Technology brings clinic to families in new childhood obesity study

BUFFALO, N.Y. – A $1.9 million National Institutes of Health grant will enable University at Buffalo professor Myles S. Faith to test a family-based treatment for childhood obesity using innovative technology that allows study participants to be treated in their homes.

The five-year study, involving second-to-fourth-grade children living in rural Kansas, will take advantage of effective research and treatment for overweight children that already is used in family-based treatments, according to Faith, professor and associate chair of the Department of Counseling, School and Educational Psychology in the Graduate School of Education.

But as part of this study, children will be treated using telemedicine, taking advantage of cyberspace to link children and their families to treatment they would normally receive in an office or in school.

“This time, instead of the families coming to the clinic, the clinic is coming to the families via technology,” says Faith, who will collaborate on the grant with researchers from the University of Kansas Medical Center. “It’s the first intensive family treatment for childhood obesity with families where — guess what? — the families do not have to come into the clinic. They meet via telemedicine technology.”

Faith and his colleagues have been studying childhood obesity and how to treat it within the context of their families for years. The treatment usually has been done in schools or clinics, but this new grant allows Faith and his colleagues to reach these families in their own homes.

Faith says this study is particularly exciting for several reasons. First, it allows researchers to reach children struggling with obesity whose condition could have gone undetected or untreated.

“That’s important because families living in rural communities are at a further disadvantage because they often have less access to health care,” he says. “That puts them at an increased risk for obesity.”

Second, the grant also allows Faith to link families taking part in the study with innovative technology.

“I like to tell people if you think back to the old ‘Brady Bunch’ show, if you remember the beginning with everyone looking around, imagine that image. But here it’s on your iPad. So that you’re not looking at the Brady family, but you’re looking at images of other participants, the kids and their parents, and you’re all there at the same time.

“Families might be living far apart. But at that moment, you’re with each other in real time for your treatment. And you can talk to each other.”

Third, this program and grant also gives Faith the opportunity to measure the effectiveness of treating childhood obesity through this emerging approach of telemedicine. Will this telemedicine approach work for these children and their families, and can this type of program be used to treat other illnesses and health problems?

“Many believe telemedicine is a wave of the future,” Faith says. “This potentially is how health care is going to be administered for many health and behavioral disorders. Whether or not this happens will depend on the science to back it up. So I’m excited to see what we eventually learn.”

The group dynamic is particularly important, Faith says, something he and his colleagues will watch carefully when telemedicine links the participating families via their “Brady Bunch” channel and other technology devices.

“One of the most powerful treatment strategies for childhood obesity in the clinic is the group dynamic,” Faith says. “Groups can provide amazing social support. They provide role modeling. Group members are cheerleaders. Group members give feedback. Group members tell how they solve a problem, so when families are driving home and they pass fast food places, how do they resist temptation?

“Groups help.”

So Faith and his colleagues will carefully monitor whether technology can capture that group experience if they are linked primarily through cyberspace and technology.

“Can you get that feeling of a team, that ability to role model, literally that physical pat on the back without being in the same room?” Faith asks. “Families often do that in clinic together in a group. They literally give each other a pat on the back. Can that group energy be duplicated in these group tele-sessions?

“I would like to know the answer.”

Faith emphasizes the implications of this childhood obesity study. If this method of telemedicine works for these families, can it work for those with other disorders and sicknesses? Can the childhood obesity study be a model that can be duplicated for childhood disorders, from depression to diabetes?

“Childhood obesity is associated with many other health complications, including poorer body image, poorer health-related quality of life and depression,” Faith says. “It will be exciting to learn if group-based telemedicine treatment can help improve these other problems that often co-occur with pediatric obesity.”

And the possibilities are truly exciting, he says.

“If a treatment like this is effective and cost-effective on a large scale, you can imagine other questions,” he says. “How does this type of treatment compare to clinic visits? If you had families randomly assigned to the in-person clinic vs. the telehealth clinic, would they do the same? Would one do better?”

The five-year study views the child as a part of a family, with family members having a major influence on results.

“There is a big focus on the parent, not just the child,” Faith says. “So the parent learns how to be a coach for their child.”

Children participating in the study must be overweight or obese, Faith says, with a body-mass index falling between the 85th and 99th percentiles. Each family receives about 25 hours of intervention over eight months, including 14 technology sessions, behavioral assignments and accompanying homework. The administrative part of the study began in January. Over the course of the five years, 144 rural Kansas families will be involved.

“We will evaluate the children for changes in diet and body weight over eight months,” Faith says, “and we will follow them up after one year and two years later, so we’ll come back and see the effects of treatment.”

The study also includes quality control for a comparison group. The comparison group will receive similar information, newsletters and other instructions on healthy behavioral changes, such as how to make smart shopping decisions and how to find easy ways to be active during the day.

“So these families are getting that,” Faith says. “But they’re not getting the tele-help. They’re not getting the group sessions or the weekly contact with other families, or the group role modeling, as well as the other intensive, behavioral-intervention components that have been established in the clinic.”

Another crucial aspect of clinic-based treatments for childhood obesity includes teaching more positive parenting techniques to caregivers, Faith says, such as positive reinforcement, praise and setting goals for success.

“Parents learn as a group to pay greater attention to child progress and to build upon that, rather than being negative or critical,” he says. “This is really important. I’m fascinated to learn if these same skills can be taught through technology — and the potential to reach so many more families.

“For those of us interested in the science of parenting, this is a great opportunity to learn.”