Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: Study protocol for a randomized controlled trial

Trials (Impact Factor: 1.73). 03/2013; 14(1):81. DOI: 10.1186/1745-6215-14-81


Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base.

This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (≥91st centile BMI) or obese (≥98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton).Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality.A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children's BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style will also be assessed.Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. A de novo decision-analytic model will estimate the lifetime cost-effectiveness of the Families for Health program.Process evaluation will document recruitment, attendance and drop-out rates, and the fidelity of Families for Health delivery. Interviews with up to 24 parents and children from each arm will investigate perceptions and changes made.

This paper describes our protocol to assess the effectiveness and cost-effectiveness of a parenting approach for managing childhood obesity and presents challenges to implementation.

Trial registration:
Current Controlled Trials http://ISRCTN45032201.

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Available from: Sarah Stewart-Brown
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    ABSTRACT: This review provides an overview on the latest literature on the costs of childhood and adolescent obesity and on the cost-effectiveness of interventions to prevent or manage this problem. Findings on the economic burden of childhood obesity are inconclusive, and the majority of the identified studies found excess healthcare costs for obese compared with normal-weight children by analysing different cost components and age groups. However, there are several limitations to these studies, e.g. short study periods and a strong focus on healthcare costs, disregarding other components of the economic burden of childhood obesity. Economic evaluation studies of childhood and adolescent obesity programmes indicate that cost-effective, in some cases even cost-saving, preventive and management interventions do exist. However, because of the strong variation in methodological aspects, it is difficult to compare preventive and treatment approaches in terms of their cost-effectiveness. To design effective public policies, a better understanding of these economic aspects of childhood and adolescent obesity is necessary. This understanding, however, depends on the collection of additional longitudinal data. Economic evaluation of childhood obesity interventions poses various methodological challenges that should be addressed in further research in order to support decision making.
    No preview · Article · Jan 2015 · Pediatric and Adolescent Medicine
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    ABSTRACT: Background: Recruitment to trials evaluating the effectiveness of childhood obesity management interventions is challenging. We report our experience of recruitment to the Families for Health study, a randomised controlled trial evaluating the effectiveness of a family-based community programme for children aged 6-11 years, versus usual care. We evaluated the effectiveness of active recruitment (contacting eligible families directly) versus passive recruitment (informing the community through flyers, public events, media). Methods: Initial approaches included passive recruitment via the media (newspapers and radio) and two active recruitment methods: National Child Measurement Programme (letters to families with overweight children) and referrals from health-care professionals. With slow initial recruitment, further strategies were employed, including active (e.g. targeted letters from general practices) and passive (e.g. flyers, posters and public events) methods. At first enquiry from a potential participant, families were asked where they heard about the study. Further quantitative (questionnaire) and qualitative data (one-to-one interviews with parents/carers), were collected from recruited families at baseline and 3-month follow-up and included questions about recruitment. Results: In total, 194 families enquired about Families for Health, and 115 (59.3 %) were recruited and randomised. Active recruitment yielded 85 enquiries, with 43 families recruited (50.6 %); passive recruitment yielded 99 enquiries with 72 families recruited (72.7 %). Information seen at schools or GP surgeries accounted for over a quarter of enquiries (28.4 %) and over a third (37.4 %) of final recruitment. Eight out of ten families who enquired this way were recruited. Media-led enquiries were low (5 %), but all were recruited. Children of families recruited actively were more likely to be Asian or mixed race. Despite extensive recruitment methods, the trial did not recruit as planned, and was awarded a no-cost extension to complete the 12-month follow-up. Conclusions: The higher number of participants recruited through passive methods may be due to the large number of potential participants these methods reached and because participants may see the information more than once. Recruiting to a child obesity treatment study is complex and it is advisable to use multiple recruitment strategies, some aiming at blanket coverage and some targeted at families with children who are overweight. Trial registration: Current Controlled Trials ISRCTN45032201 (Date: 18 August 2011).
    Full-text · Article · Nov 2015 · Trials