Prospective BMI changes in preschool children are associated with parental characteristics and body weight perceptions: the ToyBox-study.

Yannis Manios,Violeta Iotova,Luis A Moreno Aznar,Katrina A Lambert,Odysseas Androutsos,Toy Box Study Group ,George Moschonis,Eva Karaglani,Christina Mavrogianni,Anna Świąder-Leśniak,Greet Cardon,Berthold Koletzko

doi:10.1017/s1368980021001518

Abstract

To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children's body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used. Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). A sample of 6268 preschoolers aged 3·5-5·5 years (51·9 % boys). There was no intervention effect on the change in children's BMI percentile. However, parents' underestimation of their children's actual weight status, parental overweight and mothers' pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children's BMI percentile in multivariate modelling. As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children's weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.

Highlights

This study aimed to investigate whether the modification of Energy balance-related behaviours (EBRB) attributed to the Toybox intervention could potentially have a positive effect on the changes observed on children’s age- and sex-specific BMI percentile
A standardised, multistage sampling approach was applied on preschool children aged 3·5–5·5 years old and their families, who were recruited from randomly selected municipalities within the provinces of OostFlanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland)
The present study showed that parental overweight status and parental underestimation of their child’s body weight constitute unfavourable conditions for the BMI trajectory in preschool years

Summary

Methods

ToyBox-study The ToyBox-intervention study was a multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. The intervention focused on modifying EBRB (see online supplementary material, Supplementary Table 1). A standardised, multistage sampling approach was applied on preschool children aged 3·5–5·5 years old and their families, who were recruited from randomly selected municipalities within the provinces of OostFlanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland). Family/perinatal factors’ in preschool BMI and Zaragoza (Spain) (see online supplementary material, Supplementary Table 2). Randomisation of the recruited municipalities to intervention and control groups was conducted centrally by the coordinating centre, after the completion of baseline measurements. Since the randomisation was conducted at a municipality level, the 309 kindergartens within each municipality were automatically allocated to the intervention or control group.

Results

Discussion

Conclusion