Single versus multiple-family intervention in childhood overweight--Finnmark Activity School: a randomised trial

Ane Kokkvoll, Sameline Grimsgaard, Rønnaug Ødegaard, Trond Flægstad, Inger Njølstad, Ane Kokkvoll, Sameline Grimsgaard, Rønnaug Ødegaard, Trond Flægstad, Inger Njølstad

Abstract

Objective: To compare a new comprehensive lifestyle programme performed in groups of families with overweight (included obese) children with a more conventional single-family programme. The study design and interim anthropometrical results after 12 months are presented.

Design: Altogether 97 overweight and obese children aged 6-12 years with body mass index (BMI) corresponding to cut-off point ≥ 27.5 in adults were included. Study participants were randomised to multiple-family intervention (MUFI) or single-family intervention (SIFI) in a parallel design. MUFI comprised a 3-day inpatient programme at the hospital with other families and a multidisciplinary team, follow-up visits in their hometown individually and in groups, organised physical activity twice weekly and a 4-day family camp after 6 months. SIFI comprised individual counselling by paediatric nurse, paediatric consultant and nutritionist at the hospital and follow-up by public health nurse in the community. Solution focused approach was applied in both interventions. Primary outcome measures were change in BMI kg/m(2) and BMI SD score (BMI SDS).

Results: BMI increased by 0.37 units in the MUFI compared to 0.77 units in the SIFI (p=0.18). BMI SDS decreased by 0.16 units in the MUFI group compared to 0.07 units in the SIFI group (p=0.07). Secondary endpoint waist circumference decreased 0.94 cm in the multiple-family group and increased 0.95 cm in the single-family group, p=0.04.

Conclusions: Interim analysis after 12 months showed no between-group difference in terms of BMI or BMI SDS. The MUFI group had a significant decrease in waist circumference compared to the SIFI group.

The trial is registered: at http://www.clinicaltrials.gov (NCT00872807).

Keywords: Comm Child Health; Nutrition; Obesity; Paediatric Practice; Therapeutics.

Figures

Figure 1
Figure 1
Flow of participants* through first year of treatment—Finnmark Activity School. *Siblings are not included in the analysis. †Longitudinal analyses include all available data from every subject through withdrawal or study completion.
Figure 2
Figure 2
Body mass index (BMI) kg/m2 from baseline to 12 months by intervention group—Finnmark Activity School. Mean (95% CI) changes in BMI from baseline to 12-month follow-up by intervention group.
Figure 3
Figure 3
Waist circumferences from baseline to 12 months by intervention group—Finnmark Activity School. Mean (95% CI) changes in waist circumference from baseline to 12-month follow-up by intervention group.

References

    1. Reilly JJ. Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005;19:327–41
    1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 2006;1:11–25
    1. Singh AS, Mulder C, Twisk JW, et al. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008;9:474–88
    1. Quattrin T, Liu E, Shaw N, et al. Obese children who are referred to the pediatric endocrinologist: characteristics and outcome. Pediatrics 2005;115:348–51
    1. Oude Luttikhuis H, Baur L, Jansen H, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009:CD001872.
    1. Nowicka P, Savoye M, Fisher PA. Which psychological method is most effective for group treatment? Int J Pediatr Obes 2011;6(Suppl 1):70–3
    1. Savoye M, Nowicka P, Shaw M, et al. Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics 2011;127:402–10
    1. Nowicka P, Hoglund P, Pietrobelli A, et al. Family Weight School treatment: 1-year results in obese adolescents. Int J Pediatr Obes 2008;3:141–7
    1. Kalavainen M, Korppi M, Nuutinen O. Long-term efficacy of group-based treatment for childhood obesity compared with routinely given individual counselling. Int J Obes (Lond) 2011;35:530–3
    1. Kokkvoll A, Jeppesen E, Juliusson PB, et al. High prevalence of overweight and obesity among 6-year-old children in Finnmark County, North Norway. Acta Paediatr 2012;101:924–28
    1. De Shazer S, Berg IK, Lipchik E, et al. Brief therapy: focused solution development. Fam Process 1986;25:207–21
    1. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c869.
    1. Cole TJ, Bellizzi MC, Flegal KM, et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240–3
    1. Nowicka P, Flodmark CE. Family therapy as a model for treating childhood obesity: useful tools for clinicians. Clin Child Psychol Psychiatry 2011;16:129–45
    1. Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother 2009;37:129–40
    1. Institute B-HIN. Child obesity calculator using British 1990 growth reference data. Secondary Child obesity calculator using British 1990 growth reference data. .
    1. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73:25–9
    1. Juliusson PB, Roelants M, Eide GE, et al. Overweight and obesity in Norwegian children: secular trends in weight-for-height and skinfolds. Acta Paediatr 2007;96:1333–7
    1. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303
    1. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13–23
    1. Twisk JW, de Vente W. The analysis of randomised controlled trial data with more than one follow-up measurement. A comparison between different approaches. Eur J Epidemiol 2008;23:655–60
    1. McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5.0-16.9 y. Eur J Clin Nutr 2001;55:902–7
    1. Sacher PM, Kolotourou M, Chadwick PM, et al. Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity. Obesity (Silver Spring) 2010;18(Suppl 1):S62–8
    1. DeBar LL, Stevens VJ, Perrin N, et al. A primary care-based, multicomponent lifestyle intervention for overweight adolescent females. Pediatrics 2012;129:e611–20
    1. Kalarchian MA, Levine MD, Arslanian SA, et al. Family-based treatment of severe pediatric obesity: randomized, controlled trial. Pediatrics 2009;124:1060–8
    1. Croker H, Viner RM, Nicholls D, et al. Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial. Int J Obes (Lond) 2012;36:16–26
    1. Whitlock EP, O'Connor EA, Williams SB, et al. Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics 2010;125:e396–418
    1. Banks J, Cramer H, Sharp DJ, et al. Identifying families’ reasons for engaging or not engaging with childhood obesity services: A qualitative study. J Child Health Care 2013
    1. McCarthy HD. Body fat measurements in children as predictors for the metabolic syndrome: focus on waist circumference. Proc Nutr Soc 2006;65:385–92
    1. Hughes AR, Stewart L, Chapple J, et al. Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight: Scottish Childhood Overweight Treatment Trial (SCOTT). Pediatrics 2008;121:e539–46
    1. Collins CE, Okely AD, Morgan PJ, et al. Parent diet modification, child activity, or both in obese children: an RCT. Pediatrics 2011;127:619–27
    1. Wake M, Lycett K, Clifford SA, et al. Shared care obesity management in 3–10-year-old children: 12 month outcomes of HopSCOTCH randomised trial. BMJ 2013;346:f3092.
    1. McGovern L, Johnson JN, Paulo R, et al. Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. J Clin Endocrinol Metab 2008;93:4600–5
    1. Canoy D, Bundred P. Obesity in children. Clin Evid (Online) 2011;2011
    1. Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics 2012;130:e1647–71
    1. Wake M, Baur LA, Gerner B, et al. Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial. BMJ 2009;339:b3308.
    1. Janicke DM, Sallinen BJ, Perri MG, et al. Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY. Arch Pediatr Adolesc Med 2008;162:1119–25
    1. Taveras EM, Gortmaker SL, Hohman KH, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Arch Pediatr Adolesc Med 2011;165:714–22

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere