Obesity is the fastest-growing chronic condition among children in the United States, with prevalence quadrupling over the last 40 years. Nearly one in five youth are either overweight or obese. Despite the American Academy of Pediatrics publishing its first-ever guidelines for treatment in 2023, the field has struggled to translate recommendations into meaningful, actionable care for families.
For obesity treatment to succeed, care must blend clinical support with lifestyle adjustments that fit seamlessly into the daily realities of families across the US.
In 2023, we partnered with IDEO, Clarity Pediatrics, and Rise Together Ventures to explore how families on Medicaid currently navigate care—and to envision what it would take for every family to feel supported and equipped to manage their child’s health.
A Web of Compromising Demands
Obesity exists at the complex intersection of a clinical condition and a cultural force.
Clinically, it comes with a diagnosis and treatment plans. Culturally, it influences beliefs, identity, and self-worth, making care deeply personal, and often, taboo. Families, providers, and experts alike tended to avoid the fraught “o‑word”, opting for euphemisms instead.
For families on Medicaid, these challenges are even more pronounced. To better understand the challenges of accessing and providing care, we spoke with nine families—kids and parents—in Dallas, Texas, and California’s Bay Area, along with nine providers and experts nationwide.
Families spoke about the stigma and frustration they faced, recalling hurried pediatric visits that offered little guidance and left them feeling at fault. They also described the daily struggle of balancing multiple jobs, affording healthy food, and finding the time to implement the lifestyle changes prescribed to them.
Providers echoed these challenges, expressing their own frustrations with a system that makes delivering effective care difficult. Limited appointment times, a lack of culturally relevant resources, and few follow-up opportunities left them feeling like they were providing families with recommendations that were nearly impossible to implement. Many recognized the need for more practical, tailored support but lacked the tools to offer it.
And at the center of it all was food—inescapable, constant, and exhausting. Eating was unavoidable, a negotiation that had to happen multiple times a day, and even if families managed to control it within their own homes, the moment their children stepped outside, they were surrounded by unhealthy options—at school, in aftercare, at the corner store—making it feel impossible to stay in control.
Care was ultimately a web of uncompromising demands that families had little power to meet.
A Path to Transformative Care
To design a path forward, we mapped a family’s needs before, during, and after pediatric visits. This revealed critical moments where families needed more support: recognizing early signs of obesity, navigating provider conversations, and sustaining healthier habits at home.
These insights informed a theory of change framework providing actionable guidance for stakeholders involved in obesity care. Grounded in three opportunity areas—building awareness, building confidence, and building capacity—our framework highlights how trust, dignity, and systemic support lead to lasting outcomes.
To complement this, we developed ten user-centered concepts including tools for dignified diagnoses and meal kit programs, with the goal of reducing stigma,and empowering families to sustain healthier lives.
We’re excited to share this report, which brings together our findings, framework, and recommendations. We hope it inspires action across the ecosystem—from pediatricians and educators to healthcare organizations and innovators—to create care models that meet families where they are and help them move forward.
