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Staiano AE, Button AM, Baker A, Beyl R, Conn AM, Lima A, Lindros J, Newton RL, Stein RI, Welch RR, Cook S, Wilfley DE. A pragmatic trial of a family-centered approach to childhood obesity treatment: Rationale and study design. Contemp Clin Trials 2024; 138:107459. [PMID: 38278478 PMCID: PMC10922779 DOI: 10.1016/j.cct.2024.107459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Family-based behavioral treatment (FBT) is an effective intensive health behavior and lifestyle treatment for obesity reduction in children and adolescents, but families have limited access. The purpose of this randomized, pragmatic, comparative effectiveness trial was to examine changes in child relative weight in a 12-month, enhanced standard of care (eSOC) intervention combined with FBT (eSOC+FBT) vs. eSOC alone. METHODS Children aged 6 to 15 years with obesity, and their primary caregiver, were recruited from primary care clinics. Families were randomized 1:1 to eSOC, a staged approach led by the primary care provider that gradually intensified dependent on a child's response to care and aligns with the American Medical Association guidelines, or the eSOC+FBT arm, which included regular meetings with a health coach for healthy eating, physical activity, positive parenting strategies, and managing social and environmental cues. Both treatments align with the 2023 American Academy of Pediatrics clinical practice guidelines. Assessments occurred at baseline, midpoint (month 6), end-of-intervention (month 12), and follow-up (month 18). Primary outcome was change from baseline to 12 months in child percent overweight (percentage above the median body mass index in the general US population normalized for age and sex). Secondary outcomes were parent weight, child psychosocial factors, heterogeneity of treatment effects, and cardiometabolic risk factors. Exploratory outcomes assessed reach, effectiveness, adoption, implementation, and maintenance. CONCLUSION This pragmatic trial will generate evidence for the comparative effectiveness of implementing two guidelines-based approaches in primary care for obesity reduction in children and adolescents. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03843424.
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Affiliation(s)
- Amanda E Staiano
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America.
| | - Alyssa M Button
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Alison Baker
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robbie Beyl
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Anne-Marie Conn
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Angela Lima
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Jeanne Lindros
- American Academy of Pediatrics, 345 Park Blvd., Itasca, IL 60143, United States of America
| | - Robert L Newton
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA 70808, United States of America
| | - Richard I Stein
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - R Robinson Welch
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
| | - Stephen Cook
- University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY 14642, United States of America
| | - Denise E Wilfley
- Washington University School of Medicine, 660 S. Euclid Ave., Mail Stop 8134-29-2100, St. Louis, MO 63110, United States of America
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