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Bright Bodies Weight Management Program

Blueprints Program Rating: Promising

A childhood obesity program that teaches inner-city kids, teens & their families about healthy weight management and how to prevent the health risks of childhood obesity with the use of nutrition education, behavior modification and exercise.

  • Chronic Health Problems
  • Obesity
  • Physical Health and Well-Being

    Program Type

    • Counseling and Social Work
    • Skills Training

    Program Setting

    • Home
    • Hospital/Medical Center

    Continuum of Intervention

    • Indicated Prevention (Early Symptoms of Problem)

    A childhood obesity program that teaches inner-city kids, teens & their families about healthy weight management and how to prevent the health risks of childhood obesity with the use of nutrition education, behavior modification and exercise.

      Population Demographics

      Bright Bodies targets overweight children (body mass index > 95th percentile for age and sex) ages 8-16.

      Age

      • Late Childhood (5-11) - K/Elementary
      • Early Adolescence (12-14) - Middle School
      • Late Adolescence (15-18) - High School

      Gender

      • Male and Female

      Gender Specific Findings

      • Male
      • Female

      Race/Ethnicity

      • All Race/Ethnicity

      Race/Ethnicity/Gender Details

      Bright Bodies comprised an ethnically diverse group of children from economically disadvantaged neighborhoods. There were no differences in any outcome measures between ethnic groups and sexes.

      Poor diet and lack of exercise are likely risk factors for health outcomes.

      • Individual
      • Family
      Risk Factors
      • Individual: Poor diet
      • Family: Low socioeconomic status
      Protective Factors
      • Individual: Coping Skills, Exercise
      • Family: Parent social support

      The Yale Bright Bodies Weight Management Program is a family-based, intensive lifestyle intervention that uses nutrition education, behavior modification and exercise to address weight and weight-related issues in children and adolescents. The program is designed for ethnically diverse, obese, inner-city youth. Participants and caregivers are provided nutrition education and behavior modification techniques in 40-minute sessions, once per week, for six months, followed by every other week for the next six months. The exercise component, facilitated by exercise physiologists, is provided in two 50-minute sessions once per week for the first 6 months and two 50-minute sessions twice per month for the next 6 months.

      The Yale Bright Bodies Weight Management Program is a family-based, intensive lifestyle intervention that is designed for ethnically diverse, obese, inner-city youth. The program uses nutrition education, behavior modification and exercise and requires a significant time commitment of participants.

      Nutrition education is provided by a registered dietician using the 'Smart Moves Workbook' (a curriculum developed for overweight children) and emphasizes food choice and portion control. Participants and caregivers attend these sessions once per week for 40 minutes for the first 6 months, followed by once every other week for the next 6 months.

      The behavior modification component of the program also uses the 'Smart Moves Workbook' and teaches techniques such as self-awareness and goal setting, and uses coping skills training, cognitive behavioral skills training and contingency management as modalities. Behavior modification classes are also provided to the caregivers of the children enrolled in the program and topics focus on challenges that the caregivers are experiencing with the children with the overall goal of empowering the caregiver. Participants and caregivers attend these sessions once per week for 40 minutes for the first 6 months, followed by once every other week for the next 6 months.

      The exercise component, facilitated by exercise physiologists, consists of a warm up, high-intensity aerobic exercise (e.g., obstacle courses, games, sprints, dance), and a cool down. Participants wear heart monitors as well as report their level of perceived exertion. The minimum requirement of this component is two 50-minute sessions per week for the first 6 months and two 50-minute sessions twice per month for the next 6 months.

      The program uses an education and skill-building theoretical rationale which highlights the importance of (1) actively engaging the participants and caregivers in learning new skills; (2) using incentives to reinforce positive behavior; and, (3) emphasizing coping skills training to increase the participants' and caregivers' efficacy at managing difficult situations.

      • Behavioral
      • Cognitive Behavioral
      • Skill Oriented

      Bright Bodies was evaluated using a parallel group, randomized control trial that recruited participants from a Pediatric Obesity Clinic who were between the ages of 8 and 16, with a body mass index (BMI) above 95th percentile based on the Center for Disease Control growth chart. A total of 209 participants were randomly assigned to a weight management group and a control group. However, due to discontinuation of a part of the program, 105 participants ended up in the treatment group and 69 participants in the control group. The program was delivered for one year; measures were collected at baseline, 6 months, 12 months and 24 months for both the treatment and control groups at the same facility using the same scales and instruments. Changes in outcomes between the two groups were compared using a mixed effects model with covariate adjustments for baseline measures. A subset of 23 participants was examined to evaluate the program's impact on glucose metabolism and insulin sensitivity.

      The Bright Bodies program demonstrated sustained treatment effects up to 24 months when compared with a standard clinical care on outcome measures such as weight, BMI, body fat, lipid panels and insulin sensitivity.

      Participants in the Bright Bodies program experienced the following outcomes:

      • minimal weight gain over 12 months, despite increases in height resulting in a reduction in BMI
      • a 4% reduction in body fat; and reductions in total cholesterol and insulin sensitivity at 12 months
      • maintenance of the improvements for 1 year after the intervention (2 year study)

      A subsample of participants was also measured on glucose and insulin sensitivity and participants in the treatment group experienced the following outcomes after 12 months:

      • a 53% reduction in insulin levels
      • a 42% increase in whole body insulin sensitivity index
      • a small, but statistically significant, decrease in glucose levels
      • a significant conversion from prediabetes to normal glucose for intervention and conversion from normal to prediabetes in control group

      Mediating effects of food consumption and exercise were not studied.

      Study reports absolute changes in outcomes but not standardized effect sizes.

      The study focused on ethnically diverse, economically disadvantaged children and their caregivers.

      The studies completed on the Bright Bodies program have the following limitations:

      • While expected, due to the difficult nature of the program, the study suffered from a high attrition rate.
      • There was no actual measurement of mediating behavior changes during the study (e.g., no reports of actual changes in diet or implementation of exercise routines in life outside of the program).
      • Study was conducted with a sample selected from youth attending an obesity clinic, so these youth were likely very motivated to lose weight.
      • The program is expensive to implement and a cost-benefit analysis is needed.

      • Blueprints: Promising

      Savoye, M., Nowicka, P., Shaw, M., Yu, S., Dziura, J., Chavent, G., ... Caprio, S. (2011). Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics, 127(3),1-9.

      Savoye, M., Shaw, M., Dziura, J., Tamborlane, W., Rose, P., Guandalini, C., ... Caprio, S. (2007). Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized control trial. Journal of the American Medical Association, 297(24),2697-2704.

      Shaw, M., Savoye, M., Cali, A., Dziura, J., Tamborlane, W., & Caprio, S. (2009). Effect of a successful intensive lifestyle program on insulin sensitivity and glucose tolerance in obese youth. Diabetes Care, 32(1),45-47.

      Mary Savoye
      Yale University School of Medicine
      2 Church St. South, Suite 201
      New Haven, CT 06520
      (203) 737-4384
      mary.savoye@yale.edu
      www.brightbodies.org
      Curriculum: www.smartmovesforkids.com

      Study 1

      Savoye, M., Nowicka, P., Shaw, M., Yu, S., Dziura, J., Chavent, G., ... Caprio, S. (2011). Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics, 127(3),1-9.

      Savoye, M., Shaw, M., Dziura, J., Tamborlane, W., Rose, P., Guandalini, C., ... Caprio, S. (2007). Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized control trial. Journal of the American Medical Association, 297(24),2697-2704.

      Shaw, M., Savoye, M., Cali, A., Dziura, J., Tamborlane, W., & Caprio, S. (2009). Effect of a successful intensive lifestyle program on insulin sensitivity and glucose tolerance in obese youth. Diabetes Care, 32(1),45-47.

      Savoye, M., Nowicka, P., Shaw, M., Yu, S., Dziura, J., Chavent, G., ... Caprio, S. (2011). Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics, 127 (3),1-9.

      Savoye, M., Shaw, M., Dziura, J., Tamborlane, W., Rose, P., Guandalini, C., ... Caprio, S. (2007). Effects of a weight management program on body composition and metabolic parameters in overweight children: A randomized control trial. Journal of the American Medical Association, 297 (24),2697-2704.

      Shaw, M., Savoye, M., Cali, A., Dziura, J., Tamborlane, W., & Caprio, S. (2009). Effect of a successful intensive lifestyle program on insulin sensitivity and glucose tolerance in obese youth. Diabetes Care, 32 (1),45-47.

      Evaluation Methodology

      Design: Bright Bodies was evaluated using a parallel group, randomized control trial that recruited participants from a Pediatric Obesity Clinic who met the following criteria: body mass index (BMI) above 95th percentile based on the Center for Disease Control growth chart; between the ages of 8 and 16; able to speak English; caregiver willing to participate in the educational component of the program; did not have a major mental illness or serious medical condition; were not taking medication that could potentially cause weight gain.

      A total of 284 participants were assessed for eligibility; 62 declined to participate and 13 did not meet criteria. Therefore, 209 participants were randomly assigned to a weight management group and a control group at a 2:1 ratio and then within the weight management group were randomly assigned at a 1:1 ratio to Bright Bodies using a structured meal plan and Bright Bodies using better food choices as part of the nutritional component. However, due to an 83% dropout rate by 6 months from the structured meal plan group (n=35), this portion of the program was discontinued and randomization to control and Bright Bodies continued at the 2:1 ratio. Therefore, a total of 174 participants remained in the study, 105 participants in the treatment group and 69 participants in the control group. Control group participants and their caregivers received diet and exercise counseling by dieticians and physicians once every 6 months at a pediatric obesity clinic. They also received brief psychosocial counseling by a social worker at these appointments.

      A subset of 34 participants was further randomized to undergo an oral glucose tolerance test (OGTT) to evaluate the program's impact on glucose metabolism and insulin sensitivity, however, only 23 participants (13 in the treatment group and 10 in the control group) completed these measures at baseline and 12 months.

      By the end of the 12 month program, 29% of the participants in the treatment group and 33% of the participants in the control group dropped out. At 24-month follow up, 40% of the treatment group and 30% of the control group had dropped out.

      The program was delivered for one year; measures were collected at baseline, 6 months, 12 months and 24 months for both the treatment and control groups at the same facility using the same scales and instruments.

      Sample: Of the 174 participants in the study, 61% were female, 37% were white, 38% were black and 24% were Hispanic. The average age was 12 years old.

      Measures: Measures included weight, body fat, body mass index, and blood pressure. Blood samples were also taken to determine lipid and insulin levels. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to measure insulin sensitivity and was calculated using fasting plasma and glucose levels from the blood samples. All of these measures were collected at baseline, 6 months, 12 months and 24 months for both the treatment and control groups at the same facility using the same scales and instruments. The additional measure for the subsample was an oral glucose tolerance test (OGTT) which measures glucose and insulin sensitivity. From this test, whole body insulin sensitivity index is also calculated.

      Analysis: Procedures were consistent with an intent-to-treat analysis. Baseline characteristics were compared using t-tests and chi-square tests. Changes in weight, body fat, BMI, blood pressure, lipid and insulin levels were compared between treatment and control groups using mixed model repeated measures analysis. Researchers imputed missing data using a multiple imputation method; however, separate analyses were also conducted on models without multiple imputation and no differences were found on the treatment estimates between models with and without multiple imputation of missing data. Therefore, the study only presented results from the multiple imputation analyses.

      Outcomes

      Implementation Fidelity: No information on fidelity measures was provided in the study.

      Baseline Equivalence: Baseline characteristics were compared using t-tests and chi-square tests. Control and treatment groups were statistically equivalent at baseline on all demographic and outcome variables.

      Differential Attrition: No significant differences were found in dropout rates among ethnic groups, although minority participants had a somewhat greater retention than white participants. Further, no baseline difference in demographic or outcome measures (with the exception of diastolic blood pressure) was found for those who dropped out versus those who didn't. The most common reasons for dropping out were similar for the treatment and control groups - moved with no forwarding address and lost interest in the program. The percentage of participants lost to follow up was similar in both groups (17% in the treatment group and 16% in the control group).

      Posttest (Savoye et al., 2007): Differences between the two groups in changes in BMI, weight, and body fat at 6 and 12 months were all significant (p<0.001). Specifically, while both groups had equivalent increases in height in the 12 month period, the treatment group gained an average of 0.66 lbs versus the control group that gained an average of 16.94 lbs. The treatment group lost an average of 4% body fat, whereas the control group gained an average of 2% body fat. Differences in total cholesterol measures and changes in insulin sensitivity as measured by the HOMA-IR were also statistically significant at 6 (p=.05 and p<0.001 respectively) and 12 months (p=.005 and p<0.001 respectively). However, there were no significant differences in changes in other lipid levels or blood pressure between treatment and control groups.

      Long-term (Savoye et al., 2011): Bright Bodies demonstrated sustained treatment effects on all measures that were significant at post-test. Specifically, differences between the two groups in changes in BMI, weight, and body fat were significant at 24-months (p<0.002). While both groups had equivalent increases in height in the 24 month period, the treatment group gained an average of 13 lbs versus the control group that gained an average of 26.4 lbs. The treatment group lost an average of 3.6% body fat, whereas the control group gained an average of 0.6% body fat. Differences in changes in total cholesterol measures and changes in insulin sensitivity as measured by the HOMA-IR were also statistically significant at 24 months (p=.004 and p<0.001 respectively).

      Subsample Outcomes (Shaw et al., 2009): A report on the subsample comparison between treatment and control groups was reported in a third article. Treatment group participants had a 53% reduction in insulin levels and a 42% increase in whole body insulin sensitivity index (derived from glucose and insulin levels tested using OGTT) compared to the control group (p=.0025 and 0.007 respectively). There was also a small, but statistically significant, decrease in glucose levels in the treatment group (p=0.042). Further, in three participants in the treatment group who had pre-diabetes (impaired glucose tolerance or impaired fasting glucose), their levels normalized, whereas the number of pre-diabetic participants in the control group increased from one to five at 12 months (p=0.04).