Projecting the impact of hypothetical early life interventions on adiposity in children living in low‐income households

Abstract

Background It is difficult to evaluate the effectiveness of interventions aimed at reducing early childhood obesity using randomized trials. Objective To illustrate how observational data can be analyzed using causal inference methods to estimate the potential impact of behavioral “interventions” on early childhood adiposity. Methods We used longitudinal data from 1054 children 1–5 years old enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and followed from 2008 to 2010 for a mean duration of 23 months. The data came from a random sample of WIC families living in Los Angeles County in 2008. We used the parametric g-formula to estimate the impact of various hypothetical behavioral interventions. Results Adjusted mean weight-for-height Z score at the end of follow-up was 0.73 (95% CI 0.65, 0.81) under no intervention, and 0.63 (95% CI 0.38, 0.87) for all interventions given jointly. Exclusive breastfeeding for six months or longer was the most effective intervention [population mean difference = −0.11 (95% CI −0.22, 0.01)]. Other interventions had little or no effect. Conclusions Compared with interventions promoting healthy eating and physical activity behaviors, breastfeeding was more effective in reducing obesity risk in children aged 1–5 years. When carefully applied, causal inference methods may offer viable alternatives to randomized trials in etiologic and evaluation research.

Economic evaluation of California prenatal participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to prevent preterm birth

“…We conducted this analysis from a societal perspective, and thus the resulting cost-savings included both cost-savings pertaining to intervention costs as well as cost-savings due to tangible and intangible costs associated with PTB. Using simulation and modeling approaches, 30,31 this study demonstrated that WIC's standard of care (i.e. status quo) is cost-saving and cost-effective and that WIC could save even more if it were universal.…”

The Association between the 2009 WIC Food Package Change and Early Childhood Obesity Risk Varies by Type of Infant Package Received

“…Using causal inference methods to model the potential impact of hypothetical dietary interventions among a sample of WIC-participating children in Los Angeles, Nianogo and colleagues found that increasing rates of exclusive breastfeeding for at least 6 months would be the most successful at reducing obesity risk, with other dietary-change interventions (eg, eating five fruits and vegetables per day, eliminating sugar-sweetened beverages or fast-food consumption) not having significant impacts on mean WHZ at follow-up. 21 To a lesser extent, the association between the WIC food package change and obesity was also present for children in the Mostly Formula Fed and Fully Formula Fed groups, with a lower obesity risk in period 3 vs period 1, particularly among boys. In the case of the Fully Formula Fed group, this reduced obesity risk could not have been due to breastfeeding, implying a possible role of the recalibration of infant formula amounts to match infants' age and needs, of the types of infant foods introduced after the food package change for 6to 12-month-old infants, or the new child food package (1 to 4 years).…”

Outcomes of an early childhood obesity prevention program in a low‐income community: a pilot, randomized trial

“…This study included interventions in multiple areas associated with obesity and demonstrated a significant change in 2 (breastfeeding and sleep pattern). Prolonged breastfeeding has a small but measurable effect on infant weight, (23) and an intervention that combined sleep and recognition of feeding cues (24) was also effective in reducing WFL z-scores as compared with single interventions. A multi-component intervention with each intervention contributing to a small change in BMI could translate into longer-term, childhood obesity prevention.…”