More than $13M awarded to study childhood obesity interventions in rural and minority communities in Louisiana and Tennessee
Pennington Biomedical’s Amanda Staiano and Vanderbilt University Medical Center’s Bill Heerman are co-principal investigators on the research study
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AMANDA E STAIANO, PHD, ASSOCIATE PROFESSOR. PEDIATRIC OBESITY AND HEALTH BEHAVIOR AT PENNINGTON BIOMEDICAL RESEARCH CENTER IN BATON ROUGE, LA.
view moreCREDIT: PBRC
BATON ROUGE – Pennington Biomedical Research Center and Vanderbilt University Medical Center have received $13.8 million for five years of research funding from the Patient-Centered Outcomes Research Institute to study the ideal “dose” of behavioral interventions to treat childhood obesity in rural and minority communities across Louisiana and Tennessee.
Pennington Biomedical’s Amanda Staiano and Vanderbilt University Medical Center’s Bill Heerman are co-principal investigators on the randomized, multisite trial.
Despite ongoing efforts, childhood obesity rates have continued to increase over the last 10 years, with about 1 in 5 children across the U.S. affected by obesity. The prevalence of childhood obesity is higher among children who are underrepresented minorities and those who live in rural areas due to health disparities and limited access to interventions. Across the U.S., about 22 percent of Hispanic or Latin American and 20 percent of African American children have obesity compared to about 14 percent of white children. Additionally, obesity affects about 22 percent of children who live in rural areas.
Researchers in the Dose Childhood Obesity Trial will study the optimal duration of behavioral interventions, including number of sessions and length of sessions, which are best in treating childhood obesity among these groups.
“We know that one-size fits all approaches to treating childhood obesity don’t work. This trial is an opportunity to understand what works best and for whom,” said Heerman, associate professor of Pediatrics and a general pediatrician at Monroe Carell Jr. Children’s Hospital at Vanderbilt.
Researchers plan to enroll 900 parent-child pairs, with children ages 5 to 17 who have obesity and are from rural and minority communities in Tennessee and Louisiana, where childhood obesity rates are among the highest in the country. Underserved communities often have unequal access to evidence-based obesity interventions, contributing to the higher rates among these populations.
“With Louisiana ranking near the top on lists for both children and adults living with obesity, this is an important study for families in our state to be involved in,” Staiano said. “We are gaining momentum in helping with the obesity crisis with programs like the upcoming Greaux Healthy initiative and this new grant that will help expand access to evidence-based obesity treatments to families throughout Louisiana.”
Children are diagnosed with obesity if their body mass index is at or above the 95th percentile for their age and gender category. The long-term risks associated with childhood obesity include Type 2 diabetes, hypertension and heart disease.
Current American Academy of Pediatrics, or AAP, recommendations, on which Staiano helped author, call for children with obesity to receive an intensive behavioral intervention of 26 hours of face-to-face, family-based treatment over six months. These evidence-based behavioral and lifestyle interventions can include regular check-ins with primary care physicians, personalized nutrition plans, healthy learning modules and more.
“At Pennington Biomedical, our scientists are not only working on cutting-edge research to fight chronic diseases like obesity, but they are helping define the best practices for medical professionals to follow,” said Dr. John Kirwan, Pennington Biomedical executive director. Evidence has shown that obesity treatment should begin early and at the highest intensity necessary, and having Pennington Biomedical partner with Vanderbilt University Medical Center on this project will help so many families in both Louisiana and Tennessee as we learn more about various methods to treat childhood obesity.”
In the study, researchers will compare how different “dosing” combinations of face-to-face intervention time may be optimized to help reduce a child’s weight over 12 months and impact a child’s diet, physical activity, sleep, media use and quality of life. Specifically, they want to examine: is the intensity of the AAP-recommended 26 hours needed, or can a reduced-intensity behavioral intervention between 13 and 22 hours be effective in treating childhood obesity and increasing reach to underserved communities?
The parent-child pairs will be randomly assigned to one of five study arms (26, 22, 19, 16 and 13 hours) of the trial. The types of interventions for each arm will be the same and include primary care physician visits; on-demand web-based content that includes learning modules on topics such as choosing healthy foods, being an active family, the importance of sleep; community resource counseling with social or community health workers; and parent-child personalized nutrition services with certified nutritionists. The difference between the arms will be in the frequency and duration of the personalized nutrition counseling.
Speaking about the potential impact of this study, Heerman said, “By testing the optimal dose of behavioral interventions for childhood obesity, we hope to inform future treatment recommendations and build pragmatic solutions that can reach the millions of children with obesity in the United States.”
The research team and scientific advisory board includes researchers from Vanderbilt and Pennington Biomedical, representatives from the American Academy of Pediatrics, multiple international experts in childhood obesity interventions, and patient representatives.
The grant is awarded by PCORI, which is an independent, nonprofit organization authorized by Congress with a mission to fund patient-centered comparative clinical effectiveness research that provides patients, their caregivers and clinicians with the evidence-based information they need to make better informed health and health care decisions.
About the Pennington Biomedical Research Center
The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the triggers of obesity, diabetes, cardiovascular disease, cancer and dementia. Pennington Biomedical has the vision to lead the world in promoting metabolic health and eliminating metabolic disease through scientific discoveries that create solutions from cells to society. The Center conducts basic, clinical, and population research, and is affiliated with LSU.
The research enterprise at Pennington Biomedical includes over 480 employees within a network of 40 clinics and research laboratories, and 13 highly specialized core service facilities. Its scientists and physician/scientists are supported by research trainees, lab technicians, nurses, dietitians, and other support personnel. Pennington Biomedical a state-of-the-art research facility on a 222-acre campus in Baton Rouge.
For more information, see www.pbrc.edu
Children who play baseball risk elbow injury
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ELBOW IMAGES. IN IMAGE ON THE LEFT (10-YEAR-OLD BOY), GROWTH PLATE HAS NOT YET FUSED. ON THE RIGHT (15-YEAR-OLD BOY), GROWTH PLATE HAS FUSED.
view moreCREDIT: RSNA/RADIOLOGY
CHICAGO – Youth baseball players are prone to elbow pain and injuries, including repetitive overuse changes and fractures, based on the maturity of their bones, according to a new study being presented today at the annual meeting of the Radiological Society of North America (RSNA).
The repetitive motion and force of throwing a baseball places a large amount of stress on the growing bones, joints and muscles of the elbows of baseball players. Youth baseball players who have not yet reached skeletal maturity might be especially vulnerable to elbow pain and injuries.
“When we look at the forces that baseball players, even Little League baseball players, deal with during routine practice and games, it becomes apparent why elbow injuries are so common amongst this group,” said study co-author Vandan Patel, B.S., a radiology-orthopedics research scholar at Children’s Hospital of Philadelphia (CHOP) in Pennsylvania.
Most recent estimates show that 20 to 40% of youth baseball players between the ages of nine and 12 complain of elbow pain at least once during the season.
Skeletally immature children have growth plates, which are areas of bone that are made up of cartilage, a rubbery and flexible connective tissue, that allows the bones to grow and change in shape as a child ages. Growth plates are weaker than the surrounding muscles and bones and prone to injury that can lead to either reversible changes or permanent deformity.
Skeletal maturity occurs when the growth plates have closed, and no more bone (or growth) is being made. This usually occurs at the end of puberty, typically around age 13 to 15 for girls and 15 to 17 for boys.
In this retrospective study, the researchers reviewed elbow MRI exams from 130 youth players (18 years of age and younger) being evaluated for elbow pain. MRI is an ideal method for identifying joint problems, because it can non-invasively show cross-sectional details of soft tissues (cartilage, tendons and ligaments) and bone.
“We conducted this study in order to better understand the patterns of injuries that can occur among youth baseball players with elbow pain,” said senior author Jie C. Nguyen, M.D., M.S., director for the Section of Musculoskeletal Imaging in the Department of Radiology at CHOP. “Tissue vulnerability and, thus, sites at risk for injury, change with growth and maturation. A younger player injures differently than an older player. It is our hope that this data will help us continue to improve and individualize the care of current and future generations of youth baseball players.”
The average age of this study group of patients was 13.9 years, with 115 boys and 15 girls included. The frequency with which the patients played baseball varied from daily to recreationally.
Two radiologists independently reviewed the MRI exams to categorize the skeletal maturity and different findings of each patient’s elbow. They classified 85 patients as skeletally mature and 45 patients as skeletally immature.
The most common MRI findings in skeletally immature players included fluid build-up around the joint, stress injuries near the growth plate, fractures, and osteochondritis dissecans (OCD) lesions, where a piece of bone and the overlying cartilage is injured and can detach, leading to reduced range of motion and risk for premature osteoarthritis in adulthood.
Conversely, in skeletally mature players, the injury pattern shifts from the growth plates to the soft tissue. These players most often had triceps tendinosis—a condition in which the tendon connecting the triceps muscle to the elbow bone becomes strained, irritated or torn—and fluid build-up in the bony area of the elbow where the ulnar collateral ligament attaches. The ulnar collateral ligament runs on the inner side of the elbow and helps stabilize it.
Injuries that required surgery included intra-articular bodies (small fragments inside the joint), and unstable OCD.
“In terms of the skeletally immature children, 9 patients (11%) had intra-articular bodies, and 19 patients (22%) had OCD lesions,” Patel said.
The researchers hope that the results of this study will help to identify elbow injuries in children who play baseball and to individualize treatment based on skeletal maturity.
“This information is critically important not only to physicians, but also to parents and team coaches, all of whom provide crucial support for these children, reducing injury and preventing permanent damage on and off the field,” said co-author Theodore J. Ganley, M.D., director of Sports Medicine and Performance Center in the Division of Orthopaedics at CHOP. “As parents, caregivers and coaches, it is important to be aware of these findings in order to ensure that symptoms of pain are not overlooked during the baseball season.”
Although they did find that prevalence of injury was linked to prolonged play, the researchers said further studies are needed to identify exactly which injuries are more time dependent compared to others.
“This does not mean that elbow injuries are inevitable in baseball,” Patel said. “With proper technique and proper rest, these injuries could potentially be avoided.”
Additional co-authors are Shahwar M. Tariq, B.S., Liya Gendler, D.O., Apurva S. Shah, M.D., M.B.A., and Adam C. Zoga, M.D., M.B.A.
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Note: Copies of RSNA 2023 news releases and electronic images will be available online at RSNA.org/press23.
RSNA is an association of radiologists, radiation oncologists, medical physicists and related scientists promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Illinois. (RSNA.org)
Editor’s note: The data in these releases may differ from those in the published abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please call the RSNA Newsroom at 1-312-791-6610.
For patient-friendly information on pediatric and musculoskeletal imaging, visit RadiologyInfo.org.
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