Background: Whilst multi-disciplinary intervention models for children and adolescents with obesity remain recommended best practice, there is a lack of long-term outcome data, especially in home-based models and programs embedded within the clinical setting. Whānau Pakari is a community-based multi-disciplinary assessment/intervention programme for child obesity, focused on reducing health inequity. Based in Taranaki, Aotearoa/New Zealand, it focusses on high-risk groups (predominantly Maori and those from high deprivation).
Objectives: To determine whether 12-month BMI SDS reduction persisted at 24 months in this randomised controlled clinical trial. Second, to determine whether secondary outcome measures showed improvement (e.g. cardiovascular fitness, sweet drink intake and health-related quality of life [HRQOL]).
Methods: This trial was embedded within a clinical 'real-world' setting, with a mixed urban-rural population. Participants (recruited 2012-2014) were aged 5-16 years, with a BMI ≥98th centile or >91st centile with weight-related co-morbidities. Participants were randomised either to a low-intensity control (6-monthly home-based assessments), or an intense intervention (6-monthly assessments and weekly sessions for 12 months). At home visits, participants underwent clinical assessments, with physical and psychological wellbeing evaluated. Primary outcome was change in BMI SDS from baseline.
Results: 203 children were randomised (47% Māori [NZ's Indigenous population], 43% NZ European), 53% female, 28% living in the most deprived quintile, mean age 10.7 years, mean BMI SDS 3.12 (range 1.52-5.34). 121 participants (60%) were assessed at 24 months (n=53 control, n=68 intervention). The BMI SDS reduction observed at 12 months from baseline was not retained at 24 months in the intention-to-treat analysis [control -0.03 (95% CI -0.14, 0.09) and intervention -0.02 (95% CI -0.12, 0.08)]. Achieving ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95% CI -0.38, -0.06). Sweet drink intake was reduced, water intake increased, and HRQOL improved in both groups, with improvements in cardiovascular fitness and behavioural difficulties in the high-intensity group.
Conclusion: In this population with high representation from Māori and those from most deprived households, the reduction of BMI SDS at 12 months did not persist at 24 months, a year after program completion. However, there were multiple improvements in health measures. Attendance was key to outcome, with high-attendance leading to a clinically meaningful and persistent reduction in BMI SDS.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology