A FAMILY-ORIENTED, HEALTHY EATING, ACTIVITY, AND LIFESTYLE TRAINING WITH HANDS-ON EXPERIENCE (FOR HEALTH) – INTERIM PHASE-1 RESULTS OF A COMMUNITY-BASED PILOT TREATMENT PROGRAM FOR OVERWEIGHT AND OBESE PRESCHOOLERS

Abstract

BACKGROUND: Over 30% of Canadian children and youth, and over 30% of U.S. preschool children are overweight or obese. Overweight 5-year-olds are 4-times more likely to become obese youth. Despite this, evidence to guide management of overweight and obese preschoolers is lacking. OBJECTIVES: To assess the feasibility (Phase 1) and effectiveness (Phase 2) of a 1-year multidisciplinary, community-based intervention for overweight and obese preschoolers to reduce BMI z-score (primary outcome), and to improve health-related quality of life (QoL). Other secondary objectives are to improve dietary choices, physical activity, and to decrease screen time. DESIGN/METHODS: Following physician referral and motivational pre-screening, children 2 to 6 years of age with a BMI ≥ 85th percentile for age and sex are being enrolled to receive intensive multidisciplinary group- and individual counseling, based on Social Cognitive Theory, on strategies to implement healthy dietary and physical activity habits, and on behavioural and parenting aspects. The program, based at a local YMCA, consists of a 4-month intensive phase with ten 90-minute group- and two individual sessions, two subsequent monthly sessions and follow-up at 9 and 12 months. Group sessions consist of parent education, during which children are engaged in guided, active playtime. RESULTS: 12 participants (7 girls; mean age 5.1 years, SD1.03) have so far been enrolled in Phase 1 of the program, 10 completed the intervention (attrition rate 16.7%). Session attendance (86%, SD10.6) and family satisfaction with the program (satisfaction score 55.7 of 60 (93%), SD3.98) have been high. Running the program in the community is feasible, but the referral-based recruitment process has been challenging, with the number of referrals, despite broad advertisement, significantly lagging behind expectations. Interim results are encouraging: for the 10 children who completed the program, mean BMI z-score at 12-months decreased by -0.25 (95%CI -0.08 to -0.42, p=0.013). Screen time decreased by 0.7 hours (95%CI -0.2 to -1.2, p=0.007), Readiness to Change (score 1-5, based on Prochaskas Transtheoretical Model) increased from 4.2 to 4.7 (95%CI 0.12 to 0.92, p=0.025). There was a strong trend towards improved QoL (PedsQL 4.0, scale 0-100) at the end of the core program (6-month mean total score from 65.6 to 76.1% (95%CI -5.0 to +25.9, p=0.08)), but this wasnt maintained during follow-up (12-month score 70.13, 95%CI -10.7 to +19.8,p=0.52). CONCLUSION: The novel 1-year FOR HEALTH intervention is feasible, can be implemented in the community, and has been well received by participating families with low attrition. Interim Phase 1 results show improved BMI z-score, readiness to change and screen time. Recruitment has been challenging.