Embedding weight management into safety-net pediatric primary care: randomized controlled trial

Abstract

BackgroundImplementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States).MethodsIn a 12-month trial, families of children (age 7–12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions.ResultsThe mean body mass index Z-score declined in both arms (P < 0.01) with no significant difference between the Standard Care Alone (0.12 kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15 kg [SE: 0.03]) arm (P = 0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P = 0.05), low-density lipoprotein cholesterol (P = 0.04), aspartate aminotransferase (P = 0.02), and alanine transaminase (P = 0.03) concentrations.ConclusionsSafety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters.Trial registrationClinicalTrials.gov Identifier: NCT00851201. Registered 23 February 2009.Electronic supplementary materialThe online version of this article (10.1186/s12966-017-0639-z) contains supplementary material, which is available to authorized users.

Characteristics of Multicomponent Interventions to Treat Childhood Overweight and Obesity in Extremely Cold Climates: A Systematic Review of a Randomized Controlled Trial

“…After the exclusion of the duplicates in the databases, the screening and eligibility criteria were applied. Finally, 29 articles were included for data synthesis in this review [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

Spillover Effects of a Family-Based Childhood Weight-Management Intervention on Parental Nutrient Biomarkers and Cardiometabolic Risk Factors

“…Detailed descriptions of the family-based management trial (NCT00851201 registered on clinicaltrials.gov), including design, intervention, and primary outcomes in the children, have been previously published ( 30 , 31 ). This study focused on the parents ( n = 205) of participating children (aged 7–12 y with baseline BMI z score ≥85th percentile) who had an archived fasting plasma, serum, and RBC sample at both baseline and end of the 1-y intervention.…”

“…The EP added a behavioral change component (8 weekly skill-building core sessions, each 1.5 to 2 h in duration), and subsequent monthly post-core support sessions focused on improving dietary behaviors and increasing engagement in physical activities provided by bilingual multidisciplinary staff. As described previously ( 31 ), the skill-building core sessions included alternating in-person groups and parent phone consultations. The in-person core group sessions consisted of food preparation or other skill activity for parents and children, followed by a physical activity session for the children and discussion session for parents to enhance parenting and problem-solving skills related to the themes covered in the joint family sessions.…”

“…Available CMRF data for the parents from the primary clinical trial ( 31 ) and ancillary study ( 30 ) were divided into 7 broad categories: BMI, blood pressure (systolic and diastolic), glucose metabolism (fasting glucose and insulin), lipid profile [total cholesterol (TC), LDL cholesterol, HDL cholesterol, triglycerides (TGs)], markers of inflammation [high-sensitivity C-reactive protein (hsCRP), TNF-α, IL-6], vascular adhesion [E-selectin, P-selectin, soluble intercellular adhesion molecule (sICAM)] and coagulation (thrombomodulin), and adipokines (leptin and adiponectin).…”

“…Using the latter approach, we have documented that providing targeted family-based behavioral counseling as part of standard care (American Academy of Pediatrics overweight/obesity recommendations) ( 31 ) can help children with overweight/obesity adopt healthier eating patterns that are associated with modest improvements in BMI z score (BMI score standardized for age and sex) and several cardiometabolic risk factors (CMRFs) ( 30 ). The majority of parents who participated in this intervention were female (94% mothers) and nearly all of them (92%) had a BMI that classified them as being in the overweight or obese categories.…”