Obesity prevention in pre-school Native-American Children: A pilot study using home visiting

Bernino, J. and Rourke, J.
Obesity Research, 11:606-611
May, 2003


Pediatric obesity is growing at an alarming rate in the United States. Despite this problem, few intervention efforts have focused on prevention of obesity. A review of the pediatric obesity treatment literature indicates that one of the best predictors of short- and long-term weight regulation for children from 8 to 12 years of age is parental involvement. While the development of parenting skills to facilitate healthy attitudes and interactions surrounding eating and activity may help to increase success, it is not known whether early intervention with the parents of young children can prevent obesity.

Vermont researchers performed a study with the purpose of conducting a pilot test of the feasibility and effectiveness of an innovative obesity prevention intervention with the parents of preschool Native-American children. Native Americans experience high rates of obesity, with evidence that excessive weight gain starts in children younger than 2 years of age. Forty-three mother-child pairs who met the following criteria served as subjects for the study: 1) the family had a child between the ages of 9 months and 3 years; 2) the child was walking; 3) the mother had a BMI over 25 kg/[m.sup.2]; and 4) the mother agreed to keep all treatment appointments. The subjects were randomly assigned to one of the two treatment groups: parenting support (PS) or obesity prevention plus parenting support (OPPS). Both conditions consisted of a sixteen-week program conducted by an indigenous peer educator in the home of each participant. Assessments were conducted at baseline and at the end of the treatment.

The parenting support condition included all mothers participating in a core parenting program that was based on the Active Parenting curriculum. The program emphasized the child’s psychological and behavioral goal, logical and natural consequences, mutual respect, and encouragement techniques. The structure of the OPPS was identical to the PS; however, the focus of the sessions was on how improved parenting skills could facilitate the development of appropriate eating and exercise behaviors in children. Height and weight were measured in both the mothers and children. Parents were asked to complete separate three-day food records to document their own and their child’s food intake. Physical activity was measured using TriTrack accelerometers worn over the same three-day period as the subjects that recorded food intake. Mothers were asked to report their level of agreement with 10 outcome expectations regarding participation in physical activity and dietary modification. Child feeding beliefs and practices were measured with the Child Feeding Questionnaire (CFQ).

Changes in weight for height z scores showed a trend toward significance with weight for height z scores decreasing in the PS condition and increasing among the OPPS group (-0.27 [+ or -] 1.1 vs. 0.31 [+ or -] 1.1, p = 0.06). Children in the OPPS condition also significantly decreased caloric intake (-316 [+ or -] 835 kcal/day vs. 197 [+ or -] 608 kcal/d, p <0.05). Scores on the restriction subscale of the CFQ decreased significantly in the OPPS condition (-0.22 [+ or -] 0.42 vs. 0.08 [+ or -] 0.63, p <0.05), indicating that mothers in the OPPS group were engaging in less restrictive child feeding practices over time.

It appears that a home visiting program, targeted at at-risk families, may help to reduce the occurrence of obesity in the pediatric population. Evaluation on other ethnic groups would be helpful to determine if these benefits span the population.