Parent report of child's health-related quality of life after a primary-care-based weight management program.

BACKGROUND: Health-related quality of life (HRQoL) has been recognized as an important target and health outcome in obesity research. The current study aimed to examine HRQoL in overweight or obese children after a 10-week primary-care-based weight management program, Parent-Led Activity and Nutrition for Healthy Living, in southern Appalachia. METHODS: Sixty-seven children (ages 5-12 years) and their caregivers were recruited from four primary care clinics, two of which were randomized to receive the intervention. Caregivers in the intervention groups received two brief motivational interviewing visits and four group sessions led by providers as well as four phone follow-ups with research staff. Caregivers completed the PedsQL and demographic questionnaires at baseline and at 3, 6, and 12 months postintervention. Child height and weight were collected to determine standardized BMI. RESULTS: Caregivers of children receiving the weight control intervention reported no statistically significant improvements in child total HRQoL, as compared to the control group, across the course of treatment (ß=0.178; 95% confidence interval, -0.681, 1.037; p=0.687). Additionally, no statistically significant improvements were found across other HRQoL domains. CONCLUSIONS: Future studies examining HRQoL outcomes in primary care may consider treatment dose as well as methodological factors, such as utilization of multiple informants and different measures, when designing studies and interpreting outcomes.

Home food environment, dietary intake, and weight among overweight and obese children in Southern Appalachia.

OBJECTIVES: This study examined the relation of multiple aspects of the home food environment to dietary intake and body weight among overweight and obese children in southern Appalachia. METHODS: The study used baseline data from a cluster-randomized controlled trial, Parent-Led Activity and Nutrition for Healthy Living, evaluating a parent-mediated approach to treating child overweight and obesity in the primary care setting in southern Appalachia. Sixty-seven children ages 5 to 11 years were recruited from four primary care clinics. Multiple linear regression was used to estimate the relation between multiple aspects of the home food environment to dietary intake (fruit and vegetable intake, fat and sweets intake), and standardized body mass index (zBMI), adjusted for baseline family characteristics (education, smoking status during the past month, BMI) and child characteristics (sex, age, Medicaid/TennCare). RESULTS: Findings showed greater parental restriction and pressure in feeding were associated with greater fruit and vegetable intake in children (ß = 0.33, ß = 0.30, respectively; both P < 0.05). The availability of chips and sweets in a child's home and parental inappropriate modeling of eating were associated with an increased risk for consumption of fats and sweets by children (ß = 0.47, ß = 0.54, respectively; both P < 0.01). Parental monitoring of the child's eating was associated with a reduced risk for fat and sweets intake (ß = -0.24; P < 0.01). Finally, parental responsibility for feeding the child was associated with lower zBMI (ß = -0.20; P < 0.05). CONCLUSIONS: The home food environment, including food availability and parenting behaviors, was associated with overweight and obese children's dietary intake and weight. This study adds to evidence suggesting that programs aimed at improving overweight and obese children's eating patterns may target both aspects of the physical home environment and parental behaviors surrounding eating.

Parent-Led Activity and Nutrition (PLAN) for healthy living: design and methods.

Child obesity has become an important public health concern, especially in rural areas. Primary care providers are well positioned to intervene with children and their parents, but encounter many barriers to addressing child overweight and obesity. This paper describes the design and methods of a cluster-randomized controlled trial to evaluate a parent-mediated approach utilizing physician's brief motivational interviewing and parent group sessions to treat child (ages 5-11 years) overweight and obesity in the primary care setting in Southern Appalachia. Specific aims of this pilot project will be 1) to establish a primary care based and parent-mediated childhood overweight intervention program in the primary care setting, 2) to explore the efficacy of this intervention in promoting healthier weight status and health behaviors of children, and 3) to examine the acceptability and feasibility of the approach among parents and primary care providers. If proven to be effective, this approach may be an exportable model to other primary care practices.