A staged approach to address youth unresponsive to initial obesity intervention: A randomized clinical trial

Authors: ARLINGHAUS, KATHERINE - University Of Minnesota; O'CONNOR, DANIEL - University Of Houston; LEDOUX, TRACEY - University Of Houston; HUGHES, SHERYL - Children'S Nutrition Research Center (CNRC); JOHNSTON, CRAIG - University Of Houston

Submitted to: International Journal of Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/11/2021
Publication Date: 8/20/2021
Citation: Arlinghaus, K.R., O'Connor, D.P., Ledoux, T.A., Hughes, S.O., Johnston, C.A. 2021. A staged approach to address youth unresponsive to initial obesity intervention: A randomized clinical trial. International Journal of Obesity. 45(12):2585-2590. https://doi.org/10.1038/s41366-021-00940-0.
DOI: https://doi.org/10.1038/s41366-021-00940-0

Interpretive Summary: It is difficult for some individuals to respond immediately to treatment options. Staged approaches to treatment have been shown to be effective for some participants of obesity intervention programs. One such program was implemented in a Houston school district where all participants who were overweight or obese at baseline were randomized to one of two components, Take CHARGE or PE (physical education) Planner. Take CHARGE included more frequent sessions with students, additional opportunities for parent and school staff involvement, and increased mentorship from college students. In contrast, PE Planner allowed students to decide how they wanted to be active in PE class. On average, children were 13.5 years old with 60% being female and 85% classified as Hispanic. The Take CHARGE group had greater decreases in weight status compared to the PE Planner group for those initially unresponsive. However, among those initially responsive, Take CHARGE had significantly smaller decreases in weight status compared to those in PE Planner. Evidence supported the need for staged interventions with students initially responsive to treatment benefitting from maintenance after the program, whereas those unresponsive benefitting from escalated treatment. Future intervention studies should consider staged treatment for children who are classified as overweight and/or obese at baseline.

Technical Abstract: Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (percentBMIp95) than PE Planners. From 2018 to 2020, 171 middle and high schoolers (BMI percentile greater or equal to 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. Participants were 13.63 plus or minus 1.32 years old; 59%were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in percentBMIp95 than PE Planners (beta = -0.01, p < 0.01). Conversely, among those initially responsive, Take CHARGE had significantly smaller decreases in %BMIp95 than PE Planners (beta = 0.02, p < 0.05). Intention-to-treat analysis had similar results. Participant outcomes in semester two differed based on initial response. Individuals responsive to initial intervention were most likely to benefit from a maintenance intervention and those initially unresponsive benefited more from escalated treatment. This indicates the need for staged intervention protocols to better address obesity in the school setting.