The GOALS Program: A Pediatric Obesity Intervention for Patients with Non-alcoholic Fatty Liver Disease
Asha Willis MD, MPH
Principal Investigator, GOALS Program
Attending, Pediatric Gastroenterology
Sandra Groeschel BS, MPH candidate
Research Assistant, GOALS Program
In the past 30 years the number of obese youth in the United States has more than tripled. In 2008, 43% percent of New York City (NYC) elementary school children were overweight or obese as well as 35 % of youth aged 12-19 yrs. Obesity increases the risk of chronic diseases such as diabetes mellitus, cardiovascular disease, depression, and non-alcoholic fatty liver disease (NAFLD). The prevalence of NAFLD is as high as 53% in obese children. Currently the best treatment for NAFLD is slow, consistent weight loss. The GOALS (Generating Opportunities to Achieve Learn and Succeed) Program was created to identify patients with NAFLD in Brooklyn, NY and to help them identify their own goals for healthful eating and physical activity. We will provide motivational interviewing and educational materials from the NYC Department of Health and Mental Hygiene, such as the Obesity in Children Action Kit. The GOALS Program is funded by a grant from the Maimonides Research and Development Foundation. The team is led by pediatric gastroenterologist, Asha Willis, MD, MPH, and includes pediatric nurse practitioner Amy Felix and research assistant Sandra Groeschel. It is located at the Pediatric Subspecialty Center, 6701 Bay Parkway, Brooklyn, NY.
The GOALS program looks to recruit 150 obese children with NAFLD aged 11- 18 years for a 1 year intervention. The program is open to English and Spanish speakers. We are using the stages of change model, which is a useful interventional approach in lifestyle modification programs. The 5 stages of change are precontemplation, contemplation, preparation, action, and maintenance. We will be using a survey to determine the stage of change (SOC) the 5 following behaviors: 1) increasing fruit/vegetable consumption, 2) decreasing dietary fat consumption, 3) decreasing portion size, 4) increasing daily activity and 5) increasing planned exercise. The survey will be administered at the clinical visit every 3 months for a year. The primary outcome will be the SOC score which will be calculated based on the survey answers.
We will track the scores throughout the year to see if the patients are more willing to change the behaviors at the end of the study. We will also measure the body mass index and ALT as secondary outcomes. The GOALS research team will individually educate patients about healthful eating and physical activity to help patients set realistic goals for nutrition and exercise. With the data collected from the GOALS program we hope to create individualized, targeted healthy weight motivational action plans for children and families of obese children with NAFLD using the concepts of the SOC model.
To refer patients to the GOALS program, please call 718-283-7329.