The Dutch Obesity Intervention in Teenagers (DOiT) cluster controlled implementation trial: intervention effects and mediators and moderators of adiposity and energy balance-related behaviours

Abstract

BackgroundThe Dutch Obesity Intervention in Teenagers (DOiT) programme is an evidence-based obesity prevention programme tailored to adolescents attending the first two years of prevocational education in the Netherlands. The initial programme showed promising results during an effectiveness trial. The programme was adapted and prepared for nationwide dissemination. To gain more insight into the process of translating evidence-based approaches into ‘real world’ (i.e., ‘natural’) conditions, our research aims were to evaluate the impact of the DOiT-implementation programme on adolescents’ adiposity and energy balance-related behaviours during natural dissemination and to explore the mediating and moderating factors underlying the DOiT intervention effects.MethodsWe conducted a cluster-controlled implementation trial with 20 voluntary intervention schools (n=1002 adolescents) and 9 comparable control schools (n = 484 adolescents). We measured adolescents’ body height and weight, skinfold thicknesses, and waist circumference. We assessed adolescents’ dietary and physical activity behaviours by means of self-report. Data were collected at baseline and at 20-months follow-up. We used multivariable multilevel linear or logistic regression analyses to evaluate the intervention effects and to test the hypothesised behavioural mediating factors. We checked for potential effect modification by gender, ethnicity and education level. ResultsWe found no significant intervention effects on any of the adiposity measures or behavioural outcomes. Furthermore, we found no mediating effects by any of the hypothesised behavioural mediators. Stratified analyses for gender showed that the intervention was effective in reducing sugar-containing beverage consumption in girls (B = -188.2 ml/day; 95% CI = -344.0; -32.3). In boys, we found a significant positive intervention effect on breakfast frequency (B = 0.29 days/week; 95% CI = 0.01; 0.58). Stratified analyses for education level showed an adverse intervention effect (B = 0.09; 95% CI = 0.02; 0.16) on BMI z-scores for adolescents attending the vocational education track.ConclusionsAlthough not successful in changing adolescents’ adiposity, the DOiT-implementation programme had some beneficial effects on specific obesity-related behaviours in subgroups. This study underlines the difficulty of translating intervention effectiveness in controlled settings to real world contexts. Adaptations to the implementation strategy are needed in order to promote implementation as intended by the teachers.Trial registrationCurrent Controlled Trials ISRCTN92755979.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0158-0) contains supplementary material, which is available to authorized users.

Scaling‐up evidence‐based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale‐up penalty

“…Table (characteristics of included studies) provides information on the 10 included scaled‐up trials, four of which were conducted in Australia, two each from the United Kingdom and the United States, and one each from New Zealand and the Netherlands …”

“…Two of the scaled‐up interventions included women only (40 y or older and 18‐40 y old), and one scaled‐up intervention included men only who are 30 to 65 years old . The remaining trials focused on parent/child dyads, preschool children (3‐5 y old), children (6‐11 y old), adolescents (aged 12‐14 y), and adolescent boys (in their first year of high school, aged approximately 11‐12 y) …”

“…Four scaled‐up trials used a before‐and‐after design, three used cluster RCT, and one study each employed an RCT, historical comparison, or a cluster‐controlled implementation trial . Six studies were classified as obesity prevention programmes, and the other four were concerned with weight treatment (Table ). Six of the 10 scaled‐up interventions were classified as effectiveness trials, and four as implementation or dissemination trials.…”

“…Six studies were classified as obesity prevention programmes, and the other four were concerned with weight treatment (Table ). Six of the 10 scaled‐up interventions were classified as effectiveness trials, and four as implementation or dissemination trials.…”

“…For scaled‐up trials using an uncontrolled before‐and‐after trial design, the effect sizes, calculated as a change from baseline, were subtracted from an effect size calculated as the change from baseline within the intervention group in the original efficacy trial. Where multiple time periods were provided (ie, Dutch Obesity Intervention in Teenagers [DOiT] efficacy trial), data from the time period that most closely matched the follow‐up period used in the scaled‐up trial were analysed.…”