Two Family Interventions to Reduce BMI in Low-Income Urban Youth: A Randomized Trial

Abstract

BACKGROUND: Our primary aim was to evaluate the effects of 2 family-based obesity management interventions compared with a control group on BMI in low-income adolescents with overweight or obesity. METHODS:In this randomized clinical trial, 360 urban-residing youth and a parent were randomly assigned to 1 of 2 behaviorally distinct family interventions or an education-only control group. Eligible children were entering the sixth grade with a BMI $85th percentile. Interventions were 3 years in length; data were collected annually for 3 years. Effects of the interventions on BMI slope (primary outcome) over 3 years and a set of secondary outcomes were assessed.RESULTS: Participants were primarily African American (77%), had a family income of ,25 000 per year, and obese at enrollment (68%). BMI increased over time in all study groups, with group increases ranging from 0.95 to 1.08. In an intent-to-treat analysis, no significant differences were found in adjusted BMI slopes between either of the family-based interventions and the control group (P = .35). No differences were found between the experimental and control groups on secondary outcomes of diet, physical activity, sleep, perceived stress, or cardiometabolic factors. No evidence of effect modification of the study arms by sex, race and/or ethnicity, household income, baseline levels of child and parent obesity, or exposure to a school fitness program were found. CONCLUSIONS:In this low-income, adolescent population, neither of the family-based interventions improved BMI or health-related secondary outcomes. Future interventions should more fully address poverty and other social issues contributing to childhood obesity.

Impact of weight management nutrition interventions on dietary outcomes in children and adolescents with overweight or obesity: a systematic review with meta‐analysis

“…Of the remaining 42 trials that reported no statistically significant between‐group change in dietary intake, exploratory analysis identified 28 RCTs where there was significant change in intake within one intervention arm (see Supporting information, Table S2). Fourteen studies reported no statistically significant change in any dietary outcome variables ( 13‐26 ) .…”

“…Forty‐three percent of studies ( n = 47) did not specifically mention diet adherence, 27% ( n = 29) described diet adherence methods in the methodology, and 21% ( n = 21) reported adherence based on programme attendance or log‐ins. Dietary intake assessment was primarily conducted using repeat 24‐h recalls ( n = 25) ( 16,20,22,30,35,39,40,46,56,58,60,65,70,74,83,88,89,92,99‐101,104,105,112,114 ) or ≥3‐day WFRs or food diaries ( n = 25) ( 48,51,53,54,57,61,62,67‐69,73,74,78,84‐86,91,95,97,98,107‐109,111,113 ) . Eighteen studies used multiple dietary assessment methods ( 19,29,39,44,45,57,58,60,62,74,82,86,92,95,101,103,112,116 ) .…”

“…Eight studies (27)(28)(29)(30)(31)(32)(33)(34) met all methodological quality criteria, except for 'not applicable' ratings for blinding of participants and interventionists to group allocation, which is commonly reported as not possible in a food-based dietary intervention. Another 19 studies (15,20,25,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50) met all criteria except for 'not applicable' and one 'no' or 'unsure' rating.…”

“…Detailed study characteristics of included RCTs are reported in the Supporting information (Table S1). (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) . Sixty-six percent were published from 2011 onward and 47% were conducted in the USA.…”

Applying the Behavior Change Technique Taxonomy to Four Multicomponent Childhood Obesity Interventions

“…The other intervention arm, not reviewed here, was the SystemsCHANGE intervention which focused on restructuring family environment and a series of family-designed small experiments. Neither of the family-based interventions improved BMI slope (primary outcome) over 3 years or health-related secondary outcomes (Moore et al, 2019).…”