Family-based Weight Management Research Articles

After the RCT: who comes to a family-based intervention for childhood overweight or obesity when it is implemented at scale in the community?

BackgroundWhen implemented at scale, the impact on health and health inequalities of public health interventions depends on who receives them in addition to intervention effectiveness.MethodsThe MEND 7–13 (Mind, Exercise, Nutrition…Do...

The CANadian Pediatric Weight management Registry (CANPWR): study protocol.

BackgroundOver recent decades, the prevalence of pediatric obesity has increased markedly in developed and developing countries, and the impact of obesity on health throughout the lifespan has led to urgent calls for action. Family-based weight management interventions that emphasize healthy lifestyle changes can lead to modest improvements in weight status of children with obesity. However, these interventions are generally short in duration, reported in the context of randomized controlled trials and there are few reports of outcomes of these treatment approaches in the clinical setting. Answering these questions is critical for improving the care of children with obesity accessing outpatient health services for weight management. In response, the CANadian Pediatric Weight management Registry (CANPWR) was designed with the following three primary aims:1. Document changes in anthropometric, lifestyle, behavioural, and obesity-related co-morbidities in children enrolled in Canadian pediatric weight management programs over a three-year period;2. Characterize the individual-, family-, and program-level determinants of change in anthropometric and obesity-related co-morbidities;3. Examine the individual-, family-, and program-level determinants of program attrition.Methods/DesignThis prospective cohort, multi-centre study will include children (2–17 years old; body mass index ≥85th percentile) enrolled in one of eight Canadian pediatric weight management centres. We will recruit 1,600 study participants over a three-year period. Data collection will occur at presentation and 6-, 12-, 24-, and 36-months follow-up. The primary study outcomes are BMI z-score and change in BMI z-score over time. Secondary outcomes include anthropometric (e.g., height, waist circumference,), cardiometabolic (e.g., blood pressure, lipid profile, glycemia), lifestyle (e.g., dietary intake, physical activity, sedentary activity), and psychosocial (e.g., health-related quality of life) variables. Potential determinants of change and program attrition will include individual-, family-, and program-level variables.DiscussionThis study will enable our interdisciplinary team of clinicians, researchers, and trainees to address foundational issues regarding the management of pediatric obesity in Canada. It will also serve as a harmonized, evidence-based registry and platform for conducting future intervention research, which will ultimately enhance the weight management care provided to children with obesity and their families.

From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale.

Objectives:To assess how outcomes associated with participation in a family-based weight management intervention (MEND 7–13, Mind, Exercise, Nutrition..Do it!) for childhood overweight or obesity implemented at scale in the community vary by child, family, neighbourhood and MEND programme characteristics.Methods/Subjects:Intervention evaluation using prospective service level data. Families (N=21 132) with overweight children are referred, or self-refer, to MEND. Families (participating child and one parent/carer) attend two sessions/week for 10 weeks (N=13 998; N=9563 with complete data from 1788 programmes across England). Sessions address diet and physical activity through education, skills training and motivational enhancement. MEND was shown to be effective in obese children in a randomised controlled trial (RCT). Outcomes were mean change in body mass index (BMI), age- and sex-standardised BMI (zBMI), self-esteem (Rosenberg scale) and psychological distress (Strengths and Difficulties Questionnaire) after the 10-week programme. Relationships between the outcome and covariates were tested in multilevel models adjusted for the outcome at baseline.Results:After adjustment for covariates, BMI reduced by mean 0.76 kg m−2 (s.e.=0.021, P<0.0001), zBMI reduced by mean 0.18 (s.e.=0.0038, P<0.0001), self-esteem score increased by 3.53 U (s.e.=0.13, P<0.0001) and psychological distress score decreased by 2.65 U (s.e.=0.31, P<0.0001). Change in outcomes varied by participant, family, neighbourhood and programme factors. Generally, outcomes improved less among children from less advantaged backgrounds and in Asian compared with white children. BMI reduction under service conditions was slightly but not statistically significantly less than in the earlier RCT.Conclusions:The MEND intervention, when delivered at scale, is associated with improved BMI and psychosocial outcomes on average, but may work less well for some groups of children, and so has the potential to widen inequalities in these outcomes. Such public health interventions should be implemented to achieve sustained impact for all groups.

G137(P) NHS Family-Based Paediatric Weight Management Programme: How to improve retention?

The effectiveness of the NHS’s family-based weight management programmes, which targets lifestyle behavioural change to treat childhood obesity, remains questionable due to estimated attrition rates of 27%–90%. Previous studies have...

Family-based childhood weight management programme. Service evaluation of BeeZee Bodies run in deprived community settings.

BeeZee Bodies is 17-week family-based intervention programme in deprived community settings for 7–15 yr olds referred by a health professional. We evaluated the reach and completion of the programmes 2010–2012. Socio-demographic data were collected from the parent/guardian and IMD score calculated from the home postcode. BMI was expressed as the sex- and age-specific standard deviation from expected BMI (Z-score) using the British 1990 growth reference data, and categorised as overweight or obese using British reference cut-offs (1990 category) and IOTF cut-offs (IOTF). 195 Young people (86 boys and 109 girls) participated in the programmes in 3 deprived community settings. The mean IMD score was not significantly different from the community average, but the proportion of participants from Black and Minority Ethnicities was substantially higher. Mean baseline BMI Z-score was 2.77 (SD 0.57) in boys and 2.61 (SD 0.59) in girls with 65% classified as obese by IOTF and 84% by the 1990 category. 84% participants completed the programme with no differences in completion by gender, ethnicity, IMD score, baseline BMI or age. Mean BMI and BMI Z-score significantly decreased in completers of the programme (BMI = −0.59 (SE 0.09), BMI Z-score = −0.16 (SE 0.02), p

What Factors Influence Uptake into Family-Based Obesity Treatment after Weight Screening?

To determine what factors drive participation in a family-based weight management program for 4- to 8-year-old children following screening for overweight or obesity. Children (n = 1093) attended a comprehensive screening appointment where parents completed questionnaires on demographics, motivation for healthy lifestyles, feeding practices, and beliefs about child size, prior to feedback about the child's weight. Parents of overweight or obese children (body mass index ≥85th percentile) attended a follow-up interview to assess reactions to feedback and willingness to participate in a 2-year intervention. A total of 271 (24.8%) children were overweight or obese with 197 (72.7%) agreeing to the intervention. Socioeconomic status differed in intervention participants (n = 197) compared with non-participants (n = 74), whereas no differences were observed in parental feeding practices, ineffective parenting practices, or self-determined forms of motivation. However, fewer non-participating parents believed their child to be overweight (23% vs 49%, P < .001) or were concerned about it (16% vs 43%, P < .001), despite children having an average body mass index approximating the 95th percentile. Non-participating parents did not expect their child to be overweight (P = .002) and rated receiving this information as less useful (P = .008) than participating parents. Preconceptions about child weight and reactions to feedback determined intervention uptake more than parenting or motivation for health. Many parents agreed to participate in the intervention despite not viewing their child as overweight.

Barriers Related to Delivering Pediatric Weight Management Interventions to Children and Families From Rural Communities

Rates of obesity are higher for children and adults living in rural areas relative to non-rural settings. As a result, there is an immense need for pediatric weight management programs focused on children and families living in rural areas. However, clinicians and families in rural communities experience numerous barriers when participating in these programs. This article reviews challenges faced during the course of providing family-based weight management interventions as part of the Extension Family Lifestyle Intervention Project (E-FLIP) for kids. Effective and innovative suggestions for future programs are provided for consideration when designing weight management programs for rural pediatric populations. A selected review of the pediatric and adult rural service delivery literature and clinicians' experiences are discussed. Challenges to providing pediatric weight management interventions in rural communities include the lower socioeconomic status of many rural families, unique aspects of rural culture, transportation difficulties, limited access and availability of healthy foods, lack of safe places devoted to physical activity, and time constraints. Strategies to overcome barriers related to providing pediatric weight management services and recommendations for future programs targeting children and families from rural areas are provided.

Fifteen years of the Family Eating and Activity Habits Questionnaire (FEAHQ): an update and review

The Family Eating and Activity Habits Questionnaire (FEAHQ) is a 32-item self-report instrument designed to assess the eating and activity habits of family members as well as obesogenic factors in the overall home environment (stimulus and behaviour patterns) related to weight. Originally, this questionnaire, which was developed in Israel, was designed for use in family-based weight-management interventions that emphasized changes in the environment, and in parents' knowledge, behaviours and modelling. It was developed for use with children aged 6-11 years and designed for co-completion by parents or caretakers and their children. Over the years, it has been administered in research and clinical settings in Israel, England, Australia and other countries. Its 15-year anniversary calls for an update in the literature regarding adjustments made to improve its use in different settings and with different ethnic populations and the psychometric properties of the revised version. The goal of this paper is threefold: (i) to describe the history and development of the FEAHQ; (ii) to present new data supporting the psychometric properties of the subscales of the Revised FEAHQ (FEAHQ-R) for ages 6-12 years and (iii) to review the clinical and research literature reporting on FEAHQ subscales. The psychometric properties of the revised questionnaire were evaluated in a randomized control trial and in a naturalistic, community-based study to promote healthy lifestyle among families with children 6-12 years of age from different ethnic populations. The tool demonstrated good test-retest reliability when completed by caretakers and very good internal consistency. The questionnaire scores discriminated between obese and normal-weight children and predicted the weight classification of 66% of the participants. The FEAHQ-R is a useful clinical tool for identifying target behaviors for treatment and monitoring treatment progress that centers on overweight prevention and weight management.

The association between sleep duration and weight in treatment-seeking preschoolers with obesity

To examine the association between nocturnal sleep duration and weight and caloric intake outcomes among preschool-aged children who are obese and enrolled in a family-based weight management program. Forty-one preschool-aged children who were obese (BMI ≥ 95th percentile) and enrolled in a weight management program completed pre- and posttreatment assessments of body mass, caloric intake, and sleep. Separate linear regression analyses examined the relationship between nocturnal sleep duration and posttreatment body mass index relative to age- and sex-linked norms (BMIz) and caloric intake. After controlling for pretreatment BMIz, longer posttreatment nocturnal sleep was significantly associated with lower posttreatment BMIz (β=-0.21, p=0.02) and explained a significant proportion of unique variance in posttreatment BMIz (ΔR(2)=0.04). Similarly, after controlling for pretreatment caloric intake, longer nocturnal sleep duration at posttreatment was significantly associated with lower caloric intake at posttreatment (β=-0.45, p=0.003) and explained a significant proportion of unique variance in posttreatment caloric intake (ΔR(2)=0.19). These findings extend the literature on the sleep and weight relationship and suggest that adequate sleep may be an important element in interventions for preschoolers with obesity.

Weighing the Pros and Cons in Family-Based Pediatric Obesity Intervention: Parent and Child Decisional Balance as a Predictor of Child Outcomes

This investigation examined the relations among parent/child decisional balance (perception of advantages/disadvantages), child weight status, and child outcomes. Thirty-seven parent–child dyads in a family-based weight management program participated in the study. Analyses indicated that children evidenced a more positive decisional balance profile than their parents at pre-intervention. Child pre-intervention weight status was associated with child decisional balance, but not parent decisional balance. Finally, child total decisional balance was the single best predictor of child outcomes. The results of this study emphasize the important role a child's readiness to change can play in the treatment of pediatric obesity.

Smart Choices for Healthy Families

This pre-post study used a mixed-methods approach to examine the impact of a family-based weight management program among a low-income population. Smart Choices for Healthy Families was developed through an integrated research-practice partnership and piloted with 26 children and parents (50% boys; mean age = 10.5 years; 54% Black) who were referred by their pediatrician. Smart Choices included six biweekly group sessions and six automated telephone-counseling calls over 3 months. Children displayed reduced body mass index z-scores (p < .05), increased lean muscle mass (p < .001), and increased quality of life (p < .0001). Follow-up interviews indicated that physicians valued the lay leaders' ability to provide lifestyle education, whereas lay leaders extended their reach to more community members. Parents wanted to become positive role models and found that the calls maintained focus on goals. Smart Choices shows promise to initiate weight management for children in low-income families.

Bridging the Gap between Family-Based Treatment and Family-Based Research in Childhood Obesity.

The treatment of pediatric obesity has been greatly informed by research as well as by expert opinion.1 The challenge remains to discover novel treatment approaches and translate these findings into clinical care. As with compassionate use of therapeutics in oncology, there is an urgent need to provide best-practice treatment to the millions of children presently struggling with obesity, particularly at the most advanced stages.2 In 2007, Wake Forest University School of Medicine and Brenner Children's Hospital founded Brenner FIT (Families In Training), a multidisciplinary, family-based pediatric weight management program. From the outset, Brenner FIT integrated quality healthcare principles into program development activities. From this, three innovative programs have been developed. In a somewhat reverse direction of traditional translational research, these three successful clinical programs have informed a larger research initiative and have led to the establishment of a unique and promising research center.

Food Journal Writing in a Family-Based Youth Weight Management Program

Food Journal Writing in a Family-Based Youth Weight Management Program

The MEND program: A community based initiative addressing child overweight and obesity in Maribyrnong

Introduction: Mind, Exercise, Nutrition… Do It! (MEND) is a program developed by the Institute of Child Health, University College London, and the Great Ormond Street Hospital for Children in the UK. The MEND Program is a family-based weight management intervention for overweight and obese children aged 7–13, suitable for delivery in community settings. The MEND Program equips families and communities with nutrition, exercise, and behaviour change knowledge and skills, to establish and maintain healthy lifestyles.

A Long-Term Comprehensive Evaluation of a Family-Based Pediatric Weight Management Program Implemented in Multiple Community-Based and Hospital-Based Sites

A Long-Term Comprehensive Evaluation of a Family-Based Pediatric Weight Management Program Implemented in Multiple Community-Based and Hospital-Based Sites

Family-Based Weight Management in the Pediatric Healthcare Setting

Family-Based Weight Management in the Pediatric Healthcare Setting

Selections from current literature. Treatment issues in childhood obesity.

Obesity is reaching epidemic proportions in the USA and is a growing problem in developed countries. It is associated with a number of co-morbidities, such as coronary artery disease, type 2 diabetes, gall bladder disease and sleep apnoea. The health care cost associated with obesity in US adults is estimated to be 100 billion dollars annually.1 Trends in childhood obesity are paralleling those of adult obesity, with ~25% of American children either overweight or obese.2 Childhood obesity is associated with increased risk factors, such as high cholesterol and hypertension, for chronic illness in adulthood, and with increased presentation of co-morbidities, such as type 2 diabetes, in early adolescence.3,4 These trends in childhood obesity are global, with increasing prevalence in Russia, China and Brazil, as well as the USA. Wang suggests that this trend will lead to a rise in global rates of obesity-related diseases.1 Data from the US National Health and Nutrition Examination Surveys reveal that the prevalence of adult and childhood obesity increased substantially over a single decade. This increase cannot, therefore, be attributed to changes in the genetic makeup of the population. The rapid rate of increase in the prevalence of obesity must be due to the interaction between genetic predispositions and changes in the environment, such as decreased opportunities for physical activity and increased availability of calorically dense foods.5 Such trends speak to the need for family-based behavioural weight management programmes, since families share genetic predispositions, as well as environments. This article reviews the current literature, specifically examining family-based treatment programmes, types of dietary interventions and macronutrient issues. Epstein laid the groundwork for family-based behavioural treatments with his landmark 1990 publication in which he compares 10-year follow-up data on three family treatment programmes. Golan and colleagues continue work in this area. They examine not only changes in children’s weight resulting from family-based behavioural programmes focused on children’s weight loss, but also changes in parents’ weight and cardiovascular risk factors. Lastly, Spieth and colleagues explore the hotly debated topic of dietary macronutrient content and glycaemic index in the context of behavioural change programmes. This article concludes with recommendations for family physicians in their work with obese children and their families.