Implementing Prevention Plus for Childhood Overweight and Obesity in Food Secure and Insecure Families
Condition: Obesity; Childhood Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      The ability of Prevention Plus to improve weight status when delivered by primary care
      providers is unknown, and the influence of household food security status as a moderator in
      the treatment of childhood obesity has never been examined. Thus, the investigators will
      conduct a randomized trial examining Prevention Plus delivered by CHS primary care providers
      on child zBMI in underserved children receiving their primary care at CHS who are overweight
      and obese, and test the moderating effect of household food security status on Prevention
      Plus delivered with and without caretaker goals
    

Detailed description: 
      Intervention

      PP+

      Following baseline assessment, children will continue to receive standard care at CHS and the
      monthly newsletter. Additionally, each family will be provided with a scale; wall growth
      chart to measure height; a BMI wheel to calculate BMI; a BMI-for-age growth chart; a binder
      for intervention materials; a self-monitoring diary to record child's monthly height, weight,
      BMI and BMI percentile; and picture-based diaries to monitor daily energy balance behaviors.
      Family materials provided at each session will outline a process to measure growth and
      include information about how children grow, as well as cover behavioral parenting strategies
      to assist with changing child behavior for energy balance behaviors.

      Families will meet in person with a BHC at the CHS clinic in which they receive care for 30
      minutes during months 1, 3, and 5. In these sessions, child height and weight will be taken,
      and BMI will be plotted on the BMI-for-age growth chart. Families will receive feedback about
      growth and the weight status of their child. Additionally, the session materials will be
      reviewed and behavioral parenting strategies will be encouraged to aid with changing two
      dietary and two leisure-time activity (energy balance) behaviors of the child. As is
      traditional in a family-based approach, the caretaker will also change the same energy
      balance behaviors as the child, as adult caretakers can then model healthy behaviors for the
      child, assisting the child in learning the new weight-related behaviors.13 Thus, both the
      caretaker and child will be encouraged to change and self-monitor energy balance behaviors
      with the use of the picture-based diaries.

      During months 2, 4, and 6, BHCs will complete a 20-minute phone call with the caretaker.
      Caretakers will be asked to measure the height and weight of their child, calculate BMI and
      plot it on the BMI-for-age growth chart prior to the call. During the call, the BHC will
      provide feedback on the changes in child growth since the previous contact. Additionally, the
      BHC will discuss the family's progress on achieving child and caretaker energy balance
      behavior goals and implementation of behavioral parenting strategies.

      The child's energy balance behavioral goals will be to consume < 3 sugar-sweetened beverage
      (e.g., regular carbonated soft drinks, sports drinks, lemonades, ice teas, flavored milk,
      juice drinks < 100% juice, and punches) servings /wk, ≥1 ½ cups/day of whole vegetables and ≥
      1 cup/day of whole fruit, engage in ≥ 60 minutes/day of moderate- to vigorous-intensity
      physical activity, and reduce TV viewing to < 2 hours/day. The caretaker's energy balance
      behavioral goals will be to consume < 3 sugar-sweetened beverage servings/wk, ≥ 2 ½ cups/day
      of whole vegetables and ≥ 1 ½ cups/day of whole fruit, engage in ≥ 150 minutes of moderate-
      to vigorous-intensity physical activity per week, and reduce TV viewing to < 10 hours/wk. To
      increase self-efficacy, the goals will be incrementally increased, with families implementing
      the full program goals at month four. Additionally, children and caretakers will be asked to
      achieve at least three of the five goals each day (child) or week (adult caretaker).

      PP-

      This condition will be identical to PP+ except that caretakers will not receive any energy
      balance behavior goals. Additionally, the caretaker will not self-monitor energy balance
      behaviors. The focus will be on all other behavioral parenting strategies to assist the child
      with making changes in the targeted behaviors (i.e., stimulus control, positive
      reinforcement, and assisting child in self-monitoring energy-balance behaviors).
    

Intervention name(s): Prevention Plus +; Prevention Plus -
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Families will receive 6 monthly newsletters and meet with a BHC at the clinic for 30 minutes during months 1, 3, and 5. Child height and weight will be taken. Families will receive feedback about growth and the weight status of their child. The session materials will be reviewed and behavioral parenting strategies will be encouraged to aid with changing two dietary and two leisure-time activity (energy balance) behaviors of the child. The caretaker will also change the same energy balance behaviors as the child, as adult caretakers can then model healthy behaviors. The caretaker and child will be encouraged to change and self-monitor energy balance behaviors with the use of the picture-based diaries. During months 2, 4, and 6, BHCs will complete a 20-minute phone call with the caretaker. Caretakers will be asked to measure the height and weight of their child, calculate BMI and plot it on the BMI-for-age growth chart prior to the call. The BHC will provide feedback.; This condition will be identical to PP+ except that caretakers will not receive any energy balance behavior goals. Additionally, the caretaker will not self-monitor energy balance behaviors. The focus will be on all other behavioral parenting strategies to assist the child with making changes in the targeted behaviors.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: food security