Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods

Abstract

Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; Nourishing Our Understanding of Role modeling to Improve Support and Health), targeting racially diverse parents of overweight children (ages 6–11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI ≥ the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial.

Design and rationale for NOURISH-T: A randomized control trial targeting parents of overweight children off cancer treatment

“…This 28-item questionnaire contains items that have been used in previous work by Sallis [83], Neumark-Sztainer [84] and in NOURISH [33,34]. This questionnaire assesses eating, exercise and weight-related habits of families, e.g., frequency of family meals, fast food consumption, television use during meals, fruit and vegetable and sugar sweetened beverage availability, as well as their encouragement of healthy food consumption, PA, and dieting in their children.…”

“…website pages expanding upon session information, such as PA and nutrition. In addition, as we did in our original NOURISH pilot [33,34], EUC caregivers will receive nationally available print or web-based brochures on pediatric overweight on 2 occasions during the study so that similar (but not as intensive) information is provided in the intervention and EUC arms of the study. Because post-EUC intervention assessments will take place about six weeks postwellness session, EUC participants will receive e-mailed or mailed printed materials at two weeks and five weeks postsession.…”

“…This 13-item questionnaire will assess child intake of sugar sweetened beverages, breakfast and dinner habits, as well as frequency of fast food intake [33].…”

“…PCS who relapse during the intervention will be excluded from further involvement, although medical chart follow-up will be obtained (e.g., BMI) and attempts to obtain postassessment information will be made. Eligibility criteria are based on prior parent intervention studies [33,34]. Both caregiver and PCS must meet eligibility criteria for the dyad to be enrolled.…”

“…A few small-scale studies have addressed the impact of unhealthy behaviors [28][29][30][31][32], but most do not utilize evidence-informed treatments. The current randomized control trial (RCT) pilot modifies an evidence-informed 6-week social-cognitive-behavioral parent intervention (Nourishing Our Understanding of Role Modeling to Improve Support and Health -NOURISH) [33] targeting overweight/obese children [33,34] for use with caregivers of PCS (ages 5-12) as they transition from active treatment to survivorship [35]. Because we are dealing with a specific target population, we also extend our age range from that used in the original NOURISH (ages [5][6][7][8][9][10][11] project.…”