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Title: Feasibility of an obesity intervention for paediatric primary care targeting parenting and children: Helping HAND

Author
item O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC)
item HILMERS, ANGELA - Children'S Nutrition Research Center (CNRC)
item WATSON, KATHY - Children'S Nutrition Research Center (CNRC)
item BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC)
item GIARDINO, ANGELO - Texas Children'S Hospital

Submitted to: Child: Care, Healthy, and Development
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/25/2011
Publication Date: 1/1/2013
Citation: O'Connor, T.M., Hilmers, A., Watson, K., Baranowski, T., Giardino, A.P. 2013. Feasibility of an obesity intervention for paediatric primary care targeting parenting and children:Helping HAND. Child: Care, Healthy, and Development. 39(1):141-149.

Interpretive Summary: Childhood obesity remains a significant public health concern in the USA because of the increased risk of several medical conditions among overweight children and adults. Given that almost one-third of US children are overweight or obese, there is likely not enough capacity in the US health care system to provide such intensive treatment programmes for all children who may benefit. Instead, less intensive interventions need to be developed and evaluated using systematic approaches, including feasibility trials. The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours, and improve weight status among children. Our objective was to test the feasibility of Helping HAND (Healthy Activity and Nutrition Directions), an obesity intervention for 5- to 8-year-old children in primary care clinics. We showed that 85% revealed that the subjects were positive about the Helping HAND program and received what they wanted. While there was no significant intervention effects on Body Mass Index or diet or physical activity, there was a small effect on sedentary minutes per day and a large effect on children's TV viewing. The conclusion is that Helping HAND is feasible, due to low attrition, good programme attendance, and clinically relevant improvements in some child and parenting behaviours. Pediatric primary care clinics offer a potential site to intervene with overweight children, while simultaneously reaching parents to promote effective parenting practices for healthy lifestyles.

Technical Abstract: The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours, and improve weight status among children. Our objective was to test the feasibility of Helping HAND (Healthy Activity and Nutrition Directions), an obesity intervention for 5- to 8-year-old children in primary care clinics. Our methods involved a randomized controlled pilot study of Helping HAND, a 6-month intervention, targeted children with body mass index 85–99%tile and their parents. Intervention group attended monthly sessions and self-selected child behaviours and parenting practices to change. Control group received regular paediatric care and was wait-listed for Helping HAND. Session completion, participant satisfaction, child anthropometrics, dietary intake, physical activity, TV viewing and behaviour-specific parenting practices were measured pre and post intervention. Our results showed that forty parent–child dyads enrolled: 82.5% were Hispanic, 80% had a girl and 65% reported income <=$30 000/year. There was 20% attrition from Helping HAND (attended <4/6 sessions). Families self-selected 4.35 (SD 1.75) behaviours to target during the 6-month programme and each of the seven behaviours was selected by 45–80% of the families. There were no between group differences in the child's body mass index z-score, dietary intake or physical activity post intervention. Intervention group viewed 14.9 (SE 2.3) h/week of TV post intervention versus control group 23.3 (SE 2.4) h/week (P < 0.05). Helping HAND is feasible, due to low attrition, good programme attendance, and clinically relevant improvements in some child and parenting behaviours.