Family-based treatment of pediatric obesity in low-income minority youth: Strategies, outcomes, and novel predictors of success.

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  • March 22, 2019
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  • Tripicchio, Gina
    • Affiliation: Gillings School of Global Public Health, Department of Nutrition
Abstract
  • Childhood obesity remains a pressing public health issue. Low-income minority children are disproportionately affected by obesity and disparities are potentially widening in these populations. Multicomponent family-based behavioral group (FBBG) treatment programs, which use comprehensive approaches to target multiple health behaviors, currently provide the strongest evidence for childhood obesity treatment. However, low-income minority children are not adequately represented in these studies. To address this gap, the primary aim of this study was to examine the effect of Healthy Hawks (HH), a standard FBBG treatment program, in low-income minority youth 2-19 years of age who are overweight or obese. Parent-child dyads were recruited from various urban clinics to participate in a standard 12-week FBBG program targeting diet, physical activity, and related weight-change skills. Child body mass index (BMI) percent above the 95th percentile (%BMIp95) was measured as the primary outcome at baseline, post-intervention (12-week), and 1-year follow-up. Findings from this primary aim suggest that HH is effective in improving %BMIp95 at post-intervention (n=201; β=-1.29 (0.37), p<0.001), but effects are not maintained at 1-year (n=115; β=-0.51 (1.06), p=0.64). The secondary aims of this study tested two novel strategies to improve child weight outcomes: 1) Technology adjuncts (physical activity app and web-based health coaching sessions) were added subsequently alongside the standard HH program in two cohorts; 2) the Healthy Hawks Primary Plus (HHP+) program was developed and implemented by recruiting participants from a single pediatric clinic and engaging primary care providers to administer visits between post-intervention and 1-year follow-up. Three cohorts have participated in HHP+. HHP+ participants (n=34) had significantly higher retention at 1-year follow-up compared to HH (HH: 38.3%, HHP+: 73.9%, χ2 =20.59, p≤0.001) and greater child %BMIp95 reductions at 1-year (β=-3.24(1.48), p=0.03). The cohort that received both technology adjuncts had significantly greater %BMIp95 reductions at post-intervention compared to HH, which received no technology (n=18, β=-2.42 (0.83), p=0.004). This research addresses several important gaps in the existing child obesity treatment literature and provides innovative targets for improving outcomes in high-risk populations. These approaches can be used to bolster future child obesity intervention efforts in populations most in need of efficacious treatment.
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  • In Copyright
Advisor
  • Ammerman, Alice
  • Burger, Kyle
  • Truesdale, Kimberly
  • Ward, Dianne
  • Davis, Ann
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
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