1. Having a NEW IMPACT requires participation: Factors contributing treatment completion and success
Sarah F. Griffin1 MPH, PhD; Cara Reeves2 PhD; Kerry Sease2, MD, MPH; Dorothy Schmaltz1 PhD; Kerstin K. Blomquist3 PhD.
Clemson University1; Greenville Health System Children’s Hospital2, Furman University3
Introduction
Pediatric obesity has grown at an alarming rate within the past 30 years. Data from the National Health and Nutrition Examination Survey (NHANES) estimates that approximately 17% of children and adolescents are obese, marking a 12% increase from previous decades.
South Carolina (SC) ranks 10th in the United States in adult obesity and the most recent data from the Centers for Disease Control and Prevention rank SC 2nd in childhood obesity for 10–17 year olds. Furthermore, obesity related medical comorbidities have been well established and often persist into adulthood.
Accumulated evidence has identified behavioral treatments as moderately efficacious in pediatric weight management and/or loss. However, high attrition rates (greater than 50% for medical-based treatment programs) and lack of sustainability over time suggest that these treatments are not effective in modern practice. 
Moreover, the majority of evidence comes from white, middle-class families which may not be applicable to children of minority status, living in rural communities and/or from low SES households. Finding effective treatment that address disparities has been identified as a major priority by the Obesity Society and Shaping America’s Health Foundation.
Method
This is a mixed-methods study, using both quantitative and qualitative methods.
A preliminary descriptive analysis of patient participation and BMI data was conducted in SPSS. Additionally, a paired t-test analysis was conducted in SPSS to assess changes in BMI z-scores from pre-treatment to post-treatment.
One-on-one semi-structured phone-based interviews were conducted by an independent trained interviewer with 20 of 55 identified former patients and/or their guardian. There was no meaningful variance in attrition across age, ethnicity, or gender. Therefore, New Impact patients were categorized into 1 of 4 groups based only on program completion and weight management success. Interviews were completed across all four categories until saturation was reached across interview questions. Thematic analysis was conducted using ATLAS.ti.
Qualitative Results
Interview results revealed the following thematic areas related to treatment completion:
Program Elements – characteristics or features of the program content, staff, or way the program is delivered
Personal and Interpersonal Traits - characteristics about self, interpersonal relationships and family dynamics
Logistics – program cost, proximal delivery location, delivery times
Theme
Sub-themes
Example Quotes
Program Element
Setting Goals
Goals were do-able
Being held accountable for making small changes
Staff listened
Staff supportive
“My son is really goal oriented, so he very much liked the fact he had goals”
“As long as we were going to the program we were doing good…but after we stopped we fell back into our old ways”
“The information helped my son establish his own goals for his own pace”
Personal and Interpersonal Traits
Easier/More Difficult with/without family support
Motivation  
“I did what they told me and I saw changes”
‘We both made changes to eat right”
“It is hard to cook for just me and him, the cooking is good for a family, but it is just us”
Logistics
Distance to Program sites
Program Times
Cost
“It was about a 30 to 45 minute drive, I just couldn’t get there all for all the appointments…. Nutritionist, exercise…”
“It was hard to get there with work…”
“Medicaid was paying for it, but when they stopped we stopped going”
Quantitative Results
Treatment completion analysis revealed a pattern of increased attrition (decreased completion) as treatment protocols were updated to be more aligned with best practice and to improve outcomes.
However, there was a significant improvement in mean BMI z-scores from pre-treatment (m=2.40; SD=0.312) and post-treatment (M=2.32; SD=0.374) at p<0.001 for patients completing protocol 3 (N-56).
Aims
The two aims of this study were to
Increase our understanding of:
New Impact treatment completion patterns,
Factors contributing to New Impact treatment completion and success, and
Identify preliminary impact of New Impact’s latest protocol on treatment success
Develop treatment protocol recommendations to enhance retention while maintaining adherence to best practice guidelines and maintaining or improving outcome success.
Implications
New Impact is committed to treating and ultimately preventing childhood obesity. Successfully identifying improved means of addressing the causes of childhood overweight at the community level will serve as a valuable tool in putting an end to this alarming trend. The results of this study are valuable in informing New Impact staff on the successful (and not) elements of the existing program. With continued development, New Impact will be able to establish an effective and unique program that addresses the increasing problem of childhood obesity.
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