The US Preventive Services Task Force (USPSTF) recommends that providers screen children aged 6 years and older for obesity and offer or refer them to a comprehensive behavioral intervention (≥26 hours over a period of up to 12 months) to promote improvement in weight status. Family-based behavioral treatment (FBT) is an effective treatment that targets both child and parents and meets the USPSTF recommendations. By contrast, the American Medical Association (AMA) recommends a staged approach to childhood obesity screening and counseling, which begins with prevention counseling by the primary care provider (PCP) and includes assessment of weight status, patient/family motivation and readiness to change, promotion of healthy eating and activity habits, and use of health behavior change strategies. Our study compares a staged approach enhanced standard of care (eSOC) vs. eSOC + FBT, to provide families and PCPs with information on the best intervention approach for the behavioral treatment of childhood obesity. Our project seeks to fill the gap in the evidence on family-based weight management in primary care settings among diverse and underserved populations with a special focus on Black children, families insured by Medicaid, and sex differences.

Note: our enrollment number includes two participants (one child and one parent) from each enrolled family.

Inclusion Criteria for children include:

• have a BMI percentile ≥95th for age and sex;
• comfortable speaking English language;
• able to provide written or verbal (based on age) informed assent;
• willing to change diet, physical activity, and/or weight;
• patient of a participating clinic/practice; and
• able to participate in scheduled sessions.

Inclusion Criteria for parents include:

• comfortable speaking and reading English language.

Exclusion Criteria include:

• families who plan to no longer have the child be a patient of any participating clinic/practice during any point in the 18-month study period;
• children with chronic conditions or on medications that substantially impact or interfere with growth, appetite, weight, or physical activity participation;
• families for whom the Primary Care Provider (PCP) or site PI thinks the intervention is clinically/medically inappropriate (e.g., developmental delay, or emotional or cognitive difficulties, if the PI/PCP believes these factors will interfere with study/intervention participation); and
• families in whom the parent or child exhibits eating disorder symptomatology.