-up meetups and seminars on product scaling and business development, for instance. Components of his team’s plan have been influenced by business-to-business and software-as-a-service models, he said.
“It’s really a huge step for us, being able to share a program we strongly believe in, that has great evidence supporting it,” Robinson said. “Now we can make it available, hopefully, to the world.”