Translating knowledge into action for child obesity treatment in partnership with Parks and Recreation: study protocol for a hybrid type II trial.



Safe and effective treatment exists for childhood obesity, but treatment recommendations have largely not been translated into practice, particularly among racial and ethnic minorities and low-wealth populations. A key gap is meeting the recommended treatment of ≥26 h of lifestyle modification over 6-12 months. Fit Together is an effective treatment model that meets these recommendations by integrating healthcare and community resources. Pediatric providers screen children for obesity, deliver counseling, and treat co-morbidities, while Parks and Recreation partners provide recreation space for a community nutrition and physical activity program.


This study will use a hybrid type II implementation-effectiveness design to evaluate the effectiveness of an online implementation platform (the Playbook) for delivering Fit Together. Clinical and community partners in two North Carolina communities will implement Fit Together, using the Playbook, an implementation package designed to facilitate new partnerships, guide training activities, and provide curricular materials needed to implement Fit Together. An interrupted time series design anchored in the Process Redesign Framework will be used to evaluate implementation and effectiveness outcomes in intervention sites. Implementation measures include semi-structured interviews with partners, before and after the implementation of Fit Together, and quantitative measures assessing several constructs within the Process Redesign Framework. The participants will be children 6-11 years old with obesity and their families (n=400). Effectiveness outcomes include a change in child body mass index and physical activity from baseline to 6 and 12 months, as compared with children receiving usual care. Findings will be used to inform the design of a dissemination strategy guided by the PCORI Dissemination Framework.


This project addresses the knowledge-to-action gap by developing evidence-based implementation tools that allow clinicians and communities to deliver effective pediatric obesity treatment recommendations. Future dissemination of these tools will allow more children who have obesity and their families to have access to effective, evidence-based care in diverse communities.

Trial registration identifier: NCT05455190 . Registered on 13 July 2022.





Published Version (Please cite this version)


Publication Info

Neshteruk, Cody D, Asheley C Skinner, Julie Counts, Emily M D'Agostino, Leah Frerichs, Janna Howard, Mary Story, Sarah C Armstrong, et al. (2023). Translating knowledge into action for child obesity treatment in partnership with Parks and Recreation: study protocol for a hybrid type II trial. Implementation science : IS, 18(1). p. 6. 10.1186/s13012-023-01264-5 Retrieved from

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Cody D Neshteruk

Assistant Professor in Population Health Sciences

Cody Neshteruk, PhD is a public health researcher whose work focuses on improving the health and well-being of children and families. In particular, he is interested in promoting cardiovascular health and reducing obesity through helping families adopt healthy eating and physical activity behaviors in a variety of settings including  community centers, early care and education programs, and clinical pediatric weight management. His expertise includes designing, delivering, and disseminating behavioral interventions, physical activity measurement, and implementation science methods.

Areas of Expertise: Nutrition, Physical Activity, Obesity, Health Behavior, Implementation Science


Asheley Cockrell Skinner

Professor in Population Health Sciences

Areas of expertise: Implementation Science, Health Services Research, Child Obesity, Pediatric Population Health, Opioids

Asheley Cockrell Skinner, PhD, is a health services researcher whose work addresses a variety of population health issues, particularly implementation of programs to improve the health of vulnerable populations. She is currently a Professor in Population Health Sciences at Duke University. She received her PhD in 2007 in Health Policy and Administration at the University of North Carolina at Chapel Hill.  A nationally-known expert in childhood obesity, her work uses a data-driven approach to understand pediatric obesity and improve implementation of evidence-based treatment. She applies this implementation science approach to other populations, including those with opioid use disorder and people who use drugs. In addition to her many roles in research, she also currently serves as the Director of Graduate Studies for Population Health Sciences, directs multiple training programs, and actively mentors undergraduate and graduate students, fellows, and junior faculty.


Emily Meredith D'Agostino

Assistant Professor in Orthopaedic Surgery

Emily D'Agostino, DrPH, MS, MEd, MA, is a community-engaged epidemiologist specializing in health disparities related to place. Her research expertise lies in partnering with community organizations to examine structural and social factors that reduce obesity disparities and promote physical activity and fitness. She also specializes in expanding epidemiology education to high school and undergraduate students, and incorporating contemporary teaching and learning practices into epidemiology instruction at all levels. She is currently an Assistant Professor at Duke University in Orthopaedic Surgery. She also provides research oversight for the Miami-Dade County Department of Parks, Recreation and Open Spaces, the third largest county park system in the nation, and New York City Department of Health and Mental Hygiene's NYC FITNESSGRAM co-managed by the New York City Department of Education. She received her doctorate in Epidemiology from the City University of New York's Graduate School of Public Health and Health Policy. She also holds master's degrees in Science Education, Educational Leadership, and Museum Education.


Mary T Story

Professor in Family Medicine and Community Health

Sarah Commisso Armstrong

Professor of Pediatrics

Dr. Armstrong's clinical and research interests include pediatric nutrition and the treatment of childhood and adolescent obesity, along with related health problems. As director of the Duke Children's Healthy Lifestyles Program, Dr. Armstrong oversees a cohort of over 3000 overweight children and teenagers. She is a member of the Executive Committee for the American Academy of Pediatrics Section on Obesity.  Dr. Armstrong's research focuses on leveraging innovative strategies to improve children's nutrition and activity, including mobile health interventions, community partnerships, and medication or surgical approaches.

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