Reducing paediatric overweight and obesity through motivational interviewing: study protocol for a randomised controlled trial in the AAP PROS research network

Margaret E Wright; Emerson Delacroix; Kendrin R Sonneville; Shannon Considine; Tim Proctor; Jennifer Steffes; Donna Harris; Laura P Shone; Heide Woo; Roger Vaughan; Robert W Grundmeier; Alexander G Fiks; Melissa S Stockwell; Ken Resnicow

doi:10.1136/bmjopen-2019-035720

Reducing paediatric overweight and obesity through motivational interviewing: study protocol for a randomised controlled trial in the AAP PROS research network

BMJ Open. 2020 Jul 28;10(7):e035720. doi: 10.1136/bmjopen-2019-035720.

Authors

Margaret E Wright^{1

2}, Emerson Delacroix³, Kendrin R Sonneville³, Shannon Considine³, Tim Proctor⁴, Jennifer Steffes^{5

2}, Donna Harris^{5

2}, Laura P Shone^{5

2}, Heide Woo⁶, Roger Vaughan⁷, Robert W Grundmeier⁸, Alexander G Fiks^{2

8}, Melissa S Stockwell^{2

9}, Ken Resnicow³

Affiliations

¹ Primary Care Research, American Academy of Pediatrics, Itasca, Illinois, USA mewright@uic.edu.
² Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois, USA.
³ School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Physician's Computer Company, Winooski, Vermont, USA.
⁵ Primary Care Research, American Academy of Pediatrics, Itasca, Illinois, USA.
⁶ Department of Paediatrics, University of California Los Angeles, Los Angeles, California, USA.
⁷ Department of Hospital Biostatistics, The Rockefeller University, New york City, New york, USA.
⁸ Department of Paediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁹ Departments of Pediatrics and Population and Family Health, Columbia University Irving Medical Center, New york City, New york, USA.

Abstract

Introduction: Primary care remains an underused venue for prevention and management of paediatric overweight and obesity. A prior trial demonstrated a significant impact of paediatrician/nurse practitioner (Ped/NP)-and registered dietitian (RD)-delivered motivational interviewing (MI) on child body mass index (BMI). The study described here will test the effectiveness of an enhanced version of this primary care-based MI counselling intervention on child BMI.

Methods and analysis: This cluster randomised effectiveness trial includes 24 Ped/NPs from 18 paediatric primary care practices that belong to the American Academy of Pediatrics (AAP) national Pediatric Research in Office Settings (PROS) practice-based research network. To date, practices have been randomised (nine to intervention and nine to usual care). Intervention Ped/NPs have been trained in MI, behavioural therapy, billing/coding for weight management and study procedures. Usual care Ped/NPs received training in billing/coding and study procedures only. Children 3- 11 years old with BMI >the 85th percentile were identified via electronic health records (EHRs). Parents from intervention practices have been recruited and enrolled. Over about 2 years, these parents are offered approximately 10 MI-based counselling sessions (about four in person sessions with their child's Ped/NP and up to six telephonic sessions with a trained RD). The primary outcome is change in child BMI (defined as per cent from median BMI for age and sex) over the study period. The primary comparison is between eligible children in intervention practices whose parents enrol in the study and all eligible children in usual care practices. Data sources will include EHRs, billing records, surveys and counselling call notes.

Ethics and dissemination: Institutional Review Board approval was obtained from the AAP. All Ped/NPs provided written informed consent, and intervention group parents provided consent and Health Insurance Portability and Accountability Act (HIPAA) authorisation. Findings will be disseminated through peer-reviewed publications, conference presentations and appropriate AAP channels.

Trial registration number: NCT03177148; Pre-results.

Keywords: nutrition & dietetics; paediatrics; primary care; public health.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Body Mass Index
Child
Child, Preschool
Clinical Protocols*
Female
Humans
Male
Motivational Interviewing / methods
Motivational Interviewing / standards*
Obesity / psychology
Obesity / therapy*
Overweight / psychology
Overweight / therapy*
Pediatrics / methods
Primary Health Care / methods

Associated data

ClinicalTrials.gov/NCT03177148

Grants and funding

R01 HL128231/HL/NHLBI NIH HHS/United States