Managing Obesity in Young Children: A Multiple Methods Study Assessing Feasibility, Acceptability, and Implementation of a Multicomponent, Family-Based Intervention

Laura M Kinlin, Stephan M Oreskovich, Raluca Dubrowski, Geoff D C Ball, Melanie Barwick, Elizabeth Dettmer, Jess Haines, Jill Hamilton, Theresa H M Kim, Marie Klaassen, Paola Luca, Jonathon L Maguire, Myla E Moretti, Elaine Stasiulis, Alene Toulany, Catherine S Birken, Laura M Kinlin, Stephan M Oreskovich, Raluca Dubrowski, Geoff D C Ball, Melanie Barwick, Elizabeth Dettmer, Jess Haines, Jill Hamilton, Theresa H M Kim, Marie Klaassen, Paola Luca, Jonathon L Maguire, Myla E Moretti, Elaine Stasiulis, Alene Toulany, Catherine S Birken

Abstract

Background: We developed a multicomponent, family-based intervention for young children with obesity consisting of parent group sessions, home nursing visits, and multidisciplinary clinical encounters. Our objective was to assess intervention feasibility, acceptability, and implementation. Methods: From 2017 to 2020, we conducted a multiple methods study in the obesity management clinic at a tertiary children's hospital (Toronto, Canada). We included 1-6 year olds with a body mass index ≥97th percentile and their parents; we also included health care providers (HCPs) who delivered the intervention. To assess feasibility, we performed a pilot randomized controlled trial (RCT) comparing the intervention to usual care. To explore acceptability, we conducted parent focus groups. To explore implementation, we examined contextual factors with HCPs using the Consolidated Framework for Implementation Research. Results: There was a high level of ineligibility (n = 34/61) for the pilot RCT. Over 21 months, 11 parent-child dyads were recruited; of 6 randomized to the intervention, 3 did not participate in group sessions or home visits. In focus groups, themes identified by parents (n = 8) related to information provided at referral; fit between the intervention and patient needs; parental gains from participating in the intervention; and feasibility of group sessions. HCPs (n = 10) identified contextual factors that were positively and negatively associated with intervention implementation. Conclusions: We encountered challenges related to intervention feasibility, acceptability, and implementation. Lessons learned from this study will inform the next iteration of our intervention and are relevant to intervention development and implementation for young children with obesity. Clinical Trial Registration number: NCT03219658.

Keywords: acceptability; feasibility; implementation; pediatric obesity; pilot RCT.

Conflict of interest statement

G.D.C.B has served as a consultant for Novo Nordisk. None of the other authors has a financial relationship or potential conflict of interest to disclose.

Figures

Figure 1.
Figure 1.
Core components of the STOMP-EY intervention. STOMP-EY, SickKids Team Obesity Management Program-Early Years.
Figure 2.
Figure 2.
CONSORT flow diagram for the pilot randomized controlled trial of the STOMP-EY intervention. CONSORT, Consolidated Standards of Reporting Trials.

References

    1. Kelly AS, Barlow SE, Rao G, et al. . Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches: A scientific statement from the American Heart Association. Circulation 2013;128:1689–1712.
    1. Freedman DS, Mei Z, Srinivasan SR, et al. . Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr 2007;150:12–17.e2.
    1. Carsley S, Tu K, Parkin PC, et al. . Overweight and obesity in preschool aged children and risk of mental health service utilization. Int J Obes (Lond) 2019;43:1325–1333.
    1. Reilly JJ, Martin A, Hughes AR. Early-life obesity prevention: Critique of intervention trials during the first one thousand days. Curr Obes Rep 2017;6:127–133.
    1. Moens E, Braet C, Van Winckel M. An 8-year follow-up of treated obese children: Children's, process and parental predictors of successful outcome. Behav Res Ther 2010;48:626–633.
    1. Danielsson P, Kowalski J, Ekblom Ö, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med 2012;166:1103–1108.
    1. Oude Luttikhuis H, Baur L, Jansen H, et al. . Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872.
    1. Colquitt JL, Loveman E, O'Malley C, et al. . Diet, physical activity, and behavioural interventions for the treatment of overweight or obesity in preschool children up to the age of 6 years. Cochrane Database Syst Rev 2016;3:CD012105.
    1. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev 2004;62:39–50.
    1. Quattrin T, Roemmich JN, Paluch R, et al. . Efficacy of family-based weight control program for preschool children in primary care. Pediatrics 2012;130:660–666.
    1. Lanigan J, Collins S, Birbara T, et al. . The TrimTots programme for prevention and treatment of obesity in preschool children: Evidence from two randomised controlled trials. Lancet 2013;382(Supplement 3):S58.
    1. Spence ND, Birken C, Haines J, Ball GD. Back to the future—A case for home visits for managing severe paediatric obesity. Acta Paediatr 2015;104:547–549.
    1. Gehring ND, Ball GDC, Perez A, et al. . Families' perceived benefits of home visits for managing paediatric obesity outweigh the potential costs and barriers. Acta Paediatr 2018;107:315–321.
    1. Stark LJ, Spear S, Boles R, et al. . A pilot randomized controlled trial of a clinic and home-based behavioral intervention to decrease obesity in preschoolers. Obesity (Silver Spring) 2011;19:134–141.
    1. Stark LJ, Clifford LM, Towner EK, et al. . A pilot randomized controlled trial of a behavioral family-based intervention with and without home visits to decrease obesity in preschoolers. J Pediatr Psychol 2014;39:1001–1012.
    1. Stark LJ, Spear Filigno S, Bolling C, et al. . Clinic and home-based behavioral intervention for obesity in preschoolers: A randomized trial. J Pediatr 2018;192:115–121.e1.
    1. Durlak JA, DuPre EP. Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 2008;41:327–350.
    1. De Onis M, Onyango A, Borghi E, et al. . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–667.
    1. Group WMGRS. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 2006;450:76–85.
    1. Thabane L, Ma J, Chu R, et al. . A tutorial on pilot studies: The what, why and how. BMC Med Res Methodol 2010;10:1.
    1. Birkett MA, Day SJ. Internal pilot studies for estimating sample size. Stat Med 1994;13:2455–2463.
    1. Wittes J, Brittain E. The role of internal pilot studies in increasing the efficiency of clinical trials. Stat Med 1990;9:65–71; discussion 71–72.
    1. Proctor E, Silmere H, Raghavan R, et al. . Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011;38:65–76.
    1. de Onis M, Garza C, Onyango AW, Rolland-Cachera MF, pédiatrie lCdndlSfd. [WHO growth standards for infants and young children]. Arch Pediatr 2009;16:47–53.
    1. CDC National Center for Disease Statistics. National Health and Nutrition Examination Survey Anthropometric Procedure Videos. Available at Last accessed April 24, 2020.
    1. Deverka PA, Lavallee DC, Desai PJ, et al. . Stakeholder participation in comparative effectiveness research: Defining a framework for effective engagement. J Comp Eff Res 2012;1:181–194.
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101.
    1. Damschroder LJ, Aron DC, Keith RE, et al. . Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implement Sci 2009;4:50.
    1. Gerards SM, Dagnelie PC, Gubbels JS, et al. . The effectiveness of lifestyle triple P in the Netherlands: A randomized controlled trial. PLoS One 2015;10:e0122240.
    1. Haines J, McDonald J, O'Brien A, et al. . Healthy Habits, Happy Homes: Randomized trial to improve household routines for obesity prevention among preschool-aged children. JAMA Pediatr 2013;167:1072–1079.
    1. Smith WA, Gray E, Jones TL, et al. . Waitlist management in a pediatric weight management clinic: Implementing an orientation session. BMC Pediatr 2021;21:416.
    1. Skelton JA, Beech BM. Attrition in paediatric weight management: A review of the literature and new directions. Obes Rev 2011;12:e273–e281.
    1. Barlow SE, Ohlemeyer CL. Parent reasons for nonreturn to a pediatric weight management program. Clin Pediatr (Phila) 2006;45:355–360.
    1. Rhodes ET, Boles RE, Chin K, et al. . Expectations for treatment in pediatric weight management and relationship to attrition. Child Obes 2017;13:120–127.
    1. Nobles JD, Perez A, Skelton JA, et al. . The engagement pathway: A conceptual framework of engagement-related terms in weight management. Obes Res Clin Pract 2018;12:133–138.
    1. Bernard-Genest J, Chu L, Dettmer E, et al. . Talking about weight with families-helping health care professionals start the conversation: A nonrandomized controlled trial. Clin Pediatr (Phila) 2020;59:910–917.
    1. Klupt KA, Oreskovich SM, Bernard-Genest J, et al. . Careful conversations: An educational video to support parents in communicating about weight with their children. BMC Pediatr 2020;20:397.
    1. Ball GD, Spence ND, Browne NE, et al. . The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: Study protocol. BMC Health Serv Res 2017;17:261.
    1. Sallinen Gaffka BJ, Frank M, et al. . Parents and pediatric weight management attrition: Experiences and recommendations. Child Obes 2013;9:409–417.
    1. Tremblay M, Perez AJ, Rasquinha AM, et al. . Recommendations from parents to improve health services for managing pediatric obesity in Canada. Acad Pediatr 2016;16:587–593.
    1. Kelleher E, Davoren MP, Harrington JM, et al. . Barriers and facilitators to initial and continued attendance at community-based lifestyle programmes among families of overweight and obese children: A systematic review. Obes Rev 2017;18:183–194.
    1. Newson L, Povey R, Casson A, Grogan S. The experiences and understandings of obesity: Families' decisions to attend a childhood obesity intervention. Psychol Health 2013;28:1287–1305.
    1. Borrello M, Pietrabissa G, Ceccarini M, et al. . Motivational interviewing in childhood obesity treatment. Front Psychol 2015;6:1732.
    1. Van Horn DH, Bux DA. A pilot test of motivational interviewing groups for dually diagnosed inpatients. J Subst Abuse Treat 2001;20:191–195.
    1. Pietrabissa G. Group motivation-focused interventions for patients with obesity and binge eating disorder. Front Psychol 2018;9:1104.
    1. Lincour P, Kuettel TJ, Bombardier CH. Motivational interviewing in a group setting with mandated clients: A pilot study. Addict Behav 2002;27:381–391.
    1. Alkureishi MA, Choo ZY, Rahman A, et al. . Digitally disconnected: A qualitative study of patient perspectives on the digital divide and potential solutions. JMIR Hum Factors 2021;DOI:10.2196/33364.
    1. Ramsetty A, Adams C. Impact of the digital divide in the age of COVID-19. J Am Med Inform Assoc 2020;27:1147–1148.
    1. Azar KM, Aurora M, Wang EJ, et al. . Virtual small groups for weight management: An innovative delivery mechanism for evidence-based lifestyle interventions among obese men. Transl Behav Med 2015;5:37–44.
    1. Laitinen J, Korkiakangas E, Alahuhta M, et al. . Feasibility of videoconferencing in lifestyle group counselling. Int J Circumpolar Health 2010;69:500–511.
    1. Clark DO, Keith N, Weiner M, Xu H. Outcomes of an RCT of videoconference vs. in-person or in-clinic nutrition and exercise in midlife adults with obesity. Obes Sci Pract 2019;5:111–119.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe