A Pilot Randomized Controlled Trial of a Clinic and Home‐Based Behavioral Intervention to Decrease Obesity in Preschoolers

Abstract

We evaluated the efficacy of a 6-month clinic and home-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family-based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one-time PC session. Eighteen children aged 2–5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post-treatment) BMI z (−0.59 ± 0.17), BMI percentile (−2.4 ± 1.0), and weight gain (−2.7 kg ± 1.2) than PC and this difference was maintained at follow-up (month 12). LAUNCH parents also had a significantly greater weight loss (−5.5 kg ± 0.9) at month 6 and 12 (−8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.

Stage 1 Treatment of Pediatric Overweight and Obesity: A Pilot and Feasibility Randomized Controlled Trial

“…Our success in enrollment (30% of those eligible) was comparable to other studies evaluating recruitment from a 29 Recent studies recruiting from clinics in the United States reported recruitment rates of approximately 20% 30 and 15%. 15 In this study participants were provided with a $20 gift card as an incentive to return for follow-up and we were able to remeasure 90% at the 3-month follow-up visit.…”

The home food environment of overweight gatekeepers in the Netherlands

“…Also some intervention studies have focused on the physical home food environment. For example, interventions provided individuals with serving-size-appropriate dishware (42) or interventions encouraged participants to increase the in-home availability of healthy foods (42)(43)(44) or prevented the in-home availability of unhealthy foods (45) . Although the present study is descriptive in nature, the data may provide important reference information for future studies on home food environments.…”

Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents

“…Recent guidelines recommend that the goal of these interventions is to produce small weight decreases, or stabilize weight gain in these children, as this will be sufficient to produce meaningful change as children age and grow taller (Barlow & Committee, 2007;Daniels et al, 2005). Three separate TREATMENT OF OVERWEIGHT AND OBESITY trials show promising results for the use of BWL treatment with a family component in children aged 2 to 5 (Quattrin et al, 2012;Small, Bonds-McClain, Melnyk, Vaughan, & Gannon, 2014;Stark et al, 2011) and suggest that intervening earlier may result in improved outcomes and that at-home intervention may be an efficacious addition to treatment. Multicomponent treatment with family involvement is considered possibly efficacious for toddlers; however, it should be noted that evidence is not as robust for this age group.…”

“…For example, in one trial, adolescent girls received a multicomponent intervention that was augmented with ongoing feedback from their primary care physician with promising results (DeBar et al, 2012). Research has also examined delivering the intervention directly to participants in the home, with beneficial results, possibly attributable to more direct impact on the home environment (Jiang et al, 2005;Stark et al, 2011). Additional research is needed to further explore avenues for incorporating treatment into primary care and community settings to maximize outcomes.…”