Abstract Body: Introduction: Improving access to healthcare for childhood obesity is crucial, especially in contexts where social vulnerability is a significant risk factor for developing obesity in childhood. Little is known about whether family grant programs (FGP) help remove systemic and institutional barriers to lifestyle therapies for children with obesity.
Hypothesis: We tested the hypothesis that access to a FGP favors engagement in a lifestyle modification program and body mass index z-score (BMIz) reduction of children with overweight or obesity at a pediatric obesity management clinic, the Maison de santé prévention – Approche 180, in Montreal (QC, Canada).
Methods: This study is designed as a retrospective, longitudinal, comparative analysis of medical records of children (2 to 17 years) with overweight or obesity. Data were collected between April 8, 2021 (FGP implementation) and March 31, 2023. Children in youth centers, foster families, with refugee status or whose parents had a low-income per Canada’s Revenue Agency were eligible for the FGP, which fully covered the costs of multiprofessional services at the clinic. Persistence in the lifestyle program, measured by the number of appointments and follow-up duration, and changes in BMIz over the study period were compared between children based on access to the FGP.
Results: Among the 198 included children (100 girls, 98 boys; mean age=11.1 years ± standard deviation (SD)=3.0; mean BMIz=3.30 ± SD=1.05), 62 benefited from the FGP and 136 were not eligible to it. Children from non-two-parent families were 2.46 times more likely to receive the grant compared to those from two-parent families (95% confidence interval (CI): 1.46, 4.13; P=0.0007). Children with the grant had longer follow-up duration [10.29 (95%CI: 8.59, 11.99) vs 6.71 (95%CI: 5.48, 7.93) months; P=0.0007] and similar number of appointments per month [0.81 (95%CI: 0.66, 0.95) vs 0.92 (95%CI: 0.81, 1.02); P=0.42] compared to those without it. Children with the grant achieved similar BMIz changes compared to those without it [-0.31 (95%CI: -0.61, -0.01) vs -0.32 (95%CI: -0.57, -0.06); P=0.92].
Conclusions: FGP was associated with persistence in a lifestyle program that surpassed that of those who were not eligible to it. It enabled children with social vulnerabilities to achieve BMIz reductions comparable to those of children without such vulnerabilities. Free care could help address systemic and institutional barriers to childhood obesity management.