parent skills training to enhance weight loss in overweight children: evaluation of nourish

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    genfew studies have investigated the effectiveness of interventions that target parents exclusively. Moreover, the

    ch has not been adequately assessed with racially diverse families, particularly

    mains a signicant public health concern. African American and low- only with a mother and child obesity intervention. No group differences

    y interventions in thefound that, comparedintervention showed

    Eating Behaviors 15 (2014) 225229

    Contents lists available at ScienceDirect

    Eating Be(Adkins, Sherwood, Story, & Davis, 2004; Fisher, Mitchell, Smiciklas-Wright, & Birch, 2002).

    Few parent-exclusive interventions have been empirically evalua-

    greater BMI decreases. Parent satisfaction and adherence were alsohigher in the parent-only condition. A similar study (Boutelle, Cafri, &Crow, 2011) found that parent-only and parent and child conditionsand avoid making the overweight child the identied patient, a situa-tion which could reduce self-esteem and increase disordered eating(Golan & Crow, 2004). Moreover, parents purchase children's food, con-trol mealtime routines, and role-model eating and activity behaviors

    dren in the United States.Preliminary outcomes of parent-only obesit

    United States are promising. Janicke et al. (2008)with a control group, children in a parent-onlyincome children are at high risk of obesity (Ogden, Lamb, Carroll, &Flegal, 2010; Rossen & Schoendorf, 2012). Interventions must addressbarriers to healthy eating and exercise that disproportionally affectthese groups.

    One approach to enhancing pediatric obesity interventions involvestargeting parents exclusively (Janicke et al., 2008). Parent-only inter-ventions are less costly than family approaches (Janicke et al., 2009),

    emerged with respect to children's weight; both groups reduced theirBMI. Trials conducted in Australia (Golley, Magarey, Baur, Steinbeck, &Daniels, 2007; Shelton et al., 2007; West, Sanders, Cleghorn, & Davies,2010) and the Netherlands (Jansen, Mulkens, & Jansen, 2011) yieldedsimilar results. Although these ndings support the utility of a parent-only approach to childhood obesity treatment, it is unclear whetherthey would generalize to racially and socio-economically diverse chil-ted, and most studies have been conducted in

    Corresponding author at: Virginia Commonwealth UnP.O. Box 842018, Richmond, VA 23284-2018, United State

    E-mail address: (S.E. Mazzeo).

    1471-0153/$ see front matter 2014 Elsevier Ltd. All ri, & Flegal, 2010) re-tervention experienced greaterweight reductions than those in standardtreatment. In a Swiss study, Munsch et al. (2008) compared a mother-Pediatric obesity (Ogden, Carroll, Curtin, L1. IntroductionKeywords:Pediatric obesityOverweightAfrican AmericanParentingIntervention

    Families (N= 84; 61% AA, 37%White) were randomly assigned to NOURISH or a control group.Results:NOURISH families signicantly improvedon child BMI frompre- to post-testing after adjustment for randomeffects, baseline BMI, and child race. NOURISH parents were very satised with the intervention and would recom-mend it to other parents; 91% strongly or moderately agreed that NOURISH helped them eat in a healthier manner.Conclusions: These pilot data suggest that NOURISH is acceptable and, with renement, offers promise for reducingpediatric BMI. Outcomes, lessons learned, and parent feedback will inform a larger randomized controlled trial.

    2014 Elsevier Ltd. All rights reserved.

    Crow (2004) found that Israeli children of caregivers in a parent-only in-a culturally-sensitive parenting intervention targeting overweight (AA) children (ages 611; MBMI = 98.0%ile).Available online 03 February 2014 Methods: NOURISH (Nourishing Our Understanding of Role modeling to Improve Support and Health) isAccepted 22 January 2014 African Americans(AA), a group at high risk for elevated Body Mass Index (BMI).Received in revised form 12 December 2013 effectiveness of this approaParent skills training to enhance weight loEvaluation of NOURISH

    Suzanne E. Mazzeo a,, Nichole R. Kelly b, Marilyn SterLaura M. Thornton c, Ronald K. Evans d, Cynthia M. Bula Department of Pediatrics and Psychology, Virginia Commonwealth University, Richmond, VAb Department of Psychology, Virginia Commonwealth University, Richmond, VA, United Statesc Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, Nd Department of Health and Human Performance, Virginia Commonwealth University, Richmo

    a b s t r a c ta r t i c l e i n f o

    Article history:Received 25 September 2013

    Objective: Although there isternationally. Golan and

    iversity, 806 West Franklin St.,s. Tel.: +1 804 827 1708.

    ghts overweight children:

    , Rachel W. Gow b, Elizabeth W. Cotter b,c

    ted States

    599, United StatesA, United States

    eral agreement that parents should be involved in pediatric obesity treatment,

    haviorsyielded similar weight loss and activity outcomes. However, attritionwas higher in the parent-only condition.

    Thus, results of a relatively small number of studies (Boutelle et al.,2011; Golan & Crow, 2004; Janicke et al., 2008) support the feasibilityand effectiveness of a parent-only approach to childhood obesity treat-ment. Most trials included moderately afuent (Boutelle et al., 2011)

  • and ethnically homogeneous samples (Golan & Crow, 2004; Janickeet al., 2007). Research is needed to determine whether results general-ize to low income racially diverse children in the urban United States.Thus, this study evaluated the feasibility, acceptability, and preliminaryeffectiveness of NOURISH (Nourishing Our Understanding of Rolemodeling to Improve Support and Health), a culturally-sensitive,parent-only group pediatric obesity intervention.

    2. Methods

    2.1. Procedure

    To qualify for participation, caregivers had to be at least 18 years oldand have a child (ages 611) with BMI the 85th%ile who primarily

    resided with them. Participants also had to speak English, be able to un-derstand basic instructions, and perform simple exercises. NOURISHand the control group are described in detail elsewhere (Mazzeo et al.,2012). A modication was made to NOURISH implementation afterthe rst two waves of data collection. Parents in these waves reportedthat, although they enjoyed NOURISH, they felt the number of sessions(which was initially 12) should be reduced. To maximize parents' satis-factionwhilemaintaining intervention integrity, the number of sessionswas reduced to six. All topics remained covered by extending the lengthof each session.

    The control group involved one, in-person group session focused onnutrition, exercise, and pediatric obesity. Subsequently, control partici-pants received three mailings of publicly available information onpediatric obesity.

    Assessed for eligibility (n=235 families)

    Excluded (n=151 families) Not meeting inclusion criteria (n=64 families) Declined to participate (n=13 families) Failed to attend orientation (n=74 families)

    Lost to follow-up at post-testing: (n= 15 parents/caregivers, 18 children)*does not include official withdrawal familyParent/Caregiver Reasons: work conflicts (4), phone number disconnected (1), family illness/death (1), failure to return repeated attempts to contact (7), lack of family support (1), no reason given (1)

    Lost to follow-up at 6 months: (n= 30 parents/caregivers, 35children) *does not include official withdrawal familyParent/Caregiver Reasons: work conflicts (3), phone number disconnected (1), family illness/death (2), failure to return repeated attempts to contact (21), lack of family support (1), moved out of country (1), sought out more child-focused services (1), no reason provided (1)

    Discontinued intervention (n=2 families; 2

    Assigned to intervention (n=44 families; 44 parents/caregivers, 48 children) Attended >50% of sessions (n=22 parents/caregivers) Attended

  • 227S.E. Mazzeo et al. / Eating Behaviors 15 (2014) 2252292.2. Participants

    Data were collected at baseline, post-intervention, and 6-monthfollow-up (see Fig. 1). Families were recruited via yers distributed inlocal schools, recreation centers, and pediatric specialists' practices. Eli-gibility was assessed via a phone screen prior to baseline assessment.Approximately 235 caregivers expressed interest in participating.About one third were ineligible, most commonly because child BMIwas below the 85th%ile. Eligible families were invited to an orientation;at this session, consent and assentwere obtained and baselinemeasurescompleted.

    Eighty-four families completed baseline: 91 children (Mage = 8.6 1.5 years) and 90 caregivers (Mage=39.97.4 years). Most participantswere female (85.6% of caregivers; 67.0% of children). The average BMI%ilefor children was 98.0 2.7); mean caregiver BMI was 34.2 9.3 kg/m2.

    The majority of families identied as African American (60.7%),followed by White (36.9%), Hispanic/Latino/a (1.2%) and multiracial(1.2%); 41.7% reported an annual incomeof less than $35,000. Educationalattainment among caregivers varied, the greatest percentage reported ahigh school diploma or more (79.1%); 47.2% of adults were married,34.8% were single, 12.4% were divorced, and 5.6% were separated.

    Overall, 61.9% (n= 52) of enrolled families completed post-testing.Likelihood of post-test completionwas not dependent onwhether care-givers completed the six- or 12-session group (2 = 2.84; p b .10);32.1% (n= 27) of enrolled families completed 6-month follow-up, butparticipating in the six-session compared with the 12-session groupwas not associated with follow-up completion (2 = 0.04; p b .84).F