Dyad Plus Effectiveness

Weight Loss Clinical Trial

Official title:

Effectiveness of A Coordinated Parent/Child Dyad Weight Loss Intervention:

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04036331
• Other study ID #: IRB00059569
• Status: Recruiting
• Phase: N/A
• Start date: July 30, 2021
• Est. completion date: June 2024

Study information

• Verified date: March 2024
• Source: Wake Forest University Health Sciences
• Contact: Camelia R Singletary, MPH
• Phone: 13369992469
• Email: crsingle[@]wakehealth.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this research is to determine the effectiveness of a coordinated program (Dyad Plus) that would help to facilitate self-monitoring, positive communication, joint problem solving, and social support to increase physical activity, healthy eating, and weight loss. Participants of the Brenner FIT (Families In Training) pediatric weight management program and their parent/guardian will co-enroll in weight loss programs. Parents/guardians will receive the components of By Design Essentials.

Description:

Brenner FIT is a family-based pediatric weight management clinic for youth 2-18 years old referred by a physician for overweight or obesity. By Design is an adult (>18yrs) weight loss clinic that includes tailored dietary and physical activity behavioral counseling. The preliminary data suggest that most adolescent youth who enroll in Brenner FIT have at least one adult caregiver who is eligible and would benefit from enrollment in By Design Essentials. Participants will be randomized into 1 of 3 groups. This include Brenner FIT standard care, Brenner FIT standard care+ By Design Essentials, or Dyad Plus. Brenner FIT Standard: After referral, families attend an orientation, in which they are then scheduled for an initial introductory 2-hour intake group session and cooking class; these occur within 2-4 weeks of the orientation. Monthly 1-hour long visits with the dietitian, counselor, and physical activity specialist are held for 6 months, in which the child and caregiver see the pediatrician. During the 6 months of treatment, they attend 4 group classes, choosing from topics such as meal planning, physical activity, and parenting. Specialized visits with the physical activity specialist or dietician are scheduled as pertinent issues arise. Clinic visits include individualized goal setting (for behaviors family/clinician have agreed to address), healthy eating and physical activity education, and behavioral counseling to implement changes at home. By Design Essentials: A dietitian provides each participant with a detailed program manual that describes the prescribed diet. The dietitian utilizes standard behavioral techniques to promote lifestyle behavior changes that enable participants to implement and maintain behaviors necessary to adhere to the dietary prescription. Participants also receive a standard exercise program designed to promote exercise energy expenditure of approximately 600 kilocalories*/week. The exercise prescription includes resistance training for 2 days per week and aerobic training for 3 days per week, to meet a 600 kilocalories*/week expenditure goal. Behaviorists meet with participants to provide individual and group-based counseling to learn the skills necessary to adopt the prescribed dietary pattern and exercise plans. Group sessions will be delivered consecutively over 6 months (20 total; 1.5 hours each). Dyad Plus (combination of Brenner FIT and By Design Essentials):This will include all components of the standard Brenner FIT program and By Design Essentials. In addition, group sessions, one-on-one parent/child communication sessions, joint goal setting/tracking, and home environment assessment. Dyads will attend 6 meetings that will last approximately 1 hour each.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 90
• Est. completion date: June 2024
• Est. primary completion date: June 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 13 Years to 65 Years

Eligibility

Inclusion Criteria:

• Eligible for enrollment in Brenner FIT and/or By Design Essentials
• Caregiver who lives in the house with a BMI > 30
• No contraindication for physical activity or caloric restriction
• Must be able to read and write English

Exclusion Criteria:

• BMI < 30
• Contraindication for physical activity or caloric restriction
• Cannot read or write English

Related Conditions & MeSH terms

• Family and Household
• Overweight
• Overweight Adolescents
• Parent-Child Relations
• Pediatric Obesity
• Weight Loss

Intervention

Behavioral:
• Brenner FIT Standard
After referral, families attend an orientation, in which they are then scheduled for an initial introductory 2-hour intake group session and cooking class; these occur within 2-4 weeks of the orientation. Monthly 1-hour long visits with the dietitian, counselor, and physical activity specialist are held for 6 months, in which the child and caregiver see the pediatrician. During the 6 months of treatment, they attend 4 group classes, choosing from topics such as meal planning, physical activity, and parenting. Specialized visits with the physical activity specialist or dietician are scheduled as pertinent issues arise. Clinic visits include individualized goal setting (for behaviors family/clinician have agreed to address), healthy eating and physical activity education, and behavioral counseling to implement changes at home.
• By Design Essentials
A dietitian provides each participant with a detailed program manual that describes the prescribed diet. The dietitian utilizes standard behavioral techniques to promote lifestyle behavior changes that enable participants to implement and maintain behaviors necessary to adhere to the dietary prescription. Participants also receive a standard exercise program designed to promote exercise energy expenditure of approximately 600 kilocalories*/week. The exercise prescription includes resistance training for 2 days per week and aerobic training for 3 days per week, to meet a 600 kilocalories*/week expenditure goal. Behaviorists meet with participants to provide individual and group-based counseling to learn the skills necessary to adopt the prescribed dietary pattern and exercise plans. Group sessions will be delivered consecutively over 6 months (20 total; 1.5 hours each).
• Dyad Plus
This will include all components of the standard Brenner FIT program and By Design Essentials. In addition, group sessions, one-on-one parent/child communication sessions, joint goal setting/tracking, and home environment assessment. Dyads will attend 6 meetings that will last approximately 1 hour each.

Locations

Country	Name	City	State
United States	Wake Forest Baptist Medical Center	Winston-Salem	North Carolina

Sponsors (2)

Lead Sponsor	Collaborator
Wake Forest University Health Sciences	National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

References & Publications (37)

Abildso CG, Zizzi S, Fitzpatrick SJ. Predictors of clinically significant weight loss and participant retention in an insurance-sponsored community-based weight management program. Health Promot Pract. 2013 Jul;14(4):580-8. doi: 10.1177/1524839912462393. Epub 2012 Oct 17. — View Citation

Anderson ES, Winett RA, Wojcik JR. Self-regulation, self-efficacy, outcome expectations, and social support: social cognitive theory and nutrition behavior. Ann Behav Med. 2007 Nov-Dec;34(3):304-12. doi: 10.1007/BF02874555. — View Citation

Anderson-Bill ES, Winett RA, Wojcik JR. Social cognitive determinants of nutrition and physical activity among web-health users enrolling in an online intervention: the influence of social support, self-efficacy, outcome expectations, and self-regulation. J Med Internet Res. 2011 Mar 17;13(1):e28. doi: 10.2196/jmir.1551. — View Citation

Bailey RC, Olson J, Pepper SL, Porszasz J, Barstow TJ, Cooper DM. The level and tempo of children's physical activities: an observational study. Med Sci Sports Exerc. 1995 Jul;27(7):1033-41. doi: 10.1249/00005768-199507000-00012. — View Citation

Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007 Dec;120 Suppl 4:S164-92. doi: 10.1542/peds.2007-2329C. — View Citation

Boutelle KN, Cafri G, Crow SJ. Parent predictors of child weight change in family based behavioral obesity treatment. Obesity (Silver Spring). 2012 Jul;20(7):1539-43. doi: 10.1038/oby.2012.48. Epub 2012 Feb 23. — View Citation

Brown CL, Skelton JA. Opportunities and Cautions in the Use of Commercially Delivered Weight-Management Programs for Children and Adolescents. J Pediatr. 2017 Jun;185:12-14. doi: 10.1016/j.jpeds.2017.02.068. Epub 2017 Mar 15. No abstract available. — View Citation

Chandler JL, Beets MW, Drenowatz C, et al. Analysis of Accelerometer Counts during Sedentary Activities on Dominant and Non-Dominant Wrists in 5-11 year old Children. Under review.

Chandler JL, Brazendale K, Beets MW, Mealing BA. Classification of physical activity intensities using a wrist-worn accelerometer in 8-12-year-old children. Pediatr Obes. 2016 Apr;11(2):120-7. doi: 10.1111/ijpo.12033. Epub 2015 Apr 20. — View Citation

Compas BE, Davis GE, Forsythe CJ, Wagner BM. Assessment of major and daily stressful events during adolescence: the Adolescent Perceived Events Scale. J Consult Clin Psychol. 1987 Aug;55(4):534-541. doi: 10.1037/0022-006X.55.4.534. No abstract available. — View Citation

Devakumar D, Grijalva-Eternod C, Cortina-Borja M, Williams J, Fewtrell M, Wells J. Disentangling the associations between parental BMI and offspring body composition using the four-component model. Am J Hum Biol. 2016 Jul;28(4):524-33. doi: 10.1002/ajhb.22825. Epub 2016 Feb 5. — View Citation

Djafarian K, Speakman JR, Stewart J, Jackson DM. Comparison of activity levels measured by a wrist worn accelerometer and direct observation in young children. Open Journal of Pediatrics. 2013;03(04):422-427.

Eys M, Loughead T, Bray SR, Carron AV. Development of a cohesion questionnaire for youth: the Youth Sport Environment Questionnaire. J Sport Exerc Psychol. 2009 Jun;31(3):390-408. doi: 10.1123/jsep.31.3.390. — View Citation

Golan M. Fifteen years of the Family Eating and Activity Habits Questionnaire (FEAHQ): an update and review. Pediatr Obes. 2014 Apr;9(2):92-101. doi: 10.1111/j.2047-6310.2013.00144.x. Epub 2013 Feb 28. — View Citation

Haines J, Rifas-Shiman SL, Horton NJ, Kleinman K, Bauer KW, Davison KK, Walton K, Austin SB, Field AE, Gillman MW. Family functioning and quality of parent-adolescent relationship: cross-sectional associations with adolescent weight-related behaviors and weight status. Int J Behav Nutr Phys Act. 2016 Jun 14;13:68. doi: 10.1186/s12966-016-0393-7. — View Citation

Irby MB, Boles KA, Jordan C, Skelton JA. TeleFIT: adapting a multidisciplinary, tertiary-care pediatric obesity clinic to rural populations. Telemed J E Health. 2012 Apr;18(3):247-9. doi: 10.1089/tmj.2011.0117. Epub 2012 Feb 22. — View Citation

Irby MB, Kolbash S, Garner-Edwards D, Skelton JA. Pediatric Obesity Treatment in Children With Neurodevelopmental Disabilities: A Case Series and Review of the Literature. Infant Child Adolesc Nutr. 2012 Aug 1;4(4):215-221. doi: 10.1177/1941406412448527. — View Citation

Jilcott SB, Hurwitz J, Moore JB, Blake C. Qualitative perspectives on the use of traditional and nontraditional food venues among middle- and low-income women in Eastern North Carolina. Ecol Food Nutr. 2010 Sep-Oct;49(5):373-89. doi: 10.1080/03670244.2010.507438. — View Citation

Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, Paulo R, Hettinger A, Erwin PJ, Montori VM. Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab. 2008 Dec;93(12):4606-15. doi: 10.1210/jc.2006-2411. Epub 2008 Sep 9. — View Citation

Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008 Sep;32(9):1431-7. doi: 10.1038/ijo.2008.102. Epub 2008 Jul 8. — View Citation

Kirkpatrick SI, Subar AF, Douglass D, Zimmerman TP, Thompson FE, Kahle LL, George SM, Dodd KW, Potischman N. Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall. Am J Clin Nutr. 2014 Jul;100(1):233-40. doi: 10.3945/ajcn.114.083238. Epub 2014 Apr 30. — View Citation

Little RJ, Cohen ML, Dickersin K, Emerson SS, Farrar JT, Neaton JD, Shih W, Siegel JP, Stern H. The design and conduct of clinical trials to limit missing data. Stat Med. 2012 Dec 10;31(28):3433-43. doi: 10.1002/sim.5519. Epub 2012 Jul 25. — View Citation

Loveman E, Al-Khudairy L, Johnson RE, Robertson W, Colquitt JL, Mead EL, Ells LJ, Metzendorf MI, Rees K. Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years. Cochrane Database Syst Rev. 2015 Dec 21;2015(12):CD012008. doi: 10.1002/14651858.CD012008. — View Citation

Measuring Enjoyment of Physical Activity in Children: Validation of the Physical Activity Enjoyment Scale. J Appl Sport Psychol. 2009 Jan 1;21(S1):S116-S129. doi: 10.1080/10413200802593612. — View Citation

Moore JB, Hanes JC Jr, Barbeau P, Gutin B, Trevino RP, Yin Z. Validation of the Physical Activity Questionnaire for Older Children in children of different races. Pediatr Exerc Sci. 2007 Feb;19(1):6-19. doi: 10.1123/pes.19.1.6. — View Citation

Moore JB, Schneider L, Lazorick S, Shores KA, Beighle A, Jilcott SB, Newkirk J. Rationale and development of the Move More North Carolina: Recommended Standards for After-School Physical Activity. J Public Health Manag Pract. 2010 Jul-Aug;16(4):359-66. doi: 10.1097/PHH.0b013e3181ca2634. — View Citation

Motl RW, Dishman RK, Dowda M, Pate RR. Factorial validity and invariance of a self-report measure of physical activity among adolescent girls. Res Q Exerc Sport. 2004 Sep;75(3):259-71. doi: 10.1080/02701367.2004.10609159. — View Citation

Naess M, Holmen TL, Langaas M, Bjorngaard JH, Kvaloy K. Intergenerational Transmission of Overweight and Obesity from Parents to Their Adolescent Offspring - The HUNT Study. PLoS One. 2016 Nov 16;11(11):e0166585. doi: 10.1371/journal.pone.0166585. eCollection 2016. — View Citation

Nelson JD, Moore JB, Blake C, Morris SF, Kolbe MB. Characteristics of successful community partnerships to promote physical activity among young people, North Carolina, 2010-2012. Prev Chronic Dis. 2013 Dec 12;10:E208. doi: 10.5888/pcd10.130110. — View Citation

Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014 Feb 26;311(8):806-14. doi: 10.1001/jama.2014.732. — View Citation

Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014. JAMA. 2016 Jun 7;315(21):2292-9. doi: 10.1001/jama.2016.6361. — View Citation

Saint-Maurice PF, Welk GJ, Beyler NK, Bartee RT, Heelan KA. Calibration of self-report tools for physical activity research: the Physical Activity Questionnaire (PAQ). BMC Public Health. 2014 May 16;14:461. doi: 10.1186/1471-2458-14-461. — View Citation

Skelton JA, Beech BM. Attrition in paediatric weight management: a review of the literature and new directions. Obes Rev. 2011 May;12(5):e273-81. doi: 10.1111/j.1467-789X.2010.00803.x. Epub 2010 Sep 29. — View Citation

Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, Taveras EM. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics. 2007 Dec;120 Suppl 4:S254-88. doi: 10.1542/peds.2007-2329F. — View Citation

Thompson FE, Dixit-Joshi S, Potischman N, Dodd KW, Kirkpatrick SI, Kushi LH, Alexander GL, Coleman LA, Zimmerman TP, Sundaram ME, Clancy HA, Groesbeck M, Douglass D, George SM, Schap TE, Subar AF. Comparison of Interviewer-Administered and Automated Self-Administered 24-Hour Dietary Recalls in 3 Diverse Integrated Health Systems. Am J Epidemiol. 2015 Jun 15;181(12):970-8. doi: 10.1093/aje/kwu467. Epub 2015 May 10. — View Citation

Turner-McGrievy GM, Wright JA, Migneault JP, Quintiliani L, Friedman RH. The interaction between dietary and life goals: using goal systems theory to explore healthy diet and life goals. Health Psychol Behav Med. 2014 Jan 1;2(1):759-769. doi: 10.1080/21642850.2014.927737. Epub 2014 Jul 15. — View Citation

Yang L, Colditz GA. Prevalence of Overweight and Obesity in the United States, 2007-2012. JAMA Intern Med. 2015 Aug;175(8):1412-3. doi: 10.1001/jamainternmed.2015.2405. No abstract available. — View Citation

* Note: There are 37 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	BMI z-score	Weight status of caregivers and youth will be quantified through calculation of BMI derived from measurement of height and weight at the intake and follow-up visits. Both height (plus or minus 0.1 cm) and weight (plus or minus 0.5 kg) will be recorded twice and values will be averaged to produce the final value using a Tanita (registered trademark) digital scale and a Seca (registered trademark) Height Rod (respectively). BMI will be calculated as kg /m2. BMI z-score will be calculated using CDC growth charts.	Baseline
Primary	BMI z-score	Weight status of caregivers and youth will be quantified through calculation of BMI derived from measurement of height and weight at the intake and follow-up visits. Both height (plus or minus 0.1 cm) and weight (plus or minus 0.5 kg) will be recorded twice and values will be averaged to produce the final value using a Tanita (registered trademark) digital scale and a Seca (registered trademark) Height Rod (respectively). BMI will be calculated as kg /m2. BMI z-score will be calculated using CDC growth charts.	6 months
Secondary	Physical Activity Assessed by Accelerometry	Physical activity data will be collected using ActiGraph (trademark) accelerometers worn continuously over 7 days except during bathing and sleeping. Moderate to vigorous activity will be measured in minutes.	Baseline
Secondary	Physical Activity Assessed by Accelerometry	Physical activity data will be collected using ActiGraph (trademark) accelerometers worn continuously over 7 days except during bathing and sleeping. Moderate to vigorous activity will be measured in minutes.	6 months
Secondary	Physical Activity Assessed by PAQ-A	The Physical Activity Questionnaire for Adolescents (PAQ-A) will be given to assess physical activity.; The PAQ-A ranges from 1-7. Higher score denotes better outcome.	Baseline
Secondary	Physical Activity Assessed by PAQ-A	The Physical Activity Questionnaire for Adolescents (PAQ-A) will be given to assess physical activity.; The PAQ-A ranges from 1-7. Higher score denotes better outcome.	6 months
Secondary	Physical Activity Assessed by IPAQ	The International Physical Activity Questionnaire (IPAQ) will be given to assess physical activity in adults.; The IPAQ ranges from 10-960 minutes/day of physical activity. Higher score denotes better outcome.	Baseline
Secondary	Physical Activity Assessed by IPAQ	The International Physical Activity Questionnaire (IPAQ) will be given to assess physical activity in adults.; The IPAQ ranges from 10-960 minutes/day of physical activity. Higher score denotes better outcome.	6 months
Secondary	Caloric intake expressed in kcals	Diet will be assessed by the Automated Self-Administered 24-hour (ASA24) dietary assessment tool.	Baseline
Secondary	Caloric intake expressed in kcals	Diet will be assessed by the Automated Self-Administered 24-hour (ASA24) dietary assessment tool.	6 months
Secondary	Concentration of fasting glucose for all participants, mg/dL	Fasting blood glucose will be ascertained for each participant. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is optimal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.	Baseline
Secondary	Concentration of fasting glucose for all participants, mg/dL	Fasting blood glucose will be ascertained for each participant. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is optimal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.	6 months
Secondary	Concentration of fasting Insulin for all participants, mg/dL	Fasting insulin levels will be gathered from all participants.	Baseline
Secondary	Concentration of fasting Insulin for all participants, mg/dL	Fasting insulin levels will be gathered from all participants.	6 months
Secondary	Hemoglobin A1c concentration for all participants, measured in percentage	Normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4%. Values greater denote diabetes.	Baseline
Secondary	Hemoglobin A1c concentration for all participants, measured in percentage	Normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4%. Values greater denote diabetes.	6 months
Secondary	Aspartate Aminotransferase -Levels of AST for all participants, measured in units per liter (IU/L)	AST a useful test for detecting or monitoring liver damage.	Baseline
Secondary	Aspartate Aminotransferase -Levels of AST for all participants, measured in units per liter (IU/L)	AST a useful test for detecting or monitoring liver damage.	6 months
Secondary	Alanine Aminotransferase-Levels of ALT for all participants, measured in units per liter	A low level of ALT in the blood is expected and is normal.	Baseline
Secondary	Alanine Aminotransferase-Levels of ALT for all participants, measured in units per liter	A low level of ALT in the blood is expected and is normal.	6 months
Secondary	Concentration of total cholesterol (mg/dL)	total cholesterol: less than 200 mg/dL	Baseline
Secondary	Concentration of total cholesterol (mg/dL)	total cholesterol: less than 200 mg/dL	6 months
Secondary	Economic costs of the three intervention arms over duration of program (USD)	Clinical and non-clinical costs of the interventions will be compiled over the duration of the program. All cost will be reported in the same unit.	6 months