Role of Dual-Contingency Management in Family-Based Obesity Therapy and the Effects of Weight Loss on Liver Transient Elastography Parameters in Youth: A Pilot Study

Indrajit Majumdar; Andrew H Talal; Carrol M Harmon; Emily Tabaczynsk; Kristen Cercone; Brian H Wrotniak; Lucy D Mastrandrea; Teresa Quattrin

doi:10.7759/cureus.36629

Role of Dual-Contingency Management in Family-Based Obesity Therapy and the Effects of Weight Loss on Liver Transient Elastography Parameters in Youth: A Pilot Study

Cureus. 2023 Mar 24;15(3):e36629. doi: 10.7759/cureus.36629. eCollection 2023 Mar.

Authors

Indrajit Majumdar^{1

2}, Andrew H Talal³, Carrol M Harmon⁴, Emily Tabaczynsk⁵, Kristen Cercone⁶, Brian H Wrotniak⁷, Lucy D Mastrandrea⁸, Teresa Quattrin⁹

Affiliations

¹ Pediatric Endocrinology, Mount Sinai Medical Center, New York, USA.
² Pediatric Endocrinology, Valley Medical Group, Paramus, USA.
³ Medicine, Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.
⁴ Surgery, Pediatric Surgery, John R Oishei Children's Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.
⁵ Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, USA.
⁶ Psychiatry, John R. Oishei Children's Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.
⁷ Pediatrics, John R. Oishei Children's Hospital/UBMD Pediatrics, Buffalo, USA.
⁸ Pediatrics, Division of Pediatric Endocrinology and Diabetes, John R. Oishei Children's Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.
⁹ Pediatrics, Division of Pediatric Endocrinology and Diabetes, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, USA.

Abstract

The pilot study evaluated contingency management (CM) for family-based obesity therapy (FBT). The secondary outcome assessed the association of the hepatic transient electrography (TE) parameters, including the controlled attenuation parameter (CAP) and liver stiffness (LSM), and changes in liver function blood tests and BMI changes in youth involved in intensive FBT. It included youth-parent dyads from an urban pediatric center randomized to weekly behavioral therapy (BT, n= 4) who received fixed financial compensation for attendance, or BT+CM (n= 5) who received an escalating monetary reward for weight loss. At week 30, all youth and parents had weight-loss trends without significant differences between groups. While the TE measures and blood tests were normal in the youth at baseline and week 30, the CAP changes correlated with BMI changes (R²= 0.86, P< 0.001) and LSM changes with alanine aminotransferase changes (R²= 0.79, P=0.005). In conclusion, BT+CM did not significantly add to the BMI improvement seen with BT alone in youth and their parents. However, in youth with obesity and normal liver blood tests, TE may be useful for monitoring changes in fatty liver disease.

Keywords: contingency management; fatty liver disease; liver transient elastography; obesity; pilot study; youth.

Grants and funding

The study was funded by the Clinical and Translational Science Institute (CTSI) Pilot Studies Program, which is supported by the National Center for Advancing Translational Science of the National Institute of Health under award number ULTR001412 to the University at Buffalo.