Efficacy of a community- versus Primary care–centered Program for childhood obesity: TX CORD RCT

Authors: BUTTE, NANCY - Children'S Nutrition Research Center (CNRC); HOELSCHER, DEANNA - University Of Texas Health Science Center; BARLOW, SARAH - University Of Texas Southwestern Medical Center; PONT, STEPHEN - University Of Texas At Austin; DURAND, CASEY - City University Of New York; VANDEWATER, ELIZABETH - University Of Texas Health Science Center; LIU, YAN - Children'S Nutrition Research Center (CNRC); ADOLPH, ANNE - Children'S Nutrition Research Center (CNRC); PEREZ, ADRIANA - University Of Texas Health Science Center; WILSON, THERESA - Children'S Nutrition Research Center (CNRC); GONZALEZ, ALEJANDRA - University Of Texas Health Science Center; PUYAU, MAURICE - Children'S Nutrition Research Center (CNRC); SHARMA, SHREELA - University Of Texas Health Science Center; BYRD-WILLIAMS, COURTNEY - University Of Texas Health Science Center; OLUYOMI, ABIODUN - University Of Texas Health Science Center; HUANG, TERRY - City University Of New York; FINKELSTEIN, ERIC - Duke University; SACHER, PAUL - London University; KELDER, STEVEN - University Of Texas Health Science Center

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/6/2017
Publication Date: 7/13/2017
Citation: Butte, N.F., Hoelscher, D.M., Barlow, S.E., Pont, S., Durand, C., Vandewater, E.A., Liu, Y., Adolph, A.L., Perez, A., Wilson, T.A., Gonzalez, A., Puyau, M.R., Sharma, S.V., Byrd-Williams, C., Oluyomi, A., Huang, T., Finkelstein, E.A., Sacher, P.M., Kelder, S.H. 2017. Efficacy of a community-versus primary care–centered Program for childhood obesity: TX CORD RCT. Obesity. 25(9):1584-1596. http://doi.org/10.1002/oby.21929.
DOI: https://doi.org/10.1002/oby.21929

Interpretive Summary: Efficacious weight management programs are needed to reach underserved, minority children who have the highest rates of childhood obesity in the United States. Few interventions have included low-income or minority children or addressed socioeconomic status, neighborhood safety and sociocultural values affecting access to such programs. In this randomized controlled trial targeting 549 low-income, predominately Black and Hispanic children, a 12-month community-centered program was found to be more efficacious than a health care-centered program. The comprehensive weight management program (MEND/CATCH6-12) reduced body mass index at 3 months to a greater extent than the primary care-centered program (Next Steps) in children, aged 6 to 8 years. A borderline effect on body mass index was observed among children aged 9 to 12 years and no effect in preschool-aged children. Efficacy of MEND/CATCH6-12 was demonstrated for improvement in body mass index at 3 months, but not 12 months, relative to Next Steps in low-income, predominately Hispanic and Black children. Efficacy was affected by program attendance, emphasizing the need for research on sustaining family engagement in low-income populations to achieve long-term improvement in child obesity.

Technical Abstract: This randomized controlled trial was conducted to determine comparative efficacy of a 12month 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. 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 [%BMIp95]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase). For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMIp95 than Next Steps during the Intensive Phase. Effect size (95% CI) was 21.94 (23.88, 20.01) percentage points (P5 0.05). For age group 9-12, effect size was 21.38 (22.87, 0.16) percentage points for %BMIp95 (P5 0.07). MEND2-5 did not differentially affect %BMIp95. Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMIp95 during the Intensive Phase (P<0.05). In the Transition Phase, %BMIp95 was maintained or rebounded in both programs (P<0.05). 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.