Impact of a Healthy Weight Intervention Embedded Within a National Home Visiting Program on the Home Food Environment

Journal of Nutrition Education and Behavior

et al. 2019

Self Cite

Objective: To examine whether a healthy weight intervention embedded in the Parents as Teachers (PAT) home visiting program, previously found to improve mothers' BMI and obesityrelated behaviors, changed the BMI of preschool children or feeding practices used by the mothers. Methods: This stratified randomized trial included preschool-age children at risk of overweight whose mothers were overweight or had obesity (N=179). The Healthy Eating & Active Living Taught at Home (HEALTH) intervention was based on the Diabetes Prevention Program. Differences were examined using repeated-measures mixed analysis of variance models. Results: Compared to PAT usual care, HEALTH intervention had no effect on children's BMI or mothers' feeding practices. However, combined analyses showed that children's BMI percentile decreased, BMI z-scores maintained, and three of eight feeding practices improved over time. Conclusions and Implications: Additional research is needed to assess the effectiveness of PAT to prevent preschool-age obesity using rigorous designs (e.g., group-randomized trials) and to identify its active components. HEALTH is ready to be scaled-up for prevention of maternal weight gain through embedding within the national PAT program.

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

The Impact of a Healthy Weight Intervention Embedded in a Home-Visiting Program on Children's Weight and Mothers’ Feeding Practices

Morshed

Tabak

Journal of Nutrition Education and Behavior

et al. 2019

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“…The Activity and Diet scale of the Home Self-administered Tool for Environmental survey (HomeSTEAD) and measures from the Healthy Eating and Active Living Taught at Home study were used to assess modifications of the home environment to support healthy eating and activity [ 47 – 49 ]. This included availability and accessibility of sweet and salty snacks and of soda (e.g., I have soda in the home that is easy to get to and in plain sight, easy to get to but out of sight, hidden and out of reach, or no soda in the home).…”

Section: Methodsmentioning

confidence: 99%

Raising Well at Home: a pre-post feasibility study of a lifestyle intervention for caregivers and their child with obesity

Haire‐Joshu

Jacob

et al. 2020

Pilot Feasibility Stud

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Background Few efficacious pediatric obesity interventions have been successfully translated and sustained in real-world practice, often due to inadequate fit with the priorities of under-resourced populations. Lifestyle interventions, which incorporate tailoring of essential weight loss ingredients and adaptation of mode and intensity to the living circumstances of children with obesity, are needed. The purpose of this pilot study was to test the feasibility and efficacy of a tailored lifestyle intervention for caregivers and their children with obesity, conducted in partnership with Envolve, Inc., a family of comprehensive health solutions and wholly owned subsidiary of Centene Corporation. Methods This 6-month pilot study employed a pretest-posttest design to assess the impact of a tailored lifestyle intervention delivered by peer coaches on (a) caregiver and child weight impacted by changes in dietary intake, walking, and screen time; (b) changes in the home environment; and (c) caregiver engagement and satisfaction. The intervention was delivered via 3 core home visits every 4–6 weeks, with additional support via text. Results The majority of caregivers were female (95.2%) and Black (73.7%). Children had median age of 11.1 years and majority were female (57.6%), with a median BMI near the 99th percentile (Mdn 98.8, IQR 3.5) or 118.3% (IQR 35.8) of the 95th percentile for their sex and age. Participants expressed high satisfaction with the program (mean range 96.7–100.0% agreement on satisfaction items). From baseline to post, caregivers’ BMI decreased by 1.8% (p = 0.016, r = 0.22), while children’s BMI percentile z-score decreased significantly (p = 0.023, r = 0.18) and BMI percent of the 95th percentile remained constant (p = 0.05, r = 0.15). Caregivers and children decreased sugar-sweetened beverage intake (p = 0.026, r = 0.22; p = 0.006, r = 0.23, respectively), reduced presence of soda in the home (p = 0.002, g = 0.43), and decreased screen time (p = 0.046, g = 0.22). Other eating and walking behaviors remained stable for caregivers and child. Conclusion The Raising Well at Home pilot demonstrated that tailored lifestyle interventions, delivered by peer coaches in the home and via text, are feasible and can improve weight, eating, and environmental measures of caregivers and children with obesity. Future work should determine the effectiveness, sustainability, and scalability of this intervention in sites located across the country. Trial registration ClinicalTrials.gov (NCT04224623). Registered 9 January 2020—retrospectively registered.

Weight gain prevention content delivered to mothers: Lessons from an intervention embedded in a community organization

Tabak

Morshed

Obesity Science & Practice

et al. 2019

SummaryBackgroundTransparent reporting of the intervention content study participants receive is particularly important for dissemination and implementation of evidence‐based interventions to address obesity. This study explores intervention delivery and perceptions of content when an intervention is embedded within an organization's usual practice and associations with weight outcomes.MethodsThis is a secondary analysis from the Healthy Eating and Active Living Taught at Home (HEALTH) randomized trial. HEALTH is a weight gain prevention intervention embedded within a national home visiting programme (Parents as Teachers, PAT). To be consistent with PAT practice, HEALTH has a suggested but also flexible home visit structure. Therefore, the number and frequency of home visits are determined by the family's needs and preferences based on the parent educator's professional judgement. The proportion of participants who received each curriculum core lesson was explored among the 105 families randomized to the HEALTH intervention group, as were mean parent educator perception ratings of the visits (5‐point Likert‐type scale). A chi‐square test was used to examine the association between utilization (ie, low: 1‐6, middle: 7‐12, or high: 13‐18 visits) category and weight maintenance.ResultsMothers received on average 13.3 (standard deviation 6.2) core visits. Mean parent educator perception of the mothers' response (out of 5) ranged from 3.99 to 4.27; educators' perception of their own experience with the lesson ranged from 4.13 to 4.34. Among mothers who maintained their weight, 13% were low, 22% were middle, and 65% were high utilizers, while among mothers who gained weight, 3%, 31%, and 67% were low, middle, and high utilizers, respectively; this difference was not statistically significant.ConclusionsThis study identified wide variation in the visits families received from the curriculum but minimal variation in visit perceptions. Future studies could explore whether there are optimal patterns for visit content, associated with successful outcomes.