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Preventing early childhood obesity

Behavioural changes insufficient at preventing early childhood obesity

The interventions, even for prevention, likely need to be intense and active for longer periods of time

Young children and their families in poor communities were able to make some achievable and sustainable behavioural changes during the longest and largest obesity prevention intervention, but in the end, the results were insufficient to prevent early childhood obesity, according to the outcomes from the Growing Right Onto Wellness (GROW) trial.

The study results, ‘Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index A Randomized Clinical Trial’, were published in JAMA, showed a short-term reduction in obesity that diminished over the three-year study period even in the face of improved, sustained nutrition and use of neighbourhood recreation centres.

Shari Barkin (Credit: Vanderbilt University Medical Center)

"The interventions, even for prevention, likely need to be intense and active for longer periods of time," said Principal investigator, Dr Shari Barkin, director of Pediatric Obesity Research at Monroe Carell Jr. Children's Hospital at Vanderbilt. "We tested a tiered intervention consistent with adult obesity treatment trials, but childhood obesity prevention for underserved families might require sustained highly active interventions."

She added that the amount of behavioural change likely needs to increase to be successful, but it remains unclear what would be enough to prevent childhood obesity in underserved, low-income populations - those most at-risk for obesity and its long-term health consequences.

In the trial, a total of 610 parent-preschool child pairs, 90 percent of whom were Hispanic, received high-dose behavioural intervention during the three-year study period. The children were at-risk for obesity, but not yet obese. The 36-month family-based, community-cantered programme consisted of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for nine months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of six school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library.

The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community centre use. The Benjamini-Hochberg procedure corrected for multiple comparisons.

"This was a pragmatic study, based in families and the communities in which they lived," said Barkin, also the William K.Warren Foundation Endowed Professor and chief of the Division of Academic General Pediatrics at Children's Hospital.

Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below US$25 000 for 56.7% of families. Follow-up at 36 months was 90.2%, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (p=0.39).

The intervention group children had a lower mean caloric intake (1,227kcal/d) compared with control group children (1,323kcal/d) (p=0.003). Intervention group parents used community centres with their children more than control group parents (56.8% in intervention; 44.4% in control) (p=0.006).

"The intervention seemed to work best for children who reported food insecurity with hunger at baseline," added Barkin. "We think this could be due to the fact that the intervention connected families to existing resources in their community and to other families in their neighbourhoods, but this finding needs to be tested further."

"In the face of the childhood obesity epidemic, this study underscores the ongoing need to find effective prevention interventions, particularly among low-income minority populations who have a high prevalence of obesity," said Dr Charlotte Pratt, National Heart, Lung, and Blood Institute (NHLBI) program director for the GROW trial and a co-author of the study. NHLBI is part of the National Institutes of Health (NIH).

To access this paper, please click here

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