A Novel School-clinic-community Online Model of Child Obesity Treatment in Singapore During COVID-19
Condition: Pediatric Obesity; Clinical Trial
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      Background: The Coronavirus 2019 (COVID-19) is an infectious disease, which was first
      identified in December 2019 and has then spread rapidly around the world. COVID-19 spreads
      mainly through respiratory droplets and causes people to experience mild to moderate
      respiratory illness. On 11 March 2020, the World Health Organisation (WHO) declared COVID-19
      a pandemic. With the surge in cases and to contain the spread of this disease, Singapore
      implemented a circuit breaker to reduce movements and interactions in public and private
      places. People are advised to stay at home and practise social distancing. With restrictions
      in movements, parents and children are likely to be more sedentary in this pandemic. There is
      an urgent need to move face-to-face interventions to online interventions as it is important
      to be active in this period.

      Childhood obesity threatens the health of US and Singapore populations. In the US, 30% of
      children are overweight, 17% have obesity, and 8% have severe obesity. In Singapore, 13% of
      children have obesity, and approximately half of all overweight children live in Asia. In
      both countries the prevalence is increasing, especially amongst the lower income populations,
      and is associated with future cardiovascular and metabolic disease. In US, obesity is most
      prevalent in Black and Hispanic populations and in Singapore, obesity affects Malays and
      Indians disproportionately. The underlying drivers and potential solutions thus share many
      common factors. The current evidence shows a clear dose-response effect with increasing
      number of hours of treatment, with a threshold for effectiveness at > 25 hours over a 6-month
      period. A key gap in delivering this recommendation is meeting the intensity, and delivering
      comprehensive treatment that is culturally relevant, engaging to families, and integrated
      within the community context.

      The study is an online pilot randomised controlled trial among children aged 4-7 with
      obesity, in Singapore, to test a novel school-clinic-community online intervention, the KK
      Hospital (KKH) Sports Singapore program, for child obesity treatment with usual care. The
      primary outcome is intensity of treatment as measured by hours of exposure to intervention.

      The online KKH Sports Singapore program involves 4-6 weekly online sessions of physical
      activity and nutrition lessons for children and parents.
    

Detailed description: 
      Through this trial, the investigators will address the following aims:

        1. To demonstrate implementation feasibility and fidelity of the Duke community-based
           intervention model into an online model. The investigators hypothesise that the
           evidence-based implementation strategy tested in the US with Parks and Recreation will
           be adaptable for use at Duke-National University Singapore (NUS) with Singapore Sport,
           leading to online implementation within a 3-month period, and children in the
           intervention will receive up to 60 minutes of moderate-to-vigorous physical activity per
           session.

        2. To meet current recommendations for intensity of obesity treatment. As compared with
           usual care, the investigators hypothesise that children in the online intervention will
           be more likely to receive >25 hours over 6 months of treatment.

        3. To estimate the effectiveness of the online intervention. Children who participate in
           the online intervention, as compared with usual care, will demonstrate improvements in
           health outcomes at 6-months, including cardiorespiratory fitness, weight-related quality
           of life and stabilisation or reduction in BMI at 6 months.
    

Intervention name(s): Usual Care; online KKH Sports Singapore Program with Usual Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will receive standard care which consist of the following:
a lifestyle counseling visit
educational materials
goal-setting by a healthcare professional, and
information about general weight management resources.
weighing scale and measuring tape with instructions to use
fitness tracker; Participants will receive standard care and basic sports equipment and cooking materials for the online programme.
The online programme will be available up to 4 days per week (Weekdays evenings and Weekends mornings or early afternoons) and all household family members are invited to participate. The majority of the programming will be run by trained research coordinator and volunteers from KKH and Sports Singapore coaches. A regular rotation of comprehensive programming is provided, which includes online fitness, cooking, nutrition, and peer support classes. Every session includes up to 60 minutes of exercise and/or active play, and each session has an additional special 'theme.' For example, one to two sessions per week includes nutrition related programming (e.g., cooking classes), parent specific activities (e.g., a yoga class), peer support sessions (e.g., small group discussions around issues such as weight stigmatization), and fitness classes (e.g., soccer classes).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Exercise; Child Health; Child, Preschool; Body Mass Index; Healthy Lifestyle; Community Networks; internet-based intervention