title: Education for lifestyle-based management of hyperlipidemia in children enhanced by a collaborative approach.
abstract: BACKGROUND
  Although therapeutic lifestyle changes are first-line measures in treating pediatric dyslipidemia, current didactic approaches for healthy lifestyle education are weakened by low adherence and poor sustainability. A collaborative education program including a clinician-led group education class with motivational counseling complemented by the addition of peer role models was implemented.
  
  
  OBJECTIVE
  We sought to assess the effectiveness of motivational interviewing in collaboration with peers sharing their experience and its impact on serologic and lifestyle measures vs the conventional, didactic group education approach.
  
  
  METHODS
  Changes in lipid profiles, anthropometric measurements, nutritional scores, physical activity levels, and daily screen time after 6 months were compared both within groups and between the collaborative and the didactic approach.
  
  
  RESULTS
  We reviewed 75 children ages 11.1 ± 3.5 years (n = 38 didactic/n = 37 collaborative). There were no group differences at baseline. Total cholesterol (5.79 ± 1.65 mmol/L vs 5.52 ± 1.39 mmol/L, P = .02) significantly decreased between the initial visit and the 6-month follow-up assessment with both approaches. Nutrition compliance scores significantly improved with both approaches (median: 5.3/10 vs 6.6/10, P = .004), with a marginally greater improvement for the collaborative (+1.7/10) vs the didactic approach (+1.0/10, P = .12). The collaborative approach was associated with greater reductions in weight percentile (-8.9% vs +1.8%, P = .03) and screen time (-7.0 h/wk vs +1.3 h/wk, P = .05) and a greater increase in physical activity (+4.0 h/wk vs +2.0 h/wk, P = .05).
  
  
  CONCLUSIONS
  Although not associated with differences in lipid profiles, the collaborative educational approach was associated with a greater lifestyle improvement than was the didactic approach over a 6-month period.
authors.affiliation: Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Nita
authors.initials: N
authors.lastname: Chahal
authors.affiliation: Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
authors.affiliation: Department of Pediatrics, University of Toronto, Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Canada. Electronic address: brian.mccrindle@sickkids.ca.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D008078:Cholesterol, LDL / Q000097:blood; D015444:Exercise; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D008019:Life Style; D050356:Lipid Metabolism / Q000235:genetics; D008297:Male
chemical_list: D008078:Cholesterol, LDL
keywords: Cardiovascular disease; Counseling; Education; Hyperlipidemia; Motivational interviewing; Pediatrics; Peer