What was the research about?
Children with obesity may develop health problems that usually affect adults, such as heart disease or high blood pressure. In Virginia’s Dan River Region, childhood obesity is about three times higher than in the rest of the state. This region has limited resources and a shortage of doctors and nurses.
In this study, the research team wanted to improve body mass index, or BMI, in children with obesity or overweight who live in this region. BMI is a measure of body fat. For children, BMI is based on age, height, weight, and sex. The team compared two programs shown to improve BMI:
- iChoose was for parents and children. Families took 12 classes about healthy eating and 48 exercise classes. Parents received 24 automated phone calls for support, and children received newsletters twice a month.
- Family Connections was for parents only. It included two classes and 10 phone calls.
The research team looked at BMI and other health outcomes for children and their parents.
What were the results?
After six months, the two programs didn’t improve children’s or parents’:
- Blood pressure
- Quality of life
- Intake of fruit, vegetables, water, or sugary drinks
- Exercise level
Who was in the study?
The study included 139 children and 128 parents. Of the children, 48 percent were White, 45 percent were Black, and 8 percent were another race. Also, 9 percent were Hispanic. The average age was 10, and 58 percent were girls. Based on BMI, 73 percent had obesity, and 27 percent had overweight.
Of the parents, 49 percent were White, 49 percent were Black, and 2 percent were another race. Also, 5 percent were Hispanic. The average age was 49, and 97 percent were women. Based on BMI, 76 percent had obesity, 17 percent had overweight, and 7 percent were in the healthy weight range.
What did the research team do?
The research team assigned families by chance to take part in one of the two programs. At the start of the study and six months later, the team measured the children’s BMI. They also collected information about parents’ weight, parents’ and children’s blood pressure, and families’ eating and exercise habits.
The research team worked with parents of children with obesity, community groups, and doctors to design and conduct the study.
What were the limits of the study?
Only 18 percent of eligible families enrolled in the study. Also, only 63 percent of iChoose families and 84 percent of Family Connections families completed the study. Results might have differed if more families joined or completed the study.
Future research could look at ways to get families to sign up for and complete programs for children with obesity or overweight.
How can people use the results?
Health professionals that serve families in areas with limited resources can use these results when considering ways to help children with obesity or overweight.
To compare the effectiveness of two family-based programs in reducing body mass index (BMI) among children with obesity or overweight
|Design||Randomized controlled trial|
|Population||128 parents and 139 children ages 5–12 with obesity or overweight and living in the Dan River Region of Virginia|
Primary: child BMI z-score, which is a measure of relative weight adjusted for child age and sex
Secondary: parent BMI; parents’ and children’s blood pressure, quality of life, fruit and vegetable consumption, water and sugary drink intake, and physical activity level
|Timeframe||6-month follow-up for primary outcome|
This randomized controlled trial compared the effectiveness of two family-based childhood obesity treatment programs in reducing BMI among families living in Virginia’s Dan River Region. This region is a medically underserved area with a high prevalence of childhood obesity, food insecurity, and physical inactivity.
Researchers randomly assigned families to one of two programs:
- iChoose is a high-intensity intervention for parents and children. The program included 12 two-hour family classes on healthy eating and physical activity, biweekly automated support calls to parents, biweekly children’s newsletters, and 48 one-hour family exercise sessions over six months. This program also included a six-month maintenance period with biweekly support calls and children’s newsletters.
- Family Connections is a low-intensity intervention for parents only. The program included two 90-minute classes and 10 support calls over six months.
The study included 139 children and 128 parents. Among children, 48% were White, 45% were Black, and 8% were another race; 9% were Hispanic. The average age of children was 10, and 58% were female. Based on BMI z-scores, 73% had obesity and 27% had overweight.
Among parents, 49% were White, 49% were Black, and 2% were another race; 5% were Hispanic. The average age was 39, and 97% were female. Based on BMI, 76% had obesity, 17% had overweight, and 7% were in the healthy weight range.
At baseline and six months later, researchers used height, weight, age, and gender to calculate children’s BMI z-scores. Researchers calculated parents’ BMI and measured parents’ and children’s blood pressure. For other secondary outcomes, parents and children completed surveys.
Using a community-based participatory research approach, the researchers worked with a group of community organizations and health professionals and a group of parents of children who had participated in a previous obesity program to design and conduct the study.
At six months, the two programs did not differ significantly in changes in BMI or any secondary outcomes.
Compared with baseline, neither program had statistically significant changes in children’s BMI or secondary outcomes at six months.
Only 18% of eligible families enrolled in the study. Also, only 63% of iChoose families and 84% of Family Connections families completed the 6-month follow-up. Problems with recruitment and completing follow-up assessments limited researchers’ ability to detect differences between the interventions.
Conclusions and Relevance
In this study, neither family-based obesity program significantly improved children’s BMI or other health outcomes among parents and children at six months.
Future Research Needs
Future research could examine how to improve recruitment and retention of families in childhood obesity programs, especially in medically underserved areas with a high prevalence of obesity.
Final Research Report
View this project's final research report.
Related Journal Citations
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers noted that the researchers highlighted improvements in study outcomes within treatment groups and touted descriptive information they considered to be clinically important. The reviewers asked the researchers to downplay these results and focus on between-groups differences that were the main aims and hypotheses of the project. The researchers clarified multiple times in the text that the between-groups outcomes were not significant and that the other results were more exploratory but maintained that they needed to report all of the results of the study, not just those related to the comparative effectiveness aim.
- The reviewers cautioned the researchers regarding their interpretation of study results, given the level of missing data for study outcomes. The researchers disagreed that conclusions could not be made since they demonstrated in sensitivity analyses that missing data had little to no impact on study results.
- One reviewer questioned whether there were any harms to study participants related to the interventions. The researchers added a section to the report on harms based on adverse event reporting, quality of life, and parents’ exit interviews.
Conflict of Interest Disclosures
Patient / Caregiver Partners
- Wanda Bredlove, Parent Advisory Team
- Tia Yancey, Parent Advisory Team
- Pamela Carter-Taylor, Parent Advisory Team
- Misty Roveta, Parent Advisory Team
- Arcelia Carnes, Parent Advisory Team
Other Stakeholder Partners
- Jamie Zoellner, University of Virginia
- Paul Estabrooks, University of Nebraska Medical Center
- Wen You, Virginia Tech
- Jennie Hill, University of Nebraska Medical Center
- Donna Brock, University of Virginia
- Bryan Price, University of Virginia
- Jason Bookheimer, Danville Parks and Recreation
- Deanna Jones, Children's Health Care Center
- Kimberly Wiles, Children's Health Care Center
Study Registration Information
^This study was affiliated with Virginia Polytechnic Institute and State University when it was initially awarded.
- Has Results