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

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

doi:10.1002/oby.21929

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

Obesity (Silver Spring). 2017 Sep;25(9):1584-1593. doi: 10.1002/oby.21929. Epub 2017 Jul 13.

Authors

Nancy F Butte¹, Deanna M Hoelscher², Sarah E Barlow³, Stephen Pont⁴, Casey Durand⁵, Elizabeth A Vandewater², Yan Liu¹, Anne L Adolph¹, Adriana Pérez², Theresa A Wilson¹, Alejandra Gonzalez², Maurice R Puyau¹, Shreela V Sharma², Courtney Byrd-Williams², Abiodun Oluyomi², Terry Huang⁵, Eric A Finkelstein⁶, Paul M Sacher⁷, Steven H Kelder²

Affiliations

¹ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
² Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center-School of Public Health, Austin Regional Campus, Austin, Texas, USA.
³ Children's Health, GI Practice, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴ 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.
⁵ 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.
⁶ Duke University Global Health Institute, Durham, North Carolina, USA, and Duke-NUS Medical School, Singapore.
⁷ Childhood Nutrition Research Centre, University College-London, London, UK.

PMID: 28703504
DOI: 10.1002/oby.21929

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_p95 ]) 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_p95 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_p95 (P = 0.07). MEND2-5 did not differentially affect %BMI_p95 . Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMI_p95 during the Intensive Phase (P < 0.05). In the Transition Phase, %BMI_p95 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.

Trial registration: ClinicalTrials.gov NCT02724943.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Child
Child, Preschool
Community Networks / organization & administration*
Female
Humans
Male
Pediatric Obesity / therapy*
Primary Health Care / organization & administration*

Associated data

ClinicalTrials.gov/NCT02724943

Grants and funding

U18 DP003367/DP/NCCDPHP CDC HHS/United States