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Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial.

ABSTRACT: BACKGROUND:The best outcomes for treating childhood obesity have come from comprehensive family-based programmes. However there are questions over their generalizability. OBJECTIVE:To examine the acceptability and effectiveness of 'family-based behavioural treatment' (FBBT) for childhood obesity in an ethnically and socially diverse sample of families in a UK National Health Service (NHS) setting. METHODS:In this parallel group, randomized controlled trial, 72 obese children were randomized to FBBT or a waiting-list control. Primary outcomes were body mass index (BMI) and BMI s.d. scores (SDSs). Secondary outcomes were weight, weight SDSs, height, height SDSs, waist, waist SDSs, FM index, FFM index, blood pressure (BP) and psychosocial measures. The outcomes were assessed at baseline and after treatment, with analyses of 6-month data performed on an intent-to-treat (ITT) basis. Follow-up anthropometric data were collected at 12 months for the treatment group. RESULTS:ITT analyses included all children with baseline data (n=60). There were significant BMI SDS changes (P<0.01) for the treatment and control groups of -0.11 (0.16) and -0.10 (1.6). The treatment group showed a significant reduction in systolic BP (-0.24 (0.7), P<0.05) and improvements in quality of life and eating attitudes (P<0.05), with no significant changes for the control group. However the between-group treatment effects for BMI, body composition, BP and psychosocial outcomes were not significant. There was no overall change in BMI or BMI SDSs from 0-12 months for the treatment group. No adverse effects were reported. CONCLUSIONS:Both treatment and control groups experienced significant reductions in the level of overweight, but with no significant difference between them. There were no significant group differences for any of the secondary outcomes. This trial was registered at http://www.controlled-trials.com/ under ISRCTN 51382628.

SUBMITTER: Croker H

PROVIDER: S-EPMC3272466 | biostudies-literature | 2012 Jan

REPOSITORIES: biostudies-literature

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Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial.

Croker H H Viner R M RM Nicholls D D Haroun D D Chadwick P P Edwards C C Wells J C K JC Wardle J J

International journal of obesity (2005) 20110920 1

<h4>Background</h4>The best outcomes for treating childhood obesity have come from comprehensive family-based programmes. However there are questions over their generalizability.<h4>Objective</h4>To examine the acceptability and effectiveness of 'family-based behavioural treatment' (FBBT) for childhood obesity in an ethnically and socially diverse sample of families in a UK National Health Service (NHS) setting.<h4>Methods</h4>In this parallel group, randomized controlled trial, 72 obese childre ...[more]

PMID: 21931327

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Project description:BACKGROUND:South Africa is currently undergoing a nutrition transition, and overweight and obesity is on the increase in South African children. Urbanization and other health determinants have led to reduced physical activity and unhealthy eating that have increased the risk of adverse chronic health conditions. This study aims to provide evidence of the effectiveness of a school-based intervention study that targets diet and physical activity for the prevention of child and adolescent overweight and/or obesity. METHODS:We will employ a mixed method study design which is divided into two phases. Phase 1, namely the qualitative elicitation research phase will inform the development of the quantitative intervention phase (phase 2), consisting of a cluster-randomized trial, based on input from key stakeholders. The study will be undertaken in 16 government-funded primary schools in the iLembe district of KwaZulu-Natal, South Africa. The study will target learners in Grades 4 and 7, their parents, Life Orientation educators, school principals and members of school governing bodies. Assessment for the primary objective (BMI Z scores), and the secondary objectives (change in knowledge, attitudes and behaviours regarding diet and physical activity) in both study arms will be conducted at baseline in March 2020 and at the end of the study in October 2020. DISCUSSION:The study will be a novel combined mixed methods/RCT design that focuses on diet, physical activity school and family-based interventions in the context of rapidly increasing overweight and obesity prevalence in KwaZulu-Natal. To encourage behaviour change and management of malnutrition, education including diet and physical activity, is an important strategy that must be considered. Nutrition education extends beyond the dissemination of food information; it includes addressing the needs of participants, empowers and encourages decision-making and choice of foods, change in nutrition attitudes, beliefs and influences based on resources available and within cultural boundaries. TRIAL REGISTRATION:Pan African Clinical Trial Registry PACTR201711002699153. Protocol registered on 16 November 2017.

Project description:ObjectivesTo evaluate the impact of the GOALS (Getting Our Active Lifestyles Started) family-based childhood obesity treatment intervention during the first 3?years of implementation.DesignSingle-group repeated measures with qualitative questionnaires.SettingCommunity venues in a socioeconomically deprived, urban location in the North-West of England.Participants70 overweight or obese children (mean age 10.5?years, 46% boys) and their parents/carers who completed GOALS between September 2006 and March 2009.InterventionsGOALS was a childhood obesity treatment intervention that drew on social cognitive theory to promote whole family lifestyle change. Sessions covered physical activity (PA), diet and behaviour change over 18 2?h weekly group sessions (lasting approximately 6?months). A Template for Intervention Description and Replication (TIDieR) checklist of intervention components is provided.Primary and secondary outcome measuresThe primary outcome measure was child body mass index (BMI) z-score, collected at baseline, post-intervention and 12?months. Secondary outcome measures were child self-perceptions, parent/carer BMI and qualitative changes in family diet and PA (parent/carer questionnaire).ResultsChild BMI z-score reduced by 0.07 from baseline to post-intervention (p<0.001) and was maintained at 12?months (p<0.05). There was no change in parent/carer BMI or child self-perceptions, other than an increase in perceived social acceptance from baseline to post-intervention (p<0.05). Parents/carers reported positive changes to family PA and dietary behaviours after completing GOALS.ConclusionsGOALS completion was associated with small improvements in child BMI z-score and improved family PA and dietary behaviours. Several intervention modifications were necessary during the implementation period and it is suggested childhood obesity treatment interventions need time to embed before a definitive evaluation is conducted. Researchers are urged to use the TIDieR checklist to ensure transparent reporting of interventions and facilitate the translation of evidence to practice.

Project description:The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children's family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice.Randomized controlled trial (RCT), in which families (n?=?120) are recruited from the children and adolescents (ages 6-18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off???35, or IOTF???30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m2), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires.This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity.ClinicalTrails.gov NCT02687516 . Registered 16th of February, 2016.

Project description:BackgroundChildhood overweight and obesity is a persistent public health issue in the US. Risk for obesity and obesity-related morbidity throughout the life course begins in utero. Native Americans suffer the greatest disparities in the US in childhood overweight and obesity status of any racial or ethnic group. Existing early childhood home-visiting interventions provide an opportunity for addressing obesity during the first 1000 days. However, to date, no evidence-based model has been specifically designed to comprehensively target early childhood obesity prevention.MethodsThis study is a randomized controlled trial to test the efficacy of home-visiting intervention, called Family Spirit Nurture, on reducing early childhood obesity in Native American children. Participants are expectant Native American mothers ages 14-24 and their child, enrolled from pregnancy to 24 months postpartum and randomized 1:1 to receive the Family Spirit Nurture intervention or a control condition. The intervention includes 36 lessons delivered one-on-one by locally-hired Native American Family Health Coaches to participating mothers from pregnancy until 18 months postpartum. A mixed methods assessment includes maternal self-reports, maternal and child observations, and physical and biological data collected at 11 time points from 32 weeks gestation to 2 years postpartum to measure the intervention's primary impact on maternal feeding behaviors; children's healthy diet and physical activity; children's weight status. Secondary measures include maternal psychosocial factors; household food and water security; infant sleep and temperament; and maternal and child metabolic status.DiscussionNone of the 20 current federally-endorsed home-visiting models have demonstrated impacts on preventing early childhood obesity. The original Family Spirit program, upon which Family Spirit Nurture is based, demonstrated effect on maternal and child behavioral health, not including obesity related risk factors. This trial has potential to inform the effectiveness of home-visiting intervention to reduce obesity risk for tribal communities and other vulnerable populations and expand public health solutions for the world's obesity crisis.Trial registrationClinicaltrials.gov (Identifier: NCT03334266 - Preventing Early Childhood Obesity, Part 2: Family Spirit Nurture, Prenatal - 18 Months; Retrospectively registered on 07 November 2017).

Project description:With regard to the global childhood obesity epidemic, it is imperative that effective lifestyle interventions are devised to combat childhood obesity. This paper describes the development and implementation of a comprehensive (a combination of diet and physical activity (PA)), social cognitive behaviour modification intervention using accelerometry and a dietary diary to tackle child overweight and obesity. The comprehensive intervention effect was evaluated in a comparison with diet only, PA only and a no-treatment control group.A pilot study was conducted with a non-randomized cluster design. Four hundred thirty-eight overweight and obese children aged 7-12 years from ten primary schools in Beijing were recruited to receive a one-year intervention. Participants were allocated into one of four groups: the comprehensive intervention group; the PA only group (Happy 10 program); the diet only group (nutrition education program); and a control group. The effects of intervention on adiposity, blood pressure, and biochemical indicators were assessed by examining 2-way interactions (time?×?intervention) in linear mixed models. Means and 95 % confidence intervals (CI) for the adjusted changes between post-intervention and baseline relative to changes in the control group were calculated and reported as effect sizes.The percentage of body fat in the comprehensive intervention group showed a significant relative decrease (adjusted change: -1.01 %, 95 % CI: (-1.81, -0.20) %) compared with the PA only, diet only or control groups (P?<?0.001). Systolic blood pressure significantly decreased in the comprehensive intervention group (adjusted change: -4.37 mmHg, 95 % CI: (-8.42, -0.33) mmHg), as did diastolic blood pressure (adjusted change: -5.50 mmHg, 95 % CI (-8.81, -2.19) mmHg) (P?<?0.05). Compared with the other two intervention groups and the control group, positive adjusted changes in fasting glucose in the comprehensive group were found, although not for the biochemical lipid metabolism indicators. Positive but non-significant adjusted changes in body mass index and waist circumference were observed.Compared with the diet or PA only intervention groups, the current comprehensive program had superior positive effects on body fat percentage and blood pressure but not on the biochemical lipid metabolism indicators in Chinese overweight and obese children. Future randomized controlled trials and long-term follow-up studies are required to elaborate the findings of the current intervention.ClinicalTrials.gov identifier: NCT02228434.

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Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial.

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Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial.

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