Bethany J. Sallinen

Comparison of Parent-Only vs Family-Based Interventions for Overweight Children in Underserved Rural Settings: Outcomes From Project STORY

OBJECTIVE To assess the effectiveness of parent-only vs family-based interventions for pediatric weight management in underserved rural settings. DESIGN A 3-arm randomized controlled clinical trial. SETTING All sessions were conducted at Cooperative Extension Service offices in underserved rural counties. PARTICIPANTS Ninety-three overweight or obese children (8-14 years old) and their parent(s). INTERVENTION Families were randomized to (1) a behavioral family-based intervention, (2) a behavioral parent-only intervention, or (3) a wait-list control group. OUTCOME MEASURE The primary outcome measure was change in childrens standardized body mass index (BMI). RESULTS Seventy-one children completed posttreatment (month 4) and follow-up (month 10) assessments. At the month 4 assessment, children in the parent-only intervention demonstrated a greater decrease in BMI z score (mean difference [MD], 0.127; 95% confidence interval [CI], 0.027 to 0.226) than children in the control condition. No significant difference was found between the family-based intervention and the control condition (MD, 0.065; 95% CI, -0.027 to 0.158). At month 10 follow-up, children in the parent-only and family-based intervention groups demonstrated greater decreases in BMI z score from before treatment compared with those in the control group (MD, 0.115; 95% CI, 0.003 to 0.220; and MD, 0.136; 95% CI, 0.018 to 0.254, respectively). No difference was found in weight status change between the parent-only and family-based interventions at either assessment. CONCLUSIONS A parent-only intervention may be a viable and effective alternative to family-based treatment of childhood overweight. Cooperative Extension Service offices have the potential to serve as effective venues for the dissemination of obesity-related health promotion programs.

Impact of Psychosocial Factors on Quality of Life in Overweight Youth

Objective: The psychosocial functioning of overweight youth is a growing concern. Research has shown that overweight children report lower quality of life (QOL) than their non‐overweight peers. This study sought to extend the literature by examining the association between peer victimization, child depressive symptoms, parent distress, and health‐related QOL in overweight youth. Mediator models are used to assess the effect of child depressive symptoms on the relationship between psychosocial variables and QOL.

Comparison of program costs for parent-only and family-based interventions for pediatric obesity in medically underserved rural settings.

PURPOSE To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities. METHODS Ninety-three overweight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month intervention and 6-month follow-up. Families were randomized to either a behavioral family-based intervention (n = 33), a behavioral parent-only intervention (n = 34), or a waitlist control condition (n = 26). Only program costs data for the parent-only and family-based programs are reported here (n = 67). Assessments were completed at baseline, post-treatment (month 4) and follow-up (month 10). The primary outcome measures were total program costs and cost per child for the parent-only and family interventions. FINDINGS Twenty-six families in the parent-only intervention and 24 families in the family intervention completed all 3 assessments. As reported previously, both intervention programs led to significantly greater decreases in weight status relative to the control condition at month 10 follow-up. There was no significant difference in weight status change between the parent-only and family interventions. Total program costs for the parent-only and family interventions were 13,546 US dollars and 20,928, US dollars respectively. Total cost per child for the parent-only and family interventions were 521 US dollars and 872 US dollars, respectively. CONCLUSIONS Parent-only interventions may be a cost-effective alternative treatment for pediatric obesity, especially for families in medically underserved settings.

Parent Perspectives on Attrition From Tertiary Care Pediatric Weight Management Programs

Objective. To describe parent/caregiver reasons for attrition from tertiary care weight management clinics/programs. Study design. A telephone survey was administered to 147 parents from weight management clinics/programs in the National Association of Children’s Hospitals and Related Institutions’ (now Children’s Hospital Association’s) FOCUS on a Fitter Future II collaborative. Results. Scheduling, barriers to recommendation implementation, and transportation issues were endorsed by more than half of parents as having a moderate to high influence on their decision not to return. Family motivation and mismatched expectations between families and clinic/program staff were mentioned as influential by more than one-third. Only mismatched expectations correlated with patient demographics and referral patterns. Conclusions. Although limited by small sample size, the study found that parents who left geographically diverse weight management clinics/programs reported similar reasons for attrition. Future efforts should include offering alternative visit times, more treatment options, and financial and transportation assistance and exploring family expectations.

Results From a Clinical Multidisciplinary Weight Management Program

Background/Objective: Published data regarding outcomes of pediatric behavioral weight management are mainly from research interventions. The authors wished to explore outcomes from a clinical program. Methods: A retrospective analysis of data from obese adolescents enrolled in the Michigan Pediatric Outpatient Weight Evaluation and Reduction program (April 2007 to June 2008). The multidisciplinary program included group sessions, individual visits, and exercise classes. Linear regression was used to explore associations between change in body mass index (BMI) and age, sex, race, and insurance. Results: N = 67. Mean age was 14.5 years; 71% female, 50% Medicaid enrollees, and 30% African American. Mean initial BMI was 40. Mean change in BMI was -2.3 for those completing the 24-week program (n = 48; P < .01). Reduction in BMI was not associated with participants’ demographic characteristics. Conclusions: A clinical multidisciplinary weight loss program for adolescents can lead to decreases in BMI after 24 weeks. Further work is needed to assess long-term outcomes.

The Influence of a Behavioral Weight Management Program on Disordered Eating Attitudes and Behaviors in Children with Overweight

BACKGROUND Behavioral interventions targeting children with overweight have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth. OBJECTIVE The purpose of this research was to determine whether youth with overweight receiving one of two behavioral interventions were more likely to report an increase in disordered eating attitudes over time compared to a waitlist control and to determine psychosocial predictors of eating-disordered attitudes at 6-month follow-up. DESIGN Participants were randomized to one of two behavioral lifestyle interventions or a waitlist control. Data were collected at baseline, post-treatment, and 6-month follow-up. PARTICIPANTS/SETTING Participants were 68 youths with overweight, aged 8 to 13 years, and their parent(s) who lived in rural north central Florida. The project ran from January 2006 to January 2008. INTERVENTION Each treatment condition consisted of 12 group sessions over 16 weeks. MAIN OUTCOME MEASURES Parents completed a demographic form and the Child Feeding Questionnaire. Children completed the Childrens Eating Attitudes Test, Schwartz Peer Victimization Scale, and Childrens Body Image Scale. STATISTICAL ANALYSES PERFORMED Mixed 2×2 analyses of variance were used to examine the effect of treatment on eating attitudes. Hierarchical linear regression was used to assess whether baseline levels of psychosocial variables predicted disordered eating attitudes at follow-up, controlling for baseline eating attitudes and treatment condition. RESULTS Youth who participated in the behavioral interventions did not report significant increases in disordered eating attitudes over time compared to the waitlist control. Across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices, and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up. CONCLUSIONS These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors. Future research should examine the effects of incorporating eating disorder prevention in pediatric weight management programs.

Longer Weekly Sleep Duration Predicts Greater 3-Month BMI Reduction among Obese Adolescents Attending a Clinical Multidisciplinary Weight Management Program

Aims: To determine whether baseline levels of self-reported sleep and sleep problems among obese adolescents referred to an outpatient multidisciplinary family-based weight management program predict reduction in BMI 3 months later. Methods: A retrospective medical chart review was conducted for 83 obese adolescents. The following baseline variables were extracted: self-reported sleep duration (weekdays and weekends), and presence of snoring, daytime fatigue, suspected sleep apnea, and physician-diagnosed sleep apnea. Anthropometric data at baseline and 3 months were also collected. Results: On average, adolescents reported significantly less sleeping on weeknights (7.7 ± 1.3 h) compared to weekend nights (10.0 ± 1.8 h), t(82) = 10.5, p = 0.0001. Reduction in BMI after 3 months of treatment was predicted by more weekly sleep at baseline (R2 = 0.113, F(1, 80) = 10.2, p = 0.002). Adolescents who reduced their BMI by ≥1 kg/m2 reported greater weekly sleep at baseline compared to adolescents who experienced <1 kg/m2 reduction (60.7 ± 7.5 h vs. 56.4 ± 8.6 h; F(1, 80) = 5.7, p = 0.02). Conclusion: Findings from this study, though correlational, raise the possibility that increased duration of sleep may be associated with weight loss among obese adolescents enrolled in a weight management program. Evidence-based behavioral techniques to improve sleep hygiene and increase sleep duration should be explored in pediatric weight management settings.

Slow and Steady: Readiness, Pretreatment Weekly Strengthening Activity, and Pediatric Weight Management Program Completion

BACKGROUND Pediatric weight management programs have substantial attrition rates, which have led to recommendations to assess readiness prior to enrollment. Both pretreatment readiness scales and behaviors, such as exercise, have been theorized to predict subsequent program completion. The purpose of this study was to explore the role of self-reported pretreatment exercise in adolescents on completion of a pediatric weight management program and to explore the predictive ability of standard readiness scales. METHODS A total of 146 obese (BMI≥95(th) percentile) pediatric (ages 11-18) participants joined a 6-month multidisciplinary weight management program between March, 2007, and July, 2010. Completers were compared retrospectively to noncompleters on demographic, readiness, and pretreatment exercise practices from clinic-developed intake questionnaires using univariate analyses. Regression analyses specified the degree to which these variables predicted program completion. RESULTS The 6-month completion rate was 53%. There was no relationship between self-reported readiness and program completion. Self-reported pretreatment weekly strengthening activity (SA) was significantly associated with program completion, compared to those who performed SA either never [univariate odds ratio (OR) 3.18, 95% confidence interval (CI) 1.51-6.68, p=0.002; multivariate OR 2.43, 95% CI 1.06-5.58, p=0.036] or daily (univariate OR 4.90, 95% CI 1.74-13.77, p=0.002; multivariate OR 4.69, 95% CI 1.45-15.14, p=0.010). No relationship was found between other forms of exercise and program completion. CONCLUSIONS Self-reported pretreatment weekly SA, but not standard readiness scales, predicted pediatric weight management program completion.