We are pleased to announce that the University of North Carolina at Chapel Hill has been approved for funding by the Patient-Centered Outcomes Research Institute (PCORI) to implement research findings on early childhood obesity prevention.
Even the most impactful findings from clinical research studies can take years to make it into widespread clinical practice. Cutting that lag time and smoothing the path to uptake is the focus of this PCORI-funded project.
This collaborative project with The Johns Hopkins University will focus on implementing the Greenlight Plus intervention, consisting of well-visit counseling for obesity prevention supplemented with a digital intervention using texting of healthy eating and activity goals between visits.
Greenlight Plus was shown to be effective in a PCORI-funded comparative clinical effectiveness research (CER) study showing the comparative effectiveness of this intervention for childhood obesity prevention.
The objective of this new project is to implement the Greenlight obesity prevention program in many children's primary care practices outside of research settings with the goal of promoting healthy habits and healthy weight gain among children from birth to age 2.
This project will enroll parents of healthy newborns in the Greenlight text messaging program to support healthy habits. It will also implement the Greenlight materials in children's primary care offices so that they can be used in regular checkups from birth to age 2.
The project team is working with 45 primary care offices in community settings across the U.S. where children receive regular checkups to implement the Greenlight Plus program and determine whether it is as effective in preventing obesity in these offices as it was in the research study. This implementation project will also be informed by an Advisory Board of parents and children's primary care providers from the involved practices.
The American Academy of Pediatrics (AAP), which is the major professional organization for child health providers in the U.S., is collaborating with the project team to plan how Greenlight Plus can be spread to additional primary care practices in the future.
This project is co-led by Dual Principal Investigators Dr. Kori Flower at the University of North Carolina at Chapel Hill and Dr. Eliana Perrin at The Johns Hopkins University. Other key leaders are Co-Investigators Dr. William Heerman (Vanderbilt University Medical Center), Dr. Shonna Yin (New York University), Dr. Alexander Fiks (Children's Hospital of Philadelphia), and Dr. Everly Macario (American Academy of Pediatrics). Co-Investigators Dr. Samantha Schilling and Dr. Feng-Chang Lin (University of North Carolina at Chapel Hill) and Dr. Suzanne Grieb and Dr. Jill Marsteller (The Johns Hopkins University) will also contribute expertise.
"It's unusual to be able to prevent childhood obesity," said Dr. Flower. "This project will make a research-tested intervention accessible to many pediatric practices, clinicians, and parents."
According to Dr. Perrin, "this step -putting the first successful obesity prevention intervention in pediatric practice in the hands of 35,000 parents- is important for paving the way toward prevention of obesity and cardiovascular disease for millions."
"In addition to funding patient-centered comparative clinical effectiveness research, PCORI funds dissemination and implementation projects like this one to support the uptake of findings into clinical practice," said PCORI Executive Director Nakela L. Cook, M.D., MPH. "By implementing evidence addressing a key gap in care for childhood obesity prevention, this project has the potential to improve healthcare practice and patient outcomes."
The PCORI-funded Greenlight Plus study enrolled 900 newborns and their parents from 6 academic medical centers across the U.S. Newborns and their parents were randomized to receive either office-based counseling using the Greenlight materials alone or to receive that same counseling plus being enrolled in a text messaging program to support healthy behavior change.
The text messages focused on promoting breast feeding, healthy portion sizes, not drinking sugar sweetened beverages, cutting down on screen time, and fostering physical activity. The study team monitored children's growth for the first 2 years of life.
The intervention was effective in improving childhood growth trends and preventing obesity. At age 2 years, 12.7% of the children in the group that received only office-based counseling had obesity, compared to 7.4% of children in the group that also received the text messaging intervention.
Even adjusted for all confounders, the risk of obesity was reduced by 44%. For every 19 children who receive this intervention, 1 case of obesity can be prevented. If this intervention is scaled up and widely available, it could have a large impact on preventing obesity nationwide.
These findings were published in JAMA in 2024. https://pubmed.ncbi.nlm.nih.gov/39489149/
The implementation project funding from PCORI to UNC has been approved pending completion of PCORI's business and programmatic review and issuance of a formal award contract.
PCORI is a nonprofit organization with a mission to fund research designed to provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions.
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