A Program to Help Parents Prevent Obesity in their Children

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A Program to Help Parents Prevent Obesity in their Children  

Jim Windell

 

          Prior to the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention found that about 20 % of children, or nearly one in five, are obese. Since the pandemic, those rates have only increased. Efforts to reduce the rate of childhood obesity have relied heavily on in-person interventions by pediatricians – usually with limited success.

          However, decades of research show that having obesity in early childhood significantly increases the risk of lifetime obesity, cardiovascular disease, diabetes and other serious diseases, particularly in low-income and minority populations.

           But is there a better way to intervene with parents to deal with obesity in their children?

           That’s what researchers at the University of North Carolina School of Medicine wanted to find out.

          In an earlier study led by Kori Flower, M.D., M.S., M.P.H., Division Chief of General Pediatrics and Adolescent Medicine at UNC School of Medicine, she and her investigators demonstrated that a “health literacy-informed” primary care-based intervention called the Greenlight Program was useful with parents. The Greenlight Program, which Flower and colleagues at other medical centers developed for parents, improved healthy growth in newborns until 18 months of age, but it turns out that improvements were not sustained at age two years and beyond.

          In an effort to extend the improvements up to and after two years of age, when pediatrics office visits become less frequent, the new study focused on adding text messaging to reinforce elements of the Greenlight Program, which previously only consisted of written materials and health counseling during primary care visits.

           To conduct the new study, Flower and other researchers recruited nearly 900 parent-infant pairs between October 2019 and January 2022 from newborn nurseries or pediatric primary care clinics at Duke University, University of Miami, New York University/Bellevue Hospital Center, Stanford University and Vanderbilt University Medical Center. Johns Hopkins University also collaborated in the study.

          At the start of the trial, all babies were 21 days old or younger, born after 34 weeks gestation, at a healthy weight, and with no chronic medical conditions that might affect weight gain. The participants were about 45% Hispanic, 20% white and nearly 16% Black. More than 55% were considered to have limited health literacy based on the Newest Vital Sign, a widely used health literacy screening tool developed by researchers at the University of Arizona. Nearly 16% of participants reported household food insecurity, meaning they felt they had limited access to healthy food choices.

          The infant-parent pairs were randomly sorted into two groups. Both groups received Greenlight Program education, with counseling on healthy nutrition and behaviors from their primary care providers, along with eight educational booklets matching the child’s age at regular well visits, with guidance and goal-setting tips in English or Spanish on feeding, physical activity, sleep and screen time.

          Half (449) of the infant-parent pairs received personalized, interactive text messages from a fully automated system to support health behavior goals. Goals (such as fewer sugar-sweetened beverages or less screen time) were texted in English or Spanish every two weeks until the child was two years of age. Those texts were followed by five automated check-in messages throughout the two weeks. Parents were asked to self-rate their goal progress. Based on parents’ responses, the automated digital intervention system then provided immediate feedback, tips for addressing challenges and encouragement based on progress.

           The results, which were recently published in JAMA, reveal that children of parents who received the digital intervention as well as personal counseling had healthier weight-for-length growth curves over the first two years of life than children of parents who had counseling only. Obesity prevention for the digital group was found to be significant. Some 7% of the digital intervention group had obesity, compared with nearly 13% of the clinic-only group, which is a nearly 45% adjusted relative reduction.

          “It’s unusual to be able to prevent obesity in children, and we’re thrilled to have an intervention that has evidence behind it and can be implemented widely,” said Flower. She added that the digital services were effective in populations that traditionally experience the highest risk of obesity, and “could have significant impact” if implemented on a broader scale. Tthe researchers say the digital intervention had a greater effect on children from households with food insecurity, on Hispanic and non-Hispanic Black children, and those with lower health literacy.

          The researchers found that “the intervention effect” occurred as early as four months and was sustained throughout the two years. They say this study may be one of the first ever to prevent early childhood obesity, particularly in a large group of diverse participants.

           To read the journal article, find it with this reference:

Heerman, W.J., Rothman, R.L., Sanders, L.M., et al. (2024). A Digital Health Behavior Intervention to Prevent Childhood Obesity: The Greenlight Plus Randomized Clinical Trial. JAMA. Published online November 03, 2024. doi:10.1001/jama.2024.22362

 

 

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