Randomised controlled trial of a good practice approach to treatment of childhood obesity and health-related quality of life and habitual physical activity and sedentary behaviour of obese children in Malaysia

Wafa, Sharifah Wajihah (2012) Randomised controlled trial of a good practice approach to treatment of childhood obesity and health-related quality of life and habitual physical activity and sedentary behaviour of obese children in Malaysia. PhD thesis, University of Glasgow.

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Abstract

Childhood obesity is a leading global public health issue. Chapter One of this thesis is a literature review of the evidence concerning the issue of childhood obesity and its management. The literature review describes this issue in terms of national and international prevalence and trends, health consequences and determinants. The literature review examines the evidence to guide effective management of childhood obesity. The role of parents in the management of childhood obesity has been identified as a promising area of research and specific attention is given to this issue.
This thesis examined the effect of a family-based behavioural treatment programme for obesity in 7-11 year olds (The Malaysian Childhood Obesity Treatment (MASCOT) Study). The intervention is presented in Chapter Two. Families of obese 7-11 year olds in Kuala Lumpur were randomised to either an intervention (treatment) or control (no treatment) group. The sample was characterised by BMI z-score, health related quality of life reported by participants and their parents (PedsQL questionnaire) and objectively measured habitual physical activity and sedentary behaviour (Actigraph accelerometry). The intervention was delivered over a six month period and between group differences in changes over the six month period were examined at this time point. The sample size (n=107) was calculated as sufficient to detect an estimated difference in the reduction in BMI z-score of-0.25 in over six months between groups and the SD of the change in BMI z-score of 0.21, allowing for dropout (and with power=90%, significance=95%). The primary outcome was change in BMI z-score. This chapter also describes how the MASCOT treatment
programme developed, and describes its content. The Malaysian Childhood Obesity Treatment Trial (MASCOT) was a single-blind RCT of a dietetic treatment for childhood obesity in children of primary school age (7 to11 years old) in Kuala Lumpur, Malaysia. The MASCOT comprising eight sessions, of an 8-hour family-centred group treatment programme is described, based on behavioural change techniques, covering topics on nutrition, physical activity and sedentary as well as parenting skills. All information was directed to parents, the main agent of change in which they were responsible for initiating and maintaining healthy lifestyle changes with their families.
Outcomes were recorded at baseline and six months, consisting of primary outcome indicators (body mass index (BMI) z-score) and secondary outcome indicators (weight changes, health-related quality of life (HRQoL) and, habitual physical activity and sedentary behaviour) (Chapter Three). Analysis of the primary outcome found no significant group differences at the six month time point for BMI z-score (intervention: 0.0 (0.7) vs control: 0.1 (0.5), p=0.79). There were significant differences between the groups in favour of the intervention group in weight changes (intervention: 1.7(2.5) vs control: 3.5(2.0), p<0.001) and total parent score for HRQoL (intervention: 4.2(15.5) vs control -3.8(19.3), p<0.05).
This thesis also reports complementary studies that examined:
 the quality of life of obese children compared to pair-matched controls of healthy weight (Chapter Four) and
 the physical activity levels and sedentary behaviour of obese children in the MASCOT study versus healthy weight children (Chapter Five)
The study of quality of life (Chapter Four) found significant impairment in all HRQoL dimensions (Total score, Physical Health, Psychosocial Health) in the obese children compared to healthy weight children (p<0.001, respectively). In Chapter Five it was shown that obese children spent more time in sedentary behavior (intervention: 90.2% vs control: 87.5%, p<0.001) and less time in MVPA (intervention: 0.7% vs control: 1.2%, p<0.001) compared to healthy weight children.
Chapter Six concludes the thesis by summarising its results and highlighting how they have contributed to the evidence base. Study strengths and limitations are described and those weaknesses would be improved by suggesting a few changes in the MASCOT programme for future research.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Colleges/Schools: College of Medical Veterinary and Life Sciences
Supervisor's Name: Reilly, Prof. John Joseph
Date of Award: 2012
Depositing User: Ms S Wafa
Unique ID: glathesis:2012-3786
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 07 Feb 2013 14:26
Last Modified: 07 Feb 2013 14:28
URI: http://theses.gla.ac.uk/id/eprint/3786

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