A recent systematic review indicated that the vast majority of trials that evaluated an intervention with home visitation were pragmatic in nature 15, 16, and compared an intensive intervention with home visitation to far less intensive comparators.

Thus, home visitation may improve weight loss outcomes in children from low-income households via three mechanisms: 1) increasing intervention dosage, 2) enabling tailored feedback, and 3) increasing accountability.ĭespite its potential advantages, there is a lack of empirical data to support home visitation in pediatric obesity interventions 13, 14. Conducting sessions in the home also allows caregivers to learn and rehearse new behaviors in the context in which they are to be implemented, and may instill a sense of accountability insofar as they expect intervention staff will be visiting their home on a regular basis. Home visitation also provides interventionists with regular opportunities to directly observe and address risk factors in the home environment, which may enable them to provide more specific and relevant guidance to caregivers regarding healthy changes to household routines and aspects of the physical home environment. Delivering pediatric obesity treatment in the home setting may increase completion of intervention visits, which would result families receiving a higher overall intervention dosage 12. School schedules, lack of transportation, and the challenge of arranging affordable childcare represent additional barriers. These interventions have traditionally been delivered in healthcare settings, such as academic medical centers, which may present obstacles to participation among low-income families who often have difficulty accessing the healthcare system 10, 11.

Several meta-analyses support the efficacy of family-based interventions 7– 9. The current standard of care treatment for pediatric overweight/obesity consists of family-based interventions that target children’s eating patterns, physical and sedentary activity, and sleep 5, 6. As pediatric obesity is highly predictive of future chronic disease risk 2– 4, disseminating effective pediatric obesity treatments in disadvantaged populations is essential for reducing health disparities. Children from low-income households are roughly twice as likely to have obesity as those from higher-income households 1.

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