Translational research: are community-based child obesity treatment programs scalable?

Abstract

BackgroundCommunity-based obesity treatment programs have become an important response to address child obesity; however the majority of these programs are small, efficacy trials, few are translated into real-world situations (i.e., dissemination trials). Here we report the short-term impact of a scaled-up, community-based obesity treatment program on children’s weight and weight-related behaviours disseminated under real world conditions.MethodsChildren age 6–15 years with a body mass index (BMI) ≥85th percentile with no co-morbidities, and their parents/carers participated in a twice weekly, 10-week after-school child obesity treatment program between 2009 and 2012. Outcome information included measures of weight and weight-related behaviours. Analyses were adjusted for clustering and socio-demographic variables.ResultsOverall, 2,812 children participated (54.2 % girls; Mage 10.1 (2.0) years; Mattaendance 12.9 (5.9) sessions). Beneficial changes among all children included BMI (−0.65 kg/m2), BMI-z-score (−0.11), waist circumference (−1.8 cm), and WtHtr (−0.02); self-esteem (+2.7units), physical activity (+1.2 days/week), screen time (−4.8 h/week), and unhealthy foods index (−2.4units) (all p < 0.001). Children who completed ≥75 % of the program were more likely to have beneficial changes in BMI, self-esteem and diet (sugar sweetened beverages, lollies/chocolate, hot chips and takeaways) compared with children completing <75 % of the program.ConclusionsThis is one of the few studies to report outcomes of a government-funded, program at scale in a real-world setting, and shows that investment in a community-based child obesity treatment program holds potential to produce short-term changes in weight and weight-related behaviours. The findings support government investment in this health priority area, and demonstrate that community-based models of child obesity treatment are a promising adjunctive intervention to health service provision at all levels of care.

Pediatric obesity treatment, self‐esteem, and body image: A systematic review with meta‐analysis

“…Three studies did not report on personnel involved in intervention delivery. Parental involvement was reported as part of the intervention in 50 studies …”

Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving

“…31, 33 Fourteen of the cases described an intervention that fit into one of the seven categories of investment in physical activity (Figure 1), with the most frequently represented categories being those of community-wide programs (n=6), 20, 22, 24, 31, 32, 34 ‘whole of school’ programs (n=3), 23, 26–28, 30 and physical activity promotion or NCD prevention integrated into the health care system (n=3). 18, 25, 29 No cases relating to the categories of transport systems prioritising active travel, or urban design policies and infrastructure, were identified. The remaining cases involved health education delivered by telephone or text message.…”

“…The remaining cases involved health education delivered by telephone or text message. 19, 21 Six cases described interventions targeting children or youth, 18, 23, 25–28, 30, 33 while four focused on adults, 19, 24, 29, 35 one on older adults, 32 and another one on both adults and older adults. 34 Two cases related to all age groups 21, 22 and two were not specific about age groups.…”

“…Scalability was most commonly defined exclusively as extending the reach of an intervention by replicating it in other localities, cities or states (horizontal scale-up) 16 (n=6), 20, 24, 25, 30, 34, 35 as institutionalising the intervention at government level so it could reach all citizens within a given jurisdiction (vertical scale-up) 16 (n=5), 22, 23, 29, 31, 32 or as a combination of horizontal and vertical scale-up (n=4). 18, 19, 21, 26–28 Most of the monitoring and evaluation activities pertaining to scalability assessed whether the program was reaching the specified target population and whether the intervention was being properly implemented, with several cases reporting deficiencies in these regards.…”

Cost effectiveness and return on investment of a scalable community weight loss intervention

“…17 Indeed, we join others in calling for increased funding and focus on translational research that focuses on external validity and scalability to speed the translation of effective weight-loss interventions into broad community practice. 55 …”