Background: Primary care offers a promising setting for promoting parenting practices that shape healthy eating and physical activity behaviors of young children. This study assessed the impact of a parent-based, primary care intervention on the feeding habits, health behaviors, and body mass index (BMI) of 2–5 year olds with elevated or rapidly-increasing BMI. Methods: Four private pediatric offices in West Michigan were assigned as control (n = 2) or intervention (n = 2) sites based on patient load and demographics. Treatment families were recruited at well-child visits to receive physician health-behavior counseling and four visits with a registered dietitian nutritionist (RDN) over a 6-month period. Intervention outcomes were age- and sex-specific BMI metrics, including BMI z-scores and percent of the 95th percentile (%BMIp95), the Family Nutrition and Physical Activity survey (FNPA), and the Feeding Practices and Structure Questionnaire (FPSQ). Results: Of 165 enrolled families, 127 completed follow-up measures (77% retention). Mean (±SD) FNPA scores improved in treatment vs. control (4.6 ± 4.6 vs. 0.1 ± 4.2; p < 0.001), and screen time (h/day) decreased (−0.9 ± 1.8 vs. 0.3 ± 1.1; p < 0.001). Non-responsive feeding practices (i.e., reward for behavior (p = 0.006) and distrust in appetite (p < 0.015)) and structure-related feeding practices (structured meal timing (p < 0.001)) improved in treatment parents vs. controls. Reductions in child BMI measures did not differ between groups. Conclusions: Families with preschool children participating in a low-intensity, primary care intervention improved obesogenic health behaviors, parent feeding habits, and child screen time, but not child adiposity. Future research should assess the sustainability of these family lifestyle improvements, and evaluate their future impact on the health and development of the children.

BackgroundThis paper describes Project FIT, a collaboration between the public school system, local health systems, physicians, neighborhood associations, businesses, faith-based leaders, community agencies and university researchers to develop a multi-faceted approach to promote physical activity and healthy eating toward the general goal of preventing and reducing childhood obesity among children in Grand Rapids, MI, USA.Methods/designThere are four overall components to Project FIT: school, community, social marketing, and school staff wellness - all that focus on: 1) increasing access to safe and affordable physical activity and nutrition education opportunities in the schools and surrounding neighborhoods; 2) improving the affordability and availability of nutritious food in the neighborhoods surrounding the schools; 3) improving the knowledge, self-efficacy, attitudes and behaviors regarding nutrition and physical activity among school staff, parents and students; 4) impacting the 'culture' of the schools and neighborhoods to incorporate healthful values; and 5) encouraging dialogue among all community partners to leverage existing programs and introduce new ones.DiscussionAt baseline, there was generally low physical activity (70% do not meet recommendation of 60 minutes per day), excessive screen time (75% do not meet recommendation of < 2 hours per day), and low intake of vegetables and whole grains and high intake of sugar-sweetened beverages, French fries and chips and desserts as well as a high prevalence of overweight and obesity (48.5% including 6% with severe obesity) among low income, primarily Hispanic and African American 3rd-5th grade children (n = 403).Trial registrationClinicalTrials.gov NCT01385046

Objective: To evaluate the short-term outcome of the social marketing approach used in Project FIT, we developed a school-and community-based programme for promoting healthful eating and physical activity in kindergarten to 5th-grade children and their parents. Design: A 2-year quasi-experiment for children and two cross-sectional surveys for parents. Setting: We included low-income, urban and ethnically diverse elementary schools and neighbourhoods in Grand Rapids, Michigan, USA. Method: Students in 3rd, 4th and 5th grades were surveyed in four intervention schools (four time points, N with at least one time point measurement = 664) and two control schools (N = 195). Parents of intervention students were surveyed at baseline (N = 286) and follow-up (N = 215). Key dependent variables included self-reported healthful eating and physical activity. Key independent variables included awareness, knowledge, motivation and attitudes towards Project FIT. Analysis: We analysed generalised linear mixed models and generalised estimation equation (GEE) models for the student surveys and mean difference tests and logistic regressions for the parent surveys. Results: The proportion of students who were aware of Project FIT increased over time. GEE models showed that selected key dependent variables were significantly associated with self-reported healthful eating and physical activity. Parents were more aware of Project FIT at follow-up compared to the baseline survey, and their attitudes were significantly associated with increased healthful eating (vegetables, fruits and whole grains). Conclusion: The social marketing approach utilised in Project FIT contributed to increasing awareness and achieving behavioural goals of healthful eating and physical activity.

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