Family Obesity Intervention: Motivational Interviewing and Community Support

Low-income children and children of obese parents are at high risk of obesity. Effective interventions are needed to target these families to improve the health of the parents and prevent obesity in the children. The hypothesis is that an intervention that combines engagement of community organizations, motivational interviewing (MI, a technique proven to help people set goals that are personally meaningful), and resource mobilization will change diet and physical activity habits among disadvantaged families. This proposal grew from an established community-based participatory research (CBPR) partnership between the research team and community organizations that serve high minority (45-55%), low-income populations. Partners include a community health center, a food pantry network, a work-force training program, and other agencies. These partners designed and implemented a successful pilot project on which this proposal is based. The specific aims of this proposal are 1) To evaluate the efficacy of a family-targeted obesity intervention based on MI and resource-mobilization. Hypotheses: In comparison to control families, families participating in the intervention will demonstrate a) a reduction in BMI for adults, b) an increase in minutes of moderate physical activity and decreased sedentary time for both adults and children accelerometer), and c) a reduction in the number of obesity risk behaviors and an increase in obesity prevention behaviors among children. 2) To examine the mediators of intervention effects. 3) Identify the types of resources needed most often by intervention families to support lifestyle change. This randomized controlled trial includes 260 low-income families that contain at least one obese adult and one normal or overweight child between 6 and 12. The 12-month intervention has two elements. 1) A health coach will use MI to help families explore ambivalence toward and motivations for change and set goals for improving diet and physical activity. 2) To support goals, families will be connected with community agencies that can assist with general (e.g., financial) and goal specific resources (e.g., food, physical activity opportunities). Collaboration between organizations will streamline referrals, maximize resources, and facilitate access. Control families will get a basic screen for needs and information about available community resources. Outcomes are measured at baseline, 6, 12, and 18 months. This intervention is innovative in that it 1) focuses on lifestyle changes for the entire family and measures outcomes in adults and children, 2) combines MI focused on the entire family and community resource referrals specific to family needs and goals for change, 3) partners community organizations to coordinate resources for families, and 4) involves partners in all research phases via a CBPR approach. This contribution will be significant because the proposed intervention, if successful, can be replicated elsewhere and adapted to the local resource environment to address adult obesity and prevent childhood obesity in a high-risk population. The study will also identify the types of resources low-income families need to change diet and physical activity.

Study Overview

• Status: Completed
• Conditions: Obesity
• Intervention / Treatment: Behavioral: health coaching; Behavioral: community screening

• Study Type: Interventional
• Enrollment (Actual): 472
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Iowa
    • Des Moines, Iowa, United States, 50314
      • Primary Health Care, Inc
    • Des Moines, Iowa, United States, 50316
      • DMARC food pantries
    • Iowa City, Iowa, United States, 52242
      • University of Iowa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• one parent must have a BMI of 30 or above, and be parent or guardian of at least one child
• between the ages of 6 and 12. Children this age are targeted because they benefit most from parental involvement
• are old enough to participate in family goal setting and activities, but young enough to be heavily influenced by family environment.
• a child must live with the obese parent at least 80% of the time.

Exclusion Criteria:

• adults with obesity or target children with a medical condition or medication that significantly alters their

  1. ability to follow the dietary recommendations (e.g., renal diet, severe food allergy, celiac disease)
  2. mobility (e.g. bed bound or unable to participate in any sort of physical activity even with assistive devices), or
  3. weight
• additionally we will exclude those who have a significant psychiatric disease, substance abuse disorder or cognitive impairment that would interfere with their ability to participate
• those with controlled or mild depression would not be excluded
• adults with hypertension, type II diabetes, or glucose intolerance will not be excluded, as advocated changes are consistent with their needs
• no data will be collected from non-target children who meet the exclusion criteria.
• adults with obesity who are currently pregnant at baseline will be excluded because of their altered weight and dietary patterns. If the adult with obesity becomes pregnant during the intervention their family will be allowed to continue in the intervention but the pregnant adults' anthropometric data will not be collected.
• the intervention will intentionally target low-income families through recruitment site choices but will not exclude or include families based on income requirements.
• pregnant women will not be targeted but may be included if not the adult with obesity (see above).
• weight, height, waist circumference will not be collected on pregnant women.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: health coaching and community screening; Family Health Coaching and community benefits screening	Behavioral: health coaching; Health coaching using motivational interviewing focus on family diet and exercise change and connection with community resources specific to goals set.; Behavioral: community screening; Screening for community resources that families may be eligible for to receive help with basic needs including shelter, food, health insurance etc.
Other: community screening; community benefits screening only	Behavioral: community screening; Screening for community resources that families may be eligible for to receive help with basic needs including shelter, food, health insurance etc.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Adult Body Mass Index	Change in Adult BMI from baseline to 12 months	Outcome was assessed at baseline and 12 months and then calculated by subtracting the baseline value from the value at 12 months
Change From Baseline in Duration of Daily Moderate to Vigorous Physical Activity	Moderate to vigorous physical activity of the target adult measure by an accelerometer at baseline and 12 months. Calculated by subtracting the baseline amount from the 12 month value. The accelerometer is a wrist worn device - worn for 7 days - which measures motion in three directions - the amount of motion is then used assess what level of physical activity the participant is doing at each time interval. Vigorous - such as running, moderate such as fast walking, light such as walking slowly.	measured at baseline and 12 months - outcome is the change from baseline to 12 months.
Change in Score for Target Child Over 12months on the Family Nutrition and Physical Activity Scale	Change in the Family Nutrition and Physical Activity Scale from baseline to 12 months - measure of behaviors relate to childhood obesity - parent reports for the target child. Scale scores possible range from 20 to 80. Higher indicates healthier behaviors.	measured at baseline and 12 months
Target Child - Change in Daily Moderate to Vigorous Physical Activity	Change in minutes per day of moderate to vigorous physical activity of the target child as measure by accelerometer from baseline to 12 months. Calculated by subtracting the baseline amount from the 12 month value. The accelerometer is a wrist worn device - worn for 7 days - which measures motion in three directions - the amount of motion is then used assess what level of physical activity the participant is doing at each time interval. Vigorous - such as running, moderate such as fast walking, light such as walking slowly.	baseline and 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adult - Change From Baseline in Number of 12 Ounce Cups or Cans Per Day of Sugar Sweetened Beverages	Change in self-reported sugar-sweetened beverage intake per day from baseline to 12 months as reported by participant in numbers of 12 ounce cups or cans.	baseline and 12 months
Adult - Physical Activity Questionnaires:	Reported leisure activity time on the Global Physical Activity Questionnaire reported in minutes per day.	12 month
Adult - Waist Circumference:	waist circumference in centimeters	12 months
Child - BMI Z-score:	Change in child BMI z-score from baseline to 12 months. The BMI z-score (BMIz) indicates the number of standard deviations away from the mean BMI for age and sex as determined by the CDC growth curves. A z-score of 0 is equal to the mean. Negative numbers indicate values lower than the mean and positive numbers indicate values higher than the mean.	12 months
Child - Screen Time Questionnaire:	total hours of screen time per week as collected by questionnaire given to the parent	12 months
Child -Dietary Measures: Change in 12 Ounce Cups Per Day of Sugar Sweetened Beverages	Change in parent reported sugar-sweetened beverage intake per day from baseline to 12 months as reported per 12 ounce cup or can. Calculate by subtracting the baseline value from the 12 month value.	baseline and 12 months

Collaborators and Investigators

• Sponsor: Helena Laroche
• Investigators: Principal Investigator: helena Laroche, MD, University of Iowa

Study record dates

Study Major Dates

• Study Start (Actual): March 26, 2015
• Primary Completion (Actual): October 9, 2018
• Study Completion (Actual): July 2, 2020

Study Registration Dates

• First Submitted: December 11, 2014
• First Submitted That Met QC Criteria: April 20, 2015
• First Posted (Estimated): April 23, 2015

Study Record Updates

• Last Update Posted (Actual): February 5, 2024
• Last Update Submitted That Met QC Criteria: May 26, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: family
• Additional Relevant MeSH Terms: Overnutrition; Nutrition Disorders; Overweight; Body Weight; Obesity
• Other Study ID Numbers: 201406722

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Investigator will contact PI to discuss their interest in using the data to learn about what is available - data dictionary (code book) of variable names may be made available. Investigator must complete a form outlining what analysis they are proposing. Investigator must sign a confidentiality agreement. Data provided in de-identified format and must be destroyed after analysis and publication is complete.
• IPD Sharing Time Frame: Available after 18-month data has been processed and cleaned. Estimated date: June 2020 (subject to change, dependent on COVID-19).
• IPD Sharing Access Criteria: Form will be reviewed by the PI, University of Iowa investigative team and the community advisory board and a decision about approval will be made. A University of Iowa research team member must be included in the analysis team to help with context and interpretation of data.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR