Evaluation of a Primary Care Weight Management Program in Children Aged 2–5 years: Changes in Feeding Practices, Health Behaviors, and Body Mass Index

Abstract

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.

Effects of the Healthy Children, Healthy Families, Healthy Communities Program for Obesity Prevention among Vulnerable Children: A Cluster-Randomized Controlled Trial

“…On the contrary, several studies have evaluated them in childhood obesity management (or weight management) in home-based or primary care settings. Tucker, DeFrang, Orth, Wakefield, and Howard (2019) reported that a six-month parent-based weight management programme showed a significant effect on improving FNPA scores, but not on children's BMI in primary care settings [51]. Reportedly, higher FNPA scores were positively associated with children's healthy eating behaviors and negatively associated with children's obesity status [52,53].…”

Effects of Family Intervention on Physical Activity and Sedentary Behavior in Children Aged 2.5-12 Years: A Meta-Analysis

“…A total of 1596 articles were searched from each database, 1585 articles were excluded according to the inclusion and exclusion criteria. Finally, 11 articles were included in this study [31,[38][39][40][41][42][43][44][45][46][47]. (Fig.…”

“…All of included studies were published in 2012 or later, among which 7 were published in 2015 or later. Of them, 4 studies from Australia [38,40,45,46], 3 from the United States [31,42,44]. The United Kingdom [47], Germany [43], Finland [41], Norway and Sweden [39] each have one study.…”

“…The United Kingdom [47], Germany [43], Finland [41], Norway and Sweden [39] each have one study. The included studies consisted of 10 RCTs [31,[38][39][40][41][43][44][45][46][47] and 1 CCT [42], with a total of 955 participants in the treatment group and 931 participants in the control group. Five of the included studies [31,38,39,42,44] only used theory interventions, including PA knowledge education, health behavior lectures, PA counseling services, interviews, and telephone return visits.…”

“…Of the 11 articles, 6 articles [38,40,41,43,45,46] were classi ed as low risk, 2 articles [31,47] were classi ed as moderate risk, and 3 articles [39,42,44] were classi ed as high risk. All included studies were non-selective and the integrity of the data results was described in detail.…”