National Adolescent Treatment Trial for Obesity in Kuwait (NATTO): project design and results of a randomised controlled trial of a good practice approach to treatment of adolescent obesity in Kuwait

Abstract

BackgroundFew randomised controlled trials (RCTs) of interventions for the treatment of adolescent obesity have taken place outside the western world. This RCT tested whether a simple ‘good practice’ intervention for the treatment of adolescent obesity would have a greater impact on weight status and other outcomes than a referral to primary care (control) in adolescents in Kuwait City.MethodsWe report on an assessor-blinded RCT of a treatment intervention in 82 obese 10- to 14-year-olds (mean age 12.4, SD 1.2 years), randomised to a good practice treatment or primary care control group over 6 months. The good practice intervention was intended as relatively low intensity (6 hours contact over 24 weeks, group-based), aiming to change sedentary behaviour, physical activity, and diet. The primary outcome was a change in body mass index (BMI) Z score; other outcomes were changes in waist circumference and blood pressure.ResultsThe retention of subjects to follow up was acceptable (n = 31 from the intervention group, and n = 32 from the control group), but engagement with both the intervention and control treatment was poor. Treatment had no significant effect on BMI Z score relative to control, and no other significant benefits to intervention were observed.ConclusionsThe trial was feasible, but highlights the need to engage obese adolescents and their families in the interventions being trialled. The trial should inform the development of future adolescent obesity treatment trials in the Gulf States with the incorporation of qualitative assessment in future intervention trials.Trial registrationRCT Registered as National Adolescent Treatment Trial for Obesity in Kuwait (NATTO): http://www.controlled-trials.com/ISRCTN37457227, 1 December 2009.

Prevalence of cardiometabolic risk factors and metabolic syndrome in obese Kuwaiti adolescents

“…One of the findings of the NATTO was poor engagement with treatment, as evidenced by the poor attendance of families in both the intervention and control arms of the trial 18. Therefore, findings from the present study might have been useful to demonstrate to the adolescents and their families that their obesity was a medical problem, and so possibly persuade them to engage more with treatment.…”

“…We recruited 80 obese adolescents participating in the NATTO in Kuwait City18 at the preintervention stage of the trial. They were all at or above the age- and sex-adjusted 95th body mass index (BMI) percentile, which defines obesity 19.…”

Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going?

“…Mean change in BMI z-score were not significantly better in the intervention compared to the control arm of these studies (−0.20 to 0.0 s.d) [20, 41, 49]. Resnicow (2015) [35] was able to find some changes in lower intensity intervention groups: mean change BMI percentile from baseline was −1.8 for usual care, −3.8 for PCPs care, and −4.9 for PCP and RD care.…”

“…Several studies showed that lower intensity interventions were less effective [20, 35, 41, 49]. Mean change in BMI z-score were not significantly better in the intervention compared to the control arm of these studies (−0.20 to 0.0 s.d) [20, 41, 49].…”

“…The interventions were mostly located in outpatient pediatric primary care clinics [18, 22, 25, 26, 32, 35–39, 41, 45–49, 52, 60, 61], outpatient weight management clinics [21, 28, 50, 51], hospital-based outpatient obesity clinics [54], and community health centers [20]. One arm of an intervention took place in a high school [33] and one arm of an intervention took place in a school health center [43, 44].…”