A family-based childhood obesity programme can be delivered OPW with no compromise to health or behavioural outcomes compared with TPW. Higher attendance, as a proportion of available sessions, leads to better outcomes for children.
This article reports four case studies illustrating the implementation of the ChooseHealthProgram, a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Participants were an overweight (12 years) and obese (15 years) female, and an overweight (14 years) and obese (12 years) male. The program was delivered by provisional psychologists with program specific training and supervision. All participants demonstrated improvements in body composition, and maintained or improved dietary quality and psychosocial wellbeing. The program had variable effects on physical activity and minimal effect on cardiovascular fitness for three of the four participants. While parents and adolescents required considerable assistance to develop and monitor long term program goals, these goals were a useful clinical tool to support the adolescent and parent to recognise the improvements they had made. Identification and monitoring of specific, measurable, and realistic behaviour change strategies was particularly important in assisting adolescents and their parents to translate session information into improved health behaviours. Results indicate that an adolescent overweight and obesity treatment program that promotes adolescent responsibility and autonomy, and emphasises the importance of parent support and family change is both effective and highly acceptable to both adolescents and parents.
BackgroundChildhood obesity is a concern in Australia and across the world. Community-based weight management programs are an important response to address childhood obesity. However, the scientific literature suggests that their effectiveness could potentially be enhanced by providing a structured incentive scheme. This proposal aims to determine the effectiveness of enhanced goal setting linked to a structured incentive scheme designed to improve the sustained health and wellbeing of overweight/obese children within the context of an existing community-based program.Methods/DesignThis study is a cluster randomized controlled trial delivered within the context of the existing NSW “Go4Fun” program with a 10-week and 6- and 12-month follow-up (n = 40 sites, 570 participants) that compares the effectiveness of small changes to the program in which children were asked to set goals (supported by text messages) and were given rewards for achieving them (intervention). This will be compared to the standard/existing program (control), which did not have the same structured incentive program. Data will be collected for all participants at baseline, end of program, and at 6 and 12 months. The primary outcome is a mean change in body mass index (BMI) z score at the 12-month follow-up. Secondary outcomes include anthropometric measures (body weight, height, and waist circumference) and behavioral measures collected via validated questionnaires. A process evaluation (comprising surveys and focus groups) to determine acceptability and sustainability and to inform downstream translation will also be conducted.DiscussionThis study will inform policy and program delivery as well as the broader evidence base regarding goal achievement and incentive schemes directed at children’s health-related behaviors and will provide evidence that is likely to be transferrable across a range of health conditions.Trial RegistrationACTRN12615000558527 registered on 29 May 2015.
Background: The prevalence of childhood overweight and obesity is becoming an increasing concern worldwide. This study aimed to determine effectiveness of a structured goal setting incentive scheme, delivered within a community program, on health outcomes in overweight children at 6 and 18 months. Methods: Single-blind, cluster randomized controlled trial with 10 weeks, 6 month and 18 month follow-up. Community weight-loss programs for children were randomized to (i) standard program plus incentive scheme (intervention) or (ii) standard program alone (control). Primary outcome was mean BMIz score at 18 months. Secondary outcomes included anthropometric and behavioural measures. Results: A total of 37 sites (33 urban and 4 regional) and 512 children were recruited. Compared to baseline, at 18 month follow-up, the total cohort achieved significant reductions in the mean BMIz score (1.7 v 1.0, p<0.001), median screen time (16.5 v 15.8 hours/week p=0.0414), median number of fast food meals per week (1.0 v 0.7, p<0.001) and significant increases in physical activity (6.0 v 10.0 hours/week, p<0.001) and self-esteem score (20.7 v 22.0, p<0.002). There were no significant differences between the control and intervention groups at any follow-up time-points. There were significantly more participants in the intervention than control group who completed 10 sessions of the weight management program (23% v 13%, p=0.015). Conclusions: The incentive scheme, delivered in addition to the standard program, did not have a significant impact on health outcomes in overweight children. However, the intervention increased program attendance and overall cohort achieved sustained improvements in clinical and lifestyle outcomes.
IntroductionCommunity-based weight management programmes are important in addressing childhood obesity. However, the mechanisms that lead to behaviour change within the programmes are rarely studied within the context of the programmes themselves once they have been implemented. This means that further potential gains in the effectiveness of the programme are often not made and any potential losses of efficacy are often not noticed. Qualitative research alongside randomised controlled trials (RCTs) can tell us the context in which these programmes are implemented and elucidate potential mediators or modifiers of the programmes' effectiveness. The aim of this evaluation is to determine the barriers and enablers to the delivery and impact of an incentive-based behaviour change strategy targeting child obesity to inform future translation.Methods and analysisQualitative analysis, including stakeholder and family interviews, focus groups and a survey, will be used. The research will be conducted in collaboration with policymakers, researchers and community health professionals. Participants will be selected from programme providers, and parents/carers and children participating in an Australian community weight management programme during an RCT examining the effectiveness of incentives for improving behaviour change. A maximum variation sampling method based on participant demographics and group characteristics will be used. Thematic analysis will be carried out inductively based on emergent themes, using NVivo V.9.Ethics and disseminationThis research is approved by the South West Sydney Human Ethics Committee review body (HREC/14/LPOOL/480). The evaluation will provide information about the contextual and influencing factors related to the outcomes of the RCT. The results will assist researchers, community health practitioners and policymakers regarding the development, implementation and translation of behaviour change strategies in community initiatives for obese children. Insights gained may be applicable to a range of chronic conditions where similar preventive intervention approaches are indicated.Trial registration numberACTRN12615000558527, Pre-results.
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