If you’re going to do something, as least do something good

New study in JAMA Pediatrics, “Healthy Habits, Happy Homes: Randomized Trial to Improve Household Routines for Obesity Prevention Among Preschool-Aged Children

Importance   Racial/ethnic and socioeconomic disparities exist across risk factors for childhood obesity.

Objective   To examine the effectiveness of a home-based intervention to improve household routines known to be associated with childhood obesity among a sample of low-income, racial/ethnic minority families with young children.

Design   Randomized trial.

Setting   The intervention was delivered in the families’ homes.

Participants   The study involved 121 families with children aged 2 to 5 years who had a television (TV) in the room where he or she slept; 111 (92%) had 6-month outcome data (55 intervention and 56 control). The mean (SD) age of the children was 4.0 (1.1) years; 45% were overweight/obese. Fifty-two percent of the children were Hispanic, 34% were black, and 14% were white/other. Nearly 60% of the families had household incomes of $20 000 or less.

Interventions   The 6-month intervention promoted 4 household routines, family meals, adequate sleep, limiting TV time, and removing the TV from the child’s bedroom, using (1) motivational coaching at home and by phone, (2) mailed educational materials, and (3) text messages. Control subjects were mailed materials focused on child development.

Instead of telling you what I think about the study, I encourage you to go read what I wrote about it in the accompanying editorial:

All of these have been associated in past studies with healthier weights. So achieving behavior change in the home might be associated with improved weight or body mass index (BMI) without focusing on diet and exercise. That is what their study found to be true. The 6-month intervention resulted in children sleeping longer and watching television fewer hours. However, it did not result in the removal of a television from the room or in an increase in family meals.

Still, the good news is that they also found improvements in BMI in the study group. The BMI of the children in the intervention group dropped over the 6-month period; it increased in the children in the control group.

Plenty of caveats exist. The change in BMI was small, and it is unclear whether it will persist in the long-term. The number of families who chose to participate in the study was also less than ideal, meaning that many more families might not be engaged enough for such a program to make a difference. Finally, the cost of such a program cannot be ignored. Whether the resources needed to conduct both phone and home motivational coaching, to create and mail educational materials, and facilitate text messaging are worth the gains seen in this study is debatable.

That should not lessen enthusiasm for what this study represents. After reading countless other articles calling for obesity interventions that focus on the family, encourage behavioral change in a positive manner, recognize the needs of different cultures and races/ethnicities, and focus on more than diet and exercise, it is rewarding to see that this study not only answered the call, but proved that such an intervention is both feasible and successful.

Of course, further work is needed to see how such an intervention could scale up into a larger program, let alone into public policy. But by focusing on behaviors that in and of themselves are good regardless of BMI, Haines et al have provided us with an intervention that can be considered in and of itself desirable even if the obesity effect is transient. If we need to do something, it’s good to do something that improves more than just BMI.

Go read the study and the editorial.


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