One-on-one lifestyle coaching for managing adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting

Pediatric Centre for Weight and Health, Stollery Children's Hospital
Paediatrics & child health (Impact Factor: 1.39). 06/2011; 16(6):345-50.
Source: PubMed


Interventions for obese adolescents in real-world, clinical settings need to be evaluated because most weight management care occurs in this context.
To determine whether a lifestyle intervention that includes motivational interviewing and cognitive behavioural therapy (Health Initiatives Program [HIP]) leads to weight management that is superior to a similar lifestyle intervention (Youth Lifestyle Program [YLP]) that does not include these techniques; and to determine whether the HIP and YLP interventions are superior to a wait list control (WLC) group.
Obese adolescents were randomly assigned to a YLP (n=15), HIP (n=17) or WLC (n=14) group. The YLP and HIP were 16-session, one-on-one interventions. The primary outcome was the percentage change of body mass index z-score.
Completers-only analyses revealed 3.9% (YLP) and 6.5% (HIP) decreases in the percentage change of body mass index z-score compared with a 0.8% (WLC) increase (P<0.001). Levels of attrition did not differ among groups, but were relatively high (approximately 20% to 40%).
Lifestyle interventions delivered in a real-world, clinical setting led to short-term improvements in the obesity status of adolescents.

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Available from: Ronald C Plotnikoff, Dec 12, 2013
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    • "The techniques used within the HC approach are similar to those used in group-lay led self-management programs, so would likely be amenable to a group setting. HC is an evidence-based mode of self-management support that is typically conducted in the context of health behavior change for disease prevention and chronic disease self-management (CDSM) (Ball et al, 2011; Huffman 2007; Vale et al, 2003; Wolever et al, 2010; Wong-Rieger and Rieger, 2013). Specifically, self-management support using HC to improve engagement in physical activity is significantly more efficient than health education alone (Jordan and Osborne, 2007). "
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    ABSTRACT: Purpose: To evaluate a program in support of chronic disease self-management (CDSM) that is founded on a health coaching (HC) approach, includes supervised exercise and mindfulness-based stress reduction components and is delivered within a private practice physiotherapy setting. Methods: An explanatory mixed method design, framed by theory-based program evaluation, was employed to evaluate an eight-week group-based program. Standardized self-rated and performance measures were evaluated pre- and post intervention. Additionally, participant focus groups were conducted following the intervention period. An inductive thematic approach was undertaken to analyze the qualitative data. Findings: Seventeen participants (N = 17) completed the study. Improvements were seen in both self-report and performance outcomes. Participants explained how and why they felt the program was beneficial. Six themes were generated: (1) group dynamic; (2) learning versus doing; (3) holism and comprehensive care; (4) self-efficacy and empowerment; (5) previous solutions versus new management strategies; and (6) healthcare provider support. Conclusions: This study established that a group program in support of CDSM founded on a HC approach demonstrated potential value from participants as well as favorable outcomes. A pragmatic randomized control trial is required to determine efficacy of this intervention.
    Physiotherapy Theory and Practice 07/2014; 31(1):1-10. DOI:10.3109/09593985.2014.930769
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    • "For practical reasons, at each time point, data collection occurs within a 2-month window (e.g., within 8 weeks before the first PAC session, within 8 weeks after the last PAC session, and between 4 weeks before to 4 weeks after each of the 6- and 12-month follow-up time points). Clinical and research experience by our team [48] revealed that this timeframe is needed to accommodate families’ schedules and clinical capacity to complete data collection, which also differentiates our real-world, comparative effectiveness research [51] from more stringent criteria that are applied in the context of efficacy studies. Data collection is completed by clinicians working within the PCWH, and given the real-world, applied health services environment within which the study is conducted, we are unable to blind them from knowing which families are receiving the CBT- and PEP-based versions of the PAC intervention [52]. "
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    ABSTRACT: There is an urgent need to develop and evaluate weight management interventions to address childhood obesity. Recent research suggests that interventions designed for parents exclusively, which have been named parents as agents of change (PAC) approaches, have yielded positive outcomes for managing pediatric obesity. To date, no research has combined a PAC intervention approach with cognitive behavioural therapy (CBT) to examine whether these combined elements enhance intervention effectiveness. This paper describes the protocol our team is using to examine two PAC-based interventions for pediatric weight management. We hypothesize that children with obesity whose parents complete a CBT-based PAC intervention will achieve greater reductions in adiposity and improvements in cardiometabolic risk factors, lifestyle behaviours, and psychosocial outcomes than children whose parents complete a psycho-education-based PAC intervention (PEP). This study is a pragmatic, two-armed, parallel, single-blinded, superiority, randomized clinical trial. The primary objective is to examine the differential effects of a CBT-based PAC vs PEP-based PAC intervention on children's BMI z-score (primary outcome). Secondary objectives are to assess intervention-mediated changes in cardiometabolic, lifestyle, and psychosocial variables in children and parents. Both interventions are similar in frequency of contact, session duration, group facilitation, lifestyle behaviour goals, and educational content. However, the interventions differ insofar as the CBT-based intervention incorporates theory-based concepts to help parents link their thoughts, feelings, and behaviours; these cognitive activities are enabled by group leaders who possess formal training in CBT. Mothers and fathers of children (8-12 years of age; BMI ≥85th percentile) are eligible to participate if they are proficient in English (written and spoken) and agree for at least one parent to attend group-based sessions on a weekly basis. Anthropometry, cardiometabolic risk factors, lifestyle behaviours, and psychosocial health of children and parents are assessed at pre-intervention, post-intervention, 6-, and 12-months follow-up. This study is designed to extend findings from earlier efficacy studies and provide data on the effect of a CBT-based PAC intervention for managing pediatric obesity in a real-world, outpatient clinical setting. identifier: NCT01267097.
    BMC Pediatrics 08/2012; 12(1):114. DOI:10.1186/1471-2431-12-114 · 1.93 Impact Factor
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    ABSTRACT: Background & aims Few studies evaluating treatment of adolescent obesity have been published. Therefore, long-term effects of the Go4it group treatment for obese adolescents were examined. Methods Obese adolescents (11–18 years) visiting an outpatient paediatric obesity clinic were randomly assigned to 1) intervention group (Go4it) or 2) current regular care i.e. referral to a dietician in the home care setting (controls). Linear mixed models analysis was performed to evaluate intervention effects. Effect modification by sex, age and ethnicity was checked. Outcome measures included body mass index standard deviation score (BMIsds), body composition and metabolic components at 6 and 18 months follow-up. Results 122 adolescents, 71 Go4it and 51 controls, with a mean BMIsds of 2.9 ± 0.5 were randomised. At 18 months a modest significant reduction in BMIsds (between group difference: −0.16; 95%CI: −0.30, −0.02; p = .028) was observed. None of the other body composition or metabolic components showed significant treatment effects. Ethnicity was a significant effect modifier. Posthoc analysis showed a large significant reduction on BMIsds (between group difference: −0.35; 95%CI: −0.64, −0.07) at 18 months for obese adolescents from western descent, while no effect was observed for adolescents from non-western descent. Significant treatment effects were also observed for systolic and diastolic blood pressure, as well as HDL cholesterol level, but only for obese adolescents from western descent. Conclusions Go4it showed promising long-term effects on BMIsds compared with regular care in obese adolescents. Larger benefits were achieved for adolescents of western ethnicity. This trial was registered at with the Netherlands Trial Register as ISRCTN27626398.
    Clin Nutr Suppl 2012;7(supplement 1):130(PP266); 09/2012
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