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Published on: February 2, 2017
A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial
Lee M Sanders1, Eliana M Perrin2, H Shonna Yin3
1Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California; leesanders@stanford.edu.
Insights
A primary care intervention reduced early childhood weight gain through 18 months but effects did not last until 24 months. Greater intervention intensity may be needed for sustained obesity prevention in young children.
Area of Science:
- Pediatric Health
- Obesity Prevention
- Public Health Interventions
Background:
- Early childhood overweight is a significant risk factor for long-term obesity and associated health issues.
- Identifying effective interventions in primary care settings is crucial for early obesity prevention.
Purpose of the Study:
- To evaluate the effectiveness of a primary care-based intervention aimed at reducing the prevalence of overweight children at 24 months of age.
- To assess the intervention's impact on weight status, including Body Mass Index (BMI) z-scores.
Main Methods:
- A cluster-randomized trial involving infant-caregiver dyads across four pediatric residency clinics.
- The intervention utilized health-literacy principles, including a parent toolkit and provider training in clear communication.
- The primary outcome was the proportion of children classified as overweight (BMI ≥ 85th percentile) at 24 months.
Main Results:
- A total of 459 dyads received the intervention and 406 were in the control group.
- At 24 months, 49% of all children were overweight; the intervention did not significantly alter overweight prevalence (adjusted odds ratio: 1.02).
- The intervention group showed reduced BMI z-scores from 4 to 18 months, but this difference was not significant at 24 months.
Conclusions:
- The clinic-based intervention demonstrated a temporary effect on reducing early weight gain through 18 months.
- Sustained positive effects on weight status were not observed by 24 months.
- Increased intervention intensity may be necessary to achieve and maintain long-term benefits in childhood obesity prevention.
Background And Objectives:
Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months.
Methods:
In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score).
Results:
A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively.
Conclusions:
The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
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