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Bright Bodies Weight Management Program

A family-based lifestyle intervention that aims to prevent childhood obesity by teaching inner-city kids, teens, and their families about healthy weight management through nutrition education, behavior modification, and exercise.

Program Outcomes

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

Program Type

  • Counseling and Social Work
  • Skills Training

Program Setting

  • Hospital/Medical Center
  • Home

Continuum of Intervention

  • Indicated Prevention

Age

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

Gender

  • Both

Race/Ethnicity

  • All

Endorsements

Blueprints: Promising

Program Information Contact

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

Program Developer/Owner

Mary Savoye
Yale University School of Medicine


Brief Description of the Program

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.

Outcomes

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

Brief Evaluation Methodology

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.

Study 1

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.


Risk Factors

Individual: Poor Diet

Family: Low socioeconomic status

Protective Factors

Individual: Coping Skills, Exercise

Family: Parent social support


* Risk/Protective Factor was significantly impacted by the program

Gender Specific Findings
  • Male
  • Female
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.

17 hour training of all disciplines - coordinator/director (C/D)
11 hour training for exercise (EX), nutrition (N), and parent class (P) staff

Day 1 - 5 hrs.*
Overview of Program - 1.5 hrs (ALL)
Exercise Physiologist training - 3 hrs (EX, C/D)

  • 1 hr. individual
  • 2 hr. observe program exercise

Day 2 - 6 hrs.
Overview of Obesity & Clinical

  • Observation or case study- 3 hrs (ALL)
  • Coordinator/Director Training 3 hrs (C/D)

Day 3 - 6 hrs.
Nutrition/Behavior Modification Training - 2 hrs. (C/D,N,P)
Parent Class Training - 1 hr.(C/D, N, P)
Observe Program - 3 hrs.

  • Technician Training - Onsite, during program 1 hr.
    (C/D,N,P,EX)
  • Observe nutrition/behavior - 1.5 hrs. (C/D,N,P, EX)
  • Discussion/Question & Answer Period (ALL)

Training Cost

Cost $1,200 for 3 staff members ($300 for each additional staff)
Travel, hotel, and food costs are responsibility of trainees.

Module Modification

*If a third day of training is not possible, overview and exercise training could be incorporated on Wed and Thurs. Program overview would take place 12-2 on Wednesday and exercise training would occur one hour before program at 4:30 Thursday. This module, however, does not allow for cross-training of disciplines between exercise and nutrition staff.

Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.

Start-Up Costs

Initial Training and Technical Assistance

Training will cost $1,200 beginning January 2013. Additionally, trainees must pay for travel, hotel, and food while training.

Curriculum and Materials

Equipment represents a one-time investment of $3,650, which covers items such as physical education equipment, a body fat analyzer, heart rate monitors and games. The Smart Moves curriculum is utilized. A start-up manual and an exercise and behavioral/nutrition curriculum and an initial supply of 80 student workbooks costs $4,230.

Materials Available in Other Language: Student workbooks are available in Spanish at no additional cost; facilitator manual has not been translated.

Licensing

None.

Other Start-Up Costs

Generally there is a sponsoring organization of a Bright Bodies initiative. That organization raises the funding and employs the staff. There may be some overhead cost incurred for this support.

Intervention Implementation Costs

Ongoing Curriculum and Materials

The curriculum is updated every two years. After two years, an institution might decide to purchase updated workbooks and instructor's manuals at its discretion.

Staffing

Each program would employ hourly staff with the following qualifications:

  • Program Director who is a registered dietitian, exercise specialist, or social worker/psychologist (15 hours/week for 50 weeks at $30/hour recommended),
  • Program Coordinator who is an exercise physiologist/physical therapist, dietitian, or social worker/psychologist (10 hours/week for 50 weeks at $22/hour recommended),
  • Exercise Physiologist or Physical Therapist (6 hours/week for 50 weeks at $15/hour recommended),
  • Registered Dietitian (2 hours/week for 50 weeks at $25/hour recommended),
  • Social Worker or Psychologist (2 hours/week for 25 weeks at $25/hour recommended).

The program director and/or coordinator should be in the fields of nutrition, exercise, or social work/psychology so that they have a deep understanding of one of the disciplines and can provide training.

Other Implementation Costs

Youth incentives are budgeted at $300 per year. The sponsoring organization may incur some overhead costs to support the program. Students can be used to supplement the professional staff. The program is based in schools, eliminating the cost of space rental.

Implementation Support and Fidelity Monitoring Costs

Ongoing Training and Technical Assistance

Formal 2-3 day training is provided, if desired. To purchase the nutrition/behavior modification curriculum, at minimum, staff from the nutrition and behavioral sciences must be utilized to deliver its contents. Likewise, to purchase the exercise curriculum, at minimum, staff from the exercise or physical therapy science must be utilized. Smart Moves staff is available via telephone for ongoing consultation regarding delivery of curriculum.

Fidelity Monitoring and Evaluation

Evaluation tools cost $700 annually.

Ongoing License Fees

None.

Other Implementation Support and Fidelity Monitoring Costs

No information is available

Other Cost Considerations

No information is available

Year One Cost Example

This example will include the cost for one site to offer Bright Bodies to a group of 80-90 youth/families during Year 1 implementation.

Compensation and travel for 4-5 staff to be trained at purveyor site $6,500.00
Compensation for Program Director $22,500.00
Compensation for Program Coordinator $11,000.00
Compensation for Exercise Physiologist $4,500.00
Compensation for Dietitian $2,500.00
Compensation for Social Worker $1,250.00
Equipment $3,560.00
Education Materials $4,230.00
Incentives for Participants $300.00
Evaluation Materials $700.00
Overhead for Sponsor Organization $10,000.00
Total One Year Cost $67,040.00

If the program serves 80 youth during Year 1, the cost per youth would be $838.

Funding Overview

This program has been funded by a combination of sliding scale fees, grants and insurance. In order to minimize the amount parents are expected to contribute to the cost of Bright Bodies, the developers suggest diligent attempts be made to secure grant funding.

Allocating State or Local General Funds

Funding from state and local health departments in the form of grants for obesity prevention should be considered sources of funding for Bright Bodies.

Maximizing Federal Funds

Discretionary Grants: Discretionary grants from the Department of Health and Human Services, especially those with a focus on obesity, should be explored for Bright Bodies funding. The National Institutes of Health have provided funding for the evaluation of Bright Bodies.

Foundation Grants and Public-Private Partnerships

Grant funding, especially from foundations and corporations interested in obesity prevention and child health, may provide sources of support for Bright Bodies.

Generating New Revenue

Bright Bodies programs lacking in grant funding may be forced to consider charging families fees for participation. These are commonly structured on a sliding scale to make the program affordable to as many families as possible. Families are not charged when programs are supported by NIH grants.

Data Sources

All information comes from the responses to a questionnaire submitted by the developers of Bright Bodies to the Annie E. Casey Foundation.

Program Developer/Owner

Mary SavoyeYale University School of Medicine2 Church Street South, Suite 201New Haven, CT 6520USA(203) 737-4384mary.savoye@yale.edu www.brightbodies.org

Program Outcomes

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

Program Specifics

Program Type

  • Counseling and Social Work
  • Skills Training

Program Setting

  • Hospital/Medical Center
  • Home

Continuum of Intervention

  • Indicated Prevention

Program Goals

A family-based lifestyle intervention that aims to prevent childhood obesity by teaching inner-city kids, teens, and their families about healthy weight management through 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.

Target Population

Age

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

Gender

  • Both

Gender Specific Findings

  • Male
  • Female

Race/Ethnicity

  • All

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.

Other Risk and Protective Factors

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

Risk/Protective Factor Domain

  • Individual
  • Family

Risk/Protective Factors

Risk Factors

Individual: Poor Diet

Family: Low socioeconomic status

Protective Factors

Individual: Coping Skills, Exercise

Family: Parent social support


*Risk/Protective Factor was significantly impacted by the program

Brief Description of the Program

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.

Description of the Program

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.

Theoretical Rationale

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.

Theoretical Orientation

  • Skill Oriented
  • Cognitive Behavioral
  • Behavioral

Brief Evaluation Methodology

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.

Outcomes (Brief, over all studies)

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.

Outcomes

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

Mediating effects of food consumption and exercise were not studied.

Effect Size

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

Generalizability

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

Potential Limitations

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.

Endorsements

Blueprints: Promising

Program Information Contact

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

References

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.

Certified 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.

Study 1

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).

Contact

Blueprints for Healthy Youth Development
University of Colorado Boulder
Institute of Behavioral Science
UCB 483, Boulder, CO 80309

Email: blueprints@colorado.edu

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Blueprints for Healthy Youth Development is
currently funded by Arnold Ventures (formerly the Laura and John Arnold Foundation) and historically has received funding from the Annie E. Casey Foundation and the Office of Juvenile Justice and Delinquency Prevention.