smiling photo of Bethany Forseth with white shirt and black jacekt.

KL2 Scholar Bethany Forseth, Ph.D., University of Kansas Medical Center

By Kelly Hale, Marketing & Communications Specialist

Nov 10, 2025

Project Title: Developing and refining a sequential multiple assignment randomized trial for pediatric obesity treatments.

Project Summary: Currently, 36% of children in the United States are overweight or obese, and the burden of obesity disproportionately impacts children living in rural areas. More concerning is that 34-74% of children in family-based behavioral obesity treatments do improve weight-related outcomes, demonstrating the current one-size-fits-all/most approach to treatment is not working. Sequential Multiple Assignment Randomized Trials (SMARTs) are an ideal way to address the critical need to develop efficacious weight-loss treatments for children; this design optimizes treatment by identifying non-responders (i.e., children who do not reduce their body mass index z-score [BMIz]) early and providing a modified treatment to support treatment success. However, the application of SMARTs in obesity treatment for pediatric populations is limited. Therefore, following the ORBIT model for intervention development, the objective of the current study is to rigorously determine criteria to refine and optimize a pediatric obesity treatment for rural families. This will be done through two complementary but distinct aims. The first aim will quantitively compare responders and non-responders in an ongoing pediatric obesity treatment (N = 60) to refine the tailoring variable and decision point for a SMART to treat pediatric obesity (Aim 1a) and will conduct a formative assessment with families (parents and children) and to understand their perspectives, needs, and hopes of a pediatric obesity treatment provided within homes (N = ~20; Aim 1b). The second aim will refine the developed SMART iAmHealthy intervention through formative assessments, based on user-centered design principles, with children with overweight or obesity and their families living in rural areas (N=30).

Mentor(s): Ann Davis, PhD, MPH, ABPP, University of Kansas Medical Center; John Jakicic, PhD, University of Kansas Medical Center; Joey Skelton, MD, Wake Forest University School of Medicine; Megan Roberts, PhD, CCC-SLP, Northwestern University

As Bethany Forseth, Ph.D., continues in the KL2 program, she is analyzing data from approximately 60 participants in a behavioral treatment trial for pediatric obesity. The project aims to help someone who may not be losing weight or changing behaviors early in treatment by providing an additional, tailored treatment.

“The data we collected included whether they changed their behavior regarding their diet or physical activity, and when in the intervention, can we define that earliest point to help them?” said Forseth. “We are analyzing the data now, and we are going back to the people who have been in treatments before and talking to the family. We are saying, ‘we think you could make a change here, but what do you think?’”

As part of the study, Forseth and the team are looking at ideas such as whether the child would self-monitor their behaviors through a device like a Garmin watch.

“We’ve heard that kids would track their steps, but that’s one of the things we want to know from them,” she said. “We also want to know if the families are creating good routines and boundaries around healthy behaviors. For instance, instead of the entire family watching television after dinner, can they all go on a walk? So, this is all something we are piloting now.”

The health behaviors the project is focused on include being active, getting enough sleep, healthy eating, and managing stress.

And this study is not focused on weight loss, though that may be an outcome. Forseth is really focusing on changing health behaviors and empowering children to make healthy life-long choices. And in the process, hopefully helping them build a good relationship with their body size, because, as Forseth says, “everyone has a different body size.”

“We are really only talking to the families about health behaviors and rarely about anything related to weight,” she said.

As part of the project, the kids will wear Garmin watches to track their steps each day and see how much physical activity they get and what changes can be made to ensure they get enough.