title: The effect of a multi-disciplinary obesity intervention compared to usual practice in those ready to make lifestyle changes: design and rationale of Whanau Pakari.
abstract: BACKGROUND
  Child obesity internationally has been identified as one of the major threats to future population health. Indigenous people and those from lower socio-economic backgrounds are over-represented in obesity statistics. There is a need for evidence of effect of interventions for child obesity with long-term follow-up. Whether engaging with those that are more motivated to make lifestyle changes is a useful strategy has not been fully explored. We hypothesise that in obese/overweight children, assessed as psychologically "ready for change", delivery of a 12-month multi-disciplinary intervention programme results in a significant reduction in body mass index standard deviation score.
  
  
  METHODS
  Whanau Pakari is an unblinded randomised controlled clinical trial comparing a 12 month intervention programme with standard practice, with 6 monthly assessments for 2 years, conducted in Taranaki, New Zealand (a region where 15.8 % of the population are indigenous). It specifically targets indigenous people and those in more deprived households. Obese/overweight children and adolescents aged 5-16 years are eligible. Exclusion criteria are medical/psychological conditions leading to inability to undertake physical activity/participate in group sessions; those not "ready" to make lifestyle changes; and those without a committed family member. Assessments of health parameters, dietary history, physical activity and overall health-related quality of life/psychological functioning are completed in the participant's home. Fasting blood tests are obtained at baseline, 12 and 24 months. The primary outcome is body mass index standard deviation score. Secondary outcomes include quality of life, dietary behaviour and physical activity, cardiovascular and metabolic profile (blood pressure, resting heart rate, waist circumference), glycaemic control (fasting glucose and glycated Haemoglobin), fasting insulin, and lipids. A general linear mixed model will be used to assess change from baseline using the 6, 12, 18 and 24 month measures, adjusting for age, gender, socioeconomic status and ethnicity, and whether at the contemplative or preparation/action stages of readiness for change.
  
  
  CONCLUSIONS
  This trial will inform the development of management programmes for obese children and adolescents that are appropriate for indigenous populations. It will investigate whether those at the preparation/action stage of "readiness" to make lifestyle changes are more successful in making changes than those who are contemplative.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR):12611000862943. (Date registered 15/08/2011).
authors.affiliation: Taranaki District Health Board, New Plymouth, New Zealand ; The Liggins Institute, The University of Auckland, Auckland, New Zealand.
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Anderson
authors.affiliation: Taranaki District Health Board, New Plymouth, New Zealand.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Wynter
authors.affiliation: Sport Taranaki, New Plymouth, New Zealand.
authors.forename: Kris R
authors.initials: KR
authors.lastname: Moller
authors.affiliation: The Liggins Institute, The University of Auckland, Auckland, New Zealand.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Cave
authors.affiliation: Taranaki District Health Board, New Plymouth, New Zealand.
authors.forename: Gerard M S
authors.initials: GM
authors.lastname: Dolan
authors.affiliation: Department of Paediatrics, The University of Auckland, Auckland, New Zealand ; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand ; Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Grant
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Stewart
authors.affiliation: The Liggins Institute, The University of Auckland, Auckland, New Zealand ; Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Cutfield
authors.affiliation: The Liggins Institute, The University of Auckland, Auckland, New Zealand ; Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hofman
keywords: Body mass index; Indigenous people; Intervention studies; Nutrition; Obesity; Pediatric; Physical activity; Randomised controlled trials; Research methods; Whanau Pakari