Efficacy of a Community- Versus Primary Care-Centered Program for Childhood Obesity: TX CORD RCT.

Theresa A Wilson, Steven H Kelder, Paul M Sacher, Eric A Finkelstein, Terry Huang, Abiodun Oluyomi, Courtney Byrd-Williams, Shreela V Sharma, Maurice R Puyau, Alejandra Gonzalez, Nancy F Butte, Adriana Pérez, Anne L Adolph, Yan Liu, Elizabeth A Vandewater, Casey Durand, Stephen Pont, Sarah E Barlow, Deanna M Hoelscher

Journal: Obesity (Silver Spring, Md.) 2018;25(9):1584-1593

PMID: 28703504

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Abstract

OBJECTIVE

This randomized controlled trial was conducted to determine comparative efficacy of a 12-month community-centered weight management program (MEND2-5 for ages 2-5 or MEND/CATCH6-12 for ages 6-12) against a primary care-centered program (Next Steps) in low-income children.

METHODS

Five hundred forty-nine Hispanic and black children (BMI ≥ 85th percentile), stratified by age groups (2-5, 6-8, and 9-12 years), were randomly assigned to MEND2-5 (27 contact hours)/MEND/CATCH6-12 (121.5 contact hours) or Next Steps (8 contact hours). Primary (BMI value at the 95th percentile [%BMI ]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase).

RESULTS

For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMI than Next Steps during the Intensive Phase. Effect size (95% CI) was -1.94 (-3.88, -0.01) percentage points (P = 0.05). For age group 9-12, effect size was -1.38 (-2.87, 0.16) percentage points for %BMI (P = 0.07). MEND2-5 did not differentially affect %BMI . Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMI during the Intensive Phase (P < 0.05). In the Transition Phase, %BMI was maintained or rebounded in both programs (P < 0.05).

CONCLUSIONS

MEND/CATCH6-12 was more efficacious for BMI reduction at 3 months but not 12 months compared to Next Steps in underserved children. Intervention compliance influenced outcomes, emphasizing the need for research in sustaining family engagement in low-income populations.

Address: USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.; Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA.; Children's Health, GI Practice, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Texas Center for the Prevention and Treatment of Childhood Obesity, Dell Children's Medical Center, University of Texas at Austin Dell Medical School, Austin, Texas, USA.; Center for Systems and Community Design; Department of Community Health and Social Sciences; Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA.; Duke University Global Health Institute, Durham, North Carolina, USA, and Duke-NUS Medical School, Singapore.; Childhood Nutrition Research Centre, University College-London, London, UK.

DOI: 10.1002/oby.21929