Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)

Abstract

Background Many childhood obesity intervention studies report mean outcomes but do not explore the variation in responses and the characteristics of those who respond well. Objective To identify child and family characteristics associated with improvement in the primary outcome, %BMIp95, of the Texas Childhood Obesity Research Demonstration project (TX‐CORD). Methods The 12‐month TX‐CORD secondary prevention study randomized 549 children, ages 2 to 12 years, with BMI ≥85th percentile to the intensive intervention vs. the comparison program, with measurements at baseline, 3‐, and 12‐months. A growth mixture model was used to identify mutually exclusive latent %BMIp95 trajectories. Latent class regression tested associations between baseline characteristics and latent class membership. Results A 2‐class solution emerged after accounting for the effect of intervention randomization. Latent Class 1 participants (86% of sample) were characterized by mild‐to‐moderate obesity and demonstrated a significantly greater response to the intensive intervention between 0 and 3 months (slope‐on‐group = −0.931, p = 0.03). A rebound between 3 and 12 months was not significantly different between arms. Latent Class 2 participants (14%), who had severe obesity, demonstrated no difference in response between intervention groups. Characteristics associated with Class 1 membership included younger age (2–5 years vs. 6–12 years: OR 3.70, p = .035) and lower maternal BMI category (< 35 kg/m2 vs. ≥ 35 kg/m2: OR 7.14, p < .0001). Conclusions The optimal target population for the intensive intervention are children who have milder obesity, are younger, and do not have a mother with severe obesity. Children with severe obesity may require different approaches.

Real‐world effectiveness of the Bright Bodies healthy lifestyle intervention for childhood obesity

“…In our study, those with severe obesity had the greatest magnitude of %BMIp95 reduction, which is promising in light of several previous studies that have shown greater effectiveness of behavioral obesity treatment interventions among youth with less-severe obesity/overweight; in some cases, children with severe obesity continued to gain weight [39][40][41]. These findings are particularly timely, as recent studies have shown that the greatest increase in childhood obesity prevalence has been observed in the severe-obesity category [1].…”

Expanding Implementation Research to Prevent Chronic Diseases in Community Settings

“…In contrast, secondary prevention approaches focused on children who already have overweight and obesity and who need more aggressive behavioral strategies and guidance. Secondary prevention programs focused on individual families (10,24) and included at least 26 h of contact delivered in community settings, such as the YMCA (97).…”

Novel dietary interventions for adolescents with obesity: A narrative review

“…Furthermore, reflecting the broader literature and clinical guidelines, studies do not routinely differentiate between overweight, obesity, severe obesity and obesity with co‐morbidities, despite these conditions likely requiring differential management approaches. Clinical practice and research alike would benefit from more specific definitions, while recognising that individual presentations of obesity require personalised care based on clinical interpretation, accounting for adolescent growth trajectories, level of excess weight and possible co‐morbidities 28 …”

“…To date, no one dietary approach has demonstrated superiority over another in the treatment of adolescent obesity or concomitant comorbidities. Data in children and adolescents have also shown individual variation in treatment response 27,28 . Hence, a range of dietary interventions are needed for adolescents with obesity.…”