Efficacy of Family-Based Weight Control Program for Preschool Children in Primary Care

Division of Pediatric Endocrinology, Women and Children's Hospital of Buffalo, 239 Bryant St, Buffalo, NY 14222. .
PEDIATRICS (Impact Factor: 5.47). 09/2012; 130(4):660-6. DOI: 10.1542/peds.2012-0701
Source: PubMed


To test the efficacy of an innovative family-based intervention for overweight preschool-aged children and overweight parents conducted in the primary care setting.
Children with BMI ≥85th percentile and an overweight parent were randomized to intervention or information control (IC). Trained staff delivered dietary and physical/sedentary activities education to parents over 6 months (10 group meetings and 8 calls). Parents in the intervention received also behavioral modification. An intention-to-treat analysis was performed by using mixed analysis of variance models to test changes in child percent over BMI (%OBMI) and z-BMI and to explore potential moderators of group differences in treatment response.
Ninety-six of 105 randomized families started the program: 46 children (31 girls/15 boys) in the intervention and 50 (33 girls/17 boys) in the IC, with 33 and 39 mothers and 13 and 11 fathers in intervention and IC, respectively. Baseline characteristics did not differ between groups. Children in the intervention group had greater %OBMI and z-BMI decreases at 3 and 6 months compared with those assigned to IC (P < .0021). A greater BMI reduction over time was also observed in parents in the intervention compared with parents assigned to IC (P < .0001). Child %OBMI and parent BMI changes were correlated (r = .31; P = .003). Children with greater baseline %OBMI were more likely to have a greater %OBMI decrease over time (P = .02).
Concurrently targeting preschool-aged overweight youth and their overweight parents for behavioral weight control in a primary care setting reduced child %OBMI and parent BMI, with parent and child weight changes correlating.

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    • "Childhood obesity rates in the United States (US) continue to be excessively high (Ogden, Carroll, Kit, & Flegal, 2014). Although evidence for effective intervention strategies is scarce, family-based programs can be effective in achieving and maintaining weight loss among preschool and school-aged children (Epstein, Valoski, Wing, & McCurley, 1994; Kaplan, Arnold, Irby, Boles, & Skelton, 2013; Quattrin et al., 2012). Understanding how family structure is associated with child weight status can help inform family-based programs and allow efficient tailoring of recommendations that involve interactions between family members. "
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    ABSTRACT: Birth order has been associated with childhood obesity. The objective of this cross-sectional study was to examine maternal feeding and child eating behaviors as underlying processes for increased weight status of only children and youngest siblings. Participants included 274 low-income 4-8 year old children and their mothers. The dyads completed a videotaped laboratory mealtime observation. Mothers completed the Caregiver's Feeding Styles Questionnaire and the Children's Eating Behavior Questionnaire. Child weight and height were measured using standardized procedures. Path analysis was used to examine associations of birth order, maternal feeding behaviors, child eating behavior, and child overweight/obese status. The association between only child status and greater likelihood of overweight/obesity was fully mediated by higher maternal Verbal Discouragement to eat and lower maternal Praise (all p values < 0.05). The association between youngest sibling status and greater likelihood of overweight/obesity was partially mediated by lower maternal Praise and lower child Food Fussiness (all p values < 0.05). Results provide support for our hypothesis that maternal control and support and child food acceptance are underlying pathways for the association between birth order and weight status. Future findings can help inform family-based programs by guiding family counseling and tailoring of recommendations for family mealtime interactions. Copyright © 2015. Published by Elsevier Ltd.
    Appetite 05/2015; 92. DOI:10.1016/j.appet.2015.05.021 · 2.69 Impact Factor
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    • "The previous approaches of obesity prevention cannot be accused of not having recognised the importance of obesity as a domestic phenomenon, but most intervention studies, with their limited effectiveness, chose their starting point majorly in the obesogenic environment, and not in the families themselves. Of course, there are a few studies within the field of family prevention strategies [42] struggling with the possible effectiveness of such intervention programmes. But nevertheless these endeavours are primarily focusing on the medical aspects. "
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    ABSTRACT: Background While numerous studies highlight the relevance of socio-cultural factors influencing incidence and prevalence of obesity, only a few address how obese people perceive causes and prevention of or intervention for obesity. This study contributes to a more thorough understanding of subjective aetiologies and framing themes for a mainly understudied but promising field. Thus it may serve for the development of effective public health strategies to combat obesity. Methods Autobiographically based in-depth interviews were conducted with 20 patients (adolescents and young adults) institutionalised in the obesity rehabilitation centre INSULA in Bischofswiesen (Germany). The data were analysed with Atlas.ti with regard to two main perspectives: (1) How the interviewees perceive ‘their’ obesity from a subjective point of view and (2) which conclusions they draw from their own ‘story’ concerning prevention/intervention strategies. Results The interviewees did not indicate a clear starting point for their overweight. Nevertheless, certain life-events (e.g. divorce or illness of parents) were identified as catalysing weight gain. As a consequence of coping with distress, body weight rises rapidly and not continuously. Obesity was generally framed as a problem primarily located within the family and not in the wider environment. Corresponding to this, the family was identified as the main and most important addressee of preventive measures. The interviewees highlighted the importance of personal responsibility as a prerequisite for self-determined action against obesity, but denied any link between responsibility and guilt. Conclusions This study contributes substantially to a broader perspective on the prevention of obesity. First, more attention has to be paid to the interactions of medical aspects and the social dimension of obesity. Second, prevention efforts should be more aware of the relevance of subjective aetiology when it comes to the definition of reasonable and effective governance strategies in tackling obesity. Third, current assumptions concerning the importance of personal responsibility for obesity prevention might underestimate the relevance of self-determined action of the obese.
    BMC Public Health 09/2014; 14(1):977. DOI:10.1186/1471-2458-14-977 · 2.26 Impact Factor
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    • "Taken together, these barriers make medical care settings a uniquely challenging environment in which to attempt obesity prevention interventions. Despite these barriers, there has been increased attention to developing and evaluating interventions that leverage the influential role of the pediatric primary care provider and are integrated into the health care setting, including multiple non-randomized trials and pilot studies [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] and a smaller number of completed larger-scale randomized trials [20] [21] [22] [23] [24] and randomized trials that are currently in progress [25] [26] [27] [28] [29]. These studies have taken steps towards testing primary carebased interventions that take minimal office visit time and supplement physician counseling with a supportive, often clinic-based or home-based intervention component, yet the quality of the studies, role of the pediatric primary care provider, and strength of the supportive intervention components have varied, as have other aspects of the research design, such as participation and follow-up rates, and length of follow-up. "
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    ABSTRACT: Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a contact control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well-child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The contact control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.
    Contemporary clinical trials 06/2013; 36(1). DOI:10.1016/j.cct.2013.06.017 · 1.94 Impact Factor
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