Location: Children's Nutrition Research Center2011 Annual Report
1a. Objectives (from AD-416)
Objective 1: Investigate the effectiveness of community-based intervention strategies to prevent childhood obesity and its associated health risks in 8- to 12-y-old Hispanic children with BMI >/= 85th percentile. Sub-objective 1.A. Test the effectiveness of diet behavior modification, structured aerobic exercise, or diet behavior modification plus structured aerobic exercise for obesity prevention and improvement in fitness, health risks, and psychological state in at-risk Hispanic children, ages 8-12 y, assigned to one of three treatment groups or control in a 12-month family-based RCT. Sub-objective 1.B. Evaluate the role of genetic variation in response to strategies aimed at diet and PA. Sub-objective 1.C. Model energy balance in growing children to predict the obligatory changes in energy intake and/or energy expenditure and PAL required for obesity prevention. Objective 2: Develop and evaluate family-centered intervention strategies for the pediatric primary care setting to prevent childhood obesity. Sub-objective 2.A. Develop a conceptual model and perform formative work to evaluate the model for a pediatric obesity prevention program for primary care clinics. Sub-objective 2.B. Develop and pilot test a parent-targeted obesity prevention program for pediatric primary care clinics. Sub-objective 2.C. Evaluate the parent-targeted prevention program for effectiveness in pediatric primary care clinics.
1b. Approach (from AD-416)
The long-term objective of this project is to increase our understanding of how to prevent childhood obesity through targeted community interventions. A multifactorial theoretical approach based on Social Cognitive Theory (SCT) and parenting theory will be taken to address the built environment as well as family dynamics and child behavior at the community and primary care level. A 12-month family-based randomized controlled trial (RCT) will be conducted to test the effectiveness of diet behavior modification, structured aerobic exercise, or diet behavior modification plus structured aerobic exercise for obesity prevention and improvement in fitness, health risks, and psychological state in at-risk Hispanic children (Objective 1). The role of genetic variation in response to strategies aimed at diet and physical activity (PA) will be evaluated and a model developed to predict the obligatory changes in energy intake and physical activity level (PAL) required for obesity prevention. Family-centered intervention strategies will be developed and evaluated for the pediatric primary care setting to prevent childhood obesity (Objective 2). A conceptual model will be developed and formative work performed to evaluate the model for obesity prevention program for primary care clinics. A parent-targeted obesity prevention program will be developed and a pilot study conducted in pediatric primary care clinics. A RCT will be conducted to evaluate the parent-targeted prevention program for effectiveness in pediatric primary care clinics. Together, these strategies form a new paradigm that integrates community resources and pediatric primary care in support of the child and the family in the prevention and management of childhood obesity.
3. Progress Report
In Obj. 1 the effectiveness of a family-based intervention VIVA LA SALUD INFANTIL based on diet behavior modification with and without exercise was tested in 8- to 12-year-old Hispanic children for weight loss and improvement in fitness, psychological state and co-morbidity risk. Behavior modification with exercise resulted in greater weight loss compared with behavior modification alone, -2.35 kg and -1.69 kg in 4 months, respectively. Significant improvement in fitness level was observed for both groups, as measured by the PACER shuttle test. Weight loss resulted in a decrease in fasting blood levels of LDL-cholesterol, triglycerides, insulin, and leptin, which are indicators for cardiometabolic risk. A 1-year family-based child obesity intervention called MEND (Mind Exercise Nutrition Do It) is being conducted at local YMCAs in underserved communities. MEND is a healthy lifestyle program involving a 10-week intensive phase of twice-weekly MEND sessions with parents and children in attendance. The children also participate in exercise classes while the parents receive information and counseling from trained health educators. The follow-up phase of MEND entails exercise classes, YMCA Youth Sports, and parental support groups. 47 families have been enrolled into this program. To explore the effect of genetic variation on behaviors related to diet and physical activity, we genotyped 1.1 million single nucleotide polymorphisms (SNPs) in 815 Hispanic children. Genetic association analysis has identified several statistically significant genetic variants associated with obesity-related traits. Preliminary mathematical modeling of changes in weight and body composition and energy expenditure in growing children has been initiated with collaborators at National Institutes of Health. In Obj. 2 we tested the Helping HAND program (a modular 6-month program that targets obesity-related child behaviors and corresponding effective parenting practices to support the child toward behavior change) for feasibility among 40 families from 4 community pediatric clinics. Twenty parent-child pairs were randomized to immediately start the program, and 20 were wait-listed to start the program after time 2 data collection. We conducted 29 exit interviews with participants from the study. This year we completed the qualitative and quantitative analysis to assess the feasibility and effect size of the Helping HAND intervention. We have submitted a manuscript of the Helping HAND feasibility trial outcomes to Child: Care, Health & Development, which currently has it under review. In addition, we have conducted an in-depth process evaluation of the delivery of the Helping HAND program by assessing the implementation of the patient-centered communication techniques that the Health Advisors were trained to use. A manuscript was submitted to Patient Education and Counseling. The results of the feasibility trial and process evaluation will inform the intervention to be evaluated in future studies. The ADODR monitors project activities by visits, review of purchases of equipment, review of ARS-funded foreign travel, and review of ARS funds provided through the SCA.
1. Feasibility of Helping HAND: An obesity intervention for pediatric primary care clinics targeting parenting. Experts suggest that child obesity interventions should involve parents, but many school-based programs have not been effective in reaching parents. The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviors and improve weight status among children, but few primary care interventions have thus far been evaluated. Researchers at the Children's Nutrition Research Center have conducted a feasibility study of Helping HAND, a 6-month intervention that targeted children at high risk for adult obesity and their parents in community pediatric clinics. Forty primarily Hispanic and low-income parent-child dyads enrolled, and due to low drop-out rates, good program attendance, and clinically relevant improvements in some behaviors, this intervention is feasible. Pilot data suggests that TV reduction may be important in obesity interventions among Hispanic children, thus an enhanced version of Helping HAND with a focus on screen media reduction should be tested for efficacy in pediatric community clinics.