Feasibility & Preliminary Efficacy of Structured Programming and a Parent Intervention to Mitigate Accelerated Summer BMI Gain: A pilot study

R Glenn Weaver, Bridget Armstrong, Elizabeth Adams, Michael Beets, James White, Kate Flory, Dawn Wilson, Alex Mclain, Brianna Tennie, R Glenn Weaver, Bridget Armstrong, Elizabeth Adams, Michael Beets, James White, Kate Flory, Dawn Wilson, Alex Mclain, Brianna Tennie

Abstract

BackgroundThis study assessed initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.MethodsThis pilot 2x2 factorial randomized control trial used a mixed methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV + PI) to mitigate accelerated summer body mass index (BMI) gain. Feasibility (i.e., recruitment capability, retention, compliance, treatment fidelity, acceptability) was examined using means, standard deviations, and percentages for relevant variables. Changes in BMI were estimated using intent-to-treat and post-hoc dose response analyses via multilevel mixed effects regressions.ResultsA total of 89 families participated, with 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV + PI group, and 21 randomized to the control. Parents and children found the summer program acceptable but attendance at the summer program and engagement in the PI were low due to COVID-19 and lack of transportation. Intent-to-treat analyses showed no statistically significant difference between groups in summer BMI gain. Post-hoc dose response analyses showed that for each day (0 to 29) of summer programming children attended they gained - 0.009 (95CI= -0.018, -0.001) less in BMI z-score.ConclusionsEngagement in both the SCV and PI was not ideal and was likely due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. Thus, a larger trial may be warranted, but more work is needed to ensure children attend the programming.Trial registration: The trial reported herein was prospectively registered at clinicaltrials.gov. Trial #:NCT04608188.

Conflict of interest statement

Competing interests

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Consort Flow Diagram of Participants Through the Study
Figure 2
Figure 2
BMI z-score changes by group from pre- to post-summer

References

    1. von Hippel PT, Workman J. From kindergarten through second grade, US children’s obesity prevalence grows only during summer vacations. Obesity. 2016;24(11):2296–300.
    1. Chen TA, Baranowski T, Moreno J, O’connor T, Hughes S, Baranowski J, et al. Obesity status transitions across the elementary years: use of Markov chain modelling. Pediatr Obes. 2016;11(2):88–94.
    1. Franckle R, Adler R, Davison K. Accelerated weight gain among children during summer versus school year and related racial/ethnic disparities: a systematic review. Prev Chronic Dis. 2014;11.
    1. Weaver RG, Hunt E, Armstrong B, Beets MW, Brazendale K, Turner-McGrievy G, et al. Impact of a year round school calendar on children’s BMI and tness: Final outcomes from a natural experiment. Pediatr Obes. 2021:e12789.
    1. Brazendale K, Beets M, Pate RR, Turner-McGrievy B, Kaczynski AT, Weaver RG, et al. Understanding differences between summer vs. school obesogenic behaviors of children: The Structured Days Hypothesis. International Journal of Behavioral Nutrition and Physical Activity 2017;14(1).
    1. Staiano AE, Broyles ST, Katzmarzyk PT. School term vs. school holiday: associations with Children’s physical activity, screen-time, diet and sleep. Int J Environ Res Public Health. 2015;12(8):8861–70.
    1. Wing YK, Li SX, Li AM, Zhang J, Kong APS. The effect of weekend and holiday sleep compensation on childhood overweight and obesity. Pediatrics. 2009;124(5):e994–1000.
    1. Agostini A, Pignata S, Camporeale R, Scott K, Dorrian J, Way A, et al. Changes in growth and sleep across school nights, weekends and a winter holiday period in two Australian schools. Chronobiol Int. 2018;35(5):691–704.
    1. Wang YC, Vine S, Hsiao A, Rundle A, Goldsmith J. Weight-related behaviors when children are in school versus on summer breaks: does income matter? J Sch Health. 2015;85(7):458–66.
    1. Weaver R, Armstrong B, Hunt E, Beets M, Brazendale K, Dugger R, et al. The Impact of Summer Vacation on Children’s Obesogenic Behaviors and Body Mass Index: A natural experiment. International Journal of Behavioral Nutrition and Physical Activity. 2020;153(2020).
    1. Carroll N, Sadowski A, Laila A, Hruska V, Nixon M, Ma DW, et al. The impact of COVID-19 on health behavior, stress, financial and food security among middle to high income Canadian families with young children. Nutrients. 2020;(8):2352.
    1. Pietrobelli A, Pecoraro L, Ferruzzi A, Heo M, Faith M, Zoller T, et al. Effects of COVID-19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study. Obesity. 2020;28(8):1382–5.
    1. Gruber R, Saha S, Somerville G, Boursier J, Wise MS. The impact of COVID-19 related school shutdown on sleep in adolescents: a natural experiment. Sleep Med. 2020;76:33–5.
    1. Burkart S, Parker H, Weaver RG, Beets MW, Jones A, Adams EL, et al. Impact of the COVID-19 pandemic on elementary schoolers’ physical activity, sleep, screen time and diet: A quasi‐experimental interrupted time series study. Pediatr Obes. 2021:e12846.
    1. Dunton GF, Do B, Wang SD. Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the US. BMC Public Health. 2020;20(1):1–13.
    1. Weaver RG, Hunt ET, Armstrong B, Beets MW, Brazendale K, Turner-McGrievy G, et al. COVID-19 leads to accelerated increases in children’s BMI z-score gain: An interrupted time-series study. Am J Prev Med. 2021.
    1. Vogel M, Geserick M, Gausche R, Beger C, Poulain T, Meigen C, et al. Age-and weight group-specific weight gain patterns in children and adolescents during the 15 years before and during the COVID-19 pandemic. Int J Obes. 2022;46(1):144–52.
    1. Moliterno P, Gansterer A, Czernin S, Schönthaler K, Matjazic J, Neidenbach R. 14-Months Follow-Up in 8-to 11-year-old Primary School Children from Vienna: Effects of the COVID-19 Pandemic on Weight and Body Mass Index. Ann Pediatr Res. 2021;5(2):1060.
    1. Kopp CB. Antecedents of self-regulation: A developmental perspective. Dev Psychol. 1982;18(2):199.
    1. Spagnola M, Fiese BH. Family routines and rituals: A context for development in the lives of young children. Infants & Young Children. 2007;20(4):284–99.
    1. Graziano PA, Kelleher R, Calkins SD, Keane SP, Brien MO. Predicting weight outcomes in preadolescence: The role of toddlers’ self-regulation skills and the temperament dimension of pleasure. Int J Obes. 2013;37(7):937–42.
    1. Schlam TR, Wilson NL, Shoda Y, Mischel W, Ayduk O. Preschoolers’ delay of gratification predicts their body mass 30 years later. J Pediatr. 2013;162(1):90–3.
    1. Skouteris H, McCabe M, Swinburn B, Newgreen V, Sacher P, Chadwick P. Parental influence and obesity prevention in pre-schoolers: a systematic review of interventions. Obes Rev. 2011;12(5):315–28.
    1. United States Department of Agriculture. Summer Food Service Program (SFSP). Serving Summer Meals; 2017. [Available from: .
    1. Weaver RG, Brazendale K, Chandler JL, Turner-McGrievy GM, Moore JB, Huberty JL, et al. First year physical activity findings from turn up the HEAT (Healthy Eating and Activity Time) in summer day camps. PLoS ONE. 2017;12(3):e0173791.
    1. Brazendale K, Beets MW, Weaver RG, Chandler JL, Randel AB, Turner-McGrievy G, et al. Children’s moderate-to-vigorous physical activity attending summer day camps. American Journal of Preventive Medicine. 2017.
    1. Wilson C. 2016 Camp Enrollment and Staff Recruitment Survey: American Camp Association; 2017. [Available from:
    1. Moreno JP, Johnston CA, Woehler D. Changes in Weight Over the School Year and Summer Vacation: Results of a5-Year Longitudinal Study. J Sch Health. 2013;83(7):473–7.
    1. Park K-S, Lee M-G. Effects of summer school participation and psychosocial outcomes on changes in body composition and physical fitness during summer break. J Exerc Nutr Biochem. 2015;19(2):81.
    1. Dugger R, Brazendale K, Hunt ET, Moore JB, Turner-Mcgrievy G, Vogler K, et al. The impact of summer programming on the obesogenic behaviors of children: Behavioral outcomes from a quasi-experimental pilot trial. Pilot and feasibility studies. 2020;6(1).
    1. Evans EW, Wing RR, Pierre DF, Howie WC, Brinker M, Jelalian E. Testing the effect of summer camp on excess summer weight gain in youth from low-income households: a randomized controlled trial. BMC Public Health. 2020;20(1):1–10.
    1. Rhodes RE, Naylor P-J, McKay HA. Pilot study of a family physical activity planning intervention among parents and their children. J Behav Med. 2010;33(2):91–100.
    1. Strecher VJ, Seijts GH, Kok GJ, Latham GP, Glasgow R, DeVellis B, et al. Goal setting as a strategy for health behavior change. Health Educ Q. 1995;22(2):190–200.
    1. Goldstein SP, Goldstein CM, Bond DS, Raynor HA, Wing RR, Thomas JG. Associations between self-monitoring and weight change in behavioral weight loss interventions. Health Psychol. 2019;38(12):1128.
    1. Embry DD, Biglan A. Evidence-based kernels: Fundamental units of behavioral influence. Clin Child Fam Psychol Rev. 2008;11(3):75–113.
    1. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The physical activity guidelines forAmericans. JAMA. 2018;320(19):2020–8.
    1. Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785–6.
    1. Pilot Studies. Common Uses and Misues. 2021.
    1. Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40.
    1. Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.
    1. Pearson N, Naylor PJ, Ashe MC, Fernandez M, Yoong SL, Wolfenden L. Guidance for conducting feasibility and pilot studies for implementation trials. Pilot Feasibility Stud. 2020;6(1):167.
    1. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–7.
    1. Kuczmarski R, Ogden C, Guo S, Grummer-Strawn L, Flegal K, Mei Z, et al. CDC growth charts for the US: methods and development. Vital Health Stat. 2002;11(246):1–190.
    1. Gioia GA, Isquith PK, Guy SC, Kenworthy L. BRIEF: Behavior rating inventory of executive function. Psychological Assessment Resources; Lutz, FL; 2015.
    1. Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implement Sci. 2019;14(1):1–10.
    1. Bernard HR, Wutich A, Ryan GW. Analyzing qualitative data: Systematic approaches. SAGE publications; 2016.
    1. Strauss A, Corbin J. Basics of qualitative research techniques. Sage publications; Thousand Oaks, CA; 1998.
    1. Borkan J. Immersion/Crystallization. Doing Qualitative Research. BF Crabtree and WL Miller. London: Sage; 1999.
    1. Strauss A, Corbin J. Basics of qualitative research techniques Citeseer. 1998.
    1. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inform. 2004;22(2):63–75.
    1. R CORE TEAM A. R. A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2012. URL . 2020.
    1. McCoy CE. Understanding the intention-to-treat principle in randomized controlled trials. West J Emerg Med. 2017;18(6):1075.
    1. White IR, Carpenter J, Horton NJ. Including all individuals is not enough: lessons for intention-to-treat analysis. Clin Trails. 2012;9(4):396–407.
    1. White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med. 2011;30(4):377–99.
    1. Kumar S, King EC, Christison AL, Kelly AS, Ariza AJ, Borzutzky C, et al. Health outcomes of youth in clinical pediatric weight management programs in POWER. J Pediatr. 2019;208:57–65. e4.
    1. Freedman DS, Woo JG, Ogden CL, Xu JH, Cole TJ. Distance and Percent Distance from Median BMI as Alternatives to BMI z-score. Br J Nutr. 2019:1–25.
    1. Freedman DS, Goodwin Davies AJ, Phan TLT, Cole FS, Pajor N, Rao S, et al. Measuring BMI change among children and adolescents. Pediatr Obes. 2022:e12889.
    1. Evans EW, Bond DS, Pierre DF, Howie WC, Wing RR, Jelalian E. Promoting health and activity in the summer trial: implementation and outcomes of a pilot study. Prev Med Rep. 2018;10:87–92.

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