Table 1 Inclusion, Exclusion, and Opt-out Criteria

Inclusion Criteria

• Child age 5–18 years

• Child body mass index ≥95th percentile

• Parent can speak and read in English or Spanish

• Parent ownership of a device that is able to receive and send text messages

Exclusion Criteria

• Live farther than a 20-mile radius from the Bull City Fit program site

• Endogenous or genetic cause of obesity

• Taking a medication that causes weight gain

• Participation in a pediatric weight management program within 12 months

• Parent or child significant health problem that would limit participation

• Pregnancy in patients of child-bearing age

Opt-out Criteria

✓ Primary care physician opts patient out of study for reasons including: severe obesity (BMI > 160% of sex- and age-specific 95th percentile), urgent co-morbidities, parental unwillingness to be contacted by a research assistant, or at physician clinical judgment.