Preventing Obesity among At-risk Children of Adult Weight Management Patients
(PI: Pratt; Co-Is: Bradley Needleman, MD; Sabrena Noria, MD, PhD; Colleen Spees, PhD, RD; Christopher Taylor, PhD, RD)
The long-term goal of this integrated, multidisciplinary proposal is to advance the knowledge of how parental weight loss and behavior change achieved during organized weight management programs (WMPs) can be enhanced to be family-based to prevent childhood obesity. The short-term goals will determine 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 are parent-youth dyads over 6 months after parents initiate adult weight management programming. We will examine the prelminary effect that parental WMP participation has on children, by enrolling 20 parent-child dyads, where the parent is initiating an outpatient WMP and has a child 7-18 years-old in the home, to track dyadic changes in weight status, weight-related behaviors, and parent-child and family relationships. 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.
Funded by: OARDC SEEDS Grant #OHOA1634
Graduate Research Assistants: Katie VanFossen and Haley Kiser
Feasibility and Preliminary Efficacy of Support Figure Attendance at Bariatric Patients’ Clinical Visits
(PI: Pratt; Co-Is: Brian Focht, PhD; Bradley Needleman, MD; Sabrena Noria, MD, PhD; Colleen Spees, PhD, RD; Co-I: Megan Ferriby, MS, Doctoral Candidate)
The purpose of this study is to examine the feasibility, acceptability, and preliminary efficacy for the inclusion of support figures and romantic partners throughout the bariatric surgery process, from pre-surgery to two months post-surgery. This will be done using a four-arm randomized controlled trial (RCT). Using simple randomization, female patients in romantic relationships will be randomized into partner attended (PA) groups and treatment as usual (PA-TU) groups; patients (female or male) not in romantic relationships will be randomized into support figure attended (SFA) and SFA-TU groups. The goals of this study are to provide preliminary evidence for including support figures/partners in patients’ routine surgery healthcare visits, including the subsequent impact on post-surgery patient and support figure/partner behavior change and weight loss, relationship outcomes, and exploration of barriers to support figure/partner involvement.
Aim 1: To assess the feasibility and acceptability of support figure/partner involvement for surgery patients. Feasibility will be assessed throughout the study by attendance at the four pre-surgery classes and the clinic visit assessment time points. Perceived fiscal and time involved in the study will be assessed. Acceptability will be assessed from patient and support figure/partner interviews regarding the barriers and benefits to attendance, and alternative mediums to engage support figures/partners.
Aim 2: To evaluate the effect of support figure/partner attendance (SFA, PA arms) on patient weight loss, behavior change, and relationship outcomes from T1-T4. Estimates of effect size and variance in patient weight loss and behavior change will be collected from T1-T4 for comparison of the SFA/PA and SFA-TU/PA-TU arms.
ClinicalTrials.gov identifier (NCT number): NCT03642197
Graduate Research Assistant: Megan Ferriby, MS, Doctoral Candidate (doctoral dissertation 2-arm couples RCT)
Examining the Impact of Household and Relational Factors on Adult Weight Management Efforts
(OSU PI: Pratt; Wake Forest co-PIs: Callie Brown, MD; Joseph Skelton, MD, MS)
The purpose of this research is to explore the familial and household factors that impact adult weight management patients’ weight loss, health behavior change, and communication about health behavior change. Specifically, the study aims to examine both patients’, and family members’ (i.e. romantic partners and children) perceptions of family relationships (overall, parent-child, and romantic relationships), health behaviors, and the home environment to determine which factors could be potential intervention targets for future weight management programs.
Aim 1. Using cross-sectional survey methods, we describe patients’ family relationships (family functioning, romantic, and parent-child), behaviors (diet and physical activity), and household environment to determine what family relationships, behaviors, and household factors may be potential intervention targets.
Aim 2. Using in-depth family interviews, we will explore patient and family members’ perceptions of family and household supports and barriers to patient weight loss and behavior change. Specifically, the topics of dietary choices, meal preparation, planning, buying, and decision-making, physical activity routines, home-food environment, communication about health, and family, romantic, and parent-child dynamics are discussed.
Graduate Research Assistant: Megan Ferriby MS, Doctoral Candidate
Family Functioning in Pediatric and Adult Weight Management
(OSU PI: Pratt; Wake Forest PI: Joseph Skelton, MD, MS)
The purpose of this line of inquiry is to determine what role family functioning plays in the prevention and treatment of obesity in youth and adults. For example, does family functioning change over the course of treatment, and if so, how do changes in family functioning associate with patient and family changes in weight status and behaviors? Does family functioning serve as a moderator or a mediator between parent-child dynamics (e.g., parenting styles and practices, feeding styles) and couple dynamics (relationship anxiety and avoidance, relationship satisfaction) and weight status? What is the incidence of families in pediatric and adult weight management that report impaired family functioning, and may benefit from intervention?
Our lab has completed foundational studies that report:
- Adult bariatric surgery patients who perceived their child to be overweight/obese reported more impaired family functioning, less family exercise participation, and more discouragement for eating habit change in the family compared to patients who did not perceive their child to be overweight/obese. Single parents more often perceived their children to be overweight/obese, and had more impaired family functioning, and less support for changing eating habits and family exercise participation. Patients with impaired family functioning reported less support for changing eating habits and family exercise participation. (see Pratt et al., 2018)
- Approximately 25% of adult weight management patients reported impaired family functioning. Parents who reported impaired family functioning reported more restrictive feeding practices. Significant relationships were found between restrictive feeding and pressure to eat practices and child weight status. (see Pratt et al., Under Review)
- In pediatric primary care, caregivers who reported impaired family functioning were more likely to report that their child had a higher BMI and BMI z-score. Caregivers with impaired family functioning and who identified as being in two-parent families, with at least a Bachelor’s degree, and were at or above the federal poverty level were more likely to report their child was higher weight status. (see VanFossen et al., 2018; Pratt et al., Under Review)
Designing clinical algorithms using family functioning as a screener for referral and treatment outcomes:
- Family-based care is recommended for the treatment of youth and adolescent obesity. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm (see below) is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics. (see Pratt & Skelton, 2018)
Graduate Research Assistant: Katie VanFossen, MS