Promotion of Healthier Food Habits/ Choices within the family to combat

Obesity .

Sorcia Kristi-Rose D’ArceuilUniversity of the West Indies

St Augustine Trinidad WI

A childhood obesity intervention developed byfamilies for families: results from a pilot study

Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed

to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study

utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with

preschool-aged children enrolled in Head Start

Davisonet al.: A childhood obesity interventiondeveloped by families for families: results from a pilot study.International Journal of Behavioral Nutrition and Physical Activity 201310:3

Study Details • Two year Pre- Post Cohort Study (119 families)• Funded by a US federal program “Head Start.” • All families with a child 2 years or older enrolled in the target Head Start

centers were eligible to participate. • All analyses were performed using SAS version 9.3(Cary, NC). • McNemar’s (chi-square) test was used to compare pre-post intervention

differences in the percentage of children who were obese and the percentage of children with a TV in their bedroom.

• Paired t-tests were used to compare pre and post intervention differences in continuous measures including (a) children’s BMI z-score, physical activity, dietary intake, and screen time, and (b) food, physical activity, and screen-related parenting practices and attitudes.

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First Year

Methodology for Data Collection

1) During year 1 (2009–2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention.

• Community-based participatory research (CBPR) • The Family-centered Action Model of Intervention Layout and

Implementation (FAMILI) and the Family Ecological Model (FEM)

• Community-based participatory research (CBPR)- is a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process and in which all partners contribute expertise and share decision making and ownership. The aim of CBPR is to increase knowledge and understanding of a given phenomenon and integrate the knowledge gained with interventions and policy and social change to improve the health and quality of life of community members.

• The Family-centered Action Model of Intervention Layout and Implementation, or FAMILI, draws on theories of family development to frame research and intervention design, uses a mixed-methods approach to conduct ecologically valid research, and positions family members as active participants in the development, implementation, and evaluation of family-centered obesity prevention programs. FAMILI is intended to facilitate the development of culturally responsive and sustainable prevention programs with the potential to improve outcomes. Although childhood obesity was used to illustrate the application of FAMILI, this model can be used to address a range of child health problems.

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Principles of the Data Collection/ Intervention

Steps to Community Intervention Development

Community Advisory Board{CAB} (Parents, Board Members, Nutritionist, Teachers)

The CAB developed and approved partnership principles to provide guiding values and codified expectations and operating guidelines to sustain active involvement

To operationalized the participatory process various strategies and structural accommodations were employed to foster parents involvement throughout all phases of the research process

Foundation of the Community Intervention Devolvement

Based on the Family Ecological Model, personal definitions of health, strategies used to foster family health, chronic stressors that

affect parenting and family interactions.

Monthly meeting in the community, compensation provided (meals, childcare)

Parents (Experts)

Method’s of Community Assessment

Community Assessment

self-report

surveys

Focus Groups

Photovoice

Windshield Surveys

Children’s weight status

Children’s Dietary Intake

Children’s Physical Activity

Second Year

Methodology of Intervention Implication

• During year 2 (2010–2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design

Steps to Intervention Implication

Health Communication

Campaign

Children’s Health

Parameter letter’s

Nutritional Information Counseling Sessions

Parents Connect for Healthy

Living Program

Steps to Intervention Implication

• Health communication campaign, which integrated quotes from the focus groups conducted during the community assessment, was developed to increase parents’ awareness of childhood obesity and dispel myths around children’s weight (e.g. “it’s just baby fat, he will grow out of it”

• Second letters mailed home to families by Head Start reporting children’s BMI, and other health indicators, were revised based on parent feedback to facilitate parents’ understanding of the information provided.

• Third, informal nutritional counseling sessions were integrated into Head Start family engagement activities. Community nutrition graduate students from a local college attended Head Start family events, provided samples of healthy foods, and were available to answer questions parents had about their child’s (or their own) diet and weight status.

• The final and central component was the Parents Connect for Healthy Living program, a 6-week, onsite, parent-led program to promote parent social networking, advocacy, communication skills, media literacy and conflict resolution-all of which were behavioral targets of interest to parents identified through the community assessment.

Results of the study

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Common Bad food habits made by families

Common Bad Food Habits made by families

Adults • Eating too fast • Eating snacks Continuously • Inappropriate Dinners • Lack of physical activity

Teens • Skipping Breakfast • Consuming too much processed foods • Eating fast food meals outside of the home• Heavy soft drink/ sugary beverage consumption

Children • Parents are always busy so fast food meals are high consumed • Restaurant serving sizes for kids are increasing • Schools are cutting Physical activity from their programs • High sugar high salt foods and snacks are readly made available to children

Consequences of bad food habits

Consequences of Childhood Obesity

• Childhood obesity is associated with a higher chance of premature death and disability in adulthood.

• Obese children and adolescents suffer from both short-term and long-term health consequences.

• The most significant health consequences of childhood overweight and obesity, that often do not become apparent until adulthood, include: cardiovascular diseases (mainly heart disease and stroke);diabetes; musculoskeletal disorders, especially osteoarthritis; and certain types of cancer (endometrial, breast and colon).

• At least 2.6 million people each year die as a result of being overweight or obese.

• Many low- and middle-income countries are now facing a "double burden" of disease: as they continue to struggle with the problems of infectious diseases and under-nutrition; at the same time they are experiencing a rapid increase in risk factors of NCDs such as obesity and overweight, particularly in urban settings. It is not uncommon to find under-nutrition and obesity existing side-by-side within the same country, the same community and even within the same household in these settings.

• This double burden is caused by inadequate pre-natal, infant and child nutrition which is then followed by exposure to high-fat, energy-dense, micronutrient-poor foods and a lack of physical activity as the child grows older.

Our Intervention: Hybrid of the Mind, Exercise, Nutrition, Do it (MEND)

Program for Urban Community in Trinidad

Our Study Details

• MEND will consist of 16 sessions delivered over 8 weeks (2 hour sessions held twice weekly during the evening time) by two MEND leaders and an assistant to groups of 10-15 children accompanied by their parents or caregivers in a community setting such as sport center or in schools

• Sixty ethnically diverse obese students (BMI > or = to the 95th percentile, reference data) ages 6 to 8 in a Urban community in Trinidad

• Funded by a local NGO’s or governmental subsidies • All families with a child 2 years or older enrolled• Mind, Exercise, Nutrition, Do it (MEND) Program, a multicomponent community-based

childhood obesity intervention among boys and girls. • A local community advisory board will be set up• Food vouchers, food hampers, child care services will be provided as incentives to stay

enrolled within the program.

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Mind, Exercise, Nutrition, Do it (MEND) Program

The MEND Program was created to help overweight and obese children improve their lifestyles and health, with the support and encouragement of their families. MEND aims to improve the children’s and families' eating and activity habits, to

prevent children from becoming obese adults. MEND is a 20-session family Program that meets for two hours twice a week and

is attended by the child and at least one parent or caregiver. The first hour is an interactive family session on nutrition and behavior topics, followed by one hour of fun exercise for the children while the parents meet for support and discussion

on topics such as goals and rewards, label reading and problem solving.Before and after the Program, children are measured and they and their families

complete questionnaires that help us monitor and evaluate improvements in body mass index (BMI), waist circumference, fitness and self-esteem. At the

graduation, each family receives a directory of community resources for post-Program support such as local MEND Graduate activities, afterschool physical

activity programs, follow-up measurements, and other local opportunities to help the children continue with the positive changes they made during MEND.

Unique Factors specific to our intervention program

• Relative and Absolute poverty • Food security • Socioeconomic factors • Stigma (Child and Parents) • Culture and Family Traditions• Religion • Family Structure • Attitudes and believes of parents • Food Prices

MEND 8 Week Program Health

Communication Campaign

(WEEKS 1-2)

parents are encouraged to express what are the burdens faced, stressors, food

security, socioeconomic factors,

Brochures, Pamphlets on Stress

management, cutting food cost,

encouraged to find solutions and fill out

questionnaires

Children’s Health Parameter Letters

(WEEKS 3-4)

BMI, physical activity level,

dietary intake, TV viewing

hours of children

obtained

Nutritional Information

Counseling Sessions (WEEKS 5-6)

Importance and benefits of nutritional

information, cooking classes,

Childhood nutrition and

benefits, consequences of obesity, financial

burden of obesity,

Parents Connect for Healthy Living

Program/ Kidz FOOD Fair

(WEEKS 7-8)

Parents establish connections with

other parents, provide support,

share information/ Kids learn how to help

prepare meals with family

members, kids learn to play fun games at home,

learn the value of making good food

habits.

Health Communication Campaign (WEEKS 1-2)

• Parents are encouraged to express what are the burdens faced, stressors, food security, socioeconomic factors.

• Brochures, Pamphlets on Stress management, cutting food cost, encouraged to find solutions and fill out questionnaires.

Children’s Health Parameter Letters (WEEKS 3-4)

• BMI, physical activity level, dietary intake, TV viewing hours of children obtained

Nutritional Information Counseling Sessions (WEEKS 5-6)

• Importance and benefits of nutritional information, cooking classes, Childhood nutrition and benefits, consequences of obesity, financial burden of obesity

Parents Connect for Healthy Living Program/ Kidz FOOD Fair (WEEKS 7-8)

• Parents establish connections with other parents, provide support, share information/ Kids learn how to help prepare meals with family members, kids learn to play fun games at home, learn the value of making good food habits.

Expected Results of Our Intervention

From the results of Kirsten K Davison, Janine M Jurkowski Kaigang Li Sibylle Kranz and Hal A Lawson(2013) it can be expected that there will be a 14% decline in BMI, a 70.6% drop in TV viewing

time, a 2% increase in physical activity in children.

THANK YOU