Identification and Characterization of Families That Are Positively Deviant for Childhood Obesity in a Latino Population: A Case-Control Study

Abstract

Background Childhood obesity is a complex public health challenge that requires innovative, sustainable solutions. Positive deviance, inspired by the science of complexity, is an approach that examines what allows certain individuals to succeed despite being predicted to fail. This study is aimed at identifying and defining positive deviants for early childhood obesity. Methods This case-control study used medical record data to identify Latino children aged 2–5 and classify them using their longitudinal weight change. Parents of children with trajectories toward a healthy weight from an obese weight (cases) and parents of children with stable obese weight trajectories over time (controls) were recruited. Mixed-methods analyses were used including a semistructured interview and quantitative surveys evaluating diet, physical activity, sleep, feeding practices, and self-efficacy. Qualitative description was applied to the qualitative data; quantitative data were analyzed using descriptive statistics and logistic regression modeling. Results Of eligible Latino children identified from the overall data set (n=1,621), 257 (16%) had trajectories toward a healthy weight, and among these, 21 positively deviant cases completed the study with 23 matched controls. Positive deviant families were characterized by lower education, higher self-efficacy, and a more Mexican cultural orientation. Findings suggest that effective engagement of other caregivers and creating healthy food environments were important determinants of healthy weight outcomes. Conclusions Positive deviants (cases) were distinct from controls in several parenting strategies such as creating healthy food environments and engaging caregivers. They had higher self-efficacy despite lower education. There were fewer differences in diet and physical activity than expected.

Parent Feeding Practices in the Context of Food Insecurity

“…Specifically, a positive deviance approach identifies “social deviants” who have healthy outcomes despite facing the same challenges and having no more resources than their peers [ 104 ]. A social deviance approach to childhood obesity is starting to become more common [ 105 , 106 ]. This work has found self-efficacy to be a salient characteristic of positive deviant families who were able to reduce child adiposity [ 106 ].…”

Growing Healthy Together: protocol for a randomized clinical trial using parent mentors for early childhood obesity intervention in a Latino community

“…The experimental curriculum available in both English and Spanish was developed on the basis of findings from a positive deviance study that identified behaviors and practices from Latino families who were successful in changing their child’s weight status from obese toward a healthy weight [17]. After these behaviors were identified, we used a behavioral intervention mapping approach to create the curriculum for parent mentors to apply with parents in the experimental (positive deviance) arm [22, 23].…”

“…Identifying the successful behaviors of positive deviants can inform an intervention for the larger population at risk. We previously identified core characteristics of positive deviants for early childhood obesity in a low-income, Latino population [17]. The potential benefit of using positive deviance is that by identifying strategies that already exist in the community, the intervention may be more scalable and overcome challenges related to cultural beliefs [12].…”

Characterizing Micro-scale Disparities in Childhood Obesity: Examining the Influence of Multilevel Factors on 4-Year Changes in BMI, Healthy Eating, and Physical Activity, Among a Cohort of Children Residing in Disadvantaged Urban Enclaves

“…However, our findings on the specific factors associated with positive deviance contrast with those of other recent studies of low-income, predominantly Hispanic communities. Foster et al conducted a similar study in San Antonio, Texas, and identified low parental education, high parental self-efficacy, and predominant Mexican cultural identity (low acculturation) among parents, as factors associated with positive deviance for healthy weight trajectories in children aged 2–5 years of age (37). None of these factors were found to be associated with decreasing BMI in our study.…”