Latino Families, Primary Care, and Childhood Obesity

Abstract

Background Few successful treatment modalities exist to address childhood obesity. Given Latinos’ strong identity with family, a family-focused intervention may be able to control Latino childhood obesity. Purpose To assess the feasibility and effectiveness of a family-centered, primary care–based approach to control childhood obesity through lifestyle choices. Design Randomized waitlist controlled trial in which control participants received the intervention 6 months after the intervention group. Setting/participants Forty-one Latino children with BMI >85%, aged 9–12 years, and their caregivers were recruited from an urban community health center located in a predominantly low-income community. Intervention Children and their caregivers received 6 weeks of interactive group classes followed by 6 months of culturally sensitive monthly in-person or phone coaching to empower families to incorporate learned lifestyles and to address both family and social barriers to making changes. Main outcomes measures Caregiver report on child and child self-reported health-related quality of life (HRQoL); metabolic markers of obesity; BMI; and accelerometer-based physical activity were measured July 2010–November 2011 and compared with post-intervention assessments conducted at 6 months and as a function of condition assignment. Data were analyzed in 2012. Results Average attendance rate to each group class was 79%. Socio-environmental and family factors, along with knowledge, were cited as barriers to changing lifestyles to control obesity. Caregiver-proxy and child-self-reported HRQoL improved for both groups with a larger but not nonsignificant difference among intervention vs control group children (p=0.33). No differences were found between intervention and control children for metabolic markers of obesity, BMI, or physical activity. Conclusions Latino families are willing to participate in group classes and health coaching to control childhood obesity. It may be necessary for primary care to partner with community initiatives to address childhood obesity in a more intense manner. Trial registration This study is registered at Clinicaltrials.partners.org 2009P001721.

Active and Healthy Families: A Randomized Controlled Trial of a Culturally Tailored Obesity Intervention for Latino Children

“…There is a dearth of RCTs examining programs in the primary care setting to address overweight and obesity among Latino children 29,30 ; the present study is the first to date to show a significant impact on BMI. O'Connor and colleagues 29 conducted a feasibility RCT of Helping HAND, an intervention for overweight or obese 5-to 8-year-olds and their parents.…”

“…The second feasibility trial evaluated a culturally sensitive intervention consisting of family coaching and the Power Up curriculum, comprising 5 group sessions plus a reunion session among 9-to 12-year-old overweight or obese Latino children and their caregivers. 30 Sessions were delivered by a health educator, physical therapist, nutritionist, and primary care pediatrician and did not result in betweengroup differences in BMI z score. Other nonrandomized obesity interventions in primary care have been assessed among Latino youth with mixed results.…”

A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions

“…For example, Taveras et al [58] included in-person clinician visits, clinician telephone calls, and changes to the primary care system. In another study [61], intervention components were group sessions delivered by a team of health care providers (primary care provider, health educator, nutritionist, and physical therapist) and individual coaching sessions with a health coach conducted in person or by telephone.…”

Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents

“…BWL treatment with the addition of an active gaming component was also found to be more effective than usual BWL treatment in increasing moderate-tovigorous PA and greater reductions in anthropometric outcomes (Trost, Sundal, Foster, Lent, & Vojta, 2014). In the remaining five trials, the multicomponent intervention was not different from control conditions (Arauz Boudreau, Kurowski, Gonzalez, Dimond, & Oreskovic, 2013;McCallum et al, 2007;Wake et al, 2009), a standard care condition (Hughes et al, 2008), and child-only treatment (Bathrellou et al, 2010). In addition, BWL treatments have been tested in an additional 11 studies of children and adolescents (ages 6-18), with nine of those trials demonstrating the efficacy of the BWL treatment compared to control conditions (Coppins et al, 2011;Jiang, Xia, Greiner, Lian, & Rosenqvist, 2005;Mellin, Slinkard, & Irwin, 1987;Nemet et al, 2005;Nowicka, Hoglund, Pietrobelli, Lissau, & Flodmark, 2008;Reinehr et al, 2010), selfhelp conditions , written dietary advice (Weigel et al, 2008), standard care (Sabet Sarvestani, Jamalfard, Kargar, Kaveh, & Tabatabaee, 2009), and dietary advice usual care (Diaz, EsparzaRomero, Moya-Camarena, Robles-Sardin, & Valencia, 2010) conditions.…”

“…Whereas the majority of treatment studies have been conducted with majority White populations (Caprio et al, 2008), several studies have been conducted with non-White populations. In one study, 6-month intensive FBT was found superior to a self-help condition in Mexican American children , another study of FBT in a Latino population found it equal to a waitlist control group (Arauz Boudreau et al, 2013), and a recent study concluded that it is possible to recruit and keep minority, low-income children in FBT, with favorable outcomes (Davis et al, 2013). It is clear that additional research is needed to examine the efficacy of existing treatments in non-White populations and to adapt these treatments as necessary to bolster access and outcomes.…”