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Introduction Childhood obesity and its comorbidities disproportionately affect Latinos, but there are not clear interventions to narrow the disparity and have a lasting impact. Our study aims to assess the 2-year outcomes and explore the potential mechanisms of behavior change, along with the barriers to sustaining those behaviors, among participants of a family-based, culturally tailored Spanish-language weight management program. Methods We conducted a mixed methods study comprised of a retrospective secondary data analysis and semi-structured interviews. The intervention, Active and Healthy Families, consisted of eight biweekly group sessions for child-caregiver dyads in an emerging Latinx community. We extracted clinic visit data from child participants and matched controls from 2017 to 2021. We compared normalized BMI measurements (BMIpct95) between the intervention and control arm participants using mixed effects linear regression modeling from the start to 2 years post-intervention. We conducted caregiver interviews from 2020 to 2021 after intervention participation and performed a thematic analysis. Results Intervention participation for the 40 AHF child participants was associated with a lower-than-expected average BMIpct95 compared to controls at two years post-intervention. Interview themes included as follows: (1) caregivers felt responsible for their children's health; (2) families acquired new knowledge that they applied; (3) the group format facilitated mutual support and sharing; and (4) the COVID-19 pandemic exposed barriers to maintaining behavior change. Conclusion The AHF intervention may effectively support long-term pediatric weight loss in an emerging Latinx community. Parents offered insights into key intervention components that may facilitate behavior change and identified opportunities to reduce barriers to sustain those behaviors.

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