Kathleen Mitchell

Randomized controlled trial to improve primary care to prevent and manage childhood obesity the high five for kids study

OBJECTIVE To examine the effectiveness of a primary care-based obesity intervention over the first year (6 intervention contacts) of a planned 2-year study. DESIGN Cluster randomized controlled trial. SETTING Ten pediatric practices, 5 intervention and 5 usual care. PARTICIPANTS Four hundred seventy-five children aged 2 to 6 years with body mass index (BMI) in the 95th percentile or higher or 85th to less than 95th percentile if at least 1 parent was overweight; 445 (93%) had 1-year outcomes. INTERVENTION Intervention practices received primary care restructuring, and families received motivational interviewing by clinicians and educational modules targeting television viewing and fast food and sugar-sweetened beverage intake. OUTCOME MEASURES Change in BMI and obesity-related behaviors from baseline to 1 year. RESULTS Compared with usual care, intervention participants had a smaller, nonsignificant change in BMI (-0.21; 95% confidence interval [CI], -0.50 to 0.07; P = .15), greater decreases in television viewing (-0.36 h/d; 95% CI, -0.64 to -0.09; P = .01), and slightly greater decreases in fast food (-0.16 serving/wk; 95% CI, -0.33 to 0.01; P = .07) and sugar-sweetened beverage (-0.22 serving/d; 95% CI, -0.52 to 0.08; P = .15) intake. In post hoc analyses, we observed significant effects on BMI among girls (-0.38; 95% CI, -0.73 to -0.03; P = .03) but not boys (0.04; 95% CI, -0.55 to 0.63; P = .89) and among participants in households with annual incomes of

Correlates of participation in a pediatric primary care-based obesity prevention intervention.

50 000 or less (-0.93; 95% CI, -1.60 to -0.25; P = .01) but not in higher-income households (0.02; 95% CI, -0.30 to 0.33; P = .92). CONCLUSION After 1 year, the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI.

Oral Rehydration Solution for Acute Diarrhea Prevents Subsequent Unscheduled Follow-up Visits

The purpose of this study was to examine the correlates of participation in a childhood obesity prevention trial. We sampled parents of children recruited to participate in a randomized controlled trial. Eligible children were 2.0–6.9 years with BMI ≥95th percentile or 85th to <95th percentile if at least one parent was overweight. We attempted contact with parents of children who were potentially eligible. We recruited 475 parents via telephone following an introductory letter. We also interviewed 329 parents who refused participation. Parents who refused participation (n = 329) did not differ from those who participated (n = 475) by number of children at home (OR 0.94 per child; 95% CI: 0.77–1.15) or by child age (OR 1.07 per year; 95% CI: 0.95–1.20) or sex (OR 1.06 for females vs. males; 95% CI: 0.80–1.41). After multivariate adjustment, parents who were college graduates vs. 95th%ile. One reason appears to be that they less frequently consider their children to have a weight problem.

Parental Perceptions of Overweight Counseling in Primary Care: The Roles of Race/ethnicity and Parent Overweight

Background. Oral rehydration solutions (ORS) for the treatment of acute diarrhea remain an underutilized therapy in the United States, despite multiple clinical trials confirming their efficacy and safety. Economic barriers to their use have been identified. Objective. To determine whether providing ORS to patients at the time of their office visit for acute diarrhea can increase ORS utilization and reduce unscheduled follow-up visits. Design. Randomized, controlled clinical trial. Setting. Seven health centers of a large health maintenance organization. Participants. Children (N = 479) 0 to 60 months of age with acute diarrhea (at least three watery or loose stools in the previous 24 hours for ≤7 days). Intervention. Prescription for 2 quarts of ORS filled for free at on-site pharmacy plus written instructions versus written instructions alone. Primary Outcome Measures. Self-reported use of ORS; unscheduled follow-up visits in office, urgent care, and/or emergency department setting. Results. Subjects in the intervention group were significantly more likely to use ORS after the initial office visit (85% vs 71%; RR: 1.19; 95% CI: 1.08–1.32). Of the standard treatment group subjects, 40 (17.3%) sought unscheduled follow-up care for diarrhea versus 27 (10.9%) of the intervention group subjects (RR: 0.63; 95% CI: 0.40–0.99). Subjects seeking unscheduled follow-up care tended to younger (15.7 vs 19.4 months old), have more stools (7.1 vs 6.2 stools), and more vomiting episodes (4.1 vs 3.0) in the 24 hours before initial evaluation than those not seeking unscheduled follow-up care. Multivariate analysis showed that randomization to the intervention group was associated with a 25% reduction in unscheduled follow-up visits for acute diarrhea. Conclusions. Providing ORS to families at the time of their office visit for acute diarrhea is associated with a significant increase in ORS use and substantially reduces the need for unscheduled follow-up visits. Health maintenance organizations should consider routine provision of ORS to children presenting with acute diarrhea.

Parental Perceptions of a Motivational Interviewing–Based Pediatric Obesity Prevention Intervention

Objective: To examine parental perceptions of primary care efforts aimed at childhood obesity prevention

Associations of Parental Control of Feeding with Eating in the Absence of Hunger and Food Sneaking, Hiding, and Hoarding

Motivational interviewing (MI) shows promise for pediatric obesity prevention, but few studies address parental perceptions of MI. The aim of this study was to identify correlates of parental perceptions of helpfulness of and satisfaction with a MI-based pediatric obesity prevention intervention. We studied 253 children 2 to 6 years of age in the intervention arm of High Five for Kids, a primary care–based randomized controlled trial. In multivariable models, parents born outside the United States (odds ratio [OR] = 8.81; 95% confidence interval [CI] = 2.44, 31.8), with lower household income (OR = 3.60; 95% CI = 1.03, 12.55), and with higher BMI (OR = 2.86; 95% CI = 1.07, 7.65) were more likely to perceive MI-based visits as helpful in improving children’s obesity-related behaviors after the first year of the intervention. Parents of female (vs male), black (vs white), and Latino (vs white) children had lower intervention satisfaction. Our findings underscore the importance of tailoring pediatric obesity prevention efforts to target populations.

Two‐year follow‐up of a primary care‐based intervention to prevent and manage childhood obesity: the High Five for Kids study

BACKGROUND Overweight children as young as 5 years old exhibit disturbances in eating behaviors. METHODS Using follow-up data from 419 participants in High Five for Kids, a randomized controlled trial of overweight children, the prevalence of (1) eating in the absence of hunger and (2) food sneaking, hiding, and hoarding was estimated and cross-sectional associations of parental control of feeding and these behaviors were examined using covariate-adjusted logistic regression models. RESULTS At follow-up, mean [standard deviation (SD)] age of the children was 7.1 (1.2) years; 49% were female; 16% were healthy weight, 35% were overweight, and 49% were obese. On the basis of parental report, 16.5% of children were eating in the absence of hunger and 27.2% were sneaking, hiding, or hoarding food; 57.5% of parents endorsed parental control of feeding. In adjusted models, children exposed to parental control of feeding were more likely to eat in the absence of hunger [odds ratio (OR) 3.37, 95% confidence interval (CI) 1.66, 6.86], but not to sneak, hide, or hoard food (OR 1.43, 95% CI 0.87, 2.36). CONCLUSIONS Disturbances in eating behaviors are common among overweight children. Future research should be dedicated to identifying strategies that normalize eating behaviors and prevent excess weight gain among overweight children.

Participant characteristics and intervention processes associated with reductions in television viewing in the High Five for Kids study.

The obesity epidemic has spared no age group, even young infants. Most childhood obesity is incident by the age of 5 years, making prevention in preschool years a priority.

Parent preferences for telephone coaching to prevent and manage childhood obesity

OBJECTIVE To evaluate the High Five for Kids intervention effect on television within subgroups, examine participant characteristics associated with process measures and assess perceived helpfulness of television intervention components. METHOD High Five (randomized controlled trial of 445 overweight/obese 2-7 year-olds in Massachusetts [2006-2008]) reduced television by 0.36 h/day. 1-year effects on television viewing, stratified by subgroup, were assessed using linear regression. Among intervention participants (n=253), associations of intervention component helpfulness with television reduction were examined using linear regression and associations of participant characteristics with processes linked to television reduction (choosing television and completing intervention visits) were examined using logistic regression. RESULTS High Five reduced television across subgroups. Parents of Latino (versus white) children had lower odds of completing ≥2 study visits (Odds Ratio: 0.39 [95% Confidence Interval: 0.18, 0.84]). Parents of black (versus white) children had higher odds of choosing television (Odds Ratio: 2.23 [95% Confidence Interval: 1.08, 4.59]), as did parents of obese (versus overweight) children and children watching ≥2 h/day (versus <2) at baseline. Greater perceived helpfulness was associated with greater television reduction. CONCLUSION Clinic-based motivational interviewing reduces television viewing in children. Low cost education approaches (e.g., printed materials) may be well-received. Parents of children at higher obesity risk could be more motivated to reduce television.

Parental Confidence in Making Overweight-Related Behavior Changes

Objective To assess parent preferences for utilisation of a parent-focused, telephone-based coaching service, or ‘FITLINE,’ to prevent or manage childhood obesity. Methods A cross-sectional survey of parents of children aged 2–12 years was conducted at a paediatric practice in Greater Boston, Massachusetts, USA, between July 2012 and May 2013. Parents received questionnaires with clinic visit paperwork and opted-in to the study by returning them to clinic staff or by mail. The anonymous pen-to-paper questionnaire assessed parents’ potential FITLINE utilisation, preferences regarding educational content and logistics, and parent/child demographics. Simple logistical regression was used to assess associations between parent and child factors and FITLINE interest. Results Among n=114 participants, most parents reported being very likely (n=53, 48%) or somewhat likely (n=44, 40%) to use a FITLINE-promoting healthy habits for children if it was made available. Interest in a FITLINE was greatest among overweight or obese parents (OR 3.12, CI 1.17 to 8.30) and those with children aged <5 years (OR 2.42, CI 1.02 to 5.73). Parents desired to discuss their own health and fitness goals (84%) along with educational topics such as healthy food shopping on a budget (91%) and how to meet childrens physical activity needs (81%). Most parents preferred to obtain a FITLINE referral from a paediatrician or nurse (73%), instead of a school nurse (42%) or child-care provider (26%). Conclusions Given strong interest among parents in a FITLINE and the urgency of the youth obesity epidemic, implementation of a pilot phone-based service should be strongly considered.