Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis

A collaborative approach to develop an intervention to strengthen health visitors' role in prevention of excess weight gain in children

BACKGROUND

The high prevalence of childhood obesity is a concern for public health policy and practitioners, leading to a focus on early prevention. UK health visitors (HVs) are well-positioned to prevent excessive weight gain trends in pre-school children but experience barriers to implementing guideline recommended practices. This research engaged with HVs to design an intervention to strengthen their role in prevention of early childhood obesity.

METHODS

We describe the processes we used to develop a behaviour change intervention and measures to test its feasibility. We conducted a systematic review to identify factors associated with implementation of practices recommended for prevention of early childhood obesity. We carried out interactive workshops with HVs who deliver health visiting services in County Durham, England. Workshop format was informed by the behaviour change wheel framework for developing theory-based interventions and incorporated systematic review evidence. As intended recipients of the intervention, HVs provided their views of what is important and acceptable in the local context. The findings of the workshops were combined in an iterative process to inform the four steps of the Implementation Intervention development framework that was adapted as a practical guide for the development process.

RESULTS

Theoretical analysis of the workshop findings revealed HVs' capabilities, opportunities and motivations related to prevention of excess weight in 0-2 year olds. Intervention strategies deemed most likely to support implementation (enablement, education, training, modelling, persuasion) were combined to design an interactive training intervention. Measures to test acceptability, feasibility, and fidelity of delivery of the proposed intervention were identified.

CONCLUSIONS

An interactive training intervention has been designed, informed by theory, evidence, and expert knowledge of HVs, in an area of health promotion that is currently evolving. This research addresses an important evidence-practice gap in prevention of childhood obesity. The use of a systematic approach to the development process, identification of intervention contents and their hypothesised mechanisms of action provides an opportunity for this research to contribute to the body of literature on designing of implementation interventions using a collaborative approach. Future research should be directed to evaluate the acceptability and feasibility of the intervention.

Influence of parental behavior on myopigenic behaviors and risk of myopia: analysis of nationwide survey data in children aged 3 to 18 years

Background

Preventive parental behavior may play an important role in the outcomes of children’s myopia. We investigated associations between parental behavior and children’s myopia status and daily activities using data from the most recent myopia survey in Taiwan.

Methods

In total, 3845 children aged 3 to 18 years who completely responded to the questionnaire were included (total score ranging from 0 to 75). A score of ≥ 50 was considered to indicate beneficial parental behavior. Time allocation data for near-work activities, using electronic devices, and outdoor activities were collected using a separate self-reported questionnaire. Associations between beneficial parental behavior and children’s myopia status and activity patterns were analyzed and stratified by school level.

Results

Beneficial parental behavior was positively associated with children’s myopia in the overall samples [adj. odds ratio (OR): 1.31, 95% confidence interval (CI): 1.08–1.59, p = 0.006)] and at the elementary school level (adj. OR: 1.43, 95% CI: 1.11–1.83, p = 0.005). However, a negative association with high myopia was observed in the overall samples (adj. OR: 0.71, 95% CI: 0.50–0.99, p = 0.049) and high school level (adj. OR: 0.62, 95% CI: 0.41–0.92, p = 0.02). Beneficial parental behavior was associated with less time spent on near work (≥ 180 min/day) and electronic device use (≥ 60 min/day), but not with outdoor activities.

Conclusion

In Taiwan, children’s myopia is associated with higher rate of parents’ beneficial behaviors, which suggests that regular vision surveillance is necessary to promote better parental behavior toward children’s eye care. Certain parental practices may influence children’s behavior pattern and reduce the risk of children’s high myopia development in the long run.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14036-5.

Feeding and Activity Environments for Infants and Toddlers in Childcare Centers and Family Childcare Homes in Southeastern New England

Few studies have documented the food and physical activity (PA) environments of childcare settings caring for children <24 months of age, although they may be key contributors to developing child PA and diet patterns. We used an adapted Environment and Policy Assessment and Observation tool to assess the food and activity environments for infants and toddlers in childcare centers (n = 21) and family childcare homes (FCCH) (n = 20) and explored differences by childcare type. Many similarities were found between childcare site types; however, centers used more recommended feeding practices than FCCH (e.g., 100% of center providers talked with toddlers about feelings of hunger or fullness compared to 18% of family childcare providers (FCCP), p < 0.01). Differences in non-recommended feeding practices (e.g., spoon feeding, bottle propping and encouraging unhealthy foods) were mixed between childcare types. Toddlers in centers spent more time playing at higher PA levels than those in FCCH (61 vs. 13 min, p < 0.001). Screen time was observed in FCCH, but not in centers. Differences between childcare types may indicate differential influences on infant and toddler feeding and PA behaviors, which could predict disparate obesity risk. Future research should further observe these behaviors in a larger sample of centers and FCCH to inform childcare interventions and policies.

Impacts of an early childhood obesity prevention program in Mexico

The Healthy Change Program aimed to improve the accuracy of maternal perceptions of children's weight (MPCW), maternal feeding style (MFS) and feeding practices. Using a randomized control trial design, the intervention group received 4-weekly group sessions focusing on MPCW, MFS and healthy behaviors. The control group received the same dose of attention-control sessions on food hygiene. Data were collected at the baseline and at the end of the program via self-administered questionnaires and anthropometric measurements. Participants included 294 mother-child dyads with 149 in the intervention group and 145 in the control group. The accuracy of MPCW significantly increased at the study end point in the intervention group (57.0-67.1%, P < 0.05) but not in the control group (67.6-69.7%, P > 0.05), with no between-group difference in pre- and post-change (P > 0.05). At the study end point, more mothers of overweight and obese children in the intervention group had accurate MPCW than their control counterparts (31.4% versus 11.1%, P < 0.01). The intervention group had a shift toward an authoritative style at the study end point (17.4% versus 26.2%, P < 0.001) and favorable changes in feeding practices. The Healthy Change Program contributed to improving the accuracy of MPCW and shifts toward favorable MFS and feeding practices.

The Association of Sugar-Sweetened Beverages to Children's Weights Status Is Moderated by Frequency of Adding Sugars and Sleep Hours

Adding extra sugars in milk and the moderating effect of sleep has yet to be investigated, setting the aim of this study. A total of 1361 school-aged children were included, aged 10−12 years old, by randomly sampling schools. Data were interview-obtained by trained personnel using a validated 17-item food frequency questionnaire, with specifics on type of milk and extra sugar additions. Analyses were stratified by average recommended hours of sleep. Predictive probability margins were obtained following necessary adjustments. Mean BMI was significantly lower, the level of SSB intake was higher, and the prevalence of adding sugars to milk four or more times per week was higher in children that slept ≥10 h. Most children (64%) consumed full fat milk, 21% had low fat, and 19.7% chocolate milk, with a significantly larger proportion of overweight or obese children consuming full fat or chocolate milk, also adding extra sugars four or more times per week (4.1% compared to 9.6%, and 12.2% compared to 39.5%, respectively). The predictive probability of being overweight or obese exponentially increased for children consuming >0.5 SSB/day while also adding sugars to their milk frequently, although this effect remained significant only for children sleeping <10 h/day. In conclusion, to accurately address the effect of SSBs on children’s body weight, frequency of any type of sugar addition in milk should be accounted for, as well as average sleep hours that may further moderate the effect.

Blindspot in the evidence base: A systematic review of psychological interventions for children and adolescents with intellectual disabilities and co-occurring obesity

BACKGROUND

Children and adolescents with intellectual disabilities (C&A-ID) face many disadvantages in healthcare research and service delivery. Intellectual disabilities have been found to precipitate weight-related problems, and together, they may be indicators of rare genetic diseases (RGDs). C&A-ID may require support for health problems exacerbated by primary diagnoses. While it is generally agreed that C&A-ID have more complex needs than typically developing individuals, psychological services to address these needs are under-explored.

AIMS

This systematic review aimed to identify psychological interventions for weight management in C&A-ID.

METHOD

MEDLINE, PsycINFO, CINAHL, The Cochrane Library and SCOPUS were systematically searched. Data extraction and quality appraisal were performed for all eligible studies RESULTS: The search strategy yielded seven studies published in English between 2010 and 2022. All interventions addressed obesity through multi-disciplinary programmes and resulted in weight reductions, with most interventions theoretically influenced by principles of behaviourism. Quality appraisal revealed methodological weaknesses in six of seven studies, such as heterogeneity in samples, interventions, and outcome measures, disallowing meta-analyses and weakening the generalisability of interventions to diverse contexts and groups CONCLUSIONS AND IMPLICATIONS: A genuine disconnect between empirical evidence and services for C&A with complex needs was observed. This emphasises an urgency for increased inclusion in clinical and behavioural research and for robust enquiries to test/adapt psychological interventions for weight management for C&A-ID. The findings of this review hold clinical utility for clinicians working with C&A-ID, and with RGDs such as Bardet-Biedl, Prader-Willi and Down syndromes. Recommendations and a conceptual framework are provided herein for enhanced efficacy of interventions.

Reducing Screen-Based Sedentary Behavior Among Overweight and Obese Hispanic Adolescents Through a Family-Based Intervention

BACKGROUND

Sedentary behaviors, including screen-based activities, are associated with obesity, cardiovascular, and mental health risks. In the US, minority and socioeconomically disadvantaged youth engage in substantial sedentariness, requiring targeted interventions. Familias Unidas for Health and Wellness (FUHW) is a family intervention to reduce risks among Hispanic youth with overweight and obesity. Analyses examined (1) FUHW's impact on parent and adolescent screen-based sedentary behavior and (2) differential intervention effects by adolescent gender, internalizing symptoms, and body mass index.

METHODS

A total of 280 overweight/obese Hispanic middle schoolers and parents were randomized to FUHW or control and assessed at baseline, 6, 12, and 24 months between 2015 and 2019.

RESULTS

Linear growth models showed that exposure to FUHW was not associated with parent sedentary behavior over time (b = -0.11, P = .32) but was associated with decreases in adolescent sedentary behavior (b = -0.27, P = .03). Neither gender nor internalizing symptoms moderated intervention effects, but there were differential effects by body mass index. Compared to controls, FUHW showed significant decreases in sedentary behavior among overweight (b = -0.85, P < .01) and obese (b = -0.79, P < .01) youth but not severely obese youth.

CONCLUSIONS

FUHW reduced youth screen-based sedentary behavior. Youth with severe obesity require additional intervention.

Maternal Feeding Styles and Child Appetitive Traits: Direction of Effects in Hispanic Families With Low Incomes

Feeding styles of parents have been associated with dietary quality/intake and weight outcomes; however, much of the research to date has been cross sectional and the direction of influence unclear. This prospective longitudinal study evaluated the direction of effects between feeding styles and child appetitive traits over time in a sample of 129 Hispanic parent/child dyads that participated in a larger study. Data analyzed for the current study were collected when the children were 4–5 years old and again at ages 7–9 years. Parents (all mothers) reported on their feeding styles and children's appetitive traits using well-established questionnaires. Cross-lagged panel analyses were used to examine the direction of effects. Fully adjusted models revealed that a number of children's appetitive traits at baseline predicted later feeding styles. A bi-directional relationship was found between authoritarian feeding and satiety responsiveness such that higher satiety responsiveness was associated with authoritarian feeding and vice versa. Lower satiety responsiveness was associated with indulgent feeding, whereas higher food responsiveness was associated with authoritarian feeding. Results show preliminary evidence that children's appetitive traits may shape mothers' approach to child feeding. There is also preliminary support for the protective role of an authoritarian feeding style in the self-regulatory processes around child appetitive traits among this population of Hispanic families with low-income levels. These results warrant continued research given that other studies have shown beneficial outcomes for authoritarian feeding among ethnically diverse families with low incomes.

Short-Term Efficacy of a Childhood Obesity Prevention Program Designed to Pair Feeding Content with Nutrition Education

Background: Family-based programs show considerable promise in preventing overweight and obesity in young children. However, dissemination is difficult because significant participant and staff involvement is required. This study examined the short-term efficacy of adding parental feeding content to a widely-used nutrition education curriculum for families in low-resourced communities comparing the influence of two delivery methods (in-class and online) on parents' feeding knowledge, practices, and styles. Methods: In this cluster randomized controlled trial, parents of 2- to 8-year-old children enrolled in the EFNEP (Expanded Food and Nutrition Education Program) in Colorado and Washington were randomly assigned to: in-class nutrition education only, in-class nutrition education with in-class feeding content, or in-class nutrition education with online feeding content. Data from the 382 participants who completed both pretest and posttest assessments are reported in this study. Results: Multilevel analyses showed empirical support for the influence of the program on parents' feeding knowledge, practices, and styles. Online and in-class methods were equally effective in delivering feeding content in low-resourced communities. Consistent effects were seen across the two delivery methods for encouraging children to try new foods (p < 0.05), use of child-centered feeding practices (i.e., greater responsiveness, p < 0.05), child involvement in food preparation (p < 0.05), and understanding the number of presentations often necessary for child acceptance of a new food (p < 0.001). Location and language differences were seen across some constructs. Conclusions: This study demonstrates the efficacy of in-class and online approaches to feeding highlighting the program's positive effects on promoting healthy feeding behaviors for parents of children in low-resourced families. ClinicalTrials.gov Identifier: NCT03170700.

Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children

Background

Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels.

Methods

A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m²) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children’s mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers’ physical activity levels and parenting practices for physical activity and screen time behaviours, children’s fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes.

Results

Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers’ physical activity levels, children’s FMS proficiency, and several parenting constructs. No effects were observed for both fathers’ and children’s accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity.

Conclusion

Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers’ physical activity levels, children’s FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12619000105145. Registered 24/01/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13424-1.

Family‐based interventions for preventing overweight or obesity among preschoolers from racial/ethnic minority groups: A scoping review

Objective

This scoping review aimed to synthesize the published literature on family‐based childhood obesity prevention interventions from 2015 to 2021 that focused on children 2–5 years of age from racial and/or ethnic minority households.

Methods

A PICOS (population, intervention, comparison, outcome, and setting) framework was used to guide the development of the research question, search strategy, and inclusion/exclusion criteria. To be included, the study must have been a randomized controlled trial or quasi‐experimental trial that enrolled participants 2–5 years of age and their caregivers who identified as being from a racial and/or ethnic minority group in the United States. The study must have also examined a family‐based intervention that incorporated components to prevent childhood obesity (i.e., fruits and vegetable intake, parental responsive feeding, physical activity), be conducted in a remote (i.e., online, text, mail), home, community, primary care setting, or early childhood education institution setting, and report on body mass index (BMI, kg/m²), BMI z‐score, anthropometric measures (weight, waist circumference, fat mass, etc.), changes in health behaviors, or increase in nutritional knowledge.

Results

Fourteen individual studies were identified. Most interventions used multiple components for promoting nutritional knowledge and behavioral changes among families. Eight interventions included culturally tailored components targeting four aspects: (1) language barriers, (2) food choices, (3) relationships between family members, and (4) rapport building.

Conclusions

There is limited research in this field focusing on children from racial and/or ethnic minority groups. Future efforts should invest in developing culturally appropriate interventions for these groups.

Examining the Effects of Fathers' Residency Status on Childhood Obesity

OBJECTIVE

To examine whether fathers' residency status is associated with increased BMI z-scores among young and pre-adolescent children.

METHODS

Propensity score matching was used to examine the effects of fathers' residency status on child BMI z-scores for children between the ages of 2-5 and 9-11 years old. Fathers self-reported their residency status as either being residential or nonresidential, based on the amount of time they lived in the same household as the child enrolled in the study. We conducted a series of cross-sectional matched analyses using three waves of data from 1448 families who participated in the Fragile Families and Child Wellbeing Study.

RESULTS

We did not find a difference in BMI z-scores among children based on their father's residency status for children between the ages of 2-5 years old but did find a marginally significant difference in BMI z-scores for children between 9 and 11 years old.

CONCLUSIONS FOR PRACTICE

Our findings suggest that fathers' residency status is not associated with increased BMI z-scores among young children but may be slightly predictive of differences in BMI z-scores among pre-adolescent children. The results from our study begin to explore the scientific gains of analyzing the influence of diverse family structures on childhood obesity outcomes. Our focus on fathers' residency status adds to the literature by highlighting some of the risks and resources that fathers from diverse family structures bring to family functioning and children's health and wellbeing.

Interventions to Prevent Obesity in Mexican Children and Adolescents: Systematic Review

The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices.

The association of grandparental co-residence and dietary knowledge with excess body weight among children aged 7-15 years in China

OBJECTIVES

To investigate the impact of grandparent's co-residence and dietary knowledge on the overweight and obesity risk among school-age children in China.

METHODS

Data of 790 children aged 7-15 years were retrieved from the China Health and Nutrition Survey (CHNS). Co-residential status was evaluated using household and individual ID. Dietary knowledge was assessed using 17 dietary statements, which was scored by participants. Three principal factors were extracted by factor analysis. Logistic regression analysis was applied to examine the influence of grandparent's co-residence and dietary knowledge on the weight status of the child.

RESULTS

The overweight and obesity incidence of the children increased significantly when they co-reside with two grandparents (OR=1.447, 95CI: 1.001-2.090, p=0.049). Mother's dietary knowledge regarding to protein-related food choices (PT) scored higher was associated with the increased risk (OR=1.270, 95CI: 1.059-1.523, p=0.010). For grandmother's dietary knowledge, the higher score in balanced food consumption (BF) was associated with the decreased overweight and obesity risk (OR=0.456, 95CI: 0.294-0.706, p<0.001). Grandfather's dietary knowledge in BF showed the similar result (OR=0.454, 95CI: 0.271-0.759, p=0.003).

CONCLUSIONS

Living with two grandparents is associated with higher overweight and obesity risk, but grandparents with an adequate knowledge in the balanced food consumption may decrease the risk.

Cultural adaptations of obesity-related behavioral prevention interventions in early childhood: A systematic review

Interventions for obesity prevention can effectively reduce obesity-related behaviors in young children. Understanding how to leverage and adapt evidence-based interventions is needed to improve reach among culturally and linguistically diverse families. This systematic review aimed to synthesize the approaches and outcomes of culturally adapted early childhood obesity-related behavioral prevention interventions. Multiple electronic databases were systematically searched in March 2021. All study designs were included if they reported cultural adaptations of an intervention targeting at least one obesity-related behavior (infant feeding, nutrition, physical activity, and/or sleep) among children aged 0-5 years. Studies that only conducted language translations or that developed new interventions were excluded. Two authors independently conducted critical appraisals using the Mixed Method Appraisal Tool. Findings were synthesized narratively, based on the Stages of Cultural Adaptation theoretical model and the Framework for Reporting Adaptations and Modifications-Enhanced. Twelve interventions met the inclusion criteria, with varied study designs. Few reported all aspects of cultural adaptation processes, and the cultural adaptation strategies documented varied. The results suggest that cultural adaptation of obesity-related behavioral prevention interventions targeting young children increases acceptability among target cultural groups, yet effectiveness is inconclusive due to a lack of trials. More detailed reporting of cultural adaptation processes and further effectiveness trials are needed to evaluate future work.

Pediatric Obesity Prevention and Treatment Among Hispanics: A Systematic Review and Meta-Analysis

INTRODUCTION

The rates of pediatric obesity in the U.S. are highest among Hispanics. There is no existing meta-analysis of the effects of obesity interventions among Hispanic youth. This systematic review and meta-analysis assesses the effects of obesity prevention and treatment interventions on Hispanic youth's weight status and lifestyle behaviors.

METHODS

PubMed, PsycINFO, and Scopus were searched between January 1, 2000 and October 30, 2020. Interventions with ≥50% Hispanic youth aged 0-18 years were included. Using a weighted inverse-variance procedure, fixed-effects and random-effects models were run for an overall effect size on the basis of the Qtotal test statistic. Hedges' g was calculated for outcomes of interest between baseline and postintervention separately for studies with multiple versus single conditions. Continuous and categorical moderators were also examined.

RESULTS

A total of 1,103 articles were screened, of which 117 were included in the narrative synthesis and 105 in the meta-analysis (n=49,276 youth). The overall effects for RCT/quasi-experimental studies on BMI status (g= -0.15, SE=0.03, 95% CI= -0.20, -0.10), waist circumference (g= -0.15, SE=0.10, 95% CI= -0.35, -0.05), physical activity (g=0.12, SE=0.05, 95% CI=0.03, 0.22), fruit and vegetable intake (g=0.08, SE=0.02, 95% CI=0.03, 0.12), and sugar-sweetened beverage intake (g= -0.07, SE= 0.03, 95% CI= -0.13, -0.01) were small. Intervention effects varied by participant developmental stage, SES, study setting, and lifestyle behavior target.

DISCUSSION

Beyond developing more impactful interventions to address obesity among Hispanic youth, findings highlight the need for targeted policies and more easily disseminable interventions that can spread small effects across a population for maximal public health impact.

Reducing Obesogenic Eating Behaviors in Hispanic Children through a Family-Based, Culturally-Tailored RCT: Abriendo Caminos

Family-based interventions that incorporate culturally-tailored multi-component curricula and are grounded on evidence-based information and theoretical frameworks can help reduce the prevalence of obesity among Hispanic children. Abriendo Caminos: Clearing the Path to Hispanic Health is a multi-site culturally-tailored randomized control trial that aims to reduce obesity rates in Hispanic families by delivering education on nutrition, family wellness, and physical activity. This study evaluated the effect of the Abriendo Caminos six-week intervention on dietary behaviors of Hispanic children (6–18 years). Mothers (n = 365) reported their child’s eating behavior intake using the U.S. Department of Education’s Early Childhood Longitudinal Study protocol (ECLS). Pre/post dietary changes were evaluated using separate generalized estimating equation models adjusted for site, child sex, and child age group. Findings indicate a reduction in the frequency of sugar-sweetened beverages (OR 0.55, 95% CI 0.35, 0.87, p = 0.01), French fries (OR 0.56, 95% CI 0.36, 0.86, p = 0.009), and fast food (OR 0.55, 95% CI 0.36, 0.84, p = 0.006) consumption among children in the intervention arm. Additionally, children in the intervention arm increased their frequency of vegetable consumption (OR 1.84, 95% CI 1.08, 3.12, p = 0.03). The Abriendo Caminos intervention effectively improved four of eight eating behaviors in a short-term intervention.

Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity

INTRODUCTION

Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups.

METHODS AND ANALYSIS

Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events.

ETHICS AND DISSEMINATION

Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases.

PROSPERO REGISTRATION NUMBER

CRD42020177408.

Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol

INTRODUCTION

Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity.

METHODS AND ANALYSIS

Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components.

ETHICS AND DISSEMINATION

The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study's findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders.

PROSPERO REGISTRATION NUMBER

CRD42020177408.

Sustainability of weight loss from a family-centered pediatric weight management program integrated in primary care

BACKGROUND

A 6-month pediatric weight loss program showed modest success, but the sustainability of this success after 12 months was unclear. The present study aims tomeasure the medium-term effectiveness of family-based weight management in pediatric primary care to reduce body weight in children living with obesity.

METHODS

In a retrospective cohort study, children ages 3 to 17 years with obesity in Kaiser Permanente Orange County, California, who enrolled in a weight management program between April 2014 and December 2018 (FB-WMG, n = 341) were compared to children referred but not enrolled (Ref-CG, n = 317) and controls matched by sex, age, zip code and BMI (Area-CG, n = 801). The relative distance from the median BMI-for-age at months 0, 6, and 12 were expressed as difference-in-differences (DID) using multivariable linear regressions with robust standard error.

RESULTS

The baseline BMI-for-age was 98.6 (SD 1.08) percentile in FB-WMG, 98.2 (SD 1.22) percentile in Ref-CG, and 98.6 (1.13 in Area-CG). FB-WMG had a median of 3 visits (P25 1 visit, P75 5 visits) in the first 6 months. Despite a more considerable decrease in the relative distance to the median BMI-for-age in FB-WMG children with 3+ visits after 6 months, the success obtained was not sustained at 12 months (DID FB-WMG vs Area-CG -0.34, 95% CI - 3.00 to 2.33%, FB-WMG vs Ref-CG -0.39, 95% CI - 3.14 to 2.35%). At 12 months, there was no statistical significant difference between the three groups (FB-WWG, Ref-CG, Area-CG).

CONCLUSIONS

The initial success in weight management was not sustained in the absence of continued support for healthy lifestyle changes. Based on current evidence, continued support is necessary to maintain and promote success beyond a brief 6 month intervention. Long-term pediatric weight management programs are needed to promote continuing progress.

Selection and use of vegetable parenting practices did not vary by parent feeding styles: Mixed methods investigation

Parents influence their child's vegetable intake through their feeding style, i.e. the emotional tone established around feeding, and vegetable parenting practices (VPPs), i.e. the specific behaviors employed to influence their child's vegetable intake. A model of precision food parenting proposes that child healthy dietary intake could be optimized by the selection and implementation of effective food parenting practices. Parents use and learn from these complex interactions with their child, which are reflective of feeding style. Intervention research has targeted VPPs in general without a delineation of which practices were selected, which were used, or why they were selected. It is not clear how these users were influenced by feeding style, nor what the parent learned from the interaction. The current study used mixed methods wherein middle socioeconomic status parents of 3-5 year old children were categorized within feeding style groups (n = 122), asked to select two VPPs, implemented them for a week (n = 63), and qualitatively interviewed about their experience. Responsiveness VPPs were most commonly selected, primarily due to their perceived ease of implementation. Parents believed there would be long term positive outcomes, e.g. more vegetable intake from using the practices selected. Frequency of use depended in part on opportunity, e.g. food purchase parenting practices could only be employed during intermittent shopping events. Few differences were detected by parent feeding styles in the types of VPPs selected, frequency of use, or effectiveness. Food parenting interventions can encourage selection of specific VPPs to employ and do not appear to have to tailor the types of VPPs offered to parent feeding style. Research is needed with larger, socioeconomically diverse samples to assess optimal categorization into feeding styles and confirm the present results.

Evaluating a social marketing campaign on healthy nutrition and lifestyle among primary-school children: A mixed-method research design

Italy has one of the highest levels of childhood overweight and obesity in Europe. Therefore, preventing children from becoming overweight is a major public health challenge. Here, we used a mixed-method research approach - including a quasi-experimental design and three surveys - to create a formative evaluation of a social marketing campaign on healthy nutrition and lifestyle in Italian primary school children. The social marketing campaign was organized around the 4 Ps of the marketing mix (product: the educational activities; place: the involved schools and supermarkets; promotion: the in-person and technology-based communication; and price: hours spent by the targeted children in fulfilling the educational activities). The campaign involved primary-school children across four Italian cities. The findings suggest that social marketing education campaigns can be effective tools to improve children's knowledge about healthy food and lifestyle, reduce their sedentary behavior, and increase their consumption of healthy food. Also, increasing children's acceptance of healthful nourishment is a valuable tool to improve the dietary habits of the entire family. With relation to the educational program assessment method, this study can inform societal interventions especially those involving children through the integration of different qualitative and quantitative research methods, which collect data from different subjects and perspectives.

Regional and sociodemographic differences in average BMI among US children in the ECHO program

OBJECTIVE

The aim of this study was to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region.

METHODS

This study used pooled data from 25 prospective cohort studies. Region of residence (Northeast, Midwest, South, West) was based on residential zip codes. Age- and sex-specific BMI z scores were the outcome.

RESULTS

The final sample included 14,313 children with 85,428 BMI measurements, 49% female and 51% non-Hispanic White. Males had a lower average BMI z score compared with females in the Midwest (β = -0.12, 95% CI: -0.19 to -0.05) and West (β = -0.12, 95% CI: -0.20 to -0.04). Compared with non-Hispanic White children, BMI z score was generally higher among children who were Hispanic and Black but not across all regions. Compared with the Northeast, average BMI z score was significantly higher in the Midwest (β = 0.09, 95% CI: 0.05 to 0.14) and lower in the South (β = -0.12, 95% CI: -0.16 to -0.08) and West (β = -0.14, 95% CI: -0.19 to -0.09) after adjustment for age, sex, race/ethnicity, and birth weight.

CONCLUSIONS

Region of residence was associated with child BMI z scores, even after adjustment for sociodemographic characteristics. Understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.

Effect of School-Based Family Health Education via Social Media on Children's Myopia and Parents' Awareness: A Randomized Clinical Trial

Importance

Myopia is a common cause of vision loss, and its prevalence is increasing globally.

Objective

To evaluate the effects of school-based family health education via WeChat in raising parents' awareness of myopia prevention and behavior and in controlling the development of myopia in children.

Design, Setting, and Participants

A single-masked cluster randomized clinical trial of children was conducted from October 1, 2018, to December 31, 2020, among grade 1 students from 12 primary schools in Guangzhou, China. The 12 primary schools were randomly selected in 2 districts and randomized to the intervention and control groups. All grade 1 students were invited to participate, and 688 students were included in the intervention group and 752 in the control group.

Interventions

Weekly health education via the social media platform WeChat was provided to the parents in the intervention group.

Main Outcomes and Measures

Data include results of eye examinations of children and questionnaires completed by parents. The primary outcome was the 2-year cumulative incidence rate of myopia. Myopia was defined as a spherical equivalent (SE) refractive error (sphere of +0.5 cylinder) of at least -0.50 diopters (D). The secondary outcomes were the 2-year changes in the axis length and SE refraction, parental awareness, children's screen time, outdoor activities, and learning tools during COVID-19.

Results

Among the 1525 children included at baseline (835 boys [54.8%]; mean [SD] age, 6.3 [0.5] years), 1244 competed the final assessment; the 2-year cumulative incidence rate of myopia was 106 of 544 (19.5%) in the intervention group and 171 of 700 (24.4%) in the control group (difference, 4.9% [95% CI, 0.3%-9.5%]; P = .04). The mean myopic shift in SE refraction in the intervention group (-0.82 D) was lower than that in the control group (-0.96 D; difference, -0.14 [95% CI, -0.22 to -0.06] D; P < .001). No difference in change in axial length was detected (difference, 0.02 [95% CI, -0.06 to 0.09] mm; P = .70).

Conclusions and Relevance

School-based weekly family health education via WeChat resulted in a small decrease in the 2-year cumulative incidence rate of myopia with a difference in SE of less than 0.25 D not accompanied by any axial length differences. Whether these findings extrapolate elsewhere in the world or are clinically relevant in the short or long term remain to be determined.

Trial Registration

Chinese Clinical Trial Registry Identifier: ChiCTR1900022236.

A dual process model to predict adolescents' screen time and physical activity

OBJECTIVE

Many adolescents report a lack of physical activity (PA) and excess screen time (ST). Psychological theories aiming to understand these behaviours typically focus on predictors of only one behaviour. Yet, behaviour enactment is often a choice between options. This study sought to examine predictors of PA and ST in a single model. Variables were drawn from dual process models, which portray behaviour as the outcome of deliberative and automatic processes.

DESIGN

411 Finnish vocational school students (age 17-19) completed a survey, comprising variables from the Reasoned Action Approach (RAA) and automaticity pertaining to PA and ST, and self-reported PA and ST four weeks later.

MAIN OUTCOME MEASURES

Self-reported time spent on PA and ST and their predictors.

RESULTS

PA and ST correlated negatively (r = -.17, p = .03). Structural equation modelling revealed that intentions and habit for PA predicted PA while ST was predicted by intentions and habit for ST and negatively by PA intentions. RAA-cognitions predicted intentions.

CONCLUSION

PA and ST and their psychological predictors seem to be weakly interlinked. Future studies should assess more behaviours and related psychological influences to get a better picture of connections between different behaviours.

HighlightsPhysical activity and screen time are largely mutually exclusive classes of behaviours and might therefore be related in terms of their psychological predictors.411 adolescent vocational school students self-reported variables from the Reasoned Action Approach and behavioural automaticity related to physical activity and leisure time screen time behaviours as well as those behaviours.Structural equation modelling revealed expected within-behaviour predictions but, against expectations, no strong connections between the two behaviour classes in terms of their predictors. Only intentions to engage in physical activity negatively predicted screen time.Future research should aim to measure a wider range of mutually exclusive classes of behaviours that cover a large share of the day to uncover relations between behaviours and their respective predictors.

Public justification and expert disagreement over non-pharmaceutical interventions for the COVID-19 pandemic

A wide range of non-pharmaceutical interventions (NPIs) have been introduced to stop or slow down the COVID-19 pandemic. Examples include school closures, environmental cleaning and disinfection, mask mandates, restrictions on freedom of assembly and lockdowns. These NPIs depend on coercion for their effectiveness, either directly or indirectly. A widely held view is that coercive policies need to be publicly justified-justified to each citizen-to be legitimate. Standardly, this is thought to entail that there is a scientific consensus on the factual propositions that are used to support the policies. In this paper, we argue that such a consensus has been lacking on the factual propositions justifying most NPIs. Consequently, they would on the standard view be illegitimate. This is regrettable since there are good reasons for granting the state the legitimate authority to enact NPIs under conditions of uncertainty. The upshot of our argument is that it is impossible to have both the standard interpretation of the permissibility of empirical claims in public justification and an effective pandemic response. We provide an alternative view that allows the state sufficient room for action while precluding the possibility of it acting without empirical support.

Effects of the PRIMROSE prevention trial of childhood obesity on parental self-efficacy

Background

Parental self-efficacy (PSE) has been suggested as a key factor for enabling parents to support children in the development of healthy dietary and physical activity behaviors and to prevent childhood obesity. However, studies of intervention effects on PSE are lacking. The present study involved a secondary analysis of data on PSE collected in a previous primary prevention trial of childhood obesity called the PRIMROSE trial. The trial involved a family-based intervention using motivational interviewing and principles of cognitive-behavioral therapy within a social-cognitive theory framework.

Methods

In the PRIMROSE trial, parents and their children were randomly allocated to the intervention or usual care. In the present study, 928 mothers who responded to the Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD) at follow-up assessment were included. Data were analyzed using linear regression based on generalized estimating equations, with adjustment made for PSE at baseline.

Results

At follow-up assessment, there was a statistically significant difference of 1.4 units, 95% CI [0.4, 2.4], p = 0.009, between the intervention and control conditions on the subscale of the PSEPAD concerning PSE for promoting healthy dietary behaviors in children. However, this difference was deemed as without clinical importance. On the total scale or other subscales of the PSEPAD there were no statistically significant differences in PSE between conditions.

Conclusions

There was a statistically significant, but not clinically meaningful, intervention effect on PSE. However, because previous research repeatedly has shown positive associations of PSE with dietary and physical activity behaviors in children and that self-efficacy mediates behaviors, the construct may be important for influencing dietary and physical behaviors in children. Therefore, more research is warranted evaluating the effects of interventions on PSE in the context of childhood obesity prevention.

Trial registration

Retrospectively registered 9 October 2013 at ISRCTN (ISRCTN16991919).

Racial Disparities in Obesity Treatment Among Children and Adolescents

PURPOSE OF REVIEW

With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation.

RECENT FINDINGS

Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

Between-country analysis of implementing an obesity prevention intervention using RE-AIM: HENRY in Israel and UK

Health Exercise Nutrition for the Really Young (HENRY) is a UK community-based early childhood obesity prevention intervention that was adopted and implemented in Israel between 2013 and 2018. The aim of this study was to explore the implementation process in Israel and compare it with that of the 'parent' programme in the UK, in order to throw light on the challenges of introducing complex interventions into different countries and cultures. Published reports from HENRY and Haifa University's evaluation of the Israeli implementation were reviewed and comparisons between the UK and Israel were carried out utilizing the RE-AIM framework. In both countries, the intention was to implement in lower SES communities. When comparing the individual items, Reach and Effectiveness, we found a difference in the Reach although Effectiveness was similar: Reach was proportionally lower in Israel, but parent and professional changes in behaviour were positive in both countries. For the organizational items Adoption, Implementation and Maintenance, we found large differences between the countries. Major challenges identified in Israel included: failing to take adequate account when planning and implementing the intervention of the different ways social and health services are organized and how local authorities are structured and provide services. In addition, differences in culture beyond language and professional variations were challenges, when trying to transfer the intervention with high fidelity from the UK to Israel. Lessons learnt may benefit others in attempting cross-country implementation of complex interventions.

Effect of Physical Activity on Adolescent Obesity Status over Time: A Latent Growth Modeling Approach

This study aims to examine the longitudinal influence of physical activity (PA) on obesity among normal-weight adolescents in South Korea. A total of 1347 data samples from the Korean Children and Youth Panel Survey from 2011 to 2014 were used. Latent growth modeling was applied. PA was assessed by the hours spent on PA during physical education (PE) classes in the last week. Body mass index for age was considered to determine obesity status. PA during PE positively predicted the intercept of obesity status, but it was not associated with the slope of obesity status. Although a longitudinal effect of PA was not identified, PA could influence the initial status of obesity. Because obesity in early years could steadily influence future obesity status, early detection and intervention for adolescent obesity are necessary. Moreover, more studies examining the effect of PA during PE on obesity status among adolescents should be conducted to identify the association between PA during PE and obesity status over time.

Family-Based Obesity Prevention Interventions among Hispanic Children and Families: A Scoping Review

This scoping review examined intervention and sample characteristics of family-based obesity prevention interventions among Hispanic youth. This review also examined the degree to which existing interventions were culturally-adapted, acknowledged social determinants of health (SDoH), and collaborated with community stakeholders. A comprehensive search across Medline Ovid, Embase, Scopus, PsycInfo, and Pubmed was used to identify 13 studies primarily based in the U.S. (92.3%). Data was extracted by two independent reviewers. Most used a randomized control trial design (69.2%), a behavior change theory (84.6%), and reported moderate to high (≥70%) retention (69.2%). Studies targeted improvements in physical activity (69.2%) and fruit and vegetable intake (92.3%) through nutrition education, cooking demonstrations, and tastings. Younger children from low socioeconomic backgrounds (61.5%) were well represented. Most interventions were culturally-adapted (69.2%), all studies reported collaboration with stakeholders, yet only half used strategies that acknowledged SDoH (46.2%). To increase our understanding of the underlying mechanisms by which family-based approaches can reach and engage Hispanic youth and families, future studies should rigorously evaluate theoretical constructs, family processes, and SDoH that influence program participation and health behaviors. This information will guide the design and development of future interventions aimed at reducing obesity disparities among Hispanic youth.

Twelve-Month Efficacy of an Obesity Prevention Program Targeting Hispanic Families With Preschoolers From Low-Income Backgrounds

OBJECTIVE

Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children.

DESIGN

Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks.

SETTING

Families recruited from Head Start across 2 sites.

PARTICIPANTS

Two hundred fifty-five families randomized into prevention (n = 136) or control (n = 119).

INTERVENTION

Prevention received curriculum; control received no curriculum.

MAIN OUTCOME MEASURE(S)

Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child).

ANALYSIS

Multilevel analyses for nested data (time points within families; families within waves) and multinomial regression.

RESULTS

Program increased mothers' repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05).

CONCLUSIONS AND IMPLICATIONS

Program effects emphasize the importance of feeding approaches in reducing childhood obesity.

Promoting Sleep and Balanced Screen Time among School-Aged Children with Neurodevelopmental and Mental Health Disorders: A Parent Perspective

Background: Children with neurodevelopmental and mental health disorders (N/MHD), such as autism spectrum, mood disorders, and anxiety, are more likely to engage in excessive screen time, receive insufficient sleep, and to have obesity than neurotypical peers. However, little is known about how parents of these children approach promoting sleep and balanced screen time. Methods: We conducted semistructured interviews with 24 parents of children aged 8-15 years with a diagnosis of N/MHD to assess barriers and facilitators to promoting sleep and balanced screen time. Interviews were transcribed, double-coded using constant comparative methods, and summarized into themes using NVivo 11. Results: Many parents described children's chronic sleep challenges, often compounded by screen use and no clear solutions. When feeling overwhelmed, some parents reluctantly reported co-sleeping or allowing gaming devices in bed. Nearly all participants reported chronic, occasionally severe, conflict when managing children's screen time, with some parents experiencing opposition and physical aggression. Parents struggled to weigh the benefits of screen use (i.e., behavior management, learning, and social connection) with the costs (i.e., reduced self-care and limited physical activity). To combat barriers, parents described firm routines (i.e., "screens off" time and consistent bedtime on weekdays and weekends), moderating access (i.e., shutting down internet and no device in bedroom), verbal priming, and coping strategies (i.e., music and books). Conclusions: Parents of children with N/MHD face unique challenges in promoting sleep and balanced screen time. Given these behaviors may impact weight status and mental health, future interventions should examine ways to support parents in reducing conflict while promoting healthy habits.

Black American and Latinx Parent/Caregiver Participation in Digital Health Obesity Interventions for Children: A Systematic Review

Parents/caregivers are consistently described as integral targets given their influential role in supporting and managing behaviors such as diet and physical activity. Identifying effective obesity prevention interventions to enhance and sustain parent participation is needed. Digital obesity prevention interventions are a promising strategy to improve parent/caregiver participation. Digital health interventions demonstrate acceptable participation and retention among parents/caregivers. However, our understanding of digital obesity prevention interventions targeting Black American and Latinx parents/caregivers is limited. This systematic review aims to identify Black American and Latinx parents'/caregivers' level of participation in digital obesity prevention and treatment interventions and determine the relationship between parent/caregiver participation and behavioral and weight status outcomes. This review adheres to PRISMA guidelines and is registered in PROSPERO. Eligibility criteria include: intervention delivered by digital technology, targeted Black American and Latinx parents/caregivers of young children (2-12 years), reported parent/caregiver participation outcomes, targeted diet or physical activity behaviors, and randomized controlled trial study design. Searches were conducted in September 2020 in ERIC, PsychInfo, PubMed, and Web of Science. Initial searches returned 499 results. Four reviewers screened records against eligibility criteria and 12 studies met inclusion criteria. Across all studies, parent/caregiver participation ranged from low to high. Only half of the included studies reported significant improvements in behavioral or weight status outcomes for parents/caregivers and/or children. Of these studies, three reported high parental/caregiver participation rates, and three reported high satisfaction rates. These findings suggest that participation and satisfaction may impact behavior change and weight status. The small number of studies indicates that additional research is needed to determine whether engagement or other factors predict responsiveness to the digital health intervention. Our results lay the groundwork for developing and testing future digital health interventions with the explicit goal of parental/caregiver participation and considers the need to expand our digital health intervention research methodologies to address obesity inequities among diverse families better.

Comparing Maternal and Paternal Complementary Feeding Practices: Findings From an Online Survey

OBJECTIVE

To explore differences between mothers' and fathers' complementary feeding practices.

METHODS

An online survey of UK parents with a healthy child in complementary feeding age. Timing of introducing solid foods and adherence to feeding guidelines were assessed. Dietary quality was measured using the Complementary Feeding Utility Index.

RESULTS

In a sample of 60 mothers and fathers (nondyads), there were no differences between fathers and mothers in the timing of introduction of solid foods, compliance with complementary feeding guidelines, or dietary quality. Most fathers who participated had a male child, whereas mothers had an equal number of male and female children (P < 0.001). The proportion of mothers who followed baby-led weaning was higher compared with fathers (P = 0.02).

CONCLUSIONS AND IMPLICATIONS

Study findings reveal no gender differences in parental complementary feeding practices apart from the use of baby-led weaning. Future studies with bigger male samples are warranted to explore the paternal role during complementary feeding.

Family-based intervention to prevent childhood obesity among school-age children of low socioeconomic status: study protocol of the FIVALIN project

Background

Childhood obesity represents a global public health crisis: the number of obese children and adolescents (aged 519years) worldwide has risen tenfold in the past four decades. The vast majority of overweight and obese children live in high-income countries, and low socio-economic status (SES) is a significant risk factor. Family Based Interventions (FBI) have demonstrated positive results in preventing obesity, although these results are strongly influenced by SES. Moreover, we still poorly understand how FBI can determine a positive trend in weight status in low-income communities. Therefore, there is an urgent need to define and evaluate innovative and multi-target projects to reduce obesity risk behaviors and health inequalities and the present study aims to present the study protocol of FIVALIN a FBI that pretends to achieve this goal.

Methods

We will conduct a quasi-experimental design within 60 Community Child Centers (CCC) in Barcelona metropolitan area. Each cluster (CCC) will be assigned by convenience to the intervention and control groups. For the whole study, a total of 810 children aged 812years and 600 parents will be recruited during 3 consecutive editions (1st 2019/2020; 2nd 2020/2021; 3rd 2021/2022) of 10months each. The action is a regular multicomponent health-promotion intervention targeting children, families, and CCC. All activities are based on the Motivational Interviewing (MI) approach and will focus on promoting good dietary habits, physical activity, appropriate screen time and sleep duration, and psychological well-being. The control group participate in a unique workshop on general awareness of healthy lifestyles for families. We will perform a comparative analysis of the evolution of weight status, healthy lifestyles, and socioeconomic variables, between the intervention and control groups.

Discussion

There is a need for more evidence on how to target and evaluate holistic interventions in low SES families. Our multi-targeting intervention for obesity prevention tackles risky behaviors that go beyond diet and physical activity (PA). Therefore, future interventions can effectively promote all the behavioral domains that determine trends in the weight status.

Trial registration

ISRCTN Registry: ISRCRN12682870. Registered 9 July 2020. Retrospectively registered.

Protocol version: 30 April 2021, version 5.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02697-x.

Perceptions of Family-Level Social Factors That Influence Health Behaviors in Latinx Adolescents and Young Adults at High Risk for Type 2 Diabetes

Given that health behaviors occur within the context of familial social relationships, a deeper understanding of social factors that influence health behaviors in Latinx families is needed to develop more effective diabetes prevention programming. This qualitative study identified perceived family-level social factors that influence health behaviors in Latinx adolescents (12-16 years; N = 16) and young adults (18-24 years; N = 15) with obesity and explored differences in perceptions across sex and age. Participants completed an in-depth interview that was recorded, transcribed, and coded using thematic content analysis. Emergent themes central to health behaviors included: perceived parental roles and responsibilities, perceived family social support for health behaviors, and familial social relationships. Mom's role as primary caregiver and dad's role as a hard worker were seen as barriers to engaging in health behaviors among adolescent females and young adults, males and females. Adolescents perceived receiving more support compared to young adults and males perceived receiving more support compared to females. Health behaviors in both age groups were shaped through early familial social interactions around physical activity. These insights suggest that traditional gender roles, social support, and social interaction around health behaviors are critical components for family-based diabetes prevention programs in high-risk Latinx youth and young adults.

An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework

BACKGROUND

The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP.

OBJECTIVE

This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP.

METHODS

The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program.

RESULTS

In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2).

CONCLUSIONS

The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP.

TRIAL REGISTRATION

Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.

The impact of the coronavirus disease 2019 pandemic on physical activity in U.S. children

BACKGROUND

Daily moderate-to-vigorous physical activity (MVPA) is vital to the physical, mental, and social well-being of children. Early restrictions during the coronavirus disease 2019 (COVID-19) pandemic included the closure of schools and physical activity (PA) amenities across the US. This study aimed to examine the impact of the pandemic on the PA and play behavior of U.S. children and to provide evidence-based recommendations to improve their PA.

METHODS

A cross-sectional, online, parent-reported survey was conducted of children aged 3-18 years between April and June 2020 to assess light PA and MVPA using a modified Godin Leisure-Time Exercise Questionnaire. Additional items included family/child socioeconomic demographics, child adaptability to the pandemic, and community access. The survey was shared through social media and snowball sampling distribution.

RESULTS

Analysis of 1310 surveys indicated child PA scores declined significantly during the pandemic (from 56.6 to 44.6, max 119, p < 0.001). Specifically, MVPA score decreased (from 46.7 to 34.7, max 98, p < 0.001) while light PA remained the same. Age-based changes were seen in the quantity, variety, and intensity of PA, with the lowest pandemic-related impact seen in preschoolers and the highest in high schoolers (-4.7 vs. -17.2, p < 0.001). Community-based peer PA decreased across all age groups.

CONCLUSION

This study shows decreased PA levels in U.S. children, according to parent reporting, during the COVID-19 pandemic. Recommendations for community leaders, educators, and parents to improve PA in children are provided. With continued spread of COVID-19, these results and recommendations may be imperative to the physical well-being of U.S. children.

Primary prevention of fat and weight gain among obesity susceptible healthy weight preschool children. Main results from the "Healthy Start" randomized controlled intervention

BACKGROUND

A vital public health challenge lies in understanding the primary drivers behind excessive weight gain among healthy weight individuals.

OBJECTIVES

To examine if excessive weight and fat gain can be prevented among healthy weight, obesity susceptible children aged 2 to 6 years.

METHODS

Eligible children were identified based on information on either a high birth weight, maternal pre-pregnancy obesity or maternal low educational level from national registries, and randomized into an intervention group, a control group and a shadow control group. All children with overweight at baseline were excluded from subsequent analysis (n = 196), while healthy weight children were included (n = 926). The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep quantity and quality, and reduction of family stress. The average intervention period was 1.3 years.

RESULTS

Intention-to-treat analyses indicated a lower gain in percentage fat mass and a higher gain in fat-free mass in the intervention group compared with the control group. However, the results should be interpreted with caution, as they were clinically small and borderline significant, only.

CONCLUSION

This primary prevention intervention among young healthy weight children with susceptibility to future obesity had clinically small effects on growth and body composition. More interventions, conducting primary obesity prevention, are urgently needed.

Behavioral Weight Loss Intervention Preferences of Adolescents with Overweight/Obesity

Background: Behavioral lifestyle interventions are the foundation of adolescent obesity treatment. Tailoring an intervention using adolescent stakeholder engagement during the development process could improve intervention effectiveness. Methods: Adolescents with overweight/obesity ages 14-19 (n = 41) participated in 11 sex-specific focus groups (girls = 6, boys = 5) and were asked their preferences regarding who should lead the intervention and be involved, what the messaging of the program should be, how to make the program engaging and maintain participation, and how to best measure nutrition intake and activity. Transcripts were coded and analyzed for emergent themes. Results: Mean age was 16.0 ± 1.8 years and participants were racially/ethnically diverse. Adolescents preferred interventions that avoid a focus on "weight loss," and instead emphasize "healthy lifestyle," which represents a more comprehensive goal of targeting physical and mental well-being. Most participants indicated preferences for a relatable instructor with prior weight loss experience. Both sexes preferred optional parental involvement, as some parents were described as helpful, while others were perceived as a hindrance to success. Boys and girls identified incentives, engaging activities, and electronic communication as core components for engagement and retention, with girls emphasizing socialization and building relationships. Sex differences in preferences were observed. Girls had more concerns about intervention participation and preferred interventions to be sex stratified. Conclusions: Behavioral interventions to treat adolescent obesity should focus messaging/content on healthy lifestyles, rather than weight loss, and be sex stratified. Development and implementation of future behavioral interventions for adolescent obesity should consider tailoring to adolescent preferences when possible to improve feasibility, acceptability, and effectiveness.

Antenatal Determinants of Childhood Obesity in High-Risk Offspring: Protocol for the DiGest Follow-Up Study

Childhood obesity is an area of intense concern internationally and is influenced by events during antenatal and postnatal life. Although pregnancy complications, such as gestational diabetes and large-for-gestational-age birthweight have been associated with increased obesity risk in offspring, very few successful interventions in pregnancy have been identified. We describe a study protocol to identify if a reduced calorie diet in pregnancy can reduce adiposity in children to 3 years of age. The dietary intervention in gestational diabetes (DiGest) study is a randomised, controlled trial of a reduced calorie diet provided by a whole-diet replacement in pregnant women with gestational diabetes. Women receive a weekly dietbox intervention from enrolment until delivery and are blinded to calorie allocation. This follow-up study will assess associations between a reduced calorie diet in pregnancy with offspring adiposity and maternal weight and glycaemia. Anthropometry will be performed in infants and mothers at 3 months, 1, 2 and 3 years post-birth. Glycaemia will be assessed using bloodspot C-peptide in infants and continuous glucose monitoring with HbA1c in mothers. Data regarding maternal glycaemia in pregnancy, maternal nutrition, infant birthweight, offspring feeding behaviour and milk composition will also be collected. The DiGest follow-up study is expected to take 5 years, with recruitment finishing in 2026.

The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia

Background

Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia.

Methods

The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program.

Results

Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials).

Conclusions

This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10270-5.

Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial

Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.

Effects of Three Different Family-Based Interventions in Overweight and Obese Children: The "4 Your Family" Randomized Controlled Trial

Childhood overweight and obesity prevalence has risen dramatically in the past decades, and family-based interventions may be an effective method to improve children's eating behaviors. This study aimed to evaluate the effectiveness of three different family-based interventions: group-based, individual-based, or by website approach. Parents and school aged overweight or obese children, 8-12 years of age, were eligible for the study. A total of 115 children were randomly allocated in one of the three interventions, and 91 completed the study (79% compliance); Group 1 (n = 36) received group-based interventions by various experts; Group 2 (n = 30) had interpersonal family meetings with a dietitian; and Group 3 (n = 25) received training through a specifically developed website. Anthropometric, dietary, physical activity, and screen time outcomes were measured at baseline and at the end of the study. Within-group comparisons indicated significant improvement in body weight, body mass index (BMI)-z-score, physical activity, and screen time from baseline in all three study groups (p < 0.05). Furthermore, total body fat percentage (%TBF) was also decreased in Groups 2 and 3. Between-group differences varied with body weight and %TBF change, being larger in Group 3 compared to Groups 1 and 2, in contrast to BMI-z-score, screen time, and health behaviors, which were significantly larger in Group 2 than the other two groups. In conclusion, personalized family-based interventions are recommended to successfully improve children's lifestyle and body weight status.

Engaging Fathers to Improve Physical Activity and Nutrition in Themselves and in Their Preschool-Aged Children: The "Healthy Youngsters, Healthy Dads" Feasibility Trial

BACKGROUND

Few lifestyle programs for young children have targeted fathers. This study examined the feasibility of a lifestyle intervention for fathers and their preschool-aged children.

METHOD

A total of 24 father/preschool child dyads were recruited from Newcastle, Australia, into a single-arm, feasibility trial (baseline and 3-mo postbaseline assessments). The 9-session program aimed to improve physical activity and dietary habits of fathers and children. A priori feasibility benchmarks targeted recruitment (15 dyads), eligibility rate (>60%), attendance (80%), retention (≥85%), and program acceptability (≥4 out of 5). Acceptability of data collection procedures, research team program/resource management, home-program compliance, and preliminary intervention outcomes were also assessed.

RESULTS

Feasibility benchmarks were surpassed for recruitment (24 dyads), eligibility rate (61.5%), attendance (89%), retention (100%), and program acceptability (4.6 out of 5). Data collection procedures were acceptable. Challenges included mothers reporting their own dietary intake rather than their child's, children moving during body composition measurement, and resetting pedometers. Resource and program management were excellent. Most families met home-program requirements (83%). Preliminary intervention outcomes were encouraging for fathers and children.

CONCLUSION

Program feasibility was demonstrated by excellent recruitment, attendance, acceptability, retention, program administration, and promising preliminary intervention outcomes. A few data collection difficulties were identified. A larger scale efficacy trial is warranted.

Obesogenic Programming Effects during Lactation: A Narrative Review and Conceptual Model Focusing on Underlying Mechanisms and Promising Future Research Avenues

Animal studies have consistently demonstrated that maternal obesity and a high-fat diet during lactation enhances obesity risk in the offspring. However, less is known about these potential obesogenic programming effects in obese humans. We propose three important pathways that may explain obesogenic programming effects of human breastmilk. First, human milk components and hormones may directly affect child eating and satiety characteristics. Second, human milk constituents can affect child microbiota that, in turn, may influence child eating and weight outcomes. Third, human milk composition may affect child eating and weight outcomes through flavor exposure. We reviewed a few very recent findings from well-powered longitudinal or experimental human research with regard to these three pathways. Moreover, we provide a research agenda for future intervention research with the overarching aim to prevent excessive pediatric weight gain during lactation and beyond. The ideas presented in this paper may represent important “black box” constructs that explain obesogenic programming effects during lactation. It should be noted, however, that given the scarcity of studies, findings should be seen as working hypotheses to further test in future research.

General Parenting and Hispanic Mothers' Feeding Practices and Styles

Previous research has shown that general parenting styles, general parenting dimensions, maternal feeding styles, and maternal feeding practices all show specific relationships with the weight status of young children. This study examined the relationships between general parenting and maternal feeding styles/practices in a sample of 187 Hispanic mothers with low incomes. As part of a larger study, mothers of preschool children were recruited through Head Start programs and completed validated questionnaires assessing their general parenting, feeding styles, and feeding practices. Results identified numerous associations between general parenting dimensions and specific feeding practices: i.e., maternal nurturance was positively associated with healthy eating guidance and feeding responsiveness; inconsistency was positively associated with restriction for weight and promotion of overconsumption; follow through on discipline was positively associated with monitoring, healthy eating guidance, and feeding responsiveness; and family organization was positively associated with monitoring and healthy eating guidance. General parenting styles were associated with feeding practices as well, with authoritative mothers showing the highest levels of healthy eating guidance and authoritarian mothers showing the lowest levels of monitoring. There were no significant associations between mothers' general parenting styles and mothers' feeding styles. Implications of these findings for the prevention of childhood obesity are considered.

The Effectiveness of a Blended In-Person and Online Family-Based Childhood Obesity Management Program

Background: The purpose of this study was to evaluate the effectiveness of a 10-week blended family-based childhood obesity management program, relative to a wait-list control, in improving child body mass index (BMI) z-scores, child lifestyle behaviors, parental support for healthy eating and physical activity, and self-regulation for healthy eating and physical activity support. Methods: This study was registered as a randomized wait-listed controlled trial; however, due to low recruitment and program delivery logistics, this study transitioned into a quasi-experimental design. Families with children 8-12 years of age with a BMI ≥85th percentile for age and sex were recruited (October 2018 to March 2019) in British Columbia, Canada. The intervention provided families 10 weeks of in-person and online support on improving lifestyle behaviors. Results: Children's BMI z-scores were not significantly changed. Intervention group significantly improved their days of moderate-to-vigorous physical activity relative to control (0.75 ± 1.5; p < 0.01; ηp² = 0.15); however, child dietary behaviors were not significantly changed. Relative to control, intervention group showed significant improvements in parental support for healthy eating (0.13 ± 0.36; p < 0.05; ηp² = 0.06) and physical activity (1.0 ± 1.6; p < 0.05; ηp² = 0.09) and self-regulation for healthy eating (2.0 ± 3.5; p < 0.01; ηp² = 0.11) and physical activity support (2.0 ± 3.2; p < 0.05; ηp² = 0.28). Conclusions: Preliminary evidence showed that the intervention was not effective in improving child BMI z-scores, but it was effective in promoting children's physical activity and parents' support behaviors. A longer study period may be required to change BMI z-scores. Clinical Trial Registration number: NCT03643341.