A Multi-Level Intervention to Address Childhood Obesity in Rural Hispanic Communities

Pediatric obesity disproportionately affects children of lower socioeconomic status, racial and ethnic minorities, and rural communities, and is influenced by social and physical environments. Community-engaged interventions can address pediatric obesity and have been implemented in rural settings for other conditions, but few have specifically targeted rural childhood obesity. Together We STRIDE study is a community-based trial designed to test the effectiveness of a multi-level obesity prevention intervention in Hispanic children living in rural communities.

The trial enrolled 653 children (8-12 years old). The 13-month (March 2017-April 2018) multi-level intervention included comic books, nutrition and physical activity (PA) classes, media literacy education and PA breaks, and an open-street community program (Ciclovía). The primary outcome was between-group differences in BMI z-score, measured at baseline, 6 months, and 18 months.

There were no significant between-group differences in BMI z-scores and BMI-for-age percentile relative to 95th percentile at 6 months or 18 months follow up. The mean difference in BMI z-score between intervention and comparison communities was -0.02 (95% CI -0.05, 0.02; p = 0.31) at 6 months and 0.03 (95% CI -0.03, 0.09; p = 0.32) at 18 months, respectively. BMI z-scores decreased progressively with increased exposure to intervention components (unadjusted p-trend = 0.008 and adjusted p-trend = 0.009).

Although this multi-level community-based intervention did not show an overall intervention effect on BMI z-scores, greater engagement with the intervention components was associated with higher reductions in BMI z-scores. The findings underscore both the promise and the challenges of community-based obesity prevention interventions in rural communities.

NCT02982759 (Together We STRIDE) retrospectively registered during study recruitment.