The effect of a multi-disciplinary obesity intervention compared to usual practice in those ready to make lifestyle changes: design and rationale of Whanau Pakari

Abstract

BackgroundChild obesity internationally has been identified as one of the major threats to future population health. Indigenous people and those from lower socio-economic backgrounds are over-represented in obesity statistics. There is a need for evidence of effect of interventions for child obesity with long-term follow-up. Whether engaging with those that are more motivated to make lifestyle changes is a useful strategy has not been fully explored. We hypothesise that in obese/overweight children, assessed as psychologically “ready for change”, delivery of a 12-month multi-disciplinary intervention programme results in a significant reduction in body mass index standard deviation score.Methods/DesignWhanau Pakari is an unblinded randomised controlled clinical trial comparing a 12 month intervention programme with standard practice, with 6 monthly assessments for 2 years, conducted in Taranaki, New Zealand (a region where 15.8 % of the population are indigenous). It specifically targets indigenous people and those in more deprived households.Obese/overweight children and adolescents aged 5–16 years are eligible. Exclusion criteria are medical/psychological conditions leading to inability to undertake physical activity/participate in group sessions; those not “ready” to make lifestyle changes; and those without a committed family member.Assessments of health parameters, dietary history, physical activity and overall health-related quality of life/psychological functioning are completed in the participant’s home. Fasting blood tests are obtained at baseline, 12 and 24 months.The primary outcome is body mass index standard deviation score. Secondary outcomes include quality of life, dietary behaviour and physical activity, cardiovascular and metabolic profile (blood pressure, resting heart rate, waist circumference), glycaemic control (fasting glucose and glycated Haemoglobin), fasting insulin, and lipids.A general linear mixed model will be used to assess change from baseline using the 6, 12, 18 and 24 month measures, adjusting for age, gender, socioeconomic status and ethnicity, and whether at the contemplative or preparation/action stages of readiness for change.DiscussionThis trial will inform the development of management programmes for obese children and adolescents that are appropriate for indigenous populations. It will investigate whether those at the preparation/action stage of “readiness” to make lifestyle changes are more successful in making changes than those who are contemplative.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR):12611000862943. (Date registered 15/08/2011).

Dietary Intake and Eating Behaviours of Obese New Zealand Children and Adolescents Enrolled in a Community-Based Intervention Programme

“…Details of the study methods including sample size and power calculations have been previously published [13]. Recruitment period was between January 2012 and August 2014.…”

“…Data collected included weight-related assessments (including measured weight and height), a focussed medical, dietary, physical and psychological review (including measuring heights and weights) [13], as well as fasting blood samples. Baseline comorbidity data (including metabolic data) have been reported [15].…”

Prevalence of comorbidities in obese New Zealand children and adolescents at enrolment in a community‐based obesity programme

“…Whanau Pakari is a community‐based obesity programme currently being conducted in Taranaki, a semi‐rural region of NZ with a population of 23 139 children aged 0–15 years, of which 81% identify as NZE, 28% as Maori and 1% as other ethnicity . The methodology of Whanau Pakari has been described elsewhere . Essentially, Taranaki children and adolescents were eligible if aged from 5 to 16 years and were either obese or overweight with significant weight‐related comorbidities.…”

“…For example, we adopted strategies to remove barriers to access, such as providing a home‐visit model and ‘de‐medicalising’ the assessment. In addition, barriers and facilitators to engagement were considered in service and trial design . We defined obesity and overweight using a modification of the United Kingdom Cole definitions of body mass index (BMI) ≥98th centile and >91st centile, respectively …”

“…9 The methodology of Whanau Pakari has been described elsewhere. 10 Essentially, Taranaki children and adolescents were eligible if aged from 5 to 16 years and were either obese or overweight with significant weight-related comorbidities. Accessibility and appropriateness of the service were key to our approach in targeting at-risk groups.…”