Oral Presentation ANZOS-OSSANZ-AOCO Joint Annual Scientific Meeting 2017

A novel home-based intervention for child and adolescent obesity: the 12 month outcomes of Whānau Pakari randomised controlled trial.   (#180)

Yvonne C Anderson 1 2 , Lisa E Wynter 1 , Cameron C Grant 3 , Tami L Cave 1 4 , Jose G B Derraik 4 , Wayne S Cutfield 2 , Paul L Hofman 2
  1. Taranaki Base Hospital, New Plymouth, New Zealand
  2. Paediatric Endocrinology, Liggins Institute, the University of Auckland, Auckland, New Zealand
  3. Department of Paediatrics, The University of Auckland, Auckland, New Zealand
  4. Liggins Institute, The University of Auckland, Auckland, New Zealand

Introduction:

Childhood obesity is a problem requiring innovative solutions. In New Zealand (NZ), Māori, Pacific people, and those living in most deprived households are over-represented in obesity statistics. We report 12-month post-treatment outcomes from ‘Whānau Pakari’, a multi-disciplinary child obesity intervention programme targeting high-risk groups (predominantly Māori and those from deprivation in this region).

Methods:

This was an unblinded randomised controlled clinical trial. Participants (recruited January 2012-August 2014) were aged 5-16-years, resided in Taranaki, NZ, with a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related co-morbidities. Participants were randomised by minimisation (using age and ethnicity) either to intense intervention (12-month multi-disciplinary programme with weekly multi-disciplinary group sessions) or a lower intensity control arm with 6-monthly home-based assessments. At ‘demedicalised’ home visits, participants underwent clinical assessments, with physical and psychological wellbeing evaluated. The primary outcome was change in BMI standard deviation score (SDS) 12-months from baseline.

Results:

203 children were randomised (47% Māori, 43% NZ European [NZE]), 53% female, 28% living in the most deprived quintile of households, mean age 10.7 years, mean BMI SDS 3.12 (range 1.52-5.34). There were no differences in primary or secondary outcomes between intense intervention and lower intensity control. Participants in both groups displayed a reduction in BMI SDS at 12 months from baseline (-0.12 control and -0.10 intervention). For those attending ≥70% of intense intervention sessions, change in BMI SDS was -0.22 compared with -0.04 for those attending <70% (p=0.04), with NZE more likely to attend (p<0.0001).

Conclusion:

In this home-based obesity programme, where almost half of those recruited were Māori, BMI SDS was reduced irrespective of intervention intensity. With high adherence to the intense intervention, substantially improved outcomes are seen. Future obesity programmes need to be accessible and appropriate for high-risk groups, and focus on ways to improve adherence.