Recipient Organization
OHIO STATE UNIVERSITY
1680 MADISON AVENUE
WOOSTER,OH 44691
Performing Department
College of Human Ecology
Non Technical Summary
Parental obesity is the strongest risk factor for the development of obesity in children. As the majority of US children are living with a parent who is overweight/obese and are likely pursing weight loss, the effects of parental weight loss and weight management programs (WMP) on children needs to be determined to inform effective family-based interventions to prevent obesity in future generations. In-line with the OARDC mission, the long-term goal of this innovative, multidisciplinary proposal is to advance the knowledge of how WMPs for parents can include children to prevent obesity in a group of children who are placed at greater risk. The short-term goals of this application are to determine positive influences of adult weight loss and WMPs on children's weight-related development and behaviors, and how to bolster the positive effects from parents in WMPs into family-based interventions to prevent childhood obesity. Using the skills of faculty at The Ohio State University (OSU) we will develop a WMP-network (WMP-N) to engage, assess, and follow parents in a WMP and their children over one year. This approach allows for the assessment of urban and rural parent-child dyads diverse in race/ethnicity and socioeconomic status in the greater Columbus, OH radius.
Animal Health Component
50%
Research Effort Categories
Basic
50%
Applied
50%
Developmental
(N/A)
Goals / Objectives
Directly aligned with the Ohio Agriculture Research and Development Center, the long-term goal of this integrated, multidisciplinary proposal will advance the knowledge of how parental weight loss and behavior change achieved duringorganized weight management programs (WMPs) can be enhanced to be family-based to prevent childhood obesity. The short-term goals will determine how the positive influences of adult weight loss and behavior change resulting from WMPs affect children's growth and weight-related behaviors, and how to bolster positive effects from parents in weight management into theory-driven family-based interventions to prevent childhood obesity.Using the skills of faculty in Medical Dietetics, Adult Weight Management, and Family Science at The Ohio State University (OSU) we will: (1) develop a network to engage, assess, and follow parents and youth over a one-year period including 6 months of adult weight management programming and follow-up. The patient population at the OSU Comprehensive Weight Management Program and Bariatric Surgery Center will allow us to assess and follow both urban and rural parents and youth, including parent-youth dyads with diversity in race/ethnicity, socioeconomic status (SES), and level of need. OSU has an extensive WMP enrolling >350 unique patients per year, 70% of which indicate they are parents of children residing at home.Objectives/AimsAim 1. A WMP network (WMP-N) will be developed at OSU comprised of an advisory council and stakeholder groups of diverse parents (racial/ethnic, SES, and rural and urban residence) in the OSU WMP, family members, and healthcare providers to directly inform patient-centered and family-engaged research efforts with the goal of promoting healthy families and preventing obesity among children of parents enrolled in the WMP.Aim 2. We will examine the effect that parents in the WMP have on children, by enrolling 50 parent-child dyads, where the parent is initiating an outpatient WMP and has a child 2-12 years-old in the home, into a one-year prospective longitudinal study to track dyadic changes in weight status, weight-related behaviors, parent-child and family relationships, and additional factors that the WMP-N prioritizes in Aim 1.
Project Methods
The aims of this proposal are integrated; Aim 1 provides the foundation for the entire project, where the WMP-N is created and guides the research in Aim 2.Aim 1 Approach. The overall goal of Aim 1 is to develop the WMP-N. Using CBPR methods38-39 in Specific Aim 1, we will develop the infrastructure for the WMP-N. The WMP-N will be comprised of an advisory council and stakeholder groups of parents in WMPs, patient's family members, healthcare providers and researchers, and students at OSU interested in pediatric and adult weight management. These stakeholder groups will work with the advisory council to directly inform patient-centered and family engaged research efforts with the goal of promoting health in families and preventing obesity among the children of parents in WMP. The project leadership team, including the PI (Pratt) and Co-Is (Noria, Taylor, & Spees) will work with the advisory council to ensure stakeholders' ideas are brought forward into the research aim below. All groups involved in the WMP-N will collaborate to create a prioritized list of research questions to use to develop measures the longitudinal data collection in Aim 2. These questions may include How should I talk to my child about health? How do I go about preparing family meals? What kinds of practices could help my child try new foods? The Project Leadership Team will meet with the advisory council to ensure the ideas of the stakeholder groups are represented in Aim 2. The Advisory Council will be developed with nominated (self or by group) representative stakeholder leaders from each group (e.g., one leader from Parent, Family, Healthcare Provider/Researcher). The responsibilities of the advisory council are to: 1) lead each individual stakeholder group, 2) represent each individual stakeholder group in advisory council meetings, 3) summarize stakeholder group ideas to advisory council, and 4) work with other members of the advisory council to organize and prioritize ideas. Stakeholder Groups will be developed: parents in WMPs, family members of parents in WMPs, and healthcare providers and researchers. We will strive to have diverse racial/ethnic and socioeconomic status representation. The role of the parents in WMP stakeholder group is to generate ideas, based on their own experiences about the important constructs to measure for both children and parents when the parent is enrolled in WMP. The role of family members' stakeholder group is to advise on what kinds of family and household constructs should be assessed. The Healthcare Providers stakeholder group will represent additional healthcare providers at OSU who are not part of the leadership team, but are actively working with parents in the WMP. The healthcare provider stakeholder group will also contain graduate and undergraduate students who are presently working in or interested in working in weight management (either adult or pediatric). The role of the healthcare provider group is to advise on relevant and needed assessments.Aim 1 Goals and Outcomes (see Table 1). The main outcomes of Aim 1 are the development and engagement of the WMP-N and creation of a list of research questions to be used in Aim 2. Table 1 describes the WMP-N targeted goals, methods, and evaluation. The engagement of the WMP-N also provides a foundation for a future PCORI engagement proposal submission.Aim 2 Approach. Following the establishment of the WMP-N and the creation of the prioritized list of research questions, in Aim 2 we will examine the effect parents in WMPs have on youth weight-related behaviors, healthy growth and weight status, and parent-child and family dynamics. Adults who are initiating outpatient WMP at OSU, and identify as guardians/parents of youth ages 2-12 years, will be enrolled into a one-year prospective longitudinal study. We will recruit 50 parents who are beginning a WMP and their 2-12 year-old children (dyads) and will follow them prospectively for one year (12 months). We are recruiting children 2-12 years old due to the influence of parents for children in this age range prior to adolescence. Assessments will be obtained at baseline (entry into WMP), 3 months, 6 months, and 12 months (total of 4 time points). See Table 2 for the Aim 2 timeline. We will obtain IRB approval and disperse recruitment materials in May, 2018. Enrollment will take place over 6 months in Year 1. We anticipate being able to recruit 10-15 parent-child dyads per month, but have conservatively allocated extra time with a minimum of 10 dyads per month. We expect to have all baseline assessments completed by December 2018, and 12-month by December 2019, with analysis following.Recruitment. Recruitment of all parents will take place at OSU's WMP, which has established research and clinical teams to assist with coordination of patient recruitment. Information about the study will be provided to parents at pre-program information sessions (via handouts, in-person communication from providers, and a member of the research team announcing the study and fielding questions). There are ~350 new WMPs at OSU annually. Based on preliminary data collected by the PI, approximately 75% of OSU WMP patients have children, indicating we will not have difficulty recruiting. If parents have multiple children meeting our inclusion criteria, we will ask them to enroll their eldest child into the study. Recruitment has been successfully conducted in this setting before.42-44, 48-52, 66-69 Additional recruitment strategies include flyers in the clinic and provided to patients at information sessions, posting the study recruitment on university websites, and email notifications to referring providers in the area. We have anticipated up to 20% attrition in our proposed sample size. Dyads who drop out of the study at 6 months will be contacted to explore reasons for attrition. Our retention plan includes reminder follow-up calls/texts (parents' preference) one day and one week prior to data collection visits.All proposed assessments, with the exception of dietary (fruit and vegetable), for Aim 2 will be filled out via REDCap Survey Software, where parent and child assessments will be linked together by a unique identifier. Once patients and their children enter into the study they will attend an information session where parents and children will provide written consent and assent (for children ≥ 7 years-old), respectively, and fill out the first baseline assessment. At this visit, parents and children will also have their skin carotenoids (see below) read via a skin scanner to determine their fruit and vegetable intake over the last 2-3 weeks. All parent and child assessments (parents will be told their child needs to attend) will be completed on touch-screen tablets. Research staff will be available to assist participants and validate survey completion, as well as have them place their finger on the skin scanner for fruit and vegetable intake readings. Parents and their children will each receive a $20 retail gift card at each assessment interval.Measures (see Table 3). The primary outcome for Aim 2 is healthy child growth indicated by child BMI percentile and Z-score; secondary outcomes for Aim 2 include parent weight loss and parent and child behavioral and relationship measures. We will use parent %EWL and BMI for parent weight loss. Child BMI percentile and BMI Z-score change at 12 months as outcomes in predictive models to determine which behavioral relational variables are associated with child healthy growth. Demographic and weight status, dietary, and physical activity measures will be assessed at baseline, 3, 6, and 12 months (4 time points); parent-child relationship factors will be completed at baseline, 6, and 12 months (3 time points).?