Reducing paediatric overweight and obesity through motivational interviewing: study protocol for a randomised controlled trial in the AAP PROS research network

Margaret E Wright, Emerson Delacroix, Kendrin R Sonneville, Shannon Considine, Tim Proctor, Jennifer Steffes, Donna Harris, Laura P Shone, Heide Woo, Roger Vaughan, Robert W Grundmeier, Alexander G Fiks, Melissa S Stockwell, Ken Resnicow, Margaret E Wright, Emerson Delacroix, Kendrin R Sonneville, Shannon Considine, Tim Proctor, Jennifer Steffes, Donna Harris, Laura P Shone, Heide Woo, Roger Vaughan, Robert W Grundmeier, Alexander G Fiks, Melissa S Stockwell, Ken Resnicow

Abstract

Introduction: Primary care remains an underused venue for prevention and management of paediatric overweight and obesity. A prior trial demonstrated a significant impact of paediatrician/nurse practitioner (Ped/NP)-and registered dietitian (RD)-delivered motivational interviewing (MI) on child body mass index (BMI). The study described here will test the effectiveness of an enhanced version of this primary care-based MI counselling intervention on child BMI.

Methods and analysis: This cluster randomised effectiveness trial includes 24 Ped/NPs from 18 paediatric primary care practices that belong to the American Academy of Pediatrics (AAP) national Pediatric Research in Office Settings (PROS) practice-based research network. To date, practices have been randomised (nine to intervention and nine to usual care). Intervention Ped/NPs have been trained in MI, behavioural therapy, billing/coding for weight management and study procedures. Usual care Ped/NPs received training in billing/coding and study procedures only. Children 3- 11 years old with BMI >the 85th percentile were identified via electronic health records (EHRs). Parents from intervention practices have been recruited and enrolled. Over about 2 years, these parents are offered approximately 10 MI-based counselling sessions (about four in person sessions with their child's Ped/NP and up to six telephonic sessions with a trained RD). The primary outcome is change in child BMI (defined as per cent from median BMI for age and sex) over the study period. The primary comparison is between eligible children in intervention practices whose parents enrol in the study and all eligible children in usual care practices. Data sources will include EHRs, billing records, surveys and counselling call notes.

Ethics and dissemination: Institutional Review Board approval was obtained from the AAP. All Ped/NPs provided written informed consent, and intervention group parents provided consent and Health Insurance Portability and Accountability Act (HIPAA) authorisation. Findings will be disseminated through peer-reviewed publications, conference presentations and appropriate AAP channels.

Trial registration number: NCT03177148; Pre-results.

Keywords: nutrition & dietetics; paediatrics; primary care; public health.

Conflict of interest statement

Competing interests: None declared

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
BMI2+ study aims and comparisons. 1Compare outcome between children of enrolled parents (intervention) and all eligible children (usual care). 2Compare outcome between children of actively engaged parents (intervention) and all eligible children (usual care). 3Compare outcome between all eligible children in both intervention and usual care. 4Eligibility based on age (3–11 years), BMI (>85th percentile), health supervision history (visit within 2 years of baseline with a participating Ped/NP) and medical history (no chronic, limiting, severe medical disorder or use of medications known to affect grown and mood/behaviour). 5Defined as receipt of at least 50% of the total MI counselling sessions from Ped/NPs and RDs. BMI, body mass index; EHR, electronic health record; MI, motivational interviewing; Ped/NP, paediatrician/nurse practitioner; RD, registered dietitians.
Figure 2
Figure 2
Overview of the BMI2+ study. BMI, body mass index; EHR, electronic health record; Ped/NP, paediatrician/nurse practitioner; RD, registered dietitian.
Figure 3
Figure 3
Text message sequence for an enrolled parent after selecting vegetable consumption as a goal area during a counselling call with an RD1. 1RD counselling call = day 0. 2repeated weekly for 1 month and monthly for 5 months. BMI, body mass index.

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