Heather Armstrong and her daughter, Lauren, saw positive results from their time in the SHIFT study last year. Armstrong is now a SHIFT peer interventionist helping other families.

Heather Armstrong made a commitment to a healthier lifestyle when she volunteered herself and her 8-year-old daughter, Lauren, for a weight management treatment study at Seattle Children’s Research Institute.

For five months, Armstrong and Lauren attended weekly sessions in the Success in Health: Impacting Families Together (SHIFT) study that provided guidance and education to help them reach and sustain better eating and activity behaviors and ultimately better weight management. The sessions focused on healthy eating, supporting children throughout behavior changes, improving the home environment for physical activity and healthy eating, building confidence and incorporating more physical activity into family life.

A year after first participating in SHIFT study, Lauren and her mother are both healthier, several pounds lighter and more active.

“You learn so much about yourself in SHIFT and why you’re in the patterns you’re in and how to change that,” Armstrong said. “Everyone involved is so encouraging and positive. You learn new skills as you progress, you’re getting healthier and losing weight and it starts to feel really good.”

Armstrong elected to continue participation in the study, but this time as a peer interventionist who is committed to providing the advice and instruction she received to newly-enrolled parents and children encountering the same challenges her family faced.

“It’s fun to share the program because I know it works,” Armstrong said. “It’s inspiring to see it working for other families and to hear how good their success makes them feel.”

Armstrong is one of seven parents from the first group of 22 families in the study who are now SHIFT peer interventionists. The peer interventionists are currently helping 15 other families make weekly progress toward their goals by teaching many of the skills they learned through the program, including creating and maintaining a safe home food environment by replacing junk food items with nutritious snacks; keeping a detailed food log; incorporating moderate exercise into their daily schedule and staying within a calorie intake range each day.

The peer interventionists are also helping families navigate through some of the same frustrations they experienced in treatment.

“I’m encouraged as a peer interventionist to share what I went through,” Armstrong said. “I think there is a lot of power in that. When I sit with the families and I’m coaching them, it’s like I’m seeing myself, in a way.”

It’s all part of the study’s design, said Dr. Brian Saelens, principal investigator at Seattle Children’s Research Institute and director of the SHIFT study.

“We want to see if peers can deliver long-term weight management treatment and if families who receive that treatment from their peers do as well as families who get help from professionals,” Saelens said. “We also want to know what other benefits there may be for families who become peer interventionists.”

A SHIFT in strategy

The peer-to-peer treatment model employed by the SHIFT study was born of practicality and necessity.

Childhood obesity rates have tripled in the last 40 years, with nearly one in five school-aged children now affected, according to the Centers for Disease Control and Prevention. Pediatric obesity can increase a child’s risk of high blood pressure and cholesterol, type 2 diabetes, respiratory problems and other harmful conditions.

Saelens cites high treatment costs, limited insurance coverage and availability of care as common barriers preventing many from accessing intensive behavioral health education and intervention. The U.S. Preventive Task Force’s recommendation of more than 25 hours of contact over a six-month period for moderate-to-intense child obesity intervention just doesn’t fit within our current health care system and would be very expensive out-of-pocket.

“We developed a model that we hope is more cost effective and could reach more people,” Saelens said. “Peer-to-peer approaches are not new, and we’ve seen evidence to suggest that people are engaged and have improved outcomes when receiving intervention from peers, but we haven’t seen this model applied to childhood obesity treatment.”

Peer-to-peer intervention approaches have been effective in treating health issues, including tobacco use and HIV prevention. SHIFT co-investigator and University of Washington professor Dr. Jane M. Simoni was the lead author for a review of 117 studies of peer-based HIV interventions that showed positive outcomes around behavior (76.9%), attitudes (89%) and knowledge (84.6%).

SHIFT is also interested in looking at the sustainability of the peer intervention model.

“If we start this idea of professionals treating families, and then families start treating families, how many generations out can we influence to instill healthy habits?” Saelens said. “If you have a peer that treats a set of families, can those families then become peer interventionists?”

Paying it forward to reinforce a healthy lifestyle

Many of the parents who elected to continue participation in the SHIFT study as peer interventionists wanted to give back, Saelens said.

David Culver is one of them. It was a challenge for Culver and his 10-year-old daughter, Rachel, to fit healthy food choices into their busy schedule. They finished their participation in receiving treatment with an enhanced knowledge base and the tools to maintain a healthy lifestyle, which they continue to integrate into their daily lives at home through meal preparation and in planning for healthy eating around special events.

“I’d be remiss if I didn’t try to help other families,” Culver said. “I feel like there is a bond between the peer interventionist and the families because we’ve gone through some of the same struggles. I feel fantastic that I’m able to be part of the program.”

Angela Newman and her 11-year-old son, Caleb, had trouble maintaining consistent healthy food choices and incorporating exercise into their daily routines, which fluctuated at times in their large family environment. Both saw physical changes during their time in the SHIFT study and have implemented the program’s structure and food vocabulary into their family culture.

Newman and Caleb were also able to spend quality time together exercising. Caleb grew an inch, lost 15 pounds and now enjoys preparing some of the family’s meals. He also pays special attention to food labels and ingredients, Newman said.

Newman is also experiencing added benefits in her role as a peer interventionist.

“I understand the struggles of the families going through the SHIFT study and enjoy helping them figure out solutions,” Newman said. “Being a peer interventionist also reinforces the program for me and keeps me on track.”

Study progressing toward goal

The SHIFT study, which started in 2015 and is funded by a $2 million grant from the National Institutes of Health, set a goal to have 300 families with kids ages 7 to 11 participate in intensive treatment over the course of four years. More than a year into the study, 73 families have participated at sites in Federal Way, Everett and Bellevue.

“The study is progressing well,” Saelens said. “We want to see if this model is cost effective and can sustain itself, resulting in a lasting positive impact on many generations of families to come.”

For more information on the study or to participate, visit shiftstudy.org or call the SHIFT team at 206-884-2210.