Behavioral Treatment for Obese Preschoolers

Study Overview
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Brief Summary
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This study is a 3 arm, randomized, parallel group randomized clinical trial to test a clinic and home family behavioral intervention (LAUNCH) against 1) motivational interviewing (attention control; MI) and 2) standard of care (true standard of care control; STC) with 168 children ages 2 to 5 years who meet the criteria for obesity (>95th percentile for body mass index; BMI). Participants will be randomized to receive a 6 month intervention (LAUNCH, MI) or standard of care. The primary end-point will be change in BMI z-score at the end of treatment. The investigators will also assess maintenance of treatment gains at 6 and 12 months after treatment, and changes in factors thought to be mechanisms for change in weight (food intake and activity level), changes in the obesiogenic environment (parent weight, food intake and activity, and changes in the home food environment) and factors that could be negatively impacted (parent and child eating and feeding interactions).

Detailed Description
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Obesity now affects an estimated 2.8 million children between the ages of 2 and 5 years, as the prevalence of obesity among preschool school age children has almost tripled from 5% of the population in 1971-1980 to 13.9% by 2004. Being obese at age 5 confers a 47 times greater risk of being overweight or obese at age 12. In fact being obese any time between 2 and 5 year increases the risk of remaining overweight or obese as an adult by four times the risk of nonobese preschoolers. Being obese as a preschooler also increases the risk of a number of serious health conditions, including a 2.6 times greater risk of developing type 2 diabetes by age 21 years. In fact, the obesity rate among preschoolers is thought to impose such a cumulative health risk across the life span that children born today, for the first time in history, are expected to have a shorter life expectancy than their parents by to 2 to 5 years. Early effective treatments for establish obesity during the preschool years have the potential to change the trajectory of obesity and related co-morbid health condition across the life-span by reducing obesity and changing the development of lifestyle habits of diet and exercise at a time when these are being formed. Yet research on interventions to reduce obesity in preschool children is severely limited and none exist that addresses established obesity in this age group. Therefore the current study has the potential to have a significant impact on public health by providing evidence-based treatment for obesity in preschoolers, a developmental period in which eating and activity patterns are being formed, that could significantly impact the trajectory of obesity thereby decreasing the population obesity rates and associated healthcare costs at across the life span. Fortunately, investigators are on their way to addressing the problem of obesity reduction in already obese preschoolers. The investigators have developed and conducted a pilot randomized clinical trial of a treatment program aimed at reducing obesity in already obese preschool children. The program (Learning about Activity and Understanding Nutrition for Child Health: LAUNCH) is tailored to the developmental stage of preschool children and produced promising preliminary results. In the proposed trial a 3 arm, randomized, parallel group design will test LAUNCH against 1) motivational interviewing (attention control; MI) and 2) standard of care (true standard of care control; STC) with 168 children ages 2 to 5 years who meet the criteria for obesity (>95th percentile for body mass index; BMI). Participants will be randomized to receive a 6 month intervention (LAUNCH, MI) or standard of care. The primary end-point will be change in BMI z-score at the end of treatment. The investigators will also assess maintenance of treatment gains at 6 and 12 months after treatment, and changes in factors thought to be mechanisms for change in weight (food intake and activity level), changes in the obesiogenic environment (parent weight, food intake and activity, and changes in the home food environment) and factors that could be negatively impacted (parent and child eating and feeding interactions).

Official Title
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Clinic and Home Family Based Behavioral Treatment for Obese Preschoolers

Conditions
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Obesity

Intervention / Treatment
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* Behavioral: Behavioral Family Intervention
* Behavioral: Motivational Interviewing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children ages 2 years 0 months to 5 years 11 months BMI percentile at or above the 95th percentile for age- and gender, but no more than 100% above the median BMI for age and gender. English-speaking Live within 50 miles of Cincinnati Children's Hospital Medical Center (CCHMC) Medical clearance from the child's pediatrician to participate. Exclusion Criteria: Medical conditions known to promote obesity (e.g., Prader-Willi syndrome, Cushing's syndrome) Already involved with another weight control program Taking weight-affecting medications (e.g., steroids). A disability or illness that would preclude them from engaging in at least moderate intensity physical activity Developmental disability

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 5 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Family Behavioral Treatment<br>This intervention will provide nutritional counseling for a health diet, parent training in effective child behavioral management strategies, and stimulus control of the home environment delivered via group based clinic visits and individual home visits on alternate weeks | Behavioral: Behavioral Family Intervention<br>* Three months of weekly treatment delivered via alternating group based clinic visits and individual home visits followed by three months of every other week treatment alternating between clinic and home.<br>* Other names: LAUNCH;|
| Active Comparator: Motivational Interviewing<br>This intervention will shared information with parents about their child's weight and use motivational interviewing to elicit changes parents would like to make to their child diet and activity patterns. | Behavioral: Motivational Interviewing<br>* Motivational interviewing will be delivered at the same frequency at the behavioral intervention with 4 in-person visits spaced at the first visit, month 3 and month 5. Phone calls will be conducted weekly during the first 3 months and every other week during months 4 through 6.<br>* Other names: MI;|
| No Intervention: Standard of Care<br>Participants in this arm will be followed over time and be assessed on the primary and secondary outcomes at the same time points as the two treatment arms | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in BMIz score | Body Mass Index z-score | Baseline to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in BMI z at follow up |  | Baseline, 6 months, 12 months, 18 months | 
| Change in Caloric Intake | Three 24 hour dietary recalls at each time point | Baseline, 6 months, 12 months, 18 months | 
| Change in Physical Activity | Physical Activity will be measured using Accelermeters set in 15 sec epochs | Baseline, 6 months, 12 months, 18 months | 
| Change in home health environment | Home observation recording of food (e.g.,fruits, vegetables, high calorie foods and beverages)and presence of TV in child's bedroom | Baseline, 6 months, 12 months, 18 months | 
| Changes in parent calorie intake | Will assess using Block 2005 Food Frequency | Baseline, 6 months, 12 months, 18 months | 
| Changes in parent physical activity | Will be assessed using the Paffenbarger Activity Questionnaire for calorie expenditure | Baseline, 6 months, 12 months, 18 months | 
| Parenting and Child Eating Behaviors | Will assess using Parenting Styles and Dimensions, About Your Child's Eating - Revised, and Child Feeding Questionnaire | Baseline, 6 month, 12 months, 18 months | 
| Change in Health Related Quality of Life | Will be assessed using the PedQL | Baseline, 6 months, 12 months, 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Preschoolers, Obesity, Behavioral Treatment