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Efficacy of a Community‐ Versus Primary Care–Centered Program for Childhood Obesity: TX CORD RCT
Author(s) -
Butte Nancy F.,
Hoelscher Deanna M.,
Barlow Sarah E.,
Pont Stephen,
Durand Casey,
Vandewater Elizabeth A.,
Liu Yan,
Adolph Anne L.,
Pérez Adriana,
Wilson Theresa A.,
Gonzalez Alejandra,
Puyau Maurice R.,
Sharma Shreela V.,
ByrdWilliams Courtney,
Oluyomi Abiodun,
Huang Terry,
Finkelstein Eric A.,
Sacher Paul M.,
Kelder Steven H.
Publication year - 2017
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1002/oby.21929
Subject(s) - medicine , percentile , randomized controlled trial , childhood obesity , body mass index , obesity , attendance , pediatrics , physical therapy , demography , overweight , statistics , mathematics , economics , economic growth , sociology
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.