The HOME Project – Prevention of Childhood Obesity Dorothy D. Zeviar, Ed.D., LAc

Department of Community and Family Health

Background and Significance

• Childhood obesity doubled in past 30

years

• Childhood obesity increased from 6%

to 19% among 6-11 years old

• Childhood obesity increased from 5%

to 18% among 12-19 years old

• Over 17% of child population

is overweight or obese

• Highest prevalence among African-

American, Hispanic and Native American

children

Purpose of Intervention To prevent childhood obesity by

increasing parental efficacy for meal-

planning and cooking, and increase

family meals eaten together at home

Intervention Goals • Increase the number of weekly family

meals eaten together at home

Facilitate parent/child interactive classes on

meal-planning and cooking

Demonstrate easy-to-prepare meals that

take < 30 mins to prepare

Demonstrate how to add fruits, vegetables,

and whole grains to recipes

Healthy Life Tips. Retrieved from

http://www.katrinatribute.info/childhood-obesity-

graphs-warns-us-of-future-problems.html

Theoretical Frameworks and

Project Description

Reciprocal determinism --

The individual, the behavior and the

environment all impact and influence

each other in a mutual process

Choosing locations to sponsor the

HOME project which are in selected

Tampa neighborhoods, affiliated with

neighborhood schools, churches, or

recreational facilities/clubs, and

recruiting instructors which match the

demographics of the target population.

Psychological determinants –

How confident the person is with

making correct choices, how s/he will

feel after making the choice, and

whether everyone in the referent group

feels competent at making the same

choices. Self-efficacy is the

cornerstone of this construct

Focusing on the value of “Families

come First,” how family values are

reinforced through meals together at

home, reinforcing how learners can

easily learn to plan and prepare a

healthy and low-cost meal at home,

and recognizing others’ affirmations of

ability to complete the task

Environmental determinants –

The rewards and motivations to

encourage the behaviors, and the

degree to which making these choices

is facilitated by the project

Having access to a health educator by

phone or email, providing free targeted

cookbooks for participants, and having

a large “family dinner” celebration at

the end of the project

Observational learning –

The presence of role models similar to

the neophyte practicing the new

behaviors, and cultural institutions that

reinforce desired behaviors

Having dyads of parent/child learners

learn not only from the instructor, by

from each other and also from the

other dyads. Inclusion of “ethnic”

recipes that reinforce healthy “Families

come First”

Self-regulation –

A way of rewarding and reinforcing

oneself for performing the behavior

such that intrinsic motivators are

stronger than extrinsic, and more likely

to reinforce healthy behaviors over

time.

By giving step-by-step “homework”

each week that focuses on choosing a

recipe, making a shopping list, and

coming to class to learn how to

prepare the recipe, learners will self-

reinforce that they can easily perform

the task. With social support from

other family members, learners will

feel validated in their abilities

Table 1. Social Cognitive Theory Elements of the HOME Project

“Families Come First”

Social Reciprocity –

Mutual support and resources are

given and shared in perceived equal

value

Dyads working together provide both

social time together for an activity that

benefits both – a healthy meal cooked

together

Emotional support –

Both parent and child demonstrate

mutual love and respect when both

can accomplish an activity that is

mutually beneficial

Dyads working together provide an

opportunity to do a new activity

together and bond over food cooked

and consumed together. Frequent

praising is part of the classroom

culture

Instrumental support –

Provision of tangible aid and support to

the neophyte’s early attempts to try a

new skill

Having the instructor/facilitator right

there in the class providing hands-on

guidance for how to plan and make a

healthy meal creates the conditions for

success. Having easy phone or web-

site access to another facilitator or

health educator increases access to

instrumental support. Frequent

statements of praise are part of the

process

Informational support –

Provision of information, advice or

suggestions to help learners

successfully practice a new skill

The instructor/facilitator is right in the

classroom providing advice and

suggestions for dyads to successfully

accomplish the task. A culturally-

appropriate recipe book filled with low-

cost meal-planning ideas and meals

that take under 30 minutes to cook is

given as part of class enrollment.

Guidance will also be provided on how

to increase the nutritional value of

recipes through the addition of fruits,

vegetables, and whole grains as

appropriate.

Appraisal support –

Constructive feedback and affirmation

of participants’ efforts to plan and cook

meals

The instructor/facilitator continuously

provides constructive feedback and

praise to participants as they learn and

practice new skills. The culture of the

learning environment is positive,

constructive and encouraging.

Table 2. Social Network Theory Elements of the HOME Project

Conclusion • Although obesity is a multi-faceted problem in America, beginning with small steps at the inter-personal (family)

level is the best and most direct way to influence healthy behaviors of children and thus reduce the prevalence of

childhood obesity.

• Families don’t enjoy mealtimes together as often as in the past due to busy lifestyles, no time to plan and cook

meals, and lack of skills associated with planning and cooking.

• This project attempts to minimize these barriers through the use of hands-on learning and observational

learning, provision of culturally-appropriate recipes, “field trips” to the local supermarket and Farmer’s Market,

and lots of positive reinforcement.

• By learning and cooking meals together, the family structure is supported and reinforced, healthful childhood

eating preferences are established, childhood overweight is reduced, and good habits are learned early and

carried throughout adolescence and into adulthood.

References Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall.

Bandura, A. (1997). Self-efficacy: The Exercise of Control. New York, NY: W.H. Freeman.

CDCa. (2010). Childhood Overweight and Obesity. Retrieved from http://www.cdc.gov/healthyyouth/obesity

CDCb. (2010). Childhood Obesity. Retrieved from http://www.cdc.gov/healthyyouth/obesity

Fulkerson, J., Rydell, S., Kubik, M., Lytle, L., Boutelle, K., Story, M., Neumark, D., … & Garwick, A. (2010). Healthy home offerings via the

Mealtime Environment (HOME): Feasibility, acceptability, and outcomes of a pilot study. Obesity, 18, S69-S74. doi: 10.1038/oby.2009-434

Heaney, C., & Israel, B. (2008). Social networks and social support. In K.Glanz, B.Rimer, & K.Viswanath, (Eds.), Health Behavior and Health

Education, 4th ed. (pp. 189-210). San Francisco, CA: John Wiley & Sons.