The Impact of Feeding and Parenting Guidance on the Prevention of Child Obesity
Repository Posting Date2017-07-21T19:33:24Z
Author DetailsElizabeth Reifsnider, PhD, FAAN, FAANP, WHNP-BC, PHNCS-BC; David McCormick; Michael Todd; Lucy Reyna; Irma Pecina
Lead Author Sigma AffliationBeta Upsilon
Other Title(s)Preventing Childhood Obesity
Level of EvidenceN/A
Purpose: The purpose of this study was to test an intervention, guided by public health nursing practice and delivered by community health workers, to prevent the development of obesity in infants and young children who are at risk of obesity because of maternal body size, income status, and ethnicity. We followed the Institute of Medicine’s (IOM) 2011 report on early childhood obesity prevention policies, which recommended five approaches to preventing obesity: assess, monitor, and track growth from birth to age 5; increase physical activity and decrease sedentary behavior in young children; support breastfeeding and be responsive to children’s feeding cues; limit screen time; and promote age-appropriate sleep for young children.
Methods: We recruited 150 high-risk pregnant Mexican-American women from the Houston Texas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and followed them and their infants from birth to age 3. The research design used was randomized clinical trial with two groups; the intervention group received 9 home visits by a community health worker across 2 years while the control group received nutrition education from the WIC clinic staff. The content delivered during the home visits was manualized but adapted to address specific issues such as overfeeding or physical play space. Children and mothers in both groups received measurement home visits from a data collector blinded to group assignment. Measures collected focused on anthropometrics for child and mother, diet recalls, home environment, sleep quality and quantity, maternal stress, and food insecurity.
Results: Compared with non-intervention controls, infants in the intervention group grew on a healthier weight-for-length trajectory from birth to age 24 months. Statistically significant improvements in preventing excessive weight gain were attributed independently to breastfeeding and to the educational intervention provided by the community health workers. Mothers in our study who breastfed for at least 2 months were thinner at 6 months postpartum than mothers who did not breastfeed, even non-exclusively, for 2 months.
Conclusion: Major changes in the diet occur from birth to 18 months and dietary patterns are set by age two years. Additionally, the first 2 years of life are a critical time period where parents can help their child to establish healthy patterns that may well last a lifetime and could help curb the obesity trend. Community Health Workers are effective in public health research, especially with low-income or racially and ethnically diverse populations. Conducting home visits is an effective method of data collection that minimizes the burden on subjects. Many low-income parents have difficulties maintaining regular well-child visits due to transportation barriers, lack of work flexibility, language differences, and lack of childcare for their other children. A community-based participatory research (CBPR) approach enhances resarchers' ability to recruit and retain subjects. Our CBPR approach is effective for recruiting and retaining participants and leads to improved health outcomes in studies with Hispanics. To our knowledge, our application is unique in its use of CBPR to study child obesity in partnership with WIC, which serves a low-income, racially/ethnically diverse population. Our innovative use of an ecological model allows us to study multilevel, intersecting influences on childhood obesity. Use of the ecological approach will enables researchers to view the complex environment surrounding children holistically to identify those factors of greatest significance to child obesity.