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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #340401
Title: Embedding weight management into safety-net pediatric primary care: randomized controlled trial

Author
item WYLIE-ROSETT, JUDITH - Albert Einstein College Of Medicine
item GROISMAN-PERELSTEIN, ADRIANA - Albert Einstein College Of Medicine
item DIAMANTIS, PAMELA - Albert Einstein College Of Medicine
item JIMENEZ, CAMILLE - Albert Einstein College Of Medicine
item SHANKAR, VISWANATHAN - Albert Einstein College Of Medicine
item CONLON, BETH - Albert Einstein College Of Medicine
item MOSSAVAR-RAHMANI, YASMIN - Albert Einstein College Of Medicine
item ISASI, CARMEN - Albert Einstein College Of Medicine
item MARTIN, SARAH - Albert Einstein College Of Medicine
item GINSBERG, MINDY - Albert Einstein College Of Medicine
item MATTHAN, NIRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: International Journal of Behavioral Nutrition and Physical Activity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/21/2017
Publication Date: 1/22/2018
Citation: Wylie-Rosett, J., Groisman-Perelstein, A.E., Diamantis, P.M., Jimenez, C.C., Shankar, V., Conlon, B.A., Mossavar-Rahmani, Y., Isasi, C.R., Martin, S.N., Ginsberg, M., Matthan, N., Lichtenstein, A.H. 2018. Embedding weight management into safety-net pediatric primary care: randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 15:12. https://doi.org/10.1186/s12966-017-0639-z.
DOI: https://doi.org/10.1186/s12966-017-0639-z

Interpretive Summary: The study evaluated the effects of adding a family-oriented structured skill building and support program to quarterly consultations by pediatricians addressing the American Academy of Pediatrics obesity recommendations. Our hypothesis was that children randomized to receive the additional experimental intervention would have greater improvements in their body size (as indicated by a BMI Z-score) and metabolic parameters than children in the control intervention. This was a 12-month randomized controlled trial in high risk children aged 7-12 years. They were randomly assigned to the control or experimental intervention. The control intervention consisted of quarterly pediatrician consultations to address American Academy of Pediatrics obesity recommendations. The experimental intervention included quarterly pediatrician consultations with the addition of a structured family-based behavioral change program consisting of eight skill-building core sessions and monthly post-core support sessions taught by a multidisciplinary staff. At the end of the 12-month intervention period, children in both the control and experimental interventions significantly decreased their BMI Z-score. Compared to the control group, the experimental intervention achieved greater improvements in total cholesterol low-density lipoprotein cholesterol and liver function. These data indicate that primary care pediatricians, who have expertise in weight management and provide targeted family-based behavioral counseling, can help overweight and obese children achieve a modest BMI Z-score improvement. A more intensive family-based lifestyle intervention program may help achieve cardiometabolic improvements.

Technical Abstract: Objectives: The study evaluated the effects of adding a family oriented structured skill building and support program to quarterly consultations by pediatricians addressing the American Academy of Pediatrics obesity recommendations. We hypothesized that children randomized to receive the additional experimental intervention would have greater improvements in body mass index Z-scores (BMI Z-score) and metabolic parameters than children in the control intervention. Methods: In a 12-month randomized controlled trial (N=360), children, aged 7-12 years with BMI >/= 85th percentile for age and sex, were randomly assigned to the control or experimental intervention. The control intervention consisted of quarterly pediatrician consultations to address American Academy of Pediatrics obesity recommendations. The experimental intervention included quarterly pediatrician consultations with the addition of a structured family-based behavioral change program consisting of eight skill-building core sessions and monthly post-core support sessions taught by a multidisciplinary staff. Results: During the 12-month intervention period, children in both the control and experimental interventions significantly decreased their BMI Z- score (P<0.01), but no significant difference was observed between the groups (P=0.15). Compared to the control group, the experimental intervention achieved greater decreases in total cholesterol (P=0.05), low-density lipoprotein cholesterol (P=0.03), and aspartate aminotransferase (P=0.02). Conclusions: Primary care pediatricians, who have expertise in weight management and provide targeted family-based behavioral counseling, can help overweight and obese children achieve a modest BMI Z-score improvement. However, the addition of a more intensive lifestyle intervention program may help achieve metabolic improvements.