A meta-analysis of obesity interventions among U.S. minority children

Designing Health Interventions to Meet the Needs and Experiences of Minoritized Adolescents: #DoubleTap4Health

Engagement in preventive health behaviors (PHBs; i.e., healthy eating, sleep, and physical activity) during adolescence is associated with reduced risks for chronic conditions, such as diabetes, in adulthood. Although several interventions seek to improve adolescents' engagement in health promoting behaviors, racial- and income-based disparities across PHBs persist and may be even more pronounced for adolescents with multiple minoritized identities (e.g., Black adolescents in low-income communities). Therefore, targeted interventions that better meet the needs of minoritized adolescents are critical. The design of such interventions should include: (1) adolescent involvement, (2) cultural tailoring, (3) developmental theory, and (4) consideration of the social determinants of health. This article describes how these elements have been successfully incorporated into adolescent preventive health interventions and used to design #DoubleTap4Health, a community-based social media health intervention for Black adolescents from a low-income community. The results of a feasibility pilot of #DoubleTap4Health suggest that (1) attention to these elements in the intervention design process is feasible and advantageous to ensuring that the intervention components are appropriate and well received by adolescents, and (2) the intervention demonstrated promise as adolescents showed improved engagement in PHBs and media literacy skills. Lessons learned and next steps for intervention development are discussed. Including the above four elements in the design of preventive health interventions for adolescents from minoritized communities is critical to promoting health equity.

A Scoping Review of Tailoring in Pediatric Obesity Interventions

Background: Families with children who have or are at risk for obesity have differing needs and a one-size-fits-all approach can negatively impact program retention, engagement, and outcomes. Individually tailored interventions could engage families and children through identifying and prioritizing desired areas of focus. Despite literature defining tailoring as individualized treatment informed by assessment of behaviors, intervention application varies. This review aims to exhibit the use of the term "tailor" in pediatric obesity interventions and propose a uniform definition. Methods: We conducted a scoping review following PRISMA-ScR guidelines among peer-reviewed pediatric obesity prevention and management interventions published between 1995 and 2021. We categorized 69 studies into 6 groups: (1) individually tailored interventions, (2) computer-tailored interventions/tailored health messaging, (3) a protocolized group intervention with a tailored component, (4) only using the term tailor in the title, abstract, introduction, or discussion, e) using the term tailor to describe another term, and (5) interventions described as culturally tailored. Results: The scoping review exhibited a range of uses and lack of explicit definitions of tailoring in pediatric obesity interventions including some that deviate from individualized designs. Effective tailored interventions incorporated validated assessments for behaviors and multilevel determinants, and recipient-informed choice of target behavior(s) and programming. Conclusions: We urge interventionists to use tailoring to describe individualized, assessment-driven interventions and to clearly define how an intervention is tailored. This can elucidate the role of tailoring and its potential for addressing the heterogeneity of behavioral and social determinants for the prevention and management of pediatric obesity.

Title: A Qualitative Systematic Review of Parental Perceptions, Motivators, and Barriers to Management of Childhood Obesity

Background

Childhood obesity is a global epidemic affecting millions worldwide. Children living with obesity face increased risks of health-related and psychosocial problems extending into adulthood. Parents and carers play a crucial role in cultivating healthy habits in their children. This review aims to synthesize qualitative research on parental perceptions, motivators, and barriers in managing childhood obesity and their views on weight management programs.

Methods

This systematic review was performed in accordance with the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A variety of electronic databases were explored for qualitative studies published between 2006 and 2023. The CASP checklist was employed to assess the quality of the studies. Data extraction and synthesis were carried out utilizing thematic content analysis.

Results

The search identified 20 peer-reviewed studies meeting the inclusion criteria. Key themes were mapped into five distinct groups: perceptions, facilitators and barriers influencing the management of childhood obesity, as well as facilitators and barriers to enrolment into a weight management program. Parents often perceived obesity as a temporary condition, genetically determined and believed it should not be considered as a major health concern. Identified facilitators included the restriction of screen time, school involvement, goal setting, and enhanced child-parent communication. Conversely, barriers included lack of child motivation, peer influence, easy access to junk food, as well as parental denial, insufficient knowledge or control and logistical challenges.

Conclusion

To tackle childhood obesity, it is essential to adopt a comprehensive strategy that fosters a supportive family environment. Successful initiatives should encompass nutritional education for both parents and children, increase access to healthy food choices, implement home-based programs, and improve the infrastructure that encourages physical activity. Additionally, cultural factors and technological advancements should be considered when designing these interventions.

Systematic Review Registration Number

PROSPERO (CRD42024514219).

Feasibility of a culturally adapted technology-delivered, family-based childhood obesity intervention for Latino/Hispanic families in rural Nebraska: the Hispanic Family Connections study protocol

INTRODUCTION

Addressing childhood obesity risk factors like home environment, parental roles, excess weight, physical activity and healthy eating among Latino/Hispanic (L/H) families living in rural communities is an important priority. However, evidence supporting these interventions among L/H families living in rural communities is missing. Our trial will use cultural adaptation and implementation science frameworks to evaluate the feasibility of delivering a culturally appropriate family-based childhood obesity (FBCO) programme via an automated telephone system (interactive voice response) to L/H families in rural Nebraska.

METHODS AND ANALYSIS

A mixed-methods feasibility trial for L/H families with overweight or obese children. Aim 1 will focus on collaboratively adapting and evaluating all intervention materials to fit the rural L/H community profile better, including translation of materials to Spanish, culturally relevant content and images, and use of health communication strategies to address different levels of health literacy. In aim 2, a 6-month feasibility trial with contextual evaluation will randomise 48 dyads (parent and child) to either Family Connections (FC; n=29) or a waitlist standard-care group (n=29) to determine overall study reach, preliminary effectiveness in reducing child body mass index (BMI) z-scores, potential for programme adoption, implementation and sustainability through local health departments (RE-AIM outcomes). We will also evaluate health department perceptions of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs (innovation, context, recipient characteristics) and FC participants' view of the intervention (ie, relative advantage, observability, trialability, complexity, compatibility). The study will answer three critical questions: (1) is a telephone-delivered FBCO programme in rural Nebraska culturally relevant, usable and acceptable by L/H families?; (2) is a telephone-delivered FBCO programme effective at reducing BMI z-scores in L/H children living in rural Nebraska? and (3) what real-world institutional and contextual factors influence the impact of the intervention and might affect its potential ability to sustainably engage a meaningful population of L/H families who stand to benefit?

ETHICS AND DISSEMINATION

This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB#:0745-20-EP). Dissemination of findings will occur through ClinicalTrials.gov, in scientific forums and to the local rural communities, pilot data to inform the design of a larger clinical trial.

TRIAL REGISTRATION NUMBER

NCT04731506.

Study protocol for clinical trial of the FIT Families multicomponent obesity intervention for African American adolescents and their caregivers: Next step from the ORBIT initiative

INTRODUCTION

This study will test the effectiveness of FIT Families (FIT), a multicomponent family-based behavioural intervention, against a credible attention control condition, Home-Based Family Support (HBFS). This protocol paper describes the design of a randomised clinical trial testing the efficacy of the FIT intervention. The protocol will assess the efficacy of FIT to improve health status in African American adolescents with obesity (AAAO) and their primary caregivers on primary (percent body fat) and secondary (physical activity, metabolic control, weight loss) outcomes and its cost-effectiveness.

METHODS

180 youth/caregiver dyads are randomised into FIT or HBFS, stratified by age, gender and baseline per cent overweight. The proposed study follows a two condition (FIT, HBFS) by four assessment time points. Tests will be conducted to identify potential relationship of baseline demographic and clinical variables to our dependent variables and see whether they are balanced between groups. It is hypothesised that youth/caregiver dyads randomised to FIT will show significantly greater reductions in percent body fat over a 12-month follow-up period compared with AAAO receiving HBFS. Preliminary findings are expected by November 2023.

ETHICS

This protocol received IRB approval from the Medical University of South Carolina (Pro00106021; see 'MUSC IRB 106021 Main Approval.doxc' in online supplemental materials).

DISSEMINATION

Dissemination activities will include summary documents designed for distribution to the broader medical community/family audience and submission of manuscripts, based on study results, to relevant peer-reviewed scientific high-impact journals.

TRIAL REGISTRATION NUMBER

NCT04974554.

Development of a checklist to assess potentially effective components in combined lifestyle interventions for children with overweight or obesity

BACKGROUND

In the Netherlands, Combined Lifestyle Interventions (CLIs), offered in primary care, aim to reduce the number of children with overweight or obesity. CLIs are carried out by a multidisciplinary team and focus on dietary advice and guidance, exercise and behaviour change. These CLIs are not uniformly designed and vary in protocols to suit the local circumstances. Due to the variation in content of CLIs it is difficult to investigate their effectiveness. To enable a proper evaluation of CLIs, we first need to unravel the 'black boxes' of CLIs by identifying the various potentially effective components.

METHODS

First of all we identified potentially effective components in literature. Subsequently we organized an online consultation with experts with diverse backgrounds and asked if they could add potentially effective components. These components were then assembled into a checklist meant to determine the presence or absence of potentially effective components in CLIs for children.

RESULTS

42 experts participated. We identified 65 potentially effective components for CLIs for children with overweight or obesity that we categorized into three themes: content, organisation and implementation.

CONCLUSIONS

Based on literature and expert opinions we developed a practical 65-item checklist to determine the presence of potentially effective components in a CLI. This checklist can be used in the development of CLIs as well as evaluation of CLIs.

A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design

BACKGROUND

Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan.

METHODS/DESIGN

The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference.

DISCUSSION

This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care.

TRIAL REGISTRATION

This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.

Implementation of Combined Lifestyle Interventions for Children with Overweight or Obesity: Experiences of Healthcare Professionals in Multiple Communities

BACKGROUND

To counteract children with obesity, different protocols for combined lifestyle interventions (CLIs) are implemented by healthcare providers (HCPs). To understand the effects of CLI, we studied the implementation process, facilitators and barriers experienced by HCPs.

METHODS

A multiple case study design in which community-based CLIs (n = 4), implemented in a total of ten different communities, are conceptualized as a "case". Qualitative data were collected via group interviews among HCPs (n = 48) regarding their implementation protocol, their network involvement and the adoption of the CLI in a community. Transcripts were coded and analysed using ATLAS.ti.

RESULTS

Barriers were the absence of a proper protocol, the low emphasis on the construction of the network and difficulty in embedding the CLI into the community. Funding for these activities was lacking. Facilitating factors were the involvement of a coordinator and to have everyone's role regarding signalling, diagnosis, guidance and treatment clearly defined and protocolled. HCPs suggested adding certain professions to their team because they lacked expertise in parenting advice and providing mental support to children.

CONCLUSIONS

Carrying out and adapting the content of the CLI to the community was experienced as easier compared to the management of the organizational aspects of the CLI. For these aspects, separate funding is essential. In the future, mapping the characteristics of a community will help to clarify this influence on the implementation even better.

Recruitment and retention of emerging adults in lifestyle interventions: Findings from the REACH trial

OBJECTIVE

Emerging adulthood (EA) is a critical time to promote cardiometabolic health, but EAs are underrepresented in lifestyle intervention trials. Knowledge gaps exist regarding how best to recruit and retain sociodemographically diverse EAs. Our goal was to begin to address these gaps using data from the Richmond Emerging Adults Choosing Health (REACH) Trial.

METHODS

REACH was a comparative efficacy trial for EAs, age 18-25, with a body mass index of 25-45 kg/m2. Enrollment goals were: N = 381, ≥40% underrepresented race/ethnicity, ≥30% men, ≥85% retention at 6 months. We translated formative work into a recruitment and retention plan, examined yield for recruitment and retention overall, and by gender and race/ethnicity, as well as cost data. Descriptive statistics and chi square tests were used.

RESULTS

Enrollment benchmarks were met overall (N = 382) and for participants from underrepresented race/ethnic backgrounds (58.0%), but not men (17.3%). The most common recruitment sources were email (26.9%), radio (22.2%), and online radio (15.4%); this pattern largely held true across gender and race/ethnic groups, though word of mouth and participant referral together accounted for nearly a quarter of enrolled men. Costs averaged $155 per randomized participant. Retention was 89% at 3-months, 84% at 6-months (primary endpoint) and 80% at 12-months (follow-up), with no significant differences by gender or race/ethnicity (all p's > 0.05). Retention did not differ by recruitment method (p = .69).

CONCLUSIONS

Grounding our approach in formative data and embracing participants as partners in research contributed to the recruitment and retention of sociodemographically diverse EAs. Additional efforts are needed to enroll EA men.

Motivational interviewing to reduce anthropometrics among children: A meta-analysis, moderation analysis and Grading of Recommendations Assessment, Development and Evaluation assessment

BACKGROUND

Limited systematic reviews exist to evaluate the effects of motivational interviewing (MI) on children's anthropometric factors.

OBJECTIVE

This review examined the effects of MI interventions for children and/or parents on children's anthropometric factors and included moderation analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched Cochrane Library, PubMed, CINAHL, EMBASE, PsycINFO, Sociological Abstracts, SPORTDiscus, Education Resources Information Center, and Web of Science in December 2020. A two-step double screening approach was applied: (1) screening titles and abstracts, and (2) screening full-text articles obtained in step 1. At each step, discussion occurred until reaching consensus. The Cochrane risk-of-bias tool was used to evaluate risk of bias, and GRADE system was applied to assess overall quality of evidence. We performed meta-analyses using the Comprehensive Meta-Analysis software.

RESULTS

A total of 2209 records were found, and 45 eligible articles were retained. MI interventions had a pooled effect of -0.15 on body mass index (BMI; 95% confidence interval [CI]: -0.24 to -0.06), -0.36 on waist circumference (WC; 95% CI: -0.71 to -0.01) and -0.22 on percent body fat (95% CI: -0.41 to -0.03). Child baseline weight status and percent low-income families were identified as significant intervention moderators. According to the GRADE assessment, the quality of evidence on BMI percentile, BMI z-score and percent body fat was moderate, while quality on BMI and WC was low.

CONCLUSIONS

In conclusion, culturally appropriate clinic- or home-based MI interventions with adequate duration, dose and active parental involvement are promising in reducing anthropometrics among children.

Age, Sex, Race/Ethnicity, and Income Patterns in Ideal Cardiovascular Health Among Adolescents and Adults in the U.S

INTRODUCTION

Ideal cardiovascular health is present in <50% of children and <1% of adults, yet its prevalence from adolescence through adulthood has not been fully evaluated. This study characterizes the association of age with ideal cardiovascular health and compares these associations across sex, race/ethnicity, and SES subgroups.

METHODS

This study, conducted in 2020, analyzed adolescents and adults aged 12-79 years from the cross-sectional National Health and Nutrition Examination Survey 2005-2016 (N=38,706). Polynomial models were used to model the association of age with ideal cardiovascular health, defined using the American Heart Association's Life's Simple 7 criteria (scales 0-14, with higher values indicating better cardiovascular health).

RESULTS

Mean cardiovascular health was lower with increasing age, starting in early adolescence and dropping to a nadir by age 60 years before stabilizing. At age 20 years, only 45% of adults had ideal cardiovascular health (≥5 ideal cardiovascular health metrics), and >50% of adults had poor cardiovascular health (≤2 ideal cardiovascular health metrics) at age 53 years. Women had higher mean cardiovascular health than men in early life but lower mean cardiovascular health from age 60 years onward. Mean cardiovascular health scores were highest for non-Hispanic White and higher-income adults and lowest for non-Hispanic Black and low-income adults across all ages. Mean cardiovascular health scores fell from intermediate to poor levels approximately 30 years earlier for non-Hispanic Black than for non-Hispanic White adults and approximately 35 years earlier for low-income adults than in higher-income adults.

CONCLUSIONS

Cardiovascular health scores are lower with increasing age from early adolescence through adulthood. Race/ethnicity and income disparities in cardiovascular health are observed at young ages and are more profound at older ages.

Predictors of Weight Loss and Weight Loss Maintenance in Children and Adolescents With Obesity After Behavioral Weight Loss Intervention

Objective

Predictors of body weight loss (BWL) and body weight loss maintenance (BWLM) after behavioral weight loss intervention are well-investigated in adults. Less is known for children and adolescents and a systematic overview on the topic for this age group was aim of the review.

Methods

A systematic research according to PRISMA guidelines using several databases was performed. The outcome was the BMI z-Score of longitudinal studies. The extracted predictors were classified in clusters (Physiology, Behavior, Psychology, Environment) and compared with a theory-driven model based on international guidelines and known predictors for adults.

Results

Out of 2,623 articles 24 met the eligibility criteria, 23 investigating BWL and 8 BWLM. The expected key predictor in research for adults “Behavior” was hardly investigated in children. The most examined cluster was “Physiology” with the most significant predictors, in particular genetics (BWL) and blood parameters (BWLM). Factors in the cluster “Psychology” also predicted BWL and BWLM. The cluster “Environment,” which was highlighted in most intervention guidelines, was neglected in studies regarding BWLM and hardly investigated in studies with BWL.

Conclusion

The comparison with the theory-driven children model outlined research gaps and differences between predictors for adults and children providing further direction of research.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020200505.

Effectiveness of obesity interventions among South Korean children and adolescents and importance of the type of intervention component: a meta-analysis

BACKGROUND

Various interventions have been tested to prevent or treat childhood obesity in South Korea. However, the overall effect of those interventions is unclear, as very few reviews and meta-analyses were specific to Korean children and adolescents.

PURPOSE

We aimed to examine the overall effect of obesity interventions among Korean children and adolescents, while also examining differences by sex, age group, baseline weight category, intervention duration, number of intervention components, and type of intervention components.

METHODS

A meta-analysis was conducted for all intervention studies sampling Korean children and adolescents, with at least one control group and one month of follow-up, published between January 2000 and August 2020. Cohen d was calculated as an effect size for treatment effect, using the standardized difference between intervention group's body mass index (BMI) change and control group's BMI change.

RESULTS

The final sample included 19 intervention studies with 2,140 Korean children (mean age, 12.2 years). Overall, interventions were strongly favored over their controls (d=1.61; 95% confidence interval [CI], 1.12-2.09). The subgroup analysis showed that interventions with at least one physical activity component (d=2.43; 95% CI, 1.63-3.24) were significantly better than those that did not include physical activity (d=0.02; 95% CI, -0.26 to 0.31).

CONCLUSION

Type of intervention component appeared important, though no differential association was observed by sex, age, baseline weight category, intervention duration, and number of intervention components. Korean and non-Korean interventions may be substantively different. Additional studies are needed to understand why and how Korean interventions differ from non-Korean interventions.

Kids N Fitness Junior: Outcomes of an Evidence-Based Adapted Weight Management Program for Children Ages Three-Seven Years

Background: Few weight management interventions target young children with obesity from low-income minority families. Objective: To conduct a nonrandomized, pragmatic, pilot study of an adapted, evidence-based, weight management program (Kids N Fitness [KNF]) customized for children ages 3-7 years (Kids N Fitness Jr. [KNF-JR]) on changes in adiposity, nutrition, and physical activity behaviors. Methods: One hundred eighty children (ages 3-16) with ≥85th percentile BMI and their parents participated in one of two 6-week weight management interventions dependent on the child's age: KNF-JR: 3-7 or regular KNF: 8-16. Comparisons were made between baseline anthropometrics and health questionnaire responses, and those from weeks 6 to 18. Two-sample tests for equality of proportions with continuity were used to measure proportions of success between KNF-JR and KNF. Results: At week 6, both cohorts showed a mean decrease in BMI z-score (zBMI) of -0.02 (p = 0.3 for KNF-JR [n = 43]; p = 0.02 for KNF [n = 59], with no significant group differences. Among program completers, 75% of KNF-JR and 83% of KNF maintained or lowered zBMI at week 18 (within-group difference p < 0.01). On average across all participants, at week 18 vs. baseline, improvements occurred in screen time (p < 0.01 KNF-JR, p < 0.02 KNF), sweetened beverage intake (p < 0.01 KNF-JR, p = 0.03 KNF), physical activity (p < 0.01 KNF-JR and KNF), and water (p = 0.01 KNF-JR, non-significant KNF) and vegetable (p < 0.01 KNF-JR, p = 0.02 KNF) consumption. Conclusion: This pilot demonstrated that an evidence-based weight management program can be adapted for all age groups and results in improved BMI status. Larger, randomized controlled trials are needed to verify effectiveness and sustained impact.

Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis

BACKGROUND

Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions.

OBJECTIVE

The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes.

METHODS

Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat.

RESULTS

In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=-1.26 kg/m2, 95% CI -2.24 to -0.28), lifestyle modification comparator (WMD=-1.75, 95% CI -2.76 to -0.74), intervention involving both boys and girls (WMD=-1.30, 95% CI -2.14 to -0.46), and intervention involving obesity only (WMD=-1.92, 95% CI -3.75 to -0.09).

CONCLUSIONS

The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity.

Racial and socioeconomic disparities in the efficacy of a family-based treatment programme for paediatric obesity

BACKGROUND

Family-based behavioural weight loss treatment (FBT) is an evidence-based intervention for paediatric overweight/obesity (OV/OB), but little research has examined the relative efficacy of FBT across socioeconomic status (SES), and racial groups.

METHOD

A total of 172 youth (7-11 years; 61.6% female; 70.1% White, 15.7% Black; child percent OV = 64.2 ± 25.2; 14.5% low-income) completed 4 months of FBT and 8 months of additional intervention (either active social facilitation-based weight management or an education control condition). Parents reported family income, social status (Barratt simplified measure of social status) and child race at baseline. Household income was dichotomized into < or >50% of the area median family income. Race was classified into White, Black or other/multi-race. Treatment efficacy was assessed by change in child % OV (BMI % above median BMI for age and sex) and change in child BMI % of 95th percentile (BMI % of the 95th percentile of weight for age and sex). Latent change score models examined differences in weight change between 0 and 4 months, 4 and 12 months and 0 and 12 months by income, social status and race.

RESULTS

Black children had, on average, less weight loss by 4 months compared to White children. Low-income was associated with less weight loss at 4 months when assessed independent of race. No differences by race, social status or income were detected from 4 to 12-months or from 0 to 12 months.

CONCLUSIONS

FBT is effective at producing child weight loss across different SES and racial groups, but more work is needed to understand observed differences in initial efficacy and optimize treatment across all groups.

Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents

PURPOSE OF REVIEW

This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity.

RECENT FINDINGS

Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.

Message Design Choices Don't Make Much Difference to Persuasiveness and Can't Be Counted On-Not Even When Moderating Conditions Are Specified

Persuaders face many message design choices: narrative or non-narrative format, gain-framed or loss-framed appeals, one-sided or two-sided messages, and so on. But a review of 1,149 studies of 30 such message variations reveals that, although there are statistically significant differences in persuasiveness between message forms, it doesn't make much difference to persuasiveness which option is chosen (as evidenced by small mean effect sizes, that is, small differences in persuasiveness: median mean rs of about 0.10); moreover, choosing the on-average-more-effective option does not consistently confer a persuasive advantage (as evidenced by 95% prediction intervals that include both positive and negative values). Strikingly, these results obtain even when multiple moderating conditions are specified. Implications for persuasive message research and practice are discussed.

Trends in health behavior and weight outcomes following enhanced afterschool programming participation

BACKGROUND

The United States needs to increase access to effective obesity prevention and treatment programming for impoverished youth at risk for health disparities. Although recommended, schools have difficulty consistently implement evidence-based obesity programing. We report on the effectiveness of adding structured nutrition education and minimum physical activity (PA) requirements to standard middle school after-school programming.

METHODS

Using a longitudinal pre-post study design, we evaluated program effectiveness at one year on target behaviors on students recruited during three consecutive school years (2016-2018). We used generalized linear (or logistic) mixed-effects modeling to determine: 1) impact on healthy weight and target healthy behavior attainment, and 2) whether target behavior improvement and weight change were associated with after-school program attendance. The seven target behaviors relate to eating healthy, physical activity, and sleep.

RESULTS

Over the three years, a total of 76 students enrolled and completed one year of programming (62% Hispanic, 46% girls, 72% with BMI > 85th %ile, 49% with BMI > 95th %ile). Of students with BMI > 85th %ile, 44% maintained or decreased BMI Z-score. There were improvements (non-significant) in BMI Z-score and the adoption of four healthy eating behaviors: fruit, vegetables, sugar-free beverages, and unhealthy snack food. Students with higher after-school attendance (> 75%) had greater improvements (non-significant) in composite behavior scores, BMI Z-score, and in most target behaviors (5/7) than students with lower after-school attendance (< 75%). Sleep improvements were significantly associated with BMI Z-score decrease (Beta = - 0.05, 95% CI (- 0.1,-0.003), p = 0.038.) CONCLUSIONS: Enhancement of existing after-school programming with structured nutrition education and minimum physical activity requirements demonstrates positive improvements in several health behaviors and weight outcomes. Adopting enhanced after-school programming increases access to health activities and may bring us closer to solving obesity in at-risk youth in impoverished communities.

TRIAL REGISTRATION

ClinicalTrials.gov identifier (NCT number): NCT03565744 . Registered 21 June 2018 - Retrospectively registered.

Child Health Behaviour and Parent Priorities for a School-Based Healthy Lifestyle Programme

OBJECTIVE

The purpose of this study was to characterise parents' concerns for their children's health behaviours and perceptions of motivators and barriers to positive child health behaviour change, and to determine associations between motivators and barriers and parents' priorities for a school-based healthy lifestyle programme.

DESIGN

Cross-sectional study of 46 parents who had completed an un-validated survey distributed during school-wide events.

SETTING

School for children aged 5-14 years in The Bronx, New York City, USA.

METHODS

Wilcoxon Rank Sum tests compared motivators and barriers to positive child health behaviour change by heath behaviour concern; Spearman's correlation measured associations between motivators and barriers and programme priorities.

RESULTS

Parents concerned about child weight significantly ranked keeping up with others and decreasing clothing size as motivators, while parents concerned about child food choices significantly ranked improving food choices and decreasing BMI and clothing size as motivators. Food-, play-, and self-esteem-related motivators were associated with nutrition education (r_s ≥ .41, p ≤ .01), physical activity classes (r_s ≥ .29, p ≤ .04) and child involvement in programme decision-making (r_s ≥ .43, p ≤ .01) priorities. Consistency-, child resistance-, and home rules-related barriers were associated with nutrition education (r_s ≥ .37, p=.02), physical activity classes (r_s ≥ .32, p = .02), and child involvement (r_s ≥ .40, p ≤ .02) priorities.

CONCLUSIONS

Despite the study sample size, selection bias, and generalisability limitations, prioritising nutrition, physical activity and child involvement in programme decision-making may enhance parent support for school-based healthy lifestyle programmes.

The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia

Background

Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia.

Methods

The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program.

Results

Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials).

Conclusions

This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10270-5.

Satisfaction and acceptability of paediatric weight management services amongst parents and carers: A mixed-methods study

To optimize treatment for children and adolescents with obesity and minimize attrition, consideration of parents' engagement and satisfaction with paediatric weight management services is crucial. The aim of this study was to conduct a mixed-methods evaluation of parental acceptability and satisfaction of available paediatric weight management services in New South Wale, Australia's most populous state. Parents/carers referred to one of six weight management services between March 2018 and July 2019 were invited to participate. The study involved: (a) surveys and one-on-one phone interviews to assess overall satisfaction, acceptability of service design and delivery, treatment expectations, and service accessibility, strengths, weaknesses and areas of improvement; (b) a survey to determine costs to families of attending the service; and (c) a survey assessing families' reasons for treatment non-attendance. N = 146 participants completed the survey to assess service satisfaction and acceptability and 37 of these also participated in phone interviews. Ninety-three per cent were satisfied with the overall care they received and patient weight loss/cessation of weight gain and improvement in the family's overall health were rated as the most valued changes. Content analysis of interviews highlighted participants' recognition of positive changes achieved during treatment and appreciation of the resources provided, and the encouraging/empathetic nature of staff. The most common reasons for treatment attrition were difficulty in accessing the weight management service and flexibility of appointment times. Findings from this study can be utilized in future planning and development of paediatric weight management services to facilitate integrated, responsive and effective care of children and adolescents with obesity.

Comparison of Early Life Obesity-Related Risk and Protective Factors in Non-Hispanic Black Subgroups

OBJECTIVES

Previous obesity prevention studies in preschool-age children have included non-Hispanic Black (NHB) children, but few have investigated between-subgroup differences even though there may be cultural risk and protective practice differences, challenging the generalizability of findings. The purpose of this study was to examine differences in early childhood obesity-related factors in NHB subgroups (Haitian, other Caribbean Islander and African-American [AA]) children.

METHODS

Baseline data from two randomized controlled trials in 52 childcare centers of which 35 had data to test a preschool-based obesity prevention intervention was analyzed. The sub-sample included 370 caregiver-child dyads; 209 self-identified as AA, 120 as Haitian and 41 as Caribbean Islander/West Indian or mixed race. Multilevel regression models generated outcome estimates for group differences in body mass index (BMI) percentile, birthweight, breastfeeding initiation and duration, bottle feeding duration and age when solid foods were introduced.

RESULTS

Mean BMI percentile was similar for AA, Haitian and Caribbean Islander/West Indian/Multiracial (60.1th percentile, 60.8th percentile, 62.8th percentile, respectively) as was birthweight (6.3, 6.8, and 6.6 lb, respectively). Children of US-born caregivers had significantly lower BMI percentiles (9.13 percentile points) versus foreign-born caregivers. Haitian women were significantly more likely to initiate breastfeeding (64.9%) versus AA (47.6%) and Caribbean Islander/West Indian/Multiracial (62.2%) (p < .01). No significant group differences were found in breastfeeding or bottle feeding duration or age solid foods were introduced.

CONCLUSIONS

Findings here suggest that NHB race classification can identify important subgroup behavioral similarities which in turn may inform culturally sensitive strategies to promote early childhood healthy weight. Foreign-born caregivers may benefit from healthy weight promotion information, and as early as possible in their child's development.

Impact of Race and Ethnicity on Weight-Loss Outcomes in Pediatric Family-Based Obesity Treatment

INTRODUCTION

Minority children are disproportionately affected by obesity and little is known about how race/ethnicity impacts outcomes in pediatric weight-loss treatment. This study aimed to evaluate whether race/ethnicity affected weight-loss outcomes in a pediatric obesity intervention. Secondary aims included evaluating whether race/ethnicity was associated with energy intake, exercise, program adherence, acceptability, and attendance.

METHODS

One hundred fifty parent/child dyads (age 8-12 years, BMI% 85-99.9; 32% Hispanic, 24% Non-Hispanic, Non-White, 44% Non-Hispanic White) participated in a randomized control trial evaluating weight loss in family-based behavioral treatment with (FBT) or without child participation (i.e., Parent-Based Treatment, PBT). Assessments occurred at baseline, mid-treatment (month 3), post-treatment (month 6), and follow-up (months 12 and 24). Analyses included linear mixed effect models, linear models, and a negative binomial model.

RESULTS

Weight loss in Hispanic, Non-Hispanic White, and Non-Hispanic, Non-White children was not significantly different by race/ethnicity at months 6, 12, and 24 (p = 0.259) and was similar across both treatments (FBT = - 0.16 BMIz; PBT = - 0.21 BMIz; p = 0.61). There were no differences in energy intake, physical activity, acceptability ratings, or adherence to treatment (as measured by a post-treatment survey) (p's > 0.123). However, Hispanic families attended fewer treatment visits than Non-Hispanic White families (p = 0.017).

CONCLUSION

On average, children lost weight participating in our pediatric obesity treatment and there was no statistical difference in weight loss between groups. Future research evaluating whether culturally adapted treatments would be more effective for racial/ethnic minorities or whether the personalization inherent in family-based behavioral treatment may be sufficient is needed.

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

BACKGROUND

Current recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how "dose delivered" was associated with body mass index z-score (BMI-Z) across 3 years of follow-up.

METHODS

Parent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face "intensive sessions" (90 min each) and 6.75 h over the next 9 months via 9 "maintenance phone calls" (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having "zero" dose.

RESULTS

Among 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B = -0.011; 95% CI [- 0.021, - 0.001]; p = 0.029) and maintenance calls (B = -0.015; 95% CI [- 0.026, - 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parent-child pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2- or 3-year follow-up.

CONCLUSIONS

In a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-to-face sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up.

CLINICAL TRIAL REGISTRATION

The trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.

Mindful Eating and Active Living: Development and Implementation of a Multidisciplinary Pediatric Weight Management Intervention

Pediatric overweight and obesity are significant individual and public health issues that require an innovative approach. While evidence suggests that intensive family-based behavioral lifestyle modification can improve weight status, practical and logistical realities limit the ability of primary healthcare providers to intervene effectively. MEALs (Multidisciplinary Engagement and Learning/Mindful Eating and Active Living) is a family-based mindfulness intervention developed to address pediatric overweight and obesity, while improving healthy lifestyle behaviors through cooking classes. The incorporation of mindfulness, a psychological strategy associated with increased awareness of internal experiences, allows for a focus on the importance of healthy eating along with safe and efficacious kitchen practices. The Template for Intervention Description and Replication (TIDieR) checklist and guide is used to describe the intervention with the intention of providing necessary details to implement the intervention in clinical practice or replicate the intervention for further study. Lessons learned from pilot iterations of the intervention are provided.

Competency-Based Approaches to Community Health: A Randomized Controlled Trial to Reduce Childhood Obesity among Latino Preschool-Aged Children

Background: Health behavior change interventions that target childhood obesity in minority populations have led to inconsistent and short-lived results. The purpose of this study was to test a novel intervention that was personalized and family-based in a Latino population to reduce childhood obesity. Methods: Competency-Based Approaches to Community Health (COACH) was a randomized controlled trial. Latino parent-child pairs were recruited from community settings in Nashville, TN. Child eligibility criteria included age 3-5 years and a BMI ≥50th percentile. The intervention included 15 weekly, 90-minute sessions followed by 3 months of twice-monthly health coaching calls. The control group was a twice-monthly school readiness curriculum for 3 months. Sessions were conducted by a health coach in local community centers, with groups of 8-11 parent-child pairs. The primary outcome was child BMI trajectory across 12 months, measured at four times. The intervention's effect was assessed by using a longitudinal, linear mixed-effects growth model, adjusting for child gender, baseline child and parent age, and baseline parent BMI and education. Results: Of the 305 parent-child pairs assessed for eligibility, 117 were randomized (59 intervention, 58 control). Child BMI was available for 91.5% at 1-year follow-up. Mean baseline child age was 4.2 [standard deviation (SD) = 0.8] years, and 53.8% of children were female. Mean baseline child BMI was 18.1 (SD = 2.6) kg/m². After adjusting for covariates, the intervention's effect on linear child BMI growth was -0.41 kg/m² per year (95% confidence interval -0.82 to 0.01; p = 0.05). Conclusions: Over 1-year follow-up, the intervention resulted in slower linear BMI growth for Latino preschool-aged children from poverty.

Frequency of school-based intervention needed to improve weight outcomes of Mexican-American adolescents with overweight or obesity: a randomized controlled trial

BACKGROUND

Efficacious school-based interventions among ethnic minority youth are often intensive and difficult to disseminate.

OBJECTIVE

This parallel, open-label-randomized controlled trial aimed to compare changes in adolescent-standardized body mass index (zBMI) from a school-based obesity intervention given 0, 1, 3, or 5 days a week.

METHODS

Mexican-American youth (n = 243) with overweight or obesity were recruited from a Houston school district and randomized to receive an obesity intervention with established efficacy 0 (control), 1, 3, or 5 d/wk (respectively, equating to 0, 40, 120, or 200 min of contact each week). In each condition, 80% of intervention time was allocated to physical activity and 20% to nutrition, with behavioural modification overlaid throughout. zBMI was calculated from directly measured height and weight. A linear mixed model evaluated differences in zBMI over time between conditions.

RESULTS

Participants were 12.02 ± 0.57 years old with a zBMI of 1.80 ± 0.46 at baseline. Among those with complete data at 1 year (n = 203), a significant condition by time interaction was indicated (F = 9.42, P < .001). Those who received the intervention 3 or 5 d/wk had significantly greater decreases in zBMI than control (respectively, -0.19 zBMI units/y; 95% CI, -0.28 to -0.11; and -0.18 zBMI units/y; 95% CI, -0.27 to -0.10, both P < .001). No differences were found between 3 and 5 d/wk (95% CI, -0.09-0.08, P = .87).

CONCLUSIONS

The intervention provided 3 d/wk resulted in similar zBMI improvements as the intervention provided 5 d/wk. This information can be used to develop scalable school-based obesity interventions.

Qualitative analysis of COACH: A community-based behavioral intervention to reduce obesity health disparities within a marginalized community

Background

The purpose of this study was to conduct a qualitative evaluation of a behavioral intervention to prevent and treat childhood obesity in minority children. Using qualitative methods to augment understanding of intervention success may be one way to gain insight into the types of behavior change strategies that are most effective in childhood obesity interventions.

Methods

COACH was a randomized controlled trial of 117 Latino parent-child (ages 3–5) pairs in Nashville, TN that resulted in improved child BMI in intervention vs. control families at 1-year follow-up. All participant parents were invited to focus groups after the trial. Discussions were audiotaped, transcribed, and translated into English. A hierarchical coding scheme was generated, and qualitative analysis done using an inductive/deductive approach. Both theme saturation and consensus between the coders were achieved. Responses were compared between intervention and control groups.

Results

We conducted seven focus groups with 43 participants. 4 themes emerged from the intervention group: 1) perceived barriers to health behavior change; 2) strategies learned to overcome perceived barriers; 3) behavioral changes made in response to the program; and 4) knowledge, skills, and agency for family health behaviors. 4 themes emerged from the control group: 1) a desire to engage in health behaviors without specific strategies; 2) common set of barriers to health behavior change; 3) engagement in literacy activities, including creative problem-solving strategies; and 4) changes made in response to study visits. Analysis of coded data showed the intervention increased healthy behaviors (e.g., fruit/vegetable consumption) despite barriers (e.g., time, cost, culture, family dynamics). Intervention participants described using specific behavior change strategies promoted by the intervention including: substituting ingredients in culturally-normative recipes; avoiding grocery shopping when hungry; and coping with inability to meet goals with acceptance and problem-solving. Control participants reported little success in achieving healthy changes for their family. Intervention participants described successful health behavior changes that were shared across generations and were maintained after the program. Intervention participants reported increased awareness of their own agency in promoting their health.

Conclusions

Qualitative evaluation of COACH provides a more detailed understanding of the intervention's quantitative effectiveness: child and adult health behaviors and personal agency were improved.

Rationale and design of a pilot study to evaluate the acceptability and effectiveness of a revised protein sparing modified fast (rPSMF) for severe obesity in a pediatric tertiary care weight management clinic

Aggressive dietary interventions may provide an accessible treatment option for children and adolescents with severe obesity who are not successful with traditional lifestyle behavioral interventions or do not want or qualify for weight loss surgery. One such intensive dietary option is the protein sparing modified fast (PSMF). The PSMF involves minimal carbohydrate intake to induce ketosis, while maintaining adequate or high protein intake to minimize catabolism. The PSMF, under medical supervision, can be an effective and safe intervention for children and adolescents, yet the PSMF diet is not regularly used in the treatment of pediatric severe obesity. This paper describes the rationale and design for a pilot study to evaluate the acceptability and effectiveness of a revised PSMF (rPSMF) implemented as a weight loss treatment option for children and adolescents with severe obesity in a pediatric tertiary care weight management clinic. The primary aim of the study is to evaluate the acceptability of the rPSMF as assessed by adherence, satisfaction with the intervention, and participation rate using quantitative and qualitative methods. The secondary aim is to investigate the effectiveness of the rPSMF on improving a) anthropometric measures (weight, body mass index [BMI], BMI z-score); b) metabolic measures (lipid profile, glycosylated hemoglobin, liver function tests); and c) quality of life. Results of this study will provide guidance for the standardization of a pediatric rPSMF protocol in a clinic setting, delineate which factors improve or hinder adherence and weight loss and provide preliminary data for a multicenter randomized controlled trial.

CLINICALTRIALSGOV IDENTIFIER

NCT03899311.

Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity

BACKGROUND

Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity.

PURPOSE

The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design.

METHODS

Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight.

RESULTS

All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%).

CONCLUSIONS

Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.

Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses

BACKGROUND

The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity.

METHODS

An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included.

RESULTS

Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity.

CONCLUSIONS

Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.

Secondary benefits of the families improving together (FIT) for weight loss trial on cognitive and social factors in African American adolescents

BACKGROUND

Although weight loss is an important primary outcome in obesity interventions, family-based interventions may have cascading ripple effects that extend to other aspects of health and well-being. Identifying these secondary benefits may be useful for understanding how to best engage underserved African American families in weight loss. The present research examines whether African American adolescents and parents perceive secondary benefits from participating in a family-based weight-loss intervention, including secondary health, social, or cognitive benefits.

METHODS

Qualitative data were obtained from families participating in the group-based intervention of the Families Improving Together (FIT) for Weight Loss trial. During the final week of the face-to-face motivational and family-based intervention program, families completed a guided open-ended group discussion about changes they experienced from participating (14 groups, N = 41 adolescents and 41 parents). Sessions were audiotaped, transcribed, and coded by independent pairs of raters using both inductive and deductive approaches. Guided by the multi-theoretical framework for the FIT trial, some themes were determined prior to coding using a deductive approach, including: (a) health outcomes (e.g., monitoring strategies for diet and physical activity), (b) social outcomes (e.g., involvement in family support, group support, autonomy support, family bonding, positive communication) and (c) cognitive outcomes (e.g., expression of self-confidence through self-efficacy, self-regulation, establishment of long-term goals). In addition to these pre-determined themes, the coding process included an inductive assessment, allowing for unexpected themes to surface as well around positive self-talk, relapse prevention, and monitoring strategies for different types of weight-related behaviors.

RESULTS

Across both adolescents and parents, the cognitive outcomes were the most frequently discussed outcomes, including self-regulation, monitoring strategies for diet, establishing long-term goals, and ultimate relapse prevention. Parents made a greater number of comments about the social outcomes, including family support, group support, self-efficacy, and family connectedness, whereas adolescents made a greater number of comments about positive family communication.

CONCLUSIONS

The results provide preliminary support for the positive secondary effects of weight loss programs on improving both cognitive and social well-being in underserved African American adolescents.

TRIAL REGISTRATION

ClinicalTrials.gov # NCT01796067. https://clinicaltrials.gov/ct2/show/NCT01796067?term=NCT01796067&rank=1 The trial was registered on February 21, 2013 and the first participant was enrolled July 12, 2013.

¡Viva Maryvale!: A Multilevel, Multisector Model to Community-Based Diabetes Prevention

INTRODUCTION

Latino communities are disproportionately affected by type 2 diabetes and experience disparities in access to diabetes prevention programs. The purpose of this study was to test the preliminary efficacy of a culturally grounded, diabetes prevention program for high-risk Latino families delivered through an integrated research-practice partnership.

STUDY DESIGN

The integrated research-practice partnership was established in a predominantly Latino community and consisted of a Federally Qualified Health Center, a YMCA, an accredited diabetes education program, and an academic research center. Data were collected and analyzed from 2015 to 2018.

SETTING/PARTICIPANTS

Latino families consisting of a parent with an obese child between age 8 and 12 years.

INTERVENTION

The 12-week lifestyle intervention included nutrition education and behavioral skills training (60 minutes, once/week) and physical activity classes (60 minutes, three times/week) delivered at a YMCA.

MAIN OUTCOME MEASURES

Outcomes included measures of adiposity (BMI, waist circumference, and body fat); HbA1c; and weight-specific quality of life.

RESULTS

Over the course of the 2-year project period, 58 families (parents n=59, children n=68) were enrolled with 36% of parents and 29% of children meeting the criteria for prediabetes at baseline. Feasibility and acceptability were high, with 83% of enrolled families completing the program, 91% of the intervention sessions attended, and 100% of families stating they would recommend the program. The intervention led to significant decreases in percentage body fat among parents (46.4% [SD=10.8] to 43.5% [SD=10.5], p=0.001) as well as children (43.1% [SD=8.0] to 41.8% [SD=7.2], p=0.03). Additionally, HbA1c was significantly reduced in parents (5.6% [SD=0.4] to 5.5% [SD=0.3], p=0.03), and remained stable in children (5.5% [SD=0.3] vs 5.5% [SD=0.3], p>0.05). Significant improvements in quality of life were reported in parents (64.6 [SD=15.8] to 71.0 [SD=13.7], p=0.001) and children (69.7 [SD=15.8] to 72.6 [SD=13.7], p=0.05).

CONCLUSIONS

These findings support the preliminary efficacy of an integrated research-practice partnership to meet the diabetes prevention needs of high-risk Latino families within a vulnerable community.

A Review of Systematic Reviews Targeting the Prevention and Treatment of Overweight and Obesity in Adolescent Populations

PURPOSE

Adolescent obesity is a powerful predictor of morbidity and mortality, yet amenable to modifiable behaviors. To accurately summarize the effects of behavioral interventions on changes in adolescent body mass index and/or weight status, we assessed existing systematic reviews for reporting transparency and methodological quality.

METHODS

Five databases were searched through September 2017 to identify relevant systematic reviews. Reviews were evaluated for reporting transparency and methodological quality using PRISMA Reporting Checklist and Assessment of Multiple Systematic Reviews Instrument. Evidence was synthesized across high-quality reviews.

RESULTS

Four of twelve systematic reviews were of high methodological quality. All four focused on the treatment of overweight/obesity in adolescent populations, representing 97 international studies. Findings indicate intervention compared with no intervention/wait list showed larger effects for improving BMI/BMI z-scores. Small improvements (averaging a 3.7-kg decrease) in weight/weight percentile were observed following a supervised exercise plus dietary and/or behavior support intervention. Health-related quality of life may improve following interventions, but overall attention to associated psychological variables (depression, self-esteem/perception) is limited.

CONCLUSIONS

Adherence to objective checklists and protocols for rigorous conduct and reporting of systematic reviews is warranted. Consensus evidence is urgently needed to define and report behavior change interventions related to obesity prevention and treatment.

Competency Based Approach to Community Health (COACH): The methods of a family-centered, community-based, individually adaptive obesity randomized trial for pre-school child-parent pairs

Competency-Based Approaches to Community Health (COACH) is a randomized controlled trial of a family-centered, community-based, and individually-tailored behavioral intervention for childhood obesity among Latino pre-school children. COACH focuses on improving personal agency for health behavior change by tailoring content to overcome contextual barriers. The intervention focuses on diet, physical activity, sleep, media use, and engaged parenting. The content is individually adapted based on routine assessments of competency in specific health behaviors using a mobile health platform and novel measurement tools developed by our team. In response to these regular assessments, health coaches provide tailored health behavior change strategies to help families focus on the areas where they decide to improve the most. The intervention consists of a 15-week group-based intensive phase, with weekly sessions delivered by health coaches in community centers. Following weekly sessions, a 3-month maintenance phase of the intervention consists of twice monthly coaching calls for participants to focus on individual health goals for their families. The primary outcome of the trial is child body mass index trajectory over 1 year. Secondary outcomes include parent body mass index change, child waist circumference, child diet, child physical activity, and other psychosocial mediators of child health behavior change. The control arm consists of a school readiness intervention, delivered by the Nashville Public Library. By applying a personalized approach to child behavior change, in the setting of both family and community, COACH aims to develop sustainable solutions for childhood obesity by supporting healthy childhood growth in low-income, minority preschool children.

Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index: A Randomized Clinical Trial

Importance

Prevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest.

Objective

To test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity.

Design, Setting, and Participants

A randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017.

Interventions

The intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library.

Main Outcomes and Measures

The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons.

Results

Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, -99.4 kcal [95% CI, -160.7 to -38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006).

Conclusions and Relevance

A 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research.

Trial Registration

ClinicalTrials.gov Identifier: NCT01316653.

The Mastery Matrix for Integration Praxis: The development of a rubric for integration practice in addressing weight-related public health problems

In response to the limitations of siloed weight-related intervention approaches, scholars have called for greater integration that is intentional, strategic, and thoughtful between researchers, health care clinicians, community members, and policy makers as a way to more effectively address weight and weight-related (e.g., obesity, diabetes, cardiovascular disease, cancer) public health problems. The Mastery Matrix for Integration Praxis was developed by the Healthy Eating and Activity across the Lifespan (HEAL) team in 2017 to advance the science and praxis of integration across the domains of research, clinical practice, community, and policy to address weight-related public health problems. Integrator functions were identified and developmental stages were created to generate a rubric for measuring mastery of integration. Creating a means to systematically define and evaluate integration praxis and expertise will allow for more individuals and teams to master integration in order to work towards promoting a culture of health.

Scale-out of a community-based behavioral intervention for childhood obesity: pilot implementation evaluation

Background

Expanding the use of evidence-based behavioral interventions in community settings has met with limited success in various health outcomes as fidelity and dose of clinical interventions are often diluted when translated to communities. We conducted a pilot implementation study to examine adoption of the rigorously evaluated Healthier Families Program by Parks and Recreation centers in 3 cities across the country (MI, GA, NV) with diverse socio-cultural environments.

Methods

Using the RE-AIM framework, we evaluated the program both quantitatively (pre/post surveys of health behavior change; attendance & fidelity) and qualitatively (interviews with Parks and Recreation staff and participants following the program).

Results

The 3 partner sites recruited a total of 26 parent-child pairs. REACH: Among the 24 participants who completed pre/post surveys, 62.5% were 25–34 years old, and average child age was 3.6 (SD 0.7) years. The distribution of self-reported race/ethnicity was 54% non-Hispanic White, 38% non-Hispanic Black, and 8% Latino. EFFECTIVENESS: Qualitative interviews with participants demonstrated increased use of the built environment for physical activity and continued use of key strategies for health behavior change. ADOPTION: Three of five (60%) collaborating sites proceeded with implementation of the program. IMPLEMENTATION: The average attendance for the 12-week program was 7.6 (SD 3.9) sessions, with 71% attending > 50% of sessions. Average fidelity for the 12 weekly sessions was 25.2 (SD 1.2; possible range 9–27). MAINTENANCE: All 3 partner sites continued offering the program after grant funding was complete.

Conclusions

This pilot is among the first attempts to scale-out an evidence-based childhood obesity intervention in community Parks and Recreation centers. While this pilot was not intended to confirm the efficacy of the original trial on Body Mass Index (BMI) reduction, the effective and sustained behavior change among a geographically and ethnically diverse population with high attendance and fidelity demonstrates an effective approach on which to base future large-scale implementation efforts to reduce childhood obesity in community settings.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5403-z) contains supplementary material, which is available to authorized users.

Pilot Project to Integrate Community and Clinical Level Systems to Address Health Disparities in the Prevention and Treatment of Obesity among Ethnic Minority Inner-City Middle School Students: Lessons Learned

Effective obesity prevention and treatment interventions are lacking in the United States, especially for impoverished minority youths at risk for health disparities, and especially in accessible community-based settings. We describe the launch and pilot implementation evaluation of the first year of the B'N Fit POWER initiative as a middle school-based comprehensive wellness program that integrates weight management programming into existing onsite preventive and clinical services. Consistent with the existing implementation science literature, we focused on both the organizational structures that facilitate communication and the development of trust among stakeholders, students, and families and the development of realistic and timely goals to implement and integrate all aspects of the program. New implementation and programming strategies were developed and tested to increase the proportion of students screened, support the linkage of students to care, and streamline the integration of program clinical and afterschool components into routine services already offered at the school. We report on our initial implementation activities using the Standards for Reporting Implementation Studies (StaRI) framework using hybrid outcomes combining the Reach element from the RE-AIM framework with a newly conceptualized Wellness Cascade.

The dose of behavioral interventions to prevent and treat childhood obesity: a systematic review and meta-regression

BACKGROUND

A better understanding of the optimal "dose" of behavioral interventions to affect change in weight-related outcomes is a critical topic for childhood obesity intervention research. The objective of this review was to quantify the relationship between dose and outcome in behavioral trials targeting childhood obesity to guide future intervention development.

METHODS

A systematic review and meta-regression included randomized controlled trials published between 1990 and June 2017 that tested a behavioral intervention for obesity among children 2-18 years old. Searches were conducted among PubMed (Web-based), Cumulative Index to Nursing and Allied Health Literature (EBSCO platform), PsycINFO (Ovid platform) and EMBASE (Ovid Platform). Two coders independently reviewed and abstracted each included study. Dose was extracted as intended intervention duration, number of sessions, and length of sessions. Standardized effect sizes were calculated from change in weight-related outcome (e.g., BMI-Z score).

RESULTS

Of the 258 studies identified, 133 had sufficient data to be included in the meta-regression. Average intended total contact (# sessions x length of sessions) was 27.7 (SD 32.2) hours and average duration was 26.0 (SD 23.4) weeks. When controlling for study covariates, a random-effects meta-regression revealed no significant association between contact hours, intended duration or their interaction and effect size.

CONCLUSIONS

This systematic review identified wide variation in the dose of behavioral interventions to prevent and treat pediatric obesity, but was unable to detect a clear relationship between dose and weight-related outcomes. There is insufficient evidence to provide quantitative guidance for future intervention development. One limitation of this review was the ability to uniformly quantify dose due to a wide range of reporting strategies. Future trials should report dose intended, delivered, and received to facilitate quantitative evaluation of optimal dose.

TRIAL REGISTRATIONS

The protocol was registered on PROSPERO (Registration # CRD42016036124 ).

Compañeros: High School Students Mentor Middle School Students to Address Obesity Among Hispanic Adolescents

INTRODUCTION

Promotoras, Hispanic community health workers, are frequently employed to promote health behavioral change with culturally bound Hispanic lifestyle behaviors. Peer health mentors have been used in schools to promote healthy nutrition and physical activity behaviors among students. This study investigates the efficacy of combining these 2 approaches by training high school health mentors, called compañeros, to engage Hispanic middle school students in a school-based obesity intervention as a strategy to promote and sustain reductions in standardized body mass index (zBMI).

METHODS

High school compañeros were trained to participate in a 6-month obesity program alongside middle school students in Houston, Texas. Middle school students were randomized to participate in the program either with compañeros (n = 94) or without compañeros (n = 95). The intervention was conducted from 2013 through 2016 in 3 cohorts of students, 1 each school year. Students were followed for 12 months. The primary outcome was zBMI, which was analyzed at baseline, 6 months, and 12 months.

RESULTS

Significant differences were found between conditions across time (F = 4.58, P = .01). After the 6-month intervention, students in the condition with compañeros had a larger decrease in zBMI (F = 6.94, P = .01) than students in the condition without compañeros. Furthermore, students who received the intervention with compañeros showed greater sustained results at 12 months (F = 7.65, P = .01).

CONCLUSION

Using high school compañeros in an obesity intervention for Hispanic middle school students could be effective in promoting and maintaining reductions in zBMI.

Maternal and child health services and an integrated, life-cycle approach to the prevention of non-communicable diseases

Described as the ‘invisible epidemic’, non-communicable diseases (NCDs) are the world’s leading cause of death. Most are caused by preventable factors, including poor diet, tobacco use, harmful use of alcohol and physical inactivity. Diabetes, cancer and cardiovascular and chronic lung diseases were responsible for 38 million (68%) of global deaths in 2012. Since 1990, proportionate NCD mortality has increased substantially as populations have aged and communicable diseases decline. The majority of NCD deaths, especially premature NCD deaths (<70 years, 82%), occur in low-income and middle-income countries, and among poor communities within them. Addressing NCDs is recognised as central to the post-2015 agenda; accordingly, NCDs have a specific objective and target in the Sustainable Development Goals. While deaths from NCDs occur mainly in adulthood, many have their origins in early life, including through epigenetic mechanisms operating before conception. Good nutrition before conception and interventions aimed at preventing NCDs during the first 1000 days (from conception to age 2 years), childhood and adolescence may be more cost-effective than managing established NCDs in later life with costly tests and drugs. Following a life-course approach, maternal and child health interventions, before delivery and during childhood and adolescence, can prevent NCDs and should influence global health and socioeconomic development. This paper describes how such an approach may be pursued, including through the engagement of non-health sectors. It also emphasises evaluating and documenting related initiatives to underwrite systematic and evidence-based cross-sectoral engagement on NCD prevention in the future.

Should bariatric surgery be performed in adolescents?

Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial

Background

Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.

Methods

Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.

Discussion

The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.

Trial Registration

NCT02615353, registered on June 8, 2016.

Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial

BACKGROUND

Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes.

METHODS

Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance.

DISCUSSION

The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth.

TRIAL REGISTRATION

NCT02615353, registered on June 8, 2016.

Family-Centered Positive Behavior Support Interventions in Early Childhood To Prevent Obesity

Positive behavior support (PBS) strategies in early childhood, which include proactively structuring environments to support and positively reinforce healthy dietary and physical activity behaviors, are critical for preventing pediatric obesity, particularly among low-income, ethnic minority children. Existing evidence-based family-centered preventive interventions effectively impact parents' use of PBS strategies. Enhancing these programs to more directly target the key mechanisms of change specific to promoting children's healthy lifestyle behaviors could serve as the foundation for the next generation of effective protocols for preventing pediatric obesity. Two established programs that target PBS that can be feasibly implemented in a variety of service delivery systems using a multi-tiered, adaptive approach and the next steps of translation are discussed.

Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review

Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double-coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter-coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.