A Childhood obesity intervention developed by families for families: Results from a Pilot study

1. A Childhood obesity intervention developed by families for families: Results from a Pilot study Presented by: Emily Macieiski Dietetic Intern

2. Background • 1 in 10 infants & 1 in 4 toddlers and preschoolers- overweight or obese • Prevention of obesity starts with parents and/or caregivers • High family dropout rates (27-73%) in low-income • This study presents a new approach to family-centered childhood obesity prevention • Communities for Healthy Living (CHL)- developed in collaboration with low-income parents/caregivers of preschool aged children and representatives from community organizations. • Community-based participatory research (CBPR) approach- utilized to ensure that parents and organizations were actively engaged in the design, implementation, and evaluation. • This study introduces a PARENT CENTERED approach • Parents make up majority of decision making body

3. Methods • Guided by the Family-centered Action Model of Intervention Layout and Implementation (FAMILI) and its foundations in nutrition, child development, and public health* • Based on the Family Ecological Model (FEM)- • A family centered development theory • Also based by Empowerment Theory- understanding forces and controlling them by using resources- • Help parents actively participate in the research • an eye opening to the causes and risks of obesity • Help them identify ways to live healthy lifestyles with their children

4. Setting • CHL developed and tested in 5 Head Start centers • 423, 2-5 y.o in N.Y. exposed to intervention • Head Start selected as focal setting due to its mission of parent involvement • Demographics: • Parent avg age- 31 y.o, Child avg age- 3.59 y.o • 55% children were female • Respondents to child- 88% mothers, 6% fathers, 6% grandmothers • 17% married, 13% divorced, 44% single, 25% member of unmarried couple • 68% parents overweight, 36% parents obese • 44% children overweight, 20% children obese

5. Intervention development and Implementation • Development of CHL program fall 2009- summer 2010 • Implementing of intervention of CHL program fall 2010- spring 2011 • Community Advisory Board (CAB) was the foundation of participatory process • Parents (majority of board members) recruited* • Large pediatric provider and Head Start staff • 20 CAB members recruited, while 17 participated after 1st meeting • Held 1-2 x/month during 1st 6 months of project • 25 total meetings over 2 years • CAB had a process of engaging parents*

6. Conducting Community Assessment • Methods of assessment: • Self-report surveys examined roles of parents and older children in household, utilization of community programs, parents viewpoints on childhood obesity • Focus groups examined impact of having children over wide age range on food, PA, and screen-related parenting • Photovoice documented by camera the chronic and acute stressors • Windshield surveys parents led on driving tour of neighborhood and answered open-ended questions about perceived social, economic, and environmental conditions of their neighborhood and effect on daily activities, parenting, and well-being • The final CHL program was developed utilizing results from this community assessment, and feedback/discussions from the 2 community forums with CAB

7. Primary Objectives and Intervention Components • Primary objectives: • Promote parenting practices supportive of healthy lifestyles* • Increase children’s healthy lifestyle behaviors* • Reduce children’s BMI and rates of obesity • Key intervention components: • Health communication campaign- over 3 months (Jan-March 2011)- increase parent awareness of child’s weight status; dispel myths; Posters displayed in all Head Start centers • Revised BMI letters (sent home 2x in fall and spring)- explained how to interpret results and prevent/treat overweight • Family nutrition counseling (8 sessions)- graduate students provided samples of healthy foods and answered questions about weight and nutrition • Parents’ connect for Healthy Living Program and Child Program (2x in fall and spring)- addressed skills parents interested in gaining, examples about healthy living, workshops by local organizations; mini workshops run for the kids by local org (dance studios, karate)

8. CHL Intervention Summary

9. Evaluation Design • Families with a child >2 years or older enrolled in target Head Start centers eligible to participate in evaluation. • Families recruited through posters displayed in centers and flyers sent home with children • Parents agreed to complete self-report survey at baseline and follow-up. • Gave permission for investigators to extract child’s BMI data from Head Start records • $20 gift card at baseline and follow-up • 154 parents at baseline, 35 didn’t follow-up • 24-hour diet recall and accelerometry protocol • $20 gift card for each at baseline and $30 at follow-up • 55 parents at baseline for 24 hr recall, 22 didn’t follow up • 83 parents at baseline for accelerometry protocol, 26 didn’t follow up

10. Measures • Weight status obtained from Head Start in fall 2010 and spring 2011 and entered into database to extract BMI z-scores and percentiles • Dietary intake estimated using 24 hr recall; 2 recalls (one weekday and weekend) pre and post intervention, conduced via phone by staff as Purdue Univ. Intake averaged across the 2 days to estimate avg kcals, macros, and food groups • Physical activity Measured using GT3X accelerometer, worn around waist for 7 days. 83 kids met min 10 min/day x 4 days of monitoring • TV viewing time min/day

11. Parent Outcomes • Self-efficacy to provide healthy foods using 3 items 1=not at all confident to 5=very confident • Results: Pre (4.61) vs Post (4.80) intervention • Freq of offering fruits/veg with min 2 items 1=less than 1x/wk to 6=3x or more/day • Results: Pre (4.51) vs Post (4.69) intervention • Freq family eats fast food 0=never to 5=every day • Results: Pre (1.19) vs Post (1.14) intervention • Support for PA, family participation 1=strongly disagree to 4=strongly agree • Results: Pre (3.33) vs Post (3.51) intervention • Monitoring screen time to 2 hrs 1=strongly disagree to 4= strongly agree • Results: Pre (3.29) vs Post (3.27) intervention • TV on during dinner 1=never to 5=always • Results: Pre (1.24) vs Post (1.07) intervention • TV in child’s bedroom • Results: Pre (64%) vs Post (62%) intervention

12. Pre-Post differences • BMI z-score lowered and Obese % decreased from 18.413.9% by post intervention • Children recorded significantly greater min/hr in light PA by post intervention • TV viewing time decreased from 142 min/day 72 min/day • Marginally lower mins/hr of sedentary activity (33  32 min/hr) and greater mins/hr of moderate activity (4.6  5.0 min/hr) by post intervention • Decreased kcals (1593  1404 ) and macros by post intervention • No changes in screen-related parenting (monitoring TV time, TV on during dinner, or TV in child’s bedroom)

13. Conclusion • This program centered around families’ needs and interests, built on strengths, responded to their weaknesses, and helped them utilize resources in their communities. • One of first studies to use CBPR to engage low-income parents in development, implementation, and evaluation of a family-centered obesity prevention program. • Advantages: • This approach was parent centered and engaged parents as part of the CAB members. • Built on pre-existing Head Start resources such as BMI reporting and Family Fun Days for family outreach. • Parents were trained to be leaders for the Parents’ Connect program and created involvement • Disadvantages: • Lack of control group- not feasible in short time frame • Threat to internal validity- relied on parents’ report and improvements in children’s obesity risk behaviors could be seasonal effects

14. Questions?? Why do you think parents will only set standards or goals for their child who is overweight/obese?? Why not the whole family?? Why do you think the parent-centered approach works??