Group lifestyle modification vs. lifestyle newsletters for early childhood obesity: Pilot study in rural primary care - 20/02/21

Doi : 10.1016/j.jbct.2021.01.002

Myles S. Faith ^a,^⁎ , William C. Cochran ^b, Lisa Diewald ^c, Karen Hoffer ^d, Renee’ Moore ^e, Robert I. Berkowitz ^f,^g, Chelsie A. Hauer ^b, Nicolas Stettler-Davis ^h, Gina Tripicchio ⁱ, Margaret R. Rukstalis ^j
^a Department of Counseling, School, and Educational Psychology, Graduate School of Education, University at Buffalo – State University of New York, Buffalo, USA
^b Geisinger Center for Health Research, Danville, USA
^c M. Louise Fitzpatrick College of Nursing, Villanova University, Philadelphia, USA
^d Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
^e Rollins School of Public Health, Emory University, Atlanta, USA
^f Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
^g Department of Child and Adolescent Psychiatry, The Children's Hospital of Philadelphia, Philadelphia, USA
^h UnitedHealthcare Clinical Services, Las Vegas, USA
ⁱ Department of Social and Behavioral Sciences and the Center for Obesity Research and Education, Temple University, Philadelphia, USA
^j Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Wake Forest, USA

^⁎Corresponding author. 420 Baldy Hall, Buffalo, N.Y. 14260-1000, United States.420 Baldy HallBuffalo, N.Y. 14260-1000United States

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Abstract

Research on primary-care interventions for early childhood obesity in rural communities is lacking. We compared two interventions for 4- to 8-year-old children with overweight/obesity, launched from a rural primary-care clinic. Families were randomly assigned to Intensive Lifestyle Modification (ILM; n=23) or Lifestyle Newsletters (LN; n=24). The primary outcome was 5-month change in child BMI z-score. ILM groups received behavior modification challenges, the Stop Light Diet, nutrition information, and parent training. LN families received by mail information on diet and physical activity. Results indicated no significant difference between groups in BMI z-score reduction (p=0.40; Cohen's d=0.20), although treatment interacted with child food responsiveness (p=0.04) and parent perceived feeding responsibility (p=0.006) in exploratory analyses. Specifically, ILM compared with LN was better for children higher in ‘food responsiveness’, with a reverse pattern for children lower in this trait. ILM also was superior to LN when parents were lower in feeding responsibility, with a reverse pattern when parents were higher in this trait. Thus, the success of ILM and LN in rural primary care may depend upon child and parent attributes. Lower-intensity family interventions for early childhood obesity may offer scalable options in rural communities for some families.