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Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis
William J Heerman1, Evan C Sommer2, Ally Qi2
1Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN, 37212-3504, USA. bill.heerman@vumc.org.
Insights
A behavioral intervention combining face-to-face sessions and maintenance calls improved body mass index z-score (BMI-Z) in preschoolers at one year. However, these positive effects on childhood obesity prevention did not last through year three.
Area of Science:
- Pediatric obesity prevention
- Behavioral intervention research
- Public health
Background:
- Current childhood obesity interventions lack guidance on attendance, duration, and delivery mode.
- Need for interventions addressing obesity prevention in young children.
- Study analyzes a one-year behavioral intervention for childhood obesity prevention, focusing on "dose delivered" and its association with BMI-Z.
Purpose of the Study:
- To analyze the association between the "dose delivered" of a behavioral intervention and body mass index z-score (BMI-Z) in preschool children.
- To evaluate the short-term and long-term impacts of intervention components (face-to-face sessions, phone calls) on BMI-Z.
- To assess the effectiveness of a childhood obesity prevention program for underserved populations.
Main Methods:
- Secondary analysis of a one-year behavioral intervention for childhood obesity prevention.
- Included parent-child pairs from low-income, English/Spanish-speaking households with children aged 3-5 years at risk for obesity.
- Used multivariable regression to test associations between delivered intervention dose and child BMI-Z at 1, 2, and 3-year follow-ups, including a "zero" dose for the control group.
Main Results:
- A higher number of face-to-face intensive sessions and maintenance calls were significantly associated with lower BMI-Z immediately post-intervention.
- The combination of >6 face-to-face sessions and >8 maintenance calls predicted the lowest BMI-Z.
- Statistically significant impacts on BMI-Z were not observed at the 2- or 3-year follow-up points.
Conclusions:
- A combination of modest face-to-face sessions and sustained maintenance calls improved BMI-Z in underserved preschoolers at one year.
- The intervention demonstrated effectiveness in childhood obesity prevention for this demographic.
- Long-term sustained impacts beyond one year were not statistically significant.
Background:
Current recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how "dose delivered" was associated with body mass index z-score (BMI-Z) across 3 years of follow-up.
Methods:
Parent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face "intensive sessions" (90 min each) and 6.75 h over the next 9 months via 9 "maintenance phone calls" (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having "zero" dose.
Results:
Among 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B = -0.011; 95% CI [- 0.021, - 0.001]; p = 0.029) and maintenance calls (B = -0.015; 95% CI [- 0.026, - 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parent-child pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2- or 3-year follow-up.
Conclusions:
In a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-to-face sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up.
Clinical Trial Registration:
The trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.
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