Family-based Obesity Interventions Research Articles

887-P: Moderator Role of Family Protective Factors on the Association between Family Structure Type and Obesity in Children

Purpose: Current literature indicates that childhood obesity is associated with family structure type. For example, children living in grandparent-headed households are more likely to be obese compared to children living in two-parent headed households. However, little is known about the conditions that might interact with family structure to influence children’s obesity. Since family protective factors are known to directly influence childhood obesity, we examined whether two specific family protective factors might moderate the association between family structure type and childhood obesity. Methods: We utilized data from the 2017-2018 National Survey of Children’s Health (n=24,800). Multivariable logistic regressions were used to assess the moderating effect of “family resilience” and families eating meals (7 vs. < 7 days/week). We controlled for child’s sex, age, race/ethnicity, health insurance, number of adverse childhood experiences, and physical activity level. We tested the moderating effect of family resilience and family meals as dichotomous variables, on the association between family structure type and obesity. Results: In the fully adjusted models, we observed no significant moderating effect of family resilience on the association between family structure type and childhood obesity. There was a moderating effect of the family meal variable: In grandparent-headed households (compared to two-parent headed households), children were significantly less likely to be obese when families ate meals together 7 days/week (adjusted odds ratio [aOR] =0.95) vs. < 7 days/week (aOR = 2.55). In single-parent headed households, the association did not differ significantly by that variable (aOR =1.02 vs. 1.46). Conclusion: Our results provide evidence that eating meals together is one family protective factor that could be important considerations when developing family-based obesity interventions for children living with their grandparents. Disclosure M. Song: None. L. L. Hayman: None. N. Dieckmann: None. C. Musil: None.

Healthy Living, Happy Living: The Effectiveness of a Family-Based Obesity Intervention for English and Spanish Speaking Families

Background: The prevalence of individuals with obesity and overweight has increased 200-500% since the 1980’s and is now at epidemic levels throughout the developed world.1 The prevalence of obesity in children has been increasing since 1988.2 Best practices for intervention in the pediatric population have been established and are family-based and multi-disciplinary. 3 However, interventions for ethnically diverse populations are understudied. 4 Hispanics are projected to constitute 30.2% of America’s population by 2050, and have a higher prevalence of obesity compared to non-Hispanic white persons.5 Therefore, effective interventions that …

The Obesity Parenting Intervention Scale: Factorial Validity and Invariance Among Head Start Parents

Obesity affects 15.7% of U.S. preschoolers, with higher rates among low-income and Spanish-speaking populations. Food, physical activity, and sleep parenting practices, referred to collectively as obesity-related parenting practices, are linked with children's risk of obesity and are a common target in family-based obesity interventions. Yet, there is no brief, validated measure of obesity-related parenting practices that is appropriate for use in intervention studies and for diverse audiences. This study tests the factorial validity of a brief measure of obesity-related parenting and measurement invariance of the English and Spanish versions of the scale, as well as among mothers and fathers. Parents of children enrolled in Head Start (n=578; 500 mothers and 78 fathers) completed a brief survey of food (7 items), physical activity (5 items), and sleep parenting (3 items) in fall of 2017 and 2018. Scale items were drawn from existing measures and the evidence base, initially drafted in English, and then translated to Spanish. One parent per family completed the scale independently in English (n=448) or Spanish (n=130). A confirmatory factor analysis framework was adopted to test a 3-factor model for the total sample. Multi-group structural equation modeling was used to assess measurement invariance of the scale by the language of administration (English or Spanish) and among mothers and fathers separately. Results supported a 3-factor model of obesity parenting with a single factor each for food, physical activity, and sleep parenting. There was statistically significant measurement invariance across all groups (p<0.05). Internal consistency was adequate across factors (α=0.65-0.80). This brief obesity-parenting scale demonstrates adequate factorial validity in English and Spanish and among mothers and fathers. This measure has been integrated into an intervention, and future work will test sensitivity to change.

Development of a Survey to Assess Latino Fathers' Parenting Practices Regarding Energy Balance-Related Behaviors of Early Adolescents.

Latino adolescents face challenges to performing energy balance-related behaviors (EBRBs) to prevent childhood obesity, including healthy dietary intake, adequate physical activity, and limited screen time. Fathers are underrepresented in family-based obesity interventions but could be influential in shaping the EBRBs of Latino children. Three types of parenting practices (setting expectations/limits, role modeling, managing availability and accessibility) have shown relatively consistent positive relationships with children's EBRBs in studies that have mostly involved mothers. The purpose of this study was to develop measures to assess Latino fathers' parenting practices based on existing measurement instruments, focus groups and cognitive testing. Criterion validity of the measures (40 items) was examined with Latino fathers and their early adolescents (10-14 years old, n = 96 dyads) who were predominantly from low-income, two-parent households. Criterion validity was indicated by significantly higher intakes of fruit and vegetables; lower intakes of sugar-sweetened beverages, sweets/salty snacks and fast foods; more weekly physical activity hours; and fewer daily screen time hours among adolescents who reported high versus low levels/frequencies of supportive parenting practices. In addition, nearly all scales of adolescent-reported paternal behavioral modeling and availability/accessibility practices were significantly correlated with adolescents' corresponding EBRBs (r = 0.22 to 0.54). However, poor validity and agreement with early adolescents' reports were found for most father-reported parenting practices. Overall, this study indicated that the measures were acceptable for assessing adolescents' report of Latino fathers' parenting practices around EBRBs. The findings also indicate the importance of including early adolescents' reports in measuring paternal parenting practices.

Changes in diet quality and home food environment in preschool children following weight management

BackgroundFamily-based obesity treatment interventions can successfully reduce energy intake in preschoolers. An implicit goal of obesity treatment interventions is to improve diet quality, but diet quality has been less examined as a treatment outcome in studies of preschoolers. The purpose of this study was to conduct a secondary analysis comparing the change in diet quality and home food environment in preschoolers assigned to a behavioral family-based obesity intervention (LAUNCH), motivational interviewing (MI) condition, or standard care (STC) condition.MethodsThree 24-h dietary recalls were completed at baseline and 6-months and were analyzed using NDS-R software; diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Availability of foods and beverages in the home was assessed through direct observation using the Home Health Environment tool that classifies foods and beverages as ‘red’ or ‘green’ based upon fat and sugar content. Repeated measures linear mixed effects models were used to examine changes in diet quality and home food environment between conditions (LAUNCH, MI, STC).ResultsAt 6-months, preschoolers in the LAUNCH condition had a higher HEI-2010 total score (62.8 ± 13.7) compared to preschoolers in the MI (54.7 ± 13.4, P = 0.022) and STC (55.8 ± 11.6, P = 0.046) conditions. Regarding the home food environment, families in LAUNCH had significantly less ‘red’ foods in their home at 6-months (12.5 ± 3.4 ‘red’ foods) compared to families in MI (14.0 ± 3.7 ‘red’ foods, P = 0.030), and STC (14.3 ± 3.4 ‘red’ foods, P = 0.006). There were no statistically significant differences across home food environments for number of ‘green’ foods.ConclusionFamily-based obesity treatment interventions for preschoolers can improve overall diet quality and alter the home food environment through reductions in ‘red’ foods.Trial registrationClinicaltrials.gov, NCT01546727. Registered March 7, 2012.

Parent-adolescent influences on everyday dietary practices: Perceptions of adolescent females with obesity and their mothers.

Parents demonstrate an important influence on adolescent obesity and dietary behavior; yet, family-based obesity interventions continue to exhibit limited success among adolescents. To further inform family-based approaches for adolescent obesity treatment, we examined the perceptions of adolescent females with obesity and their mothers of the influences experienced within the parent-adolescent relationship that affect everyday dietary practices. We conducted six focus group interviews (three adolescent female and three mother) among 15 adolescent (12-17years old) females with obesity and 12 of their mothers. Content analysis techniques were used to analyze the transcribed interviews. Adolescent females with obesity discussed a diverse set of parental influences (controlling, supporting and cultivating, overlooking and tempting, acquiescing, providing, attending, and not providing and avoiding) on their daily dietary practices. Among mother focus groups, mothers discussed specific intentional and unintentional types of influences from children that affected the food and drink they consumed, prepared, and acquired. Findings provide a fuller view of the varied social influences on everyday dietary practices within the parent-adolescent relationship. They indicate the importance of examining both parent-to-child and child-to-parent influences and begin to illuminate the value of attending to the social circumstances surrounding dietary behaviors to strengthen family-based obesity treatment approaches.

A Tailored Family-Based Obesity Intervention: A Randomized Trial.

To determine whether a 2-year family-based intervention using frequent contact and limited expert involvement was effective in reducing excessive weight compared with usual care. Two hundred and six overweight and obese (BMI ≥85th percentile) children aged 4 to 8 years were randomized to usual care (UC) or tailored package (TP) sessions at university research rooms. UC families received personalized feedback and generalized advice regarding healthy lifestyles at baseline and 6 months. TP families attended a single multidisciplinary session to develop specific goals suitable for each family, then met with a mentor each month for 12 months, and every third month for another 12 months to discuss progress and provide support. Outcome measurements (anthropometry, questionnaires, dietary intake, accelerometry) were obtained at 0, 12, and 24 months. BMI at 24 months was significantly lower in TP compared with UC children (difference, 95% confidence interval: -0.34, -0.65 to -0.02), as was BMI z score (-0.12, -0.20 to -0.04) and waist circumference (-1.5, -2.5 to -0.5 cm). TP children consumed more fruit and vegetables (P = .038) and fewer noncore foods (P = .020) than UC children, and fewer noncore foods were available in the home (P = .002). TP children were also more physically active (P = .035). No differences in parental feeding practices, parenting, quality of life, child sleep, or behavior were observed. Frequent, low-dose support was effective for reducing excessive weight in predominantly mild to moderately overweight children over a 2-year period. Such initiatives could feasibly be incorporated into primary care.

A Tailored Family-Based Obesity Intervention: A Randomized Trial

A Tailored Family-Based Obesity Intervention: A Randomized Trial

“A little on the heavy side”: a qualitative analysis of parents' and grandparents' perceptions of preschoolers' body weights

ObjectivesParents’ difficulties in perceiving children's weight status accurately pose a barrier for family-based obesity interventions; however, the factors underlying weight misinterpretation still need to be identified. This study's objective was...

Changes in parent motivation predicts changes in body mass index z-score (zBMI) and dietary intake among preschoolers enrolled in a family-based obesity intervention.

To examine whether changes in parent motivation over the course of a pediatric obesity intervention are significantly associated with long-term changes in treatment outcomes. Study hypotheses were tested with a secondary data analysis of a randomized controlled trial (N = 42). Study analyses tested whether baseline to posttreatment change in total score for a self-report parent motivation measure (Parent Motivation Inventory [PMI]) was significantly associated with baseline to 6-month follow-up changes in body mass index z-score (zBMI), dietary variables, and physical activity. Increases in PMI were significantly associated with decreased zBMI, decreased consumption of sugar-sweetened beverages and sweets, and increased consumption of artificially sweetened beverages. Given that increases in parent motivation were associated with some treatment benefits, future research should evaluate the impact of directly assessing and targeting parent motivation on weight outcomes for preschoolers participating in a weight management program.

BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study

BackgroundMultidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent.MethodsThis cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist.ResultsMean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependant of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048).ConclusionsIndividual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases.

Latino Parents' Perceptions of Their Ability to Prevent Obesity in Their Children

The obesity epidemic in Latino children has reached staggering proportions. This study explored Latino parents' perceptions of their ability to prevent obesity in children. Three focus groups were conducted with 26 Latino parents of preschoolers at a New York City Head Start program. Parents perceived high levels of ability to prevent obesity primarily via dietary influence. Four factors negatively impacted parents' ability: family history, intergenerational and interparental issues, adolescence, and societal pressures. Culturally effective, family-based obesity interventions among Latinos should build upon parental perceptions of ability to prevent obesity, while simultaneously helping parents address the factors they perceive challenge this ability.

Risk factors for poor attendance in a family-based pediatric obesity intervention program for young children.

This study examined the role of demographic characteristics, psychological factors, and family functioning on attendance in a randomized controlled trial of a family-based pediatric obesity program. Participants included 155 children between the ages of 4 and 7 years (M age = 5.77, 57.4% female, 73.6% black, M body mass index = 25.5) and their primary caregivers who were randomized to the treatment group. Three groups of participants were created based on their patterns of attendance during the program: (1) noncompleters, (2) partial completers, and (3) completers. Results indicated no differences among the attendance groups in child gender, child body mass index, or child psychological functioning. Significant group differences were found with respect to race/ethnicity, parent marital status, and family income, such that noncompleters were more likely to be racial/ethnic minorities, to living in single parent households, and to have lower incomes than partial completers and completers. After controlling for the effects of these sociodemographic risk factors, noncompleters, and partial completers reported more family dysfunction characterized by high levels of disengagement than completers. Adapting existing weight management programs to include a focus on family engagement in the early stages of treatment may help to improve participation in family-based obesity interventions targeting high risk, socioeconomically disadvantaged youth.

Obesity Is Associated With Family History of ESRD in Incident Dialysis Patients

Obesity is an established risk factor for chronic kidney disease and aggregates in families. The objective of this study is to examine the relationship between obesity and family history of end-stage renal disease (ESRD). Data were collected from 25,883 incident patients with ESRD in US ESRD Network 6 (Georgia, North Carolina, and South Carolina) dialysis clinics between 1995 and 2003. Family history is defined as a first- or second-degree relative with ESRD. Body mass index (BMI) at dialysis therapy initiation was classified as underweight (BMI < 18.5 kg/m2), normal (BMI, 18.5 to <25 kg/m2), overweight (BMI, 25 to < 30 kg/m2), obese (BMI, 30 to <35 kg/m2), or morbidly obese (BMI > or = 35 kg/m2). Twenty-three percent of patients reported a family history of ESRD. Of patients reporting a family history of ESRD, 5.5% were underweight, 32.5% had normal BMI, 28.0% were overweight, 17.3% were obese, and 16.7% were morbidly obese. After controlling for age, race, sex, primary cause of ESRD, history of diabetes, history of hypertension, and estimated glomerular filtration rate at dialysis therapy initiation, reported family history of ESRD was associated with being overweight (odds ratio [OR], 1.17; 95% confidence interval [CI], 1.08 to 1.26), obese (OR, 1.25; 95% CI, 1.14 to 1.37), and morbidly obese (OR, 1.40; 95% CI, 1.27 to 1.55). Obesity at dialysis therapy initiation was associated independently with reported family history of ESRD. This finding suggests that behavioral factors, adiposity-related genes, and gene-by-BMI interaction may contribute to familial risk for ESRD. This finding also suggests that management of obesity may be even more important for patients with a family history of ESRD than for the general population.