Contextual readiness assessment of CDC-recognized family healthy weight programs in Southwest Georgia Cooperative Extension

Abstract Background The American Academy of Pediatrics recommends all children with obesity receive Intensive Behavioral Lifestyle Treatment Programs, yet programs are not widely available. The Centers for Disease Control and Prevention (CDC) is prioritizing dissemination of six programs known as Family Healthy Weight Programs (FHWP) and examining the potential role of community organizations like Cooperative Extension in implementation. This mixed-methods study conducts initial asset mapping and explores contextual readiness of implementing CDC-recognized FHWPs through Cooperative Extension in Southwest Georgia counties with a high obesity burden (> 40% adult obesity). Methods We used descriptive statistics and bivariate analysis (chi-square tests) to explore the availability of healthcare and recreational resources and to compare across high-obesity and non-high-obesity counties, and by Extension districts (Southwest, Southeast, Northwest, Northeast). We additionally conducted a focus group with the potential implementing staff, Cooperative Extension agents, and thematically analyzed the data. Results Only 72% of Georgia high-obesity counties have at least one physician (family medicine, pediatrician, or child psychiatrist) compared to 93% of non-high-obesity counties (χ² (1, n = 159) = 11.619, p < 0.001). Additionally, Southwest Georgia has significantly fewer counties with at least one physician (70.7%) than the other Extension districts (91.5%) (χ² (1, n = 159) = 9.360, p = 0.002), but there is no difference among high-obesity (66.7%) and non-high-obesity counties (76.5%) within the Southwest district (χ² (1, n = 41) = 0.110, p = 0.740). Less than half of the Southwest counties (46.3%) have a pediatrician to support participant recruitment, referral, and monitoring. Only one county had a YMCA in the Southwest district, and other recreational resources were limited. Extension agents perceived FHWPs to fit well with Extension’s mission, structure, and participant needs, but echoed barriers revealed in the quantitative data, including a lack of local healthcare and recreational resources, and identified small eligible populations to recruit from and limited Extension staffing as additional implementation barriers. Conclusion If Extension proceeds with adopting FHWP in Southwest Georgia, administrators should select a program that can be delivered using appropriate partnerships, adaptations, and supports for staffing, recreational resources, and creative clinical support for recruitment, referrals, and patient monitoring.