Date of Award

5-2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nutritional Sciences

Major Professor

Hollie A. Raynor

Committee Members

Betsy Haughton, Paul Erwin, Heidi Stolz

Abstract

Background: In 2007 an Expert Committee published recommendations using a staged approach for the treatment of childhood obesity in the primary care setting. Limited research has evaluated the efficacy of these recommendations. Thus, the primary aim of this study was to test the efficacy of Prevention Plus for the treatment of childhood overweight and obesity in a primary care setting. Cost is a major barrier to translation of research into practice thus, program cost-effectiveness was also evaluated. Methods: Twenty-two children (8.0 ± [plus-minus] 1.8 years; 2.34 ± 0.48 z-BMI; 68.2% female, 72.7% White, 90.9% non-Hispanic) were randomized to one of three 6-month conditions: 1) newsletter (N); 2) newsletter and growth monitoring (N+GM); 3) newsletter and growth monitoring plus family-based behavior counseling (N+GM+BC). Primary outcomes, z-BMI and program cost-effectiveness, and secondary outcomes, dietary intake and leisure-time behaviors were assessed at 0 and 6 months. Parenting factors were also explored. Outcomes were analyzed using linear mixed models, repeated measure analysis of variance (ANOVAs) and one way ANOVAs using the intent-to-treat principle. Results: There was a significant (p<0.05) main effect of time for z-BMI (Δ [change] N+GM+BC: -0.16 ± 0.22, ΔN+GM: -0.08 ± 0.15, ΔN: -0.06 ± 0.24). Cost-effectiveness was significantly (p<0.001) different between conditions. While there was a greater decrease in z-BMI in the N+GM+BC condition, it was the most expensive condition due to high personnel cost. The N condition had the smallest decrease of z-BMI, but it was the least costly condition due to low personnel costs, so was the most cost-effective. There was a significant (p < 0.05) main effect of time for servings of sugar-sweetened beverages with consumption decreasing over time from 0-months (ΔN+GM+BC: -0.30 ± 1.39 servings/day, ΔN+GM: -0.70 ± 0.50 servings/day, ΔN: -0.83 ± 1.15 servings/day) to 6-months (N: 1.6 ± 1.7 servings/day, N+GM: 0.7 ± 0.6 servings/day, N+GM+BC: 0.8 ± 1.3 servings/day). Fruit and vegetable intake, percent time in moderate- to vigorous-physical activity and hours of television did not significantly change. Parent factors did not differentially change between conditions. Conclusion: N+GM+BC promoted the greatest change in z-BMI, but personnel costs should be considered during implementation.

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