Bright Start: Description and Main Outcomes From a Group‐Randomized Obesity Prevention Trial in American Indian Children

Abstract

The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. While the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, while the control children experienced a corresponding incidence of 24.8%; a difference of −11.4% (p=0.033). The intervention significantly reduced parent reported mean child intakes of sugar-sweetened beverages, whole milk and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.

Childhood Obesity Incidence in the United States: A Systematic Review

“…Only three studies used nationally representative data. 17,18,30 Among the studies drawing on data from intervention programs, 20,23,28,31,32 many focused on specific populations, such as schools in high-risk areas 28,31,32 or Native American reservations, 23 limiting the generalizability of the results. The heterogeneity in population was a challenge for literature synthesis, making straightforward comparisons between studies difficult.…”

“…Only three used nationally representative data. 17,18,30 Studies reporting incidence included one study among children under 2 years of age, 29 two among children between 2.0-4.9 years, 24,29 seven among children 5.0-12.9 years, 6,10,11,18,23,28,31 and two among adolescents 13.0-18.0 years. 6,21 Many studies spanned age groups, including infancy through the preschool ages, 22,29 preschool through school age, 17,25,26,27,30 and school age through adolescence.…”

“…Sample sizes for studies included in this review ranged between 109 and 380,518 children. 23,29 Follow-up was on average 2.0 years (range: 0.5-9.0 years).…”

“…Nine studies analyzed primary data, including five intervention studies randomized at the school level and providing control arm data. 20,23,28,31,32 Of the three nationally representative studies, two used the NLSY-Child Cohort data. One of these three representative studies included follow-up data from 1980-1988, finding an annual incidence of 1.3% for children 4-10 years old.…”

Increasing water intake in pre-school children with unhealthy drinking habits: A year-long controlled longitudinal field experiment assessing the impact of information, water affordance, and social regulation

“…Based on the recruitment timing and research budget, the final recruited sample reached 439 children. This sample size is comparable to other recent nutritional intervention trials aiming to prevent obesity in similar-aged children which also used a multi-component approach combining environmental, educational, and parental aspects and included aspects on water intake (Natale, Lopez-Mitnik, Uhlhorn, Asfour, & Messiah, 2014;Story, et al, 2012). Natale et al aimed to examine the effect of an early childhood obesity prevention program on changes in BMI z-score and nutrition practices over 6 months in 307 children aged 2 to 5 years.…”