O1033: Fit Together: Implementation of Intensive Health Behavior and Lifestyle Treatment with Parks and Recreation

Background: The 2023 AAP Clinical Practice Guideline on pediatric obesity recommends intensive health behavior and lifestyle treatment (IHBLT) for children aged 2-18 years. However, implementation of IHBLT in clinical settings is limited. Fit Together is an evidence based IHBLT model delivered in partnership with Parks and Recreation that has demonstrated effective BMI reduction in youth aged 6-17 with obesity, and improvements in physical activity and quality of life. Here we describe a free, web-based curriculum guide for pediatricians to implement Fit Together in their communities.

Methods: We adapted the Fit Together curriculum with multiple stakeholders to create a web-based implementation guide, called the “Playbook.” We conducted a hybrid Type 3 implementation-effectiveness study of the Playbook in two locations in North Carolina. We measured constructs of acceptability, appropriateness, feasibility, cost, fidelity, reach, and sustainability according to the Process Redesign Framework and using validated survey instruments.

Results: Both sites (n=2) utilized the Playbook to connect a pediatric clinic with a local parks and recreation site, hired staff, and launched a local Fit Together program. Mean time to program start was 18 months. Baseline surveys and interviews among clinical providers and staff and recreation professionals indicated enthusiasm for offering Fit Together to families, and confidence that the curriculum met their population’s needs. Administrative challenges and delays were commonly cited as barriers to implementation, and attendance and engagement from families was a concern. The Playbook was cited as a key strength of the implementation, and was most often utilized by the Connector, who was responsible for running program sessions. All Connectors (n=3) viewed content (mean 94.3% completion), including educational videos and program planning tools (including an activity database and cooking class curriculum).

Conclusion: The Fit Together intervention can successfully deliver IHBLT through Parks and Recreation partnerships in local communities, and the online Playbook is an effective strategy to facilitate implementation. Participants at this session will be offered free access to the Playbook.