Family-Based Behavioral Treatment for Childhood Obesity Adapted to Align with the MOHealthNet Medicaid Benefit: Results of the Missouri Childhood Obesity Research Demonstration Study

Background: This study leveraged a novel Missouri Medicaid (MOHealthNet) benefit to adapt and implement evidence-based family-based behavioral treatment (FBT) within health care settings in alignment with policy requirements. Methods: In a nonrandomized matched-comparison trial, 108 parent–child dyads participated in FBT, and 92 dyads attended at least one session. Licensed Clinical Social Workers or Registered Dietitian Nutritionists offered 26–33 FBT hours delivered virtually over 6–12 months to Medicaid-insured patients in an urban and rural pediatric health system in Missouri. The matched-comparison group included 186 participants. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM) framework was used to evaluate effectiveness (primary) and reach (secondary) and explore adoption, implementation, and maintenance. Results: Children in the FBT group reduced their percent over median body mass index (BMI) compared with the matched comparison group (mean reduction: −3.9 ± 1.4, d = −0.42). Within the FBT group, participants also demonstrated improvements in coping with teasing, health-related quality of life, and family health habits (all p < 0.05). Families rated the program as highly acceptable. Reach data indicated enrolled patients had similar BMI, sex, and ethnic backgrounds compared with eligible but non-enrolled patients ( p s > 0.301). Conclusions: Data demonstrate the feasibility of adopting and implementing FBT within health care systems and inform efforts to support maintenance. FBT reached a diverse population of families receiving Medicaid in pediatric primary care settings and was associated with greater improvements in youth weight outcomes compared with a matched comparison group. Adaptations made to align with the benefit may have reduced the magnitude of effects; however, this policy provides an opportunity to deliver FBT within primary care settings and expand access.