Developing a patient-centered outcome for targeting early childhood obesity across multiple stakeholders

Abstract

BackgroundPatient-centered outcome measures for childhood obesity are limited. Identifying outcomes that patients and families consider important could be a viable avenue for better engagement of patients and interventions that are efficacious and acceptable to patients. Latino children experience high rates of obesity, and under-recognition of obesity in preschool aged children is common.MethodsWe used growth chart data to identify low-income, Latino children 2–5 years of age with obesity who decreased their adiposity (positive deviants) and a set of controls. We used qualitative interview data to identify themes around goals parents used in addressing weight. Then, we applied a modified Delphi approach across groups of caregivers and providers to identify common goals. We conducted focus groups to explore conflicts and congruency between caregivers and providers related to goals. Using the focus group data, we developed a decision tool for use between patients and providers relevant for early childhood obesity.ResultsWe identified 257 children who successfully reduced adiposity (positive deviants) from 1621 eligible growth charts. From interviews with 44 parents (21 positive deviants and 23 controls), we coded and categorized outcomes such as increased happiness, clothing size and improved activity. We recruited 81 parents, grandparents and health care providers to participate in the modified Delphi process of ranking outcomes by importance and feasibility. Focus groups (2, total n = 24) suggested potential methods for a common framework to discuss goals, including a modified growth chart. We created a decision-tool that incorporated a growth chart and a section for discussion of patient-centered goals. A final focus group (1, n = 10) provided feedback on the tool as acceptable and potentially useful.ConclusionsThe development of a patient-centered tool around achieving a healthy weight in early childhood identified common goals between providers and parents. While the tool has been developed, prospective testing of this patient-centered tool and its effects on engagement, parent motivation, and behavior change would be a useful next step.Electronic supplementary materialThe online version of this article (10.1186/s40608-018-0216-2) contains supplementary material, which is available to authorized users.

Pharmacological interventions for the management of children and adolescents living with obesity—An update of a Cochrane systematic review with meta‐analyses

“…The review findings support previous systematic reviews and meta-analyses. [74][75][76][77][78][79][80][81][82] The review is unique in that it covers the following critical features: it is the most comprehensive review because it includes all drugs used to treat children and adolescents living with obesity (regardless of regulatory approval), includes psychosocial outcomes that are prioritized by these young people and their parents, [17][18][19]22 focuses on longer term studies (6 months from baseline), which reflect a move towards treating obesity as a chronic and relapsing disease, and examines multiple sources of heterogeneity.…”

“…13 The outcomes of interest were broadened and informed by recent evidence on patient-reported outcomes in order to reflect a person-centred approach, which focusses on the needs of children and adolescents living with obesity. [17][18][19]…”

“…We followed the methods of the Cochrane review 12 but broadened the outcomes of interest and assessed the certainty of evidence using current guidance by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group 13 . The outcomes of interest were broadened and informed by recent evidence on patient‐reported outcomes in order to reflect a person‐centred approach, which focusses on the needs of children and adolescents living with obesity 17–19 …”

“…We did not exclude any of the outcomes from the Cochrane review; we were aware of the need to present more than one continuous BMI metric 21 and selected additional outcomes based on evidence from studies that investigated the importance of outcomes according to adolescents living with obesity, healthcare providers and physicians. [17][18][19]22 For each outcome category, three senior reviewers (LJE, ASK and DW) voted for their preferred choices of outcomes. From the most frequently preferred outcomes, seven outcomes were chosen for the Table 2, which was used to present the certainty of the evidence for BMI, BMI as percentage of 95th percentile (new), serious adverse events, healthrelated quality of life (HRQoL), T2DM (new), social functioning (new) and self-esteem.…”

Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention

“…The curricula containing concrete examples of healthy behavior change was noted by stakeholders as a critical aspect for PWMI's, along with the need for the program to be patient- and family-centered. Previous studies have indicated that patient-centered programs are desirable for both patients and clinicians and improve health-related outcomes ( 17 , 18 ). Furthermore, there is a growing body of literature to support the sustainability and effectiveness of family-centered interventions for childhood obesity ( 19 – 22 ).…”