Obesity In Rural Communities Research Articles

Weight outcomes of NU-HOME: a randomized controlled trial to prevent obesity among rural children

BackgroundRural children are at greater obesity risk than their urban peers. The NU-HOME study is an innovative collaborative effort to prevent childhood obesity in rural communities. Weight outcomes of the NU-HOME study, a family-meal focused randomized controlled trial (RCT) are described. We hypothesized that compared to control group children, intervention group children would have significantly lower weight-related post-intervention (PI) outcomes.MethodsParticipants were 114 dyads (7–10 year-old rural children and a parent). In 2017–2018 and 2018–2019, research staff measured height, weight and body fat at baseline (BL) and PI. Families were randomized to intervention (n = 58) or control (n = 56) groups without blinding. Designed with Social Cognitive Theory and community engagement, the NU-HOME program included seven monthly sessions delivered in community settings and four goal-setting calls. The program engaged entire families to improve healthy eating, physical activity, family meals and the home food environment. Multiple linear and logistic regression models tested PI outcomes of child BMIz-score, percent body fat, percent over 50th percentile BMI, and overweight/obesity status by treatment group, adjusted for BL values and demographics (n = 102).ResultsNo statistically significant intervention effects were seen for child BMIz or overweight/obesity status. However, a promising reduction in boys’ percent body fat (− 2.1, 95% CI [− 4.84, 0.63]) was associated with the intervention.ConclusionsAlthough our findings were in the hypothesized direction, making significant impacts on weight-related outcomes remains challenging in community trials. Comprehensive family-focused programming may require intensive multi-pronged interventions to mitigate complex factors associated with excess weight gain.Clinical trial registrationThis study is registered with NIH ClinicalTrials.gov: NCT02973815.

Conducting a pediatric randomized clinical trial during a pandemic: A shift to virtual procedures.

Prior to the COVID-19 pandemic, our research group initiated a pediatric practice-based randomized trial for the treatment of childhood obesity in rural communities. Approximately 6 weeks into the originally planned 10-week enrollment period, the trial was forced to pause all study activity due to the COVID-19 pandemic. This pause necessitated a substantial revision in recruitment, enrollment, and other study methods in order to complete the trial using virtual procedures. This descriptive paper outlines methods used to recruit, enroll, and manage clinical trial participants with technology to obtain informed consent, obtain height and weight measurements by video, and maintain participant engagement throughout the duration of the trial. The study team reviewed the IRB records, protocol team meeting minutes and records, and surveyed the site teams to document the impact of the COVID-19 shift to virtual procedures on the study. The IRB approved study changes allowed for flexibility between clinical sites given variations in site resources, which was key to success of the implementation. All study sites faced a variety of logistical challenges unique to their location yet successfully recruited the required number of patients for the trial. Ultimately, virtual procedures enhanced our ability to establish relationships with participants who were previously beyond our reach, but presented several challenges and required additional resources. Lessons learned from this study can assist other study groups in navigating challenges, especially when recruiting and implementing studies with rural and underserved populations or during challenging events like the pandemic.

Family-focused obesity prevention program implementation in urban versus rural communities: a case study

PurposeDespite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children.MethodsThis paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children.ResultsCommunity engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery.DiscussionWhen adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.

Group lifestyle modification vs. lifestyle newsletters for early childhood obesity: Pilot study in rural primary care

Research on primary-care interventions for early childhood obesity in rural communities is lacking. We compared two interventions for 4- to 8-year-old children with overweight/obesity, launched from a rural primary-care clinic. Families were randomly assigned to Intensive Lifestyle Modification (ILM; n = 23) or Lifestyle Newsletters (LN; n = 24). The primary outcome was 5-month change in child BMI z-score. ILM groups received behavior modification challenges, the Stop Light Diet, nutrition information, and parent training. LN families received by mail information on diet and physical activity. Results indicated no significant difference between groups in BMI z-score reduction ( p = 0.40; Cohen's d = 0.20), although treatment interacted with child food responsiveness ( p = 0.04) and parent perceived feeding responsibility ( p = 0.006) in exploratory analyses. Specifically, ILM compared with LN was better for children higher in ‘food responsiveness’, with a reverse pattern for children lower in this trait. ILM also was superior to LN when parents were lower in feeding responsibility, with a reverse pattern when parents were higher in this trait. Thus, the success of ILM and LN in rural primary care may depend upon child and parent attributes. Lower-intensity family interventions for early childhood obesity may offer scalable options in rural communities for some families.

‘eatNplay’ – a rurally-tailored, family-based, telehealth intervention for childhood obesity: Protocol for a mixed-methods randomized newsletter controlled pilot study

BackgroundChildhood obesity disproportionately affects rural communities where access to pediatric weight control services is limited. Telehealth may facilitate access to these services. ObjectiveThis paper describes the rationale, curriculum, and methodology for conducting a randomized controlled pilot trial of a rural, family-based, telehealth intervention that aims to improve weight-related behaviors among children, compared to monthly newsletters. MethodsA mixed-methods randomized design will randomly assign 44 rural families with one or more children aged 5 to 11 years identified as overweight or obese to an intervention or newsletter control group. The intervention group will attend ‘eatNplay’ group videoconferencing telehealth sessions, conducted weekly by a registered nurse and a motivational interviewing expert, to discuss diet, exercise, sleep, and peer group influences. The control group will receive newsletters covering these topics. Outcome measures at baseline, 12, and 26 weeks will assess 1) participant engagement and satisfaction with ‘eatNplay’; 2) child's BMI, dietary behavior, physical activity, and sleep behavior; and 3) parent/guardians' self-reported beliefs, behaviors, attitudes, perceived stress, and perceived quality of life. Analyses will employ 1) thematic analysis of semi-structured parent/guardian interviews after follow-up to help refine the intervention (e.g., curriculum), and 2) linear mixed models to compare outcomes between groups pre- and post-intervention and reduce bias from unobserved variables. Results of this pilot study could refine methodology for conducting telehealth studies, acceptability of healthcare provider-involved recruitment, interdisciplinary team approach, and addressing childhood obesity in rural communities through telehealth.

Universal childhood obesity prevention in a rural community: Study design, methods and baseline participant characteristics of the NU-HOME randomized controlled trial

Childhood obesity is a major health concern in the United States (US) and those living in rural communities are at higher risk than their urban counterparts. Few prevention trials have engaged whole families of school-age children in community settings, and none to date have promoted family meals, family activity and healthful home environments in rural settings through a rigorous, randomized controlled trial (RCT). The New Ulm at HOME (NU-HOME) study recruited 114 parent/child dyads in a two-arm (intervention versus wait-list control) RCT to test the efficacy of a family meals-focused program aimed to prevent excess weight gain among 7–10 year-old children in rural Minnesota. The NU-HOME program was adapted from a previously tested program for urban families through a unique community collaboration. The program included 7 monthly in-person sessions for all family members. Parents also participated in 4 motivational goal-setting phone calls. The primary outcome measures were age- and sex-adjusted child body mass index (BMI) z-score, percent body fat, and incidence of overweight and obesity post-intervention. Secondary outcomes included quality of food and beverage availability in the home; family meals and snacks; children's dietary intake quality (e.g., Healthy Eating Index (HEI)-2015, fruits and vegetables, sugar-sweetened beverages, snacks); and children's screen time and weekly minutes of moderate-to-vigorous physical activity, total physical activity, and sedentary behavior. The NU-HOME RCT was a collaborative effort of academic and health system researchers, interventionists and community leaders that aimed to prevent childhood obesity in rural communities through engagement of the whole family in an interactive intervention.

P31 Associations Between Snack Food and Demographics, Family Meals and Fruit/Vegetable Intake Among Rural 7- to 10-Year-Old Children

<h3>Background</h3> Snacking is common among children; often including low-nutrient dense foods. Children from rural areas consume fewer fruits and vegetables (FV) than recommended but little is known about their snacking patterns. <h3>Objective</h3> Examine associations between different types of snacks and demographics, family meal frequency and FV intake among rural children. <h3>Study Design, Setting, Participants</h3> Baseline data (2017/2018) were used from 106 parent/child dyads in the NU-HOME randomized controlled trial designed to prevent childhood obesity in rural communities. Children were mostly female (60%), 8.9 years old on average (SD = 104) and 28% of families received economic assistance. Parents reported on their child's snacking via text surveys on 7 random evenings over a 2-week period. Past week family meal frequency and demographics (child age, sex, economic assistance, parent education) were collected via parent survey. FV servings were averaged over 2 dietary recalls. <h3>Measurable Outcome/Analysis</h3> Snack categories were created using factor analysis: Fruit/Yogurt (Fruit, yogurt, 100% juice), Vegetables/Cheese, Granola bars/Chips (including cereal and crackers), and Sugar-sweetened snacks (sugar-sweetened beverages, candy, baked sweets, ice cream). Items in each snack category were summed over 7 days. Correlations and t-tests examined associations between the number of items from each snack category and demographics, family meal frequency, and FV servings. <h3>Results</h3> Children ate a variety of foods for snacks with most being sugar-sweetened snacks (M = 5.52, SD = 3.64) followed by Fruit/Yogurt (M = 4.97, SD = 3.39), Granola bars/Chips (M = 3.67, SD = 2.38), and Vegetables/Cheese (M = 2.24, SD = 2.10). Children whose families received economic assistance were more likely to eat Fruit/Yogurt snacks (6.2 vs 4.5 snacks; <i>P</i> = .02) and less likely to eat Sugar-sweetened snacks (4.2 vs 6.0 snacks; <i>P</i> = .02) than those who did not receive economic assistance. Family meal frequency was negatively correlated with Sugar-sweetened snacks (r = −0.25; <i>P</i> = .009). Servings of FV was positively correlated with Fruit/Yogurt snacks (r = 0.19; <i>P</i> = .046). <h3>Conclusions</h3> Innovative, real-time snacking data indicate nutrition educators should encourage nutrient-dense snacks particularly among families who do not regularly eat family meals.

Increasing Trend of Overweight and Obesity in a Rural Community in South East Nigeria

Background: There is a global trend of increasing obesity, affecting mostly the high-and-middle income countries. Obesity was more prevalent in the urban areas but recent studies have suggested a disproportionate increase in obesity in the rural areas outstripping that of urban areas thus fueling the global obesity epidemic. This cross-sectional community study was undertaken to determine the prevalence of obesity in a rural community in South east Nigeria using Body Mass Index (BMI), waist circumference and waist-hip ratio. Materials and Methods: Adults (≥18 years) in a rural community in Enugu State were studied in July 2019. The weight, height, waist circumference and hip circumference of the participants were taken. The BMI was calculated from the weight and height and the waist-hip ratio was determined for each participant. Results: A total of 210 participants were studied and analyzed. The prevalence of obesity and overweight by BMI was 10.9% and 28.0% respectively. There was no difference in the prevalence of obesity in males and females (10.9% vs 10.9%) and overweight (27% for males and 28% for females). Significantly more females (40%) than males (7.3%) were obese by sex specific waist circumference (p p = 0.629) and females (p = 0.439). However, middle aged females (40 - 59 years) had higher waist circumference than the younger and older females (p = 0.025), while the older males (60 - 79 years) had higher waist-hip ratio than younger age groups p = 0.002. Conclusions: The result of this study shows an increasing trend of obesity and overweight in a farming rural community in South east Nigeria compared with the prevalence recorded in the region in the past.

Opportunities and Challenges Addressing Access to Healthy Food in Five Rural Louisiana Food Stores.

The prevalence of high obesity in rural communities may result from low access to healthy foods. To improve the local food environment, a multicomponent environmental food store intervention was implemented in 3 Louisiana parishes where obesity prevalence was greater than 40%. The intervention consisted of healthy-food demonstrations, in-store marketing, and encouraging store owners to stock healthy items. We documented aspects of the rural food store climate, such as store size and the store owner’s willingness to stock healthy items, that affect improving access to healthy food. We found that although the intervention was not effective in shifting purchasing or dietary habits of customers, positive changes in some food store environments did occur. To maximize the effect that rural food store interventions can have on reducing obesity, it is essential to understand aspects of the rural food store climate.

Potential solutions for pediatric weight loss programs in the treatment of obesity in rural communities.

Pediatric obesity remains disproportionately more prevalent in rural communities; however, multidisciplinary, pediatric weight loss programs, which are often located in tertiary-care centers, may not be accessible to rural families. Limited models to specifically address pediatric obesity in rural communities exist. Therefore, innovative solutions are required for expanded treatment of pediatric obesity in rural communities. This article discusses potential solutions for multidisciplinary, tertiary-care pediatric weight loss programs to improve access and treatment of pediatric obesity in rural communities. A selected review of the literature suggests that strategies to overcome barriers to treatment in rural communities include telephone calls and telemedicine conferencing by obesity specialists from academic centers (obesity medicine specialists, endocrinologists, dietitians, and psychotherapists) as well as training local primary care providers in rural communities to screen, diagnose, and treat patients with obesity. Multidisciplinary, tertiary-care pediatric weight loss programs have a profound opportunity to impact the treatment of pediatric obesity in rural communities by training practicing rural primary care providers as well as strengthening their commitment to educate future generations of clinicians on the treatment of pediatric obesity through medical training including physician assistant, nurse practitioner, and pediatric and family medicine resident education and skill building. This article identifies potential mechanisms for expansive treatment of pediatric obesity in rural communities by multidisciplinary, tertiary-care weight loss programs and highlights areas of specific focus needed for future investigation.

Examining Key Stakeholder and Community Residents' Understanding of Environmental Influences to Inform Place-Based Interventions to Reduce Obesity in Rural Communities, Kentucky 2015.

Rural residents report high rates of obesity, physical inactivity, and poor eating habits. The objectives of this study were to (1) use the collective impact model to guide efforts to elicit community members' perceptions of county-specific factors influencing high obesity rates; (2) determine the association between utilization of food retail venues and concern about obesity and healthy eating; and (3) determine community members' utilization of physical activity infrastructure and concern about physical inactivity. The study was conducted in 6 rural counties in Kentucky with adult obesity prevalence rates >40%. Community stakeholders met to assess counties' needs and assets in implementing interventions to reduce obesity in their communities. A random-digit dial survey (n = 756) also was conducted to examine awareness and availability of community resources for healthy eating and physical activity. Stakeholders identified lack of access to fruits and vegetables and poor physical activity infrastructure as contributors to obesity. Reporting moderate and serious concern about obesity and healthy eating was associated with higher odds of shopping at a supercenter compared with those expressing little concern. Reported access to information about physical activity opportunities was associated with higher odds of reporting the availability of safe places for physical activity, sidewalks, and trails compared with those who reported that information was difficult to obtain. This study elicits community-identified barriers to healthy behaviors and provides foundational data to inform future place-based obesity reduction interventions.

Development and psychometric testing of the childhood obesity perceptions (COP) survey among African American caregivers: A tool for obesity prevention program planning

Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver’s perceptions of childhood obesity in rural communities is an important prevention effort. This article’s objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (α=0.70–0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs.

Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013.

IntroductionHealth disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity–related policy and environmental strategies for obesity prevention in rural communities.MethodsA literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity–related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers.ResultsOf 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were “enhance infrastructure supporting walking” (n = 11) and “increase opportunities for extracurricular physical activity” (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes.ConclusionSeven of the 12 COCOMO physical activity–related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.

Physical Activity–Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

Physical Activity–Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013.

IntroductionResidents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings.MethodsThe review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the “COCOMO” strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus.ResultsOf the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships.ConclusionsFindings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.

Nutrition-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

Nutrition-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002–2013

The Prevalence and the Related Factors of Metabolic Syndrome in Urban and Rural Community

Purpose: The purpose of this study is to investigate the prevalence of metabolic syndrome and its components and to examine the related factors in urban and rural community, South Korea. Methods: The data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES-V) conducted in 2010 were utilized in this study. The subjects were 5,760 adults 20 years or over. The data were consisted with health survey questionnaire and health examination. x 2 -test and logistic regression was used for the analysis SAS 9.3 applying sampling weights. Results: The prevalence of metabolic syndrome based on the latest definition proposed the joint scientific meeting was 23.4% and 29.0% respectively in urban and rural community. Rural community showed higher prevalence of abdominal obesity (29.9% vs 38.5%), elevated blood pressure (31.3% vs 38.5%), elevated blood glucose (24.3% vs 28.4%) than urban community. The related factors were age, marital status, high risk drinking, obesity in urban community and age, marital status high risk drinking, severe physical activity, obesity in rural community. Conclusion: This study showed there was difference in prevalence and the related factors of metabolic syndrome and these findings have important implications to prevent and manage metabolic syndrome in public health field.

Exercise, Overweight and Obesity in Rural Communities, the Situation of Some Communities in the Central Region of Ghana

Objective: The study aimed at finding the level of physical activity and the evidence of overweight and obesity and associated its sociodemographic factors in some rural communities in the central region of Ghana. Subjects: The study was a cross sectional survey involving a total of 470 respondents aged 18 to 91years (337 females and 133 males) in 7 rural communities in the Central Region of Ghana. Findings: Our study found that 42.1% of respondents engaged in some from of physical exercise and that the exercise of choice was walking. The incidences of obesity and overweight were 3.1% and 13.0% respectively in male and 14.9% and 26.6% respectively in females. Significant associations were found between the Body Mass Index (BMI) of respondents and the following factors; regular participation in physical activity (p=0.032), sex (<0.0001) and educational level in female (p=0.033). There were also significant associations between exercising and factors such as level of education (p<0.0001) and sex (<0.0001). Conclusion: A number of sociodemographic factors were found to have association with the BMI and regular participation in physical activity. Our findings also seem to suggest an increasing trend in weight gain particularly in the female rural population.

Telemedicine and Face-to-Face Care for Pediatric Obesity

The University of California Davis Medical Center (Sacramento, CA) has pioneered the use of telemedicine in its approach to childhood obesity to cover more than 20 rural clinics in California. In our study, we compared the outcomes of the Telemedicine Weight Management Clinic (TM) with those of its face-to-face (FTF) Weight Management Clinic counterpart over the last 5 years, predicting the results to be equivalent or in favor of TM. All children seen in the TM from June 2006 to June 2011 were included (n=121), and encounter notes in medical records were reviewed. For comparison, an equivalent sample of FTF patients was selected from that time frame (n=122). Data that were also abstracted from the medical record included age at first visit, gender, race, referral site, and comorbid diagnoses. Forty-two percent of TM patients compared with 52% of FTF patients received a change in diagnosis. Thirty-nine percent of TM patients received a change in diagnostic evaluation compared with 67% of patients in FTF. When comparing patients who received more than one visit with either form of consultation, the TM group demonstrated substantially more improvement than the FTF group in improving nutrition (88% versus 65%), increasing activity (76% versus 49%), and decreasing screen time (33% versus 8%). Substantially more TM patients were successful with a combined outcome of any one of the weight parameters that included weight loss, weight maintenance, or slowing of weight gain (69% TM versus 44% FTF). Our study suggests that telemedicine can serve as a feasible strategy to increase access to medical care for childhood obesity in rural communities and promote changes in lifestyle with the goal of maintaining a healthy weight.

Childhood obesity prevention in rural settings: background, rationale, and study design of ‘4-Health,’ a parent-only intervention

BackgroundChildhood obesity in rural communities is a serious but understudied problem. The current experiment aims to assess a wide range of obesity risk factors among rural youth and to offer an 8-month intervention program for parents to reduce obesity risk in their preteen child.Methods/DesignA two-group, repeated measures design is used to assess the effectiveness of the 4-Health intervention program. Assessments include anthropometric measures, child self-evaluations, parent self-evaluations, and parent evaluations of child. County Extension agents from 21 rural Montana counties recruit approximately 150 parent–child dyads and counties are semi-randomly assigned to the active intervention group (4-Health Educational Program) or a “best-practices” (Healthy Living Information) control group.DiscussionThis study will shed light on the effectiveness of this parent-only intervention strategy in reducing obesity risk factors among rural preteens. The 4-Health program is designed to provide information and skills development for busy rural parents that will increase healthy lifestyles of their preteen children and improve the parents’ ability to intervene effectively in the lives of their families during this critical developmental period.Trial registrationClinicalTrials.gov ID: NCT01510587