Effect of telehealth-based versus in-person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity

Aims: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post-COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. Method(s): A total of 150 patients with obesity and diabetes who were followed every 4-6 weeks either in-person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight-based daily protein intake from protein supplements and food, an activity/sleep schedule-based meal times, and an aerobic exercise goal of a 2000-calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth-based follow-up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no-show rates, number of visits, program duration, and drop-out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). Result(s): Mean age was 47.2 +/- 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 +/- 7.7-39.7 +/- 6.7 kg/m2 (p < 0.0001). Mean program duration was 189.4 +/- 169.3 days. An HbA1c% unit decline of 1.3 +/- 1.5 was achieved with a 10.1 +/- 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in-person appointments (10.6% +/- 5.1 vs. 9.6% +/- 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in-person follow-up (213.8 +/- 194 vs. 159.3 +/- 127, p = 0.019). The mean annual telehealth and in-person no-show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 +/- 3.0 vs. 8.6 +/- 5.1) and drop-out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 +/- 267.5 min vs. 200.6 +/- 110.8 min), PLT (28.9 +/- 17.5 min vs. 3.1 +/- 1.6 min), and PST (1033 +/- 628 min vs. 113.7 +/- 61.4 min) were significantly longer (p < 0.0001) for the in-person group. Conclusion(s): Telehealth offered comparable %TBWL and HbA1c decline as in-person follow-up, but with a shorter follow-up, fewer appointments, and no-shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes.Copyright © 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

Management of obesity.

From 1975-2016, the number of people with obesity in Europe increased fivefold and the overall trend is still increasing. Obesity is the result of an imbalance between energy expenditure and caloric intake. Although the importance of genetic determinants for the variance of body mass index (BMI) is about 60-70%, overeating, lack of exercise, and psychosocial stress are influenceable risk factors. For example, during the Corona pandemic, nearly 40% of Germans gained an average of 5.6kg, and people with obesity gained as much as 7.2kg. To reduce obesity-associated comorbidities, a permanent reduction in body weight of (at least) 5-10% is recommended. A significant reduction of cardiovascular endpoints can be achieved with a weight reduction of more than 10% of the initial weight. Therapeutic measures in the context of an escalating stepwise approach should include strategies for targeted weight reduction and long-term weight maintenance.Copyright © 2023, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Management of obesity.

From 1975-2016, the number of people with obesity in Europe increased fivefold and the overall trend is still increasing. Obesity is the result of an imbalance between energy expenditure and caloric intake. Although the importance of genetic determinants for the variance of body mass index (BMI) is about 60-70%, overeating, lack of exercise, and psychosocial stress are influenceable risk factors. For example, during the Corona pandemic, nearly 40% of Germans gained an average of 5.6kg, and people with obesity gained as much as 7.2kg. To reduce obesity-associated comorbidities, a permanent reduction in body weight of (at least) 5-10% is recommended. A significant reduction of cardiovascular endpoints can be achieved with a weight reduction of more than 10% of the initial weight. Therapeutic measures in the context of an escalating stepwise approach should include strategies for targeted weight reduction and long-term weight maintenance.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

A practical approach to contemporary obesity management

One of the basic issues is that health care professionals, and particularly medical graduates, have limited training in obesity care and management. Health care professionals may also have limited awareness of nutrition, physical activity, and behavioral programs to treat obesity and be reluctant to spend time developing and implementing coordinated therapy programs. Obesity management and weight loss maintenance is therefore, a long-term process requiring initial intervention with an ongoing follow-up program. Obesity is usually determined by the measurement of the body mass index, which is the individual's weight in kilograms (kg) divided by their height in meters (m) squared. The impact of COVID-19 on individuals with obesity underlines the urgent requirement for effective policies and strategies for the prevention of overweight and obesity starting in childhood but engaging young and older adults. A treatment program is usually decided upon by an assessment of adiposity and the presence of the complications of obesity. © 2022 John Wiley & Sons Ltd.

Obesity and renal disease: Benefits of bariatric surgery.

The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.

Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study.

BACKGROUND: Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. OBJECTIVE: We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support-related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. METHODS: This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children's physical activity, dietary and sedentary behaviors, and screen time, and the parent's support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. RESULTS: Both the virtual and blended GH programs improved children's moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children's physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children's physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). CONCLUSIONS: The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support-related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions.

Abstracts of the Australasian Association for Academic Primary Care Annual Research Conference, AAAPC

The proceedings contain 101 papers. The topics discussed include: exploring the health seeking narratives of Assyrian refugee women living with chronic pain;can introducing a 'COIL program' enhance medical students' awareness regarding the relevance of cross-cultural communication skills in healthcare?;diagnosing doctor Google: investigating the relationship between cognitive bias and information behavior in older Australians accessing vaccine-related online information;patterns of multimorbidity show strong association between many chronic condition pairs;adult obesity management in Australia: how can we bridge the gap between guidelines and current general practice?;adaptive research practices in a pandemic: what have we learned during COVID-19?;culturally safe ways of working with Aboriginal and Torres Strait islander peoples in focus groups on sensitive topics;and supporting resilience and recovery: understanding general practitioners' perspectives on trauma-informed care for survivors of domestic and family violence.

A Quality Improvement Initiative Using EPIC Smartsets to Improve Adherence to AAP Guidelines for Obesity Management at a Primary Care Pediatrics Clinic

Purpose/Objectives: Effective management of childhood obesity is critical to prevent long-term medical and psychosocial sequelae. In 2015, the AAP issued guidelines on monitoring body mass index (BMI) and providing comprehensive obesity care based on risk factors. However, literature demonstrates that physician adherence to these guidelines is often poor. Electronic health record (EHR) clinical decision support tools can be effective in standardizing weight management. Utilizing EPIC SmartSets to improve physician adherence to AAP obesity management guidelines, we aimed to increase by 30% in 6 months the following: formal diagnosis of elevated BMI, frequency of weight follow-up visits, adherence to recommended lab screening, and subspecialty referrals. Design/Methods: Pre- and post-intervention surveys were distributed to residents/faculty at an academic primary care clinic to identify variability in practice and barriers to guideline adherence, which informed intervention designs. Cycle 1: SmartSets were implemented in July 2020 with diagnosis codes, note templates, readiness to change surveys, recommended lab and referral orders, patient handouts/questionnaires, and follow-up visit suggestions. Education was completed for providers. Cycle 2: Based on end-user input, SmartSets were integrated into preexisting well-visit templates rather than requiring separate workflow. Analysis metrics included the percentage of: well-visits with an appropriate diagnosis of elevated BMI, acute visits designated as weight follow-ups, and weight or well-visits in which labs were ordered or subspecialty referrals placed. All patients with BMI 85-94.9%ile (overweight) and BMI ≥95%ile (obese) ages 2-17.9 years old seen from 7/1/2019 to 3/31/2021 were included. Data was plotted on run/control charts to assess trends after implementation and revision. Results: A total of 748 overweight patients and 669 patients with obesity were seen during this timeframe. There was a sustained increase in appropriate diagnosis of elevated BMI from an average of 49% pre-intervention to 71% postintervention (Fig. 1), surpassing our aim. There were no significant trends in the percentage of weight visits, labs, or referrals. Appropriate utilization of the implemented EHR tools for well-visits improved after second cycle revisions (39% to 88%). Provider-perceived barriers to AAP guideline adherence included lack of family willingness to participate in management, lack of visit time, and socioeconomic factors out of the provider's control (Fig. 2). Conclusion/Discussion: The first step to instigate practice changes is through problem identification. By utilizing end-user feedback and preserving clinical workflows, the incorporation of AAP guidelines into EPIC SmartSets improved the diagnosis of elevated BMI during well-visits. However, due to COVID-19, it is unclear whether lab orders, referrals, or weight follow-ups improved. Additional EPIC modifications, such as auto-populated lab results, could minimize the need to chart review and thus improve these behaviors. While we demonstrated improved physician recognition, more studies are warranted to address the complex challenges primary care providers and families face regarding weight management. - Control Chart for BMI Diagnoses Made at Applicable Well Child Checks (WCC) by Month Percent of patients with elevated BMI seen at a well-visit from July 2019 through March 2021 who were formally given the diagnosis of elevated BMI. Goal to increase appropriate diagnoses by 30%. -Pareto Chart of Perceived Barriers to Adherence to AAP Guidelines for Weight Management Based upon surveys of residents and faculty at the academic pediatrics clinic studied.

The WELL Clinic: A Telemedicine-based Childhood Obesity Specialty Clinic Rooted in Primary Care

Background: Childhood obesity is a prevalent chronic disease associated with multiple comorbodities that disproprionately impacts children from minority communities of lower socioeconomic status. Many affected children do not have access to high-quality, evidence-informed treatment programs. The COVID 19 pandemic worsened childhood obesity, but transformed the delivery of care at the WELL Clinic at Children's Primary Care Medical Group, which transitioned to a 100% telemedicine-based program, increasing access for patients affected by obesity across San Diego and Riverside Counties. Methods: The WELL Clinic is a primary-care based specialty clinic at Children's Primary Care Medical Group, a large single-specialty pediatrics group with 35 offices across San Diego and Riverside Counties. When the COVID-19 pandemic began the WELL clinic transitioned to a fully virtual program. The WELL clinic includes 20-minute theme-based telemedicine sessions based on the Wheel of Health which includes nutrition, physical activity, sleep, screen use, and social/emotional wellness. Patients are referred to the WELL clinic from their primary care pediatrician. The visits are held with a specially-trained board-certified pediatrician or nurse practitioner and coded as obesity and any related comorbidities and nutrition and/or exercise counseling. A certified health coach supports patients in scheduling, follow up, and care coordination. Results: In the year since the WELL clinic transitioned from in-person to video visits, pediatricians submitted 2536 referrals from all sites, of which 48% of patients have Medicaid coverage. The WELL clinic team completed 542 initial visits and 1227 follow up visits. The no-show rate decreased with the telemedicine format. All visits were covered by insurance. Conclusion: A primary-care based childhood obesity intervention delivered via telemedicine is a clinically and financially feasible approach to improve access to a high quality evidence-informed childhood obesity management program for children of diverse backgrounds.

Anti-Obesity Siddha Medicinal Plants-A Preclinical Review

Obesity is a complex multi factorial preventable disease affecting all age groups of both the sexes. Now one third of world’s population is overweight or obese. From 1980 the world-wide prevalence of obesity has become doubled. Overweight and obesity were the 5th foremost causes of death globally. Obesity is associated with many co morbid diseases. Prevalence of obesity with co morbidities is on big alarm throughout the world. Recently in COVID-19 pandemic most of the obese people get affected due to the co morbidities and reduced immunity. The anti-obesity properties of medicinal plants were known from ancient times in traditional Siddha medicine some thousand years ago. Many Siddha medicinal plants showed anti-obesity activities that can be utilized in the management of obesity, through which the complications of obesity can be prevented. Most researches explored the anti-obesity potentials of medicinal plants. Terminalia chebula, Phyllanthus niruri, zingiber officinale, Piper longum, Curcuma longa, Elettaria cardamomum, Cuminum cyminum, Picrorhiza kurroa, Ipomea turpethum, Tinospora cordifolia, Michelia champaka are some medicinal plants possess anti-obesity properties that had been indicated in Siddha classical text. The objective of this review is to validate the anti-obesity potentials of Siddha medicinal plants scientifically through various research reports. Due to the presence of Phyto compounds like phenols, flavonoids, terpenoids, alkaloids, anti-oxidants these medicinal plants revealed anti-obesity activities and its anti-obesity mechanism had been proven scientifically through various animal experimental studies collected from many research articles. Modern anti-obesity drugs produce numerous side effects. Regular consumption of Siddha anti-obesity medicinal plants, in the prescribed dose and duration, can induce gradual and sustainable weight loss effectively. Furthermore, in future, there is a need for the development of standardized, safe and effective anti-obesity drugs from medicinal plants and highly economical too. Hence eventually exploration of anti-obesity Siddha medicinal plants will lead to safe and effective treatment for obesity.

The association between depression and metabolic syndrome components in adolescents with obesity

Background: Obesity has metabolic consequences that were reported to have worsened by the co-existence of depression in adults. This relationship is explained by an overactive stress response and adoption of unhealthy lifestyle habits. The relationship between depression with obesity, its severity, and consequences is concerning, especially after an increase in prevalence of both during COVID-19. No data regarding this association is available for children and adolescents. The purpose of this study is to compare the prevalence of metabolic syndrome (MS) components in youth with obesity who are identified with depression and youth who are obese and are not diagnosed with depression. Methods: A retrospective review of patients with obesity seen at a pediatric weight management clinic between July 1, 2018 and June 30, 2021 was performed. Demographic, anthropometric, clinical and laboratory data, and PHQ-9 depression screening tool scores were ed. Results: Out of 160 patients, only 46% had PHQ9 scores less than 5, which suggested no depression. 42 (26%) had a current/prior diagnosis of depression. Moderate to severe depression (scores >= 10) was found in 25% of patients, including 18% of patients never diagnosed with depression. Scores were higher among those reporting daytime fatigue or trouble sleeping, and among patients that ate out 7 or more times per week compared to those that ate out less frequently. There were statistically significant associations between increasing weight, BMI, body fat percentage, diastolic blood pressure, and fasting blood insulin with higher PHQ9 scores (p < 0.02 for all). Nonsignificant correlations were found between PHQ9 scores and SBP of serum lipids (spearman's r < 30 for all). Conclusions: More than half of the adolescents with obesity had significant depression scores. Adolescents with higher PHQ9 scores had higher measurements of BMI, body fat percentage, diastolic blood pressure, and serum insulin. Screening and management of depression should be an important component of obesity management in adolescents. Further studies are needed to confirm our findings. comorbidity of depression is common in adolescents with obesity and often non-diagnosed.

The relationship between obesity classifications and outcomes in COVID-19 infection in New York

Background: Despite its high prevalence, published data on COVID-19 infection in obese subjects remains limited. When compared to early-onset diabetes, chronic obstructive pulmonary disease (COPD), advanced age, hypertension (HTN), immunosuppression, and chronic kidney disease (CKD), obesity was the only comorbidity that conferred an increased risk of death exclusively for COVID-19 compared to non-COVID- 19 patients. Any degree of obesity has been associated with poor prognosis in patients with COVID-19 and the risk of mechanical ventilation (MV) is the greatest in patients with BMI > 35 kg/m2, independent of age, diabetes, and hypertension. The aim of our study is to examine the association between various degrees of obesity and the clinical outcomes of patients with COVID-19 infection. Methods: This is a retrospective multicenter cohort study of adult patients with a BMI ≥30 kg/m2 presenting to six hospitals in the New York metropolitan region between March 7 and June 7, 2020, with COVID-19 infection. The clinical outcome assessed included hospitalization, in-hospital mortality, intensive care unit (ICU) admission, and MV. Outcomes were compared using a multivariate Cox regression model and Propensity Score matching model. Results: The study population comprised 9,991 patients, of whom 53.43% were obese (BMI ≥30 kg/m2). Higher comorbidity burdens, including HTN, Diabetes, CKD, and smoking, were noted in those with Class I and II obesity, relative to Class III obesity (44.54% & 38.00% vs. 22.94%). Obesity increases the risk for in-hospital mortality and intubation across all BMI ranges. Individuals with a BMI ≥ 30 were observed to have the highest risk of ICU admissions (OR 1.29;1.2-1.48;p < 0.001). There were higher rates of in-hospital mortality among obese patients across all BMI [BMI ≥ 30 (OR 1.23;1.09-1.40, p < 0.001);BMI ≥ 35 (OR 1.48;1.28-1.70, p < 0.001);BMI ≥ 40 (OR 1.81;1.55-2.13, p < 0.001). Conclusions: Obesity is an independent risk factor for increased mortality in those with COVID-19 infection. Data from this study supports and further expands the existing knowledge on the relationship between obesity and COVID-19 infection. Clinicians must focus on early prevention and management of obesity.

Severe Obesity in Children and Adolescents: Metabolic Effects, Assessment, and Treatment.

Childhood obesity has been increasing steadily in recent decades, and severe childhood obesity has emerged as a major public health problem both nationally and internationally. A current concern is that lockdown due to the coronavirus disease 2019 (COVID-19) pandemic could exacerbate the spread of childhood obesity and increase the gap in obesity risk. Recent research results indicate the aggravation of obesity after school closures. The consequences of severe childhood obesity are more devastating than those of mild to moderate obesity. Children with severe obesity are at greater risk than others for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Accurately assessing and diagnosing a child with severe obesity is the key to implementing successful therapy. A detailed and accurate patient history and physical examination are important to discriminate monogenic obesity and metabolic syndrome diagnoses from severe obesity without an underlying cause. Psychosocial factors, including eating behaviors, should be assessed to facilitate better weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. However, lifestyle modification should be the priority. Although progress has been made, safe and effective treatment for severe pediatric obesity is still challenging. More efforts and innovations are needed to find a solution for the huge medical and emotional burden that these children and their families carry. Public health organizations also need to make efforts to encourage and normalize healthy eating habits and exercise to prevent severe obesity in childhood.

Plant-Based Diet as a Strategy for Weight Control.

According to the World Health Organization, obesity has nearly tripled since the 1970s. Obesity and overweight are major risk factors for cardiovascular diseases, diabetes, inflammatory-mediated diseases, and other serious medical conditions. Moreover, recent data suggest that obesity, overweight, diabetes, and cardiovascular diseases are risk factors for COVID-19-related mortality. Different strategies for weight control have been introduced over the last two decades. Unfortunately, these strategies have shown little effect. At the same time, many studies show that plants might be the key to a successful strategy for weight control. Following the PRISMA guidelines for conducting systematic reviews, a search was conducted in PubMed, Web of Science, Scopus, and Embase using the following keywords: obesity, globesity, vegan, plant-based diet, etc. Our results show that vegan diets are associated with improved gut microbiota symbiosis, increased insulin sensitivity, activation of peroxisome proliferator-activated receptors, and over-expression of mitochondrial uncoupling proteins. The key features of this diet are reduced calorie density and reduced cholesterol intake. The combination of these two factors is the essence of the efficiency of this approach to weight control. Our data suggest that plant-based/vegan diets might play a significant role in future strategies for reducing body weight.

Evaluation of a Pilot Healthy Eating and Exercise Program for Young Adults with Autism Spectrum Disorder and Intellectual Disabilities.

OBJECTIVES: The aims of this pilot study were to examine program structure, implementation, and outcomes of a healthy eating and exercise program for young adults with Autism Spectrum Disorder (ASD) and intellectual disabilities (IDs). METHODS: Seventeen young adults with ASD and IDs, six parents, and 10 staff participated. Programming was delivered for over a year and featured healthy eating and exercise lessons. Also, group-based motivational interviewing was used to develop weekly health goals for participants. During COVID-19, lessons were delivered online. The program was modified using lectures with visual material, when participants returned to classrooms. Lessons focused on MyPlate, portion sizes, the food pyramid, vitamins and minerals in foods, and learning to eat "less" of unhealthy food groups. Exercise lessons featured information about importance of exercise, introduction to different types of exercise, and knowledge about how exercise benefits the body. Staff completed implementation logs. Height and weight of participants were examined at regular intervals. Parents completed surveys and participants completed group interviews to assess program impact. RESULTS: Two participants lost a significant amount of weight and others maintained their weight during COVID-19. Participants and parents were satisfied with the program and reported knowledge and behavior change. CONCLUSIONS: Results indicated participating in the intervention resulted in improved knowledge and health behaviors. Findings are preliminary, and research using control groups and assessing change in weight and behaviors over time are needed. Observation of meals and physical activity levels will provide more objective data in future studies.