Multicomponent Obesity Prevention Intervention in Low-Income Preschoolers: Primary and Subgroup Analyses of the NET-Works Randomized Clinical Trial, 2012–2017

Abstract

Objectives. To evaluate a multicomponent obesity prevention intervention among diverse, low-income preschoolers. Methods. Parent–child dyads (n = 534) were randomized to the Now Everybody Together for Amazing and Healthful Kids (NET-Works) intervention or usual care in Minneapolis, MN (2012–2017). The intervention consisted of home visits, parenting classes, and telephone check-ins. The primary outcomes were adjusted 24- and 36-month body mass index (BMI). Results. Compared with usual care, the NET-Works intervention showed no significant difference in BMI change at 24 (–0.12 kg/m2; 95% confidence interval [CI] = −0.44, 0.19) or 36 months (–0.19 kg/m2; 95% CI = −0.64, 0.26). Energy intake was significantly lower in the NET-Works group at 24 (–90 kcal/day; 95% CI = −164, −16) and 36 months (–101 kcal/day; 95% CI = −164, −37). Television viewing was significantly lower in the NET-Works group at 24 (rate ratio = 0.84; 95% CI = 0.75, 0.93) and 36 months (rate ratio = 0.88; 95% CI = 0.78, 0.99). Children with baseline overweight or obesity had lower BMI in the NET-Works group than those in usual care at 36 months (–0.71 kg/m2; 95% CI = −1.30, −0.12). Hispanic children had lower BMI in the NET-Works group than those in usual care at 36 months (–0.59 kg/m2; 95% CI = −1.14, −0.04). Conclusions. In secondary analyses, NET-Works significantly reduced BMI over 3 years among Hispanic children and children with baseline overweight or obesity. Trial Registration: ClinicalTrials.gov Identifier: NCT01606891.

The effect of the 2009 WIC food package change on childhood obesity varies by gender and initial weight status in Los Angeles County

“…The authors found no effect of the intervention on child BMI at age 2 or 3 years in the sample as a whole. However, they found reduced increases in BMI among Hispanic children and children with overweight or obesity at baseline and exposed to the intervention arm, with no differences by gender . Similar results were found from a mobile‐based intervention among preschoolers in Sweden, with larger effects of the intervention among those who were heavier at baseline …”

“…French et al investigated the effect of a multicomponent obesity prevention intervention among preschool‐aged children of low‐income and racially/ethnically diverse parents in Minneapolis, MN. The intervention was a 3‐year randomized control trial including home visits to address parental behavior and home‐environment change in terms of children's eating and physical activity patterns, community‐based parenting classes, and primary care provider interactions (the control group received only the latter) . The authors found no effect of the intervention on child BMI at age 2 or 3 years in the sample as a whole.…”

“…The authors found that girls benefitted significantly more from such interventions compared with boys, with no significant moderation effects of race/ethnicity, socioeconomic status (SES), or initial weight status . A very recent study found that a multicomponent obesity intervention program targeting low‐income and racially/ethnically diverse parents of preschool‐aged children had no effect on the sample as a whole, but effects emerged for Hispanic children and those who were overweight/obese at baseline upon stratification . Similarly, Lissner et al found that effects of the Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) intervention—a school‐ and community‐level obesity intervention in eight European countries focused on children 2 to 10 years of age—on weight status were only observed among children who were overweight at the start of the intervention.…”

“…Findings of the larger study indicate that children exposed to the new food package (ie, those enrolled in WIC after October 1, 2009) have healthier (ie, further from the overweight category) growth trajectories and a lower obesity prevalence at age 4 years than those exposed to the old food package . However, since other studies have suggested that children with overweight or obesity may benefit the most from obesity interventions, our objective was to investigate whether the effect of the new WIC food package, compared with the old, on obesity outcomes varied by children's initial weight status. We hypothesized that exposure to the new WIC food package, compared with the old, is associated with the greatest reduction in obesity among children with the highest initial weight status.…”

Competency-Based Approaches to Community Health: A Randomized Controlled Trial to Reduce Childhood Obesity among Latino Preschool-Aged Children

“…[8][9][10] In particular, two recently conducted randomized trials among predominantly Latino families did not achieve their primary outcome of obesity prevention among preschool-aged children. 11,12 These findings are consistent with a previous systematic review that identified only a few successful interventions among Latino children, all of which were among older children. 13 One reason that childhood obesity interventions for children from low-income and minority communities may fail is that intervention content may not account for the wide variability of cultural, social, and psychological factors that contribute to both obesity and its determinative health behaviors.…”