Management of child and adolescent obesity
The ACAORN management stream has a particular interest in developing research methods that would allow some important child and adolescent weight management research questions to be answered. These include:
- What are the elements of a simple, effective and low cost weight management program for children and adolescents?
- What is the minimum intervention required for effective weight management program for children and adolescents?
- How do we define effective weight management?
- What are the primary and secondary outcome measures that can be used to define this success?
- What is the optimal dietary prescription the various components of lifestyle change for weight management in children and adolescents?
- What is optimal frequency of management attendance and optimal length of management attendance in childhood and adolescent obesity?
- What is the effect of weight management on obesity co-morbidities?
- What is the role of very low energy diets, pharmacotherapy and bariatric surgery in childhood and adolescent obesity?
Focus has been on Australia and NZ trials but international collaborations are also promoted
Australasian trials regarding treatment and management of child and adolescent obesity
- Metformin treatment of obesity and insulin resistance
- Community-based weight management of overweight and obese adolescents: The Loozit trial
- The LEAP (Live, Eat & Play) Study
- Parenting, eating, activity for child health: PEACH
- The "Eat Smart" study
- Wollongong Sport
- An intervention to reduce sedentary behaviour, promote physical activity and improve children's health
Formal study name: Insulin resistance and obesity in adolescents - effects of therapeutic intervention with metformin RCT registry and number: ISRCTN; 43267711
Randomised controlled trial of metformin versus placebo for the treatment of insulin resistance and obesity in 9-18 year olds. The effects of metformin treatment on insulin sensitivity, body composition and other metabolic markers were assessed. The main outcomes were published in J Clin Endocr Metab 2006 Jun; 91(6): 2074-80.
Dr Shubha Srinivasan
Formal study name: KOALA at Mater Healthy Lifestyle Program: detection and prevention of cardiovascular and metabolic complications of child obesity RCT registry and number: CTRI; Registration in process. Web link: http://koala.imb.uq.edu.au
Holistic behavioural (Triple P Program)and physical activity family- and community-based (partnership with Scouts QLD) program to ameliorate child obesity linking basic, clinical and applied researchers in a clinical research and community network to support families in the study.
Gary M. Leong
Formal study name: Community-based weight management of overweight and obese adolescents: a randomised controlled trial of extended therapeutic contact vs. recommended care. RCT registry and number: ANZCTR; 12606000175572 Web link: http://www.chw.edu.au/kids/loozit
The aim of the Loozit RCT is to determine the effect of additional therapeutic contact over a 2 year period on a community-based weight management group program for overweight and obese adolescents aged 13-16 years. The additional therapeutic contact, via phone coaching, e-mail and SMS messages, is designed to give the adolescents extra support and guidance to empower them to make and maintain healthy lifestyle changes.
Formal study name: Randomised controlled trial of a brief GP intervention to reduce overweight in Victorian primary school children. RCT registry and number: ISRCTN; 52511065 Web link: http://www.rch.org.au/ccch/research.cfm?doc_id=10643
Preventing childhood obesity is an important goal - but many thousands of Australian children are already overweight or obese. What role can family doctors play in managing childhood obesity? LEAP addressed this question in a large randomised trial. Family doctors learned new techniques that aimed to help overweight Victorian children aged 5 to 10 years old develop healthier lifestyles and weight. Results are due by 2009.
Formal study name: Parent-led family-focused treatment program for overweight 5-9 year olds: the PEACHTM RCT. RCT registry and number: ANZCTR; 00001104
The aim of this study was to compare the effectiveness in moderately obese prepubertal children of two 6-month treatment interventions delivered to parents only: parenting skills training plus healthy lifestyle education versus healthy lifestyle education alone.
Formal study name: Shared Care Overweight Trial in Children RCT registry and number: ANZCTN; 12608000055303 Web link: http://www.rch.org.au/ccch/hopscotch
Most of the 200,000 overweight or obese children in Australia aren't currently receiving any care for their obesity. This could change dramatically if general practitioners were supported to work effectively with specialist services. HopSCOTCH is a randomised trial of a shared-care approach to managing obesity in 3 to 9 year olds. GPs will share care with a specialist multidisciplinary team, supported by state-of-the-art shared software. 12 month outcomes include healthier growth patterns and an economic evaluation.
Formal study name: A randomised controlled trial of a reduced carbohydrate diet versus a low fat diet for the treatment of childhood obesity: The Eat Smart Study. RCT registry and number: ISRCTN; 49438757; http://www.controlled-trials.com/ISRCTN49438757 Web link: http://www2.som.uq.edu.au/som/Research/ResearchCentres/cnrc/Pages/Obesity.aspx
This study is a 12 month study examining the relative efficacy of a low fat versus a reduced carbohydrate diet on body composition change in a randomised controlled trial. It incorporates a novel psychological preparedness phase, using a group based approach, to equipe adolescents with skills so they can engage in lifestyle change.
Formal study name: Dietary intervention for adolescents with prediabetes RCT registry and number: ANZCTR; ACTRN12608000416392
A 12 month randomised control trial investigating the effects of dietary protein on insulin sensitivity in overweight adolescents with clinical insulin resistance and/or pre-diabetes. The study includes dietary intervention, a gym based exercise program and treatment with metformin (at no cost to participants). The study is multicentred and includes the Children’s Hospital at Westmead, RPAH and Campbelltown Hospital
Along with the rise in prevalence of overweight and obesity there has been a significant increase in the number of adolescents with clinical signs of insulin resistance and/or prediabetes. The aim of this study is to determine the efficacy of two different dietary interventions (a moderate protein diet and a high carbohydrate diet) on insulin sensitivity, in adolescents with clinical insulin resistance and/or prediabetes. This trial will provide definitive data on the effective management of clinical insulin resistance and prediabetes in this age group.
Formal study name: Hunter and Illawarra Kids Challenge Using Parental Support (HIKCUPS) RCT registry and number: National Centre for Clinical Trials. 00107692
HICKUPS is a community-based randomised controlled trial that aims to evaluate and compare in overweight children the effectiveness of the following interventions: 1) a child-centred physical activity skill development program; 2) a parent-centred dietary modification program; and 3) a combination of 1 and 2. The following outcomes are being measured at baseline, 6-, 12-, and 24-months: adiposity, metabolic profile, physical activity, sedentariness, food habits and eating behaviours, movement skills, self-esteem, quality of life and an activity of daily living. Overwhelming, parents have enjoyed the program and found it helpful.
Formal study name: Wollongong Sport RCT registry and number: Feasibility trial - the RCT will be registered in 2009.
Based on the successful Stanford Sport program in the US, the aim of this project is to prevent unhealthy weight gain, increase cardio-respiratory fitness, objectively measured physical activity, perceived competence (self-esteem) and health-related quality of life among overweight or at-risk-of-overweight girls ages 8-to 11-years.
Formal study name: Western Sydney Adolescent Sport and Physical Activity Program (WASPA) RCT registry and number: ACTRN 12609000134224
In 2006, we successfully conducted a feasibility trial of the WASPA program among 16 overweight and obese adolescents. The aim of this proposed project is to build on the promising results from our feasibility trial and conduct a pilot randomised controlled trial to determine the feasibility, acceptability, and potential efficacy of the WASPA program in preventing unhealthy weight gain among overweight and obese adolescents. 40 adolescents from neighbourhoods with a high proportion of families from non-English-speaking backgrounds will be recruited and randomly allocated to either the WASPA program or an active control intervention. The main outcome measures will be adiposity, cardio respiratory fitness, physical activity, eating behaviours, quality-of-life, and implementation and process measures.
An intervention to reduce sedentary behaviour, promote physical activity and improve children's health
Formal study name: An intervention to reduce sedentary behaviour, promote physical activity and improve children's health RCT registry and number: in process of registration
Sedentary behaviours and physical inactivity play a major role in the rising prevalence of obesity among children in Australia. This intervention study will take place in the school and family settings which play a critical role in shaping children's health behaviours. The objective is to determine whether a 2-year behavioural intervention reduces sedentary behaviour and promotes physical activity and results in improved health among 8-9 year old children.
Transform us! | Abstract
Management of child and adolescent obesity - Stream publications
- Taylor R, Robinson A, Espinel PT, Baur LA, Wake M, Sabin MA. Research priorities in 2012 for the effective management of childhood obesity. J Clinical Obesity 2013; 3:3-6. Abstract.
- Baur LA, Wake M, Espinel PT. Audit of Australian childhood obesity research funding 2005-9: National research priority in name but not numbers. J Paediatr Ch Health 2010; 46:696–701. Article
- Spilchak P, Denney-Wilson E, King L, Baur LA. Tertiary paediatric obesity services in Australia. J Paediatr Ch Health 2008; 44:237-313. Abstract.
- Warren JM, Golley RK, Collins CE, Okely AD, Jones RA, Morgan PJ, Perry RA, Baur LA, Steele JR, Magarey AM. Randomised controlled trials in overweight children: practicalities and realities. Int J Pediatr Obesity 2007; 2:73-85. Abstract.
- Steinbeck KS, Baur LA, Morris AM, Ghersi D. A proposed protocol for the development of a register of trials of weight management of childhood overweight and obesity. Int J Obesity 2006; 30:2-5. Abstract.