Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study

Abstract

Background: There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among lowincome, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone.Methods: Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented.Results: Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income ( £ $25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables.

Evaluation of complex community‐based childhood obesity prevention interventions

“…Figure describes the search results – 33 interventions were entered into the data corpus as meeting all inclusion criteria. Each intervention took place across multiple community settings and focused on systems change to promote healthy behaviours at the individual level applying a range of study designs . The interventions were participatory in nature, with a foundational component built on community engagement, empowerment and capacity building.…”

“…Schools were the primary setting for data collection in 29 of 33 interventions , and barriers around recruiting, engaging and following up with schools were frequently reported . Logistically, working around school timetables and vacation periods proved challenging , and one intervention noted that several visits to schools were often necessary to re‐measure all participants in the follow‐up period .…”

“…Thirteen interventions used objective means, such as accelerometers for physical activity, to assess changes in health behaviours. With surveys, interventions reported limitations such as social desirability bias , self‐report bias and recall bias , whereas with objective measures, challenges outlined included cost , technical requirements and diligent participation to acquire accurate data. Process evaluation often accompanied outcome evaluation to provide context within which to interpret changes to proximal and/or distal outcomes . …”

Who benefits from the intervention? Correlates of successful BMI reduction in the Texas Childhood Obesity Demonstration Project (TX‐CORD)

“…The Texas Childhood Obesity Research Demonstration (TX CORD) study, an integrated, systems‐oriented model encompassing primary and secondary childhood obesity prevention approaches, engaged multiple levels and sectors in Houston and Austin, Texas between 2012 and 2014. The target population was predominantly Hispanic and non‐Hispanic Black children ages 2 to 12 years from low‐income, medically underserved areas . The secondary prevention component was a 12‐month randomized controlled trial (RCT) that compared an intensive community‐centered weight management program (Mind, Exercise, Nutrition.…”

Wildcat wellness coaching feasibility trial: protocol for home-based health behavior mentoring in girls

“…Secondary prevention measures may focus on reducing the impact of childhood obesity by slowing or reversing the weight gain through the building of healthful behaviors. Secondary prevention techniques may include self-efficacy and skill-building for behaviors related to nutrition and physical activity [10]. Given that obesity may result from prolonged positive energy imbalance, interventions typically promote increased energy expenditure or appropriately balanced caloric intake, which can each be considered independent avenues to improve obesity outcomes.…”