Early Childhood Family Intervention and Long-term Obesity Prevention Among High-risk Minority Youth

Abstract

WHAT'S KNOWN ON THIS SUBJECT:The evidence base for obesity prevention is extremely limited. Although minority youth are at higher risk of obesity, and early childhood is a critical period for prevention, only 1 program has demonstrated sustained effects on obesity in young minority children.WHAT THIS STUDY ADDS: Among youth at high risk for obesity based on income, minority status, and child behavior problems, early intervention that promotes effective parenting led to meaningful differences in obesity in preadolescence. Early family intervention is an innovative and promising approach.abstract OBJECTIVES: To test the hypothesis that family intervention to promote effective parenting in early childhood affects obesity in preadolescence.METHODS: Participants were 186 minority youth at risk for behavior problems who enrolled in long-term follow-up studies after random assignment to family intervention or control condition at age 4. Follow-up Study 1 included 40 girls at familial risk for behavior problems; Follow-up Study 2 included 146 boys and girls at risk for behavior problems based on teacher ratings. Family intervention aimed to promote effective parenting and prevent behavior problems during early childhood; it did not focus on physical health. BMI and health behaviors were measured an average of 5 years after intervention in Study 1 and 3 years after intervention in Study 2.RESULTS: Youth randomized to intervention had significantly lower BMI at follow-up relative to controls (Study 1 P = .05; Study 2 P = .006). Clinical impact is evidenced by lower rates of obesity (BMI $95th percentile) among intervention girls and boys relative to controls (Study 2: 24% vs 54%, P = .002). There were significant intervention-control group differences on physical and sedentary activity, blood pressure, and diet.CONCLUSIONS: Two long-term follow-up studies of randomized trials show that relative to controls, youth at risk for behavior problems who received family intervention at age 4 had lower BMI and improved health behaviors as they approached adolescence. Efforts to promote effective parenting and prevent behavior problems early in life may contribute to the reduction of obesity and health disparities.

Childhood Psychosocial Determinants of Cardiovascular Health

“…Follow up studies of IY report improvements in positive parenting, child behavior and school readiness, among other positive outcomes [38,39]. There is also preliminary evidence that IY parent and child groups may result in positive child health outcomes approximately five years later, including lower body mass index and blood pressure, more physical activity, less "screen time" and smaller percent of calories from carbohydrates [40], despite these not being the focus of intervention. The mechanism by which these programs may impact child health outcomes and the extent to which positive outcomes persist to adolescence and adulthood have not yet been studied, but are certainly areas of future direction.…”

Houston … We Have a Problem! Measurement of Parenting

“…48 It is not clear how important these physical activity and food parenting practices may be in influencing a child's behavior versus the parent's skill at general parenting. 49 There are substantial limitations and problems of measurement in most of the existing scales of parenting style, 50 and food, 51 physical activity, 52 and media 53 parenting practices. To advance this area of research, major advances are needed in measurement.…”

Preliminary assessment of a school-based healthy lifestyle program among rural children.

“…In addition, evidence supported that family-based interventions had long-term effects on children's BMI, physical activity, sedentary activity, blood pressure, and diet, and the influence patterns were similar between boys and girls (Brotman et al, 2012).…”

“…In response to the childhood obesity epidemic, many family-based and schoolbased healthy lifestyle programs have been designed and conducted to improve children's healthy behaviors and control the childhood obesity epidemic. Family-based healthy lifestyle programs have been supported to have effects on reducing BMI, and increasing physical activity and healthy eating behaviors (Brotman et al, 2012;Sacher et al, 2010).…”

“…One-way or two-way repeated measures (pretest vs. posttest) MANOVA were used to assess the main effects of intervention and conditions, and the interaction effects of conditions and time (West, Sanders, Cleghorn, & Davies, 2010). In addition, linear (simple or multiple) and logistic regression have been applied to model the changing patterns of outcomes over time (Brotman et al, 2012;Plachta-Danielzik, Landsberg, Lange, Seiberl, & Muller, 2011). Blackwell and colleagues (2006) suggested that mixed-effects regression models provide a more flexible and accurate framework for managing repeated measures data compared to conventional statistical techniques, such as, t-test, ANOVA, repeated measures ANOVA/MANOVA, and linear regression et al For many longitudinal studies, data collected for each subject is correlated over time.…”