Influencing the Home Food and Activity Environment of Families of Preschool Children Receiving Home-Based Treatment for Obesity.

Abstract

The prevalence of overweight and obesity remains notably higher for Hispanic preschool children (16.7%) compared with African Americans (11.3%), Asians (3.4%), and non-Hispanic White children (3.5%).1 While socioeconomic status may partially explain some of the risk for obesity between racial and ethnic groups, other behavioral and environmental modifiable factors require further study.2 The home physical environment has recently been identified as a potential target for not only intervention (eg, changing the availability of home foods) but also as a setting for the delivery of clinical intervention.3,4 To date, few treatment studies have been developed and tested to directly improve the home food environment of preschoolers with obesity and its associations with weight outcome. An exception has been the LAUNCH program (Learning about Activity and Understanding Nutrition for Child Health), which was based on behavioral family-based programs for school-aged children and adapted for families of preschoolers.4–6 The LAUNCH program was delivered over 18 sessions that alternated between clinic and home visitations. Feasibility and pilot study results showed promising improvements in weight outcomes for preschoolers with obesity4,6 and comparison of clinic only visits versus clinic plus home visits showed support for the inclusion of home visitations when treating preschool obesity.5 In particular, significant changes in the home food environment were shown for the clinic plus home visit group, including fewer high-calorie foods and more fruits and vegetables at the end of treatment [5]. However, the LAUNCH studies primarily included white families from middle to upper income levels and it remains relatively unknown how families of preschoolers from diverse backgrounds may construct their home food and activity environment and modify them during the course of a home-based obesity intervention. The goal of this study was to characterize the home food and activity environments of overweight and obese preschool-aged children from low socioeconomic status Latino families. Additionally, differences in available key foods and activity devices at the beginning of treatment were compared with end of treatment changes to assess program impact on the home health environment. Characterization of the home food and activity environment for treatment seeking families was considered exploratory. Based on prior studies, participants who completed the program were hypothesized to show increased availability of fruits and vegetables at posttreatment compared with baseline.3,4 In addition, preschool participants who showed a decreased body mass index (BMI) trajectory at posttreatment compared with baseline were hypothesized to have a higher availability of fruits and vegetables and devices that promote physical activity compared with participants who showed smaller change or no change in zBMI.4–6