Behavioral Weight Control for Overweight Adolescents Initiated in Primary Care

Department of Pediatrics, Division of Psychology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Obesity research (Impact Factor: 4.95). 02/2002; 10(1):22-32. DOI: 10.1038/oby.2002.4
Source: PubMed


This study evaluates the post-treatment and short-term follow-up efficacy of, as well as participant satisfaction for, a 4-month behavioral weight control program for overweight adolescents initiated in a primary care setting and extended through telephone and mail contact.
44 overweight adolescents were randomly assigned to either a multiple component behavioral weight control intervention (Healthy Habits [HH]; n = 23) or a single session of physician weight counseling (typical care [TC]; n = 21). Weight, height, dietary intake, physical activity, sedentary behavior, and problematic weight-related and eating behaviors and beliefs were assessed before treatment, after the 4-month treatment, and at 3-month follow-up. Participant satisfaction and behavioral skills use were measured.
HH adolescents evidenced better change in body mass index z scores to post-treatment than TC adolescents. Body mass index z scores changed similarly in the conditions from post-treatment through follow-up. Behavioral skills use was higher among HH than TC adolescents, and higher behavioral skills use was related to better weight outcome. Energy intake, percentage of calories from fat, physical activity, sedentary behavior, and problematic weight-related or eating behaviors/beliefs did not differ by condition or significantly change over time independent of condition. The behavioral intervention evidenced good feasibility and participant satisfaction.
A telephone- and mail-based behavioral intervention initiated in primary care resulted in better weight control efficacy relative to care typically provided to overweight adolescents. Innovative and efficacious weight control intervention delivery approaches could decrease provider and participant burden and improve dissemination to the increasing population of overweight youth.

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Available from: Brian Saelens, Feb 02, 2015
    • "An additional study found decreases in BMI over time (Taylor et al., 2012), whereas another study found an Internet-based program efficacious only among children who used the programs frequently (Delamater et al., 2013), suggesting that maintaining program usage is critical for establishing this treatment approach. Studies of multicomponent interventions delivered by telephone are also promising, with greater %OW decreases shown in participants who received a telephone intervention, compared to a control group (Saelens et al., 2002), and high users of a separate phonebased intervention decreased weight, BMI, and BMI z-score compared to low users (Wright et al., 2013). These approaches are promising for meeting the high need for evidence-based childhood obesity treatments, although more research is needed to determine the ideal format for these programs to enhance participant use of the program and the magnitude of outcomes. "
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    ABSTRACT: Childhood obesity is associated with increased medical and psychosocial consequences and mortality and effective interventions are urgently needed. Effective interventions are urgently needed. This article reviews the evidence for psychological treatments of overweight and obesity in child and adolescent populations. Studies were identified through searches of online databases and reference sections of relevant review articles and meta-analyses. Treatment efficacy was assessed using established criteria, and treatments were categorized as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy. Well-established treatments included family-based behavioral treatment (FBT) and Parent-Only Behavioral Treatment for children. Possibly efficacious treatments include Parent-Only Behavioral Treatment for adolescents, FBT-Guided Self-Help for children, and Behavioral Weight Loss treatment with family involvement for toddlers, children, and adolescents. Appetite awareness training and regulation of cues treatments are considered experimental. No treatments are considered probably efficacious, or of questionable efficacy. All treatments considered efficacious are multicomponent interventions that include dietary and physical activity modifications and utilize behavioral strategies. Treatment is optimized if family members are specifically targeted in treatment. Research supports the use of multicomponent lifestyle interventions, with FBT and Parent-Only Behavioral Treatment being the most widely supported treatment types. Additional research is needed to test a stepped care model for treatment and to establish the ideal dosage (i.e., number and length of sessions), duration, and intensity of treatments for long-term sustainability of healthy weight management. To improve access to care, the optimal methods to enhance the scalability and implementability of treatments into community and clinical settings need to be established.
    Journal of Clinical Child & Adolescent Psychology 12/2014; 44(4):1-17. DOI:10.1080/15374416.2014.963854 · 1.92 Impact Factor
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    • "Taken together, these barriers make medical care settings a uniquely challenging environment in which to attempt obesity prevention interventions. Despite these barriers, there has been increased attention to developing and evaluating interventions that leverage the influential role of the pediatric primary care provider and are integrated into the health care setting, including multiple non-randomized trials and pilot studies [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] and a smaller number of completed larger-scale randomized trials [20] [21] [22] [23] [24] and randomized trials that are currently in progress [25] [26] [27] [28] [29]. These studies have taken steps towards testing primary carebased interventions that take minimal office visit time and supplement physician counseling with a supportive, often clinic-based or home-based intervention component, yet the quality of the studies, role of the pediatric primary care provider, and strength of the supportive intervention components have varied, as have other aspects of the research design, such as participation and follow-up rates, and length of follow-up. "
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    ABSTRACT: Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a contact control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well-child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The contact control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.
    Contemporary clinical trials 06/2013; 36(1). DOI:10.1016/j.cct.2013.06.017 · 1.94 Impact Factor
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    • "We acknowledge three major limitations. Consistent with the literature, our sample demonstrated that weight-management programs tended to attract families with educated parents (Saelens et al., 2002). Second, the sample reported a high to very high knowledge of nutrition, but no indepth assessment was made of nutrition knowledge. "
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    ABSTRACT: The aim of this pilot study is to describe youth and parents' perceptions of potential weight-promoting factors among families seeking treatment for youth overweight. We identified 2 important gaps in the vast multidisciplinary literature: (a) a lack of studies addressing both the youth and the parent perceptions about family factors that are potentially weight-promoting and (b) a lack of interventions that community health nurses could deliver specifically targeting families seeking treatment for overweight youth. Focus group data were content analyzed. Broad themes included: (a) mixed messages, (b) food and exercise as battleground, (c) problem solving, and (d) social aspects of youth overweight. We conclude that youth and parents could benefit from community health nursing interventions to implement healthcare professionals' recommendations incorporating all family members and creating and maintaining an accepting and demanding family climate.
    Journal of Community Health Nursing 10/2012; 29(4):187-201. DOI:10.1080/07370016.2012.724278 · 0.48 Impact Factor
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