DEVELOPMENT AND PREVENTION OF CHILDHOOD OBESITY
Children's Nutrition Research Center
2011 Annual Report
1a. Objectives (from AD-416)
Childhood obesity is a major public health problem in the U.S. and successful approaches to prevent obesity are needed. The prevalence of overweight in preschool children has more than doubled in the past two decades. Currently, a third of children in the United States are at risk of overweight, while 17% are overweight. A greater concern is that most existing obesity prevention intervention approaches thus far have been found to be largely ineffective. Diverse novel behavioral, genetic, and biological methods and models are needed to better understand the causes and find effective ways to combat this problem. Children's Nutrition Research Center scientists will address these issues through targeting the following research objectives: 1) determine the extent to which relationships between appetite-related genetic factors and dietary intake are mediated by subjective feelings of hunger, satiety, and other psychosocial variables in children; 2) determine the extent to which relationships between activity-related genetic factors and physical activity are mediated by subjective feelings of enjoyment and related psychosocial variables in children; 3) investigate the effectiveness of community-based intervention strategies to prevent childhood obesity and its associated health risks in 8- to 12-y-old Hispanic children with BMI >/= 85th percentile; 4) develop and evaluate family-centered intervention strategies for the pediatric primary care setting to prevent childhood obesity; 5) develop and evaluate the effectiveness of a culturally appropriate, web-based, dietary and physical activity intervention for preventing obesity in high school students; 6) develop and evaluate the effectiveness of novel, multi-media, diet and/or physical activity interventions for preventing obesity in youth; 7) develop and evaluate a model of childhood obesogenic environments based on parent-child dynamics affecting child eating behaviors and body weight status; 8) determine environmental factors and eating pattern typologies associated with obesity and related diseases in children, adolescents, and young adults using extant datasets; 9) identify promising theoretical approaches, mediators, and intervention components of nutrition and physical activity behavior change in children using extant datasets; 10) identify risk factors, moderators, and mediators for obesity and obesity-related behaviors, including dietary, physical activity and lifestyle factors using extant datasets; 11) evaluate relationships between parent and child beliefs about physical activity, and their relationship with child physical activity, sedentary behavior, and weight status using extant datasets; 12) determine obesity-related metabolic and body composition responses to exercise programs with and without a dietary intervention in lean and obese adolescents; and 13) develop and test pilot interventions to increase and sustain physical activity at a level consistent with the Dietary Guidelines for Americans (DG) in urban African- and Mexican-American children and families.
1b. Approach (from AD-416)
A multidimensional approach will be undertaken to address the obesity research conducted at the Children's Nutrition Research Center. In summary, investigators will address childhood obesity through research in genetics, biology, behavioral modeling, and by the implementation of a wide range of interventions. Researchers will investigate the effects of a controlled exercise program alone as compared to exercise with a diet intervention and determine the impact on numerous biological measures of the research participants. Genes related to satiety or physical activity signaling pathways will be examined by researchers as they learn the association of eating and physical activity experiences in children. Additional research will permit new models of how known genes may be influencing diet and physical activity practices. Researchers will develop, test, and validate innovative youth behavioral models and validate a measure of youth physical activity problem solving ability. Additional models will be developed to understand the functional relationships of behavioral factors that influence the weight status of children, as a result of examining parent and child characteristics (individually and combined) to ascertain their contributions to the probability of pediatric obesity. Model refinement will occur by employing dyadic and mixture modeling approaches to account for latent heterogeneity in how these factors are functionally inter-related within the given population. Assessment of the validity of current theories of obesity-related behavior change will be conducted through mediating variable analyses of existing datasets. Several interventions will be conducted in order to establish functional programs that will reduce obesity and/or further weight gain. A family-based randomized controlled trial will be conducted to test the effectiveness of diet behavior modification, structured aerobic exercise, or diet behavior modification plus structured aerobic exercise for obesity prevention and improvement in fitness, health risks, and psychological state in at-risk children. Research studies will also evaluate the effectiveness of a culturally appropriate, web-based, dietary and physical activity intervention for preventing obesity in high school students when compared with a control group. Weight, dietary and physical activity behaviors, and psychosocial mediating variables will be measured and compared to determine the effectiveness of specific web-based interventions. Furthermore, as a result of these interventions, models will be developed and formative work performed to evaluate the developed model for obesity prevention.
3. Progress Report
Proj. 1 We negotiated with investigators who control a cohort of Hispanic families with children in Houston to reduce costs by collecting our psychosocial measures with an already recruited sample and using their banked tissues for conducting the genetic analysis of obesity related genes. We published the major outcomes from the Diab-Nano trial in which treatment group children increased their consumption by two-thirds of a serving of fruit and vegetables per day. Proj. 2 The effectiveness of an intervention, VIVA LA SALUD INFANTIL, based on diet behavior modification with and without exercise was tested in Hispanic children for weight loss and improvement in fitness, psychological state, and co-morbidity risk. We tested the Helping HAND program (a modular 6-month program that targets obesity-related child behaviors and corresponding effective parenting practices to support the child toward behavior change) for feasibility among 40 families from 4 community pediatric clinics. We completed the qualitative and quantitative analysis to assess the feasibility and effect size of the Helping HAND intervention. Proj. 3 We recruited 400 youth for the Teen Choice: Food and Fitness intervention. A manuscript describing the intervention development is under review. An online video demonstrating how to wear and remove an activity monitor has been produced. Youth have been recruited for the pilot validation study, and data collection is underway. Proj. 4 A manuscript is currently under review that addresses the identification of specific family characteristics (emotional climate at family meals) that influence child eating behaviors and body weight status. Two lab rooms at the CNRC have been updated with high-resolution recording equipment to be used for observational studies. Proj. 5 We conducted data analysis on National Health and Nutrition Examination Survey data. Statistical approaches were used to address differential serving size selection and food consumption among low-income preschool children. Proj. 6 An obese boy and girl have completed the 12-week exercise program and two metabolic studies. Most of the metabolic analyses are underway. A sample of 200 children were recruited for participation in the study looking at their level of engagement in physical activity. Preliminary analyses indicate that as zBMI and percent body fat increase, participation in very hard and hard physical activity decreases. Subjects were recruited for pilot testing a physical activity (PA) intervention designed to increase moderate to vigorous activity in children to achieve 60 minutes of PA daily. Proj. 7 We examined walking and bicycling to school among youth and the association with moderate-to-vigorous physical activity, adiposity, and obesity. We conducted analyses examining the association between children's adiposity and their diet quality, as measured by the USDA's Healthy Eating Index-2005.
1. Feasibility of Helping HAND: An obesity intervention for pediatric primary care clinics targeting parenting. Experts suggest that child obesity interventions should involve parents, but many school-based programs have not been effective in reaching parents. The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviors and improve weight status among children, but few primary care interventions have thus far been evaluated. Researchers at the Children's Nutrition Research Center have conducted a feasibility study of Helping HAND, a 6-month intervention that targeted children at high risk for adult obesity and their parents in community pediatric clinics. Forty primarily Hispanic and low-income parent-child dyads enrolled, and due to low drop-out rates, good program attendance, and clinically relevant improvements in some behaviors, this intervention is feasible. Pilot data suggests that TV reduction may be important in obesity interventions among Hispanic children, thus an enhanced version of Helping HAND with a focus on screen media reduction should be tested for efficacy in pediatric community clinics.
2. Interactions during dinner impact child eating behaviors and weight status. Parent-child interactions during the dinner meal have not been comprehensively studied, but some studies with low-income families have found that parents with an indulgent feeding style (parents that are responsive to their child's emotional needs but have difficulties setting appropriate boundaries) had children with a higher weight status. Children's Nutrition Research Center researchers in Houston, TX, conducted a study to observe differences in the emotional climate created by parents (including affect, tone of voice, and gestures) and behavioral feeding practices among low income parents reporting different feeding styles (authoritarian, authoritative, indulgent, and uninvolved). We showed that the emotional climate created by indulgent parents during dinner and their lack of demands on their children to eat may play an important role in the socialization of young children's eating behaviors and their risk for being overweight. These findings may help to establish recommendations for parenting behavior at the dinner table that could prevent childhood obesity.
3. Parent's emotions, responsiveness, responsibility, and distress influence children's weight status. Little is known about how parents feel about feeding their children, how responsive they are to their children during feeding, and how responsible they feel for what their child eats. Researchers at the Children's Nutrition Research Center in Houston, TX, sought to identify groups of parents based on a number of emotional climate and feeding variables and link these behaviors to children's weight status. Using a sample of Head Start families in the Houston area, we found that the emotional climate in these families was related to the weight status of their children. Parents who reported more positive emotions (in general and around meals) and were responsive to their children's needs were less likely to report difficulties with their child and distress in their parent-child relationship; the children of these parents were less likely to be overweight or obese. Health practitioners who promote healthy eating behaviors in children should consider not only the nutritious quality of the food consumed, but also the quality of parent-child interactions during feeding to potentially prevent overweight status in children.
4. Characterizing dinner meals served and consumed by low-income preschool children. Large portion sizes may contribute to the high prevalence of overweight among children by promoting excessive intake at meals. Children's Nutrition Research Center researchers conducted a study to characterize the family dinner meal of preschool children attending Head Start by measuring types and amounts of foods served. We found that plate waste was high, with 30% of the foods served to the child at the dinner meal not being consumed. The proportion of preschool children served a major food group at the dinner meal varied considerably among the children (44% fruit/juice; 97% vegetables; 99% grains; 97% meats; 74% dairy, and 40% sweets and sugars). Sixty-six percent were served sweetened beverages, and only 42% were served milk at the dinner meal. More studies are needed to look at the impact of the amount and type of food consumed at the dinner meal on overall dietary quality and nutrient adequacy over a 24-hour period.
5. Serving size selection and food consumption patterns of preschool children. The variation and influence of portion size on food intake of preschool children has not been previously well described. Children's Nutrition Research Center researchers conducted a study to examine the variability in portions served and consumed by preschoolers in Head Start centers in Houston, TX, during the lunch meals. Our research showed that heavier children were more likely to consume larger amounts of food than leaner children. Plate waste and variation in the amounts of foods served and consumed were substantial; amounts served were associated with amounts consumed. These findings further supplement the general belief that increased portion size served equates to a greater portion consumed by the child.
6. General versus central adiposity and relationship to pediatric metabolic risk. The influence of physical activity and body fatness on pediatric metabolic risk is not well described. Researchers at the Children's Nutrition Research Center, in Houston, TX, used the US National Health and Nutrition Examination Survey for analyses examining the relationship between youth physical activity, body fatness (body mass index z-score and waist circumference), and risk factors for cardiovascular disease and diabetes. Researchers found that greater physical activity was related to lower metabolic risk. For two of the risk factors, this relationship was accounted for by lower waist circumference. Lower waist circumference was also related to multiple improved risk factors. These findings suggest the need for clinical and public health programs to screen for and improve youth physical activity and waist circumference.
7. Helping minority children meet physical activity recommendations. The prevalence of obesity in children and adolescents has quadrupled over the last 4 decades, and obesity rates among minority groups are increasing at even greater rates. Lifestyle interventions that involve diet, physical activity, and behavioral components have been shown to be effective in the treatment of obesity and its co-morbidities, but several barriers to these interventions exist for minority groups, particularly lower social support for participation in physical activity, unsafe neighborhoods, and fewer resources in terms of time and money to spend on participation in physical activity. Researchers at the Children's Nutrition Research Center, Houston, TX, have developed a physical activity intervention and maintenance program for minority students designed to increase their participation in moderate to vigorous physical activity. We have found that students involved in this program were more likely to participate in school sports, and our results suggested that school-based sports participation may enhance maintenance efforts for school-based weight loss interventions. This intervention program may serve as a model to engage other minorities to help them adhere to the current dietary guidelines that recommend children should spend 60 minutes a day engaged in physical activity.
8. Validated physical activity measurements for teens. Physical activity helps decrease risks of certain chronic diseases, and teens are less active than the recommended levels. Theoretical models guide behavioral research, and measurement scales that are validated in the populations with which they are used help assess whether an intervention is effective. Researchers at the Children's Nutrition Research Center, Houston, TX, conducted research that resulted in a theoretical model of youth physical activity behavior and validated measurement scales. This research can be used to develop interventions to increase physical activity among teens and assess intervention effectiveness.
9. Stars aren't just found in Hollywood: Video on proper use of physical activity monitors. Using activity monitors is a preferred method for measuring physical activity, yet many individuals do not know how to correctly wear these monitors. Children's Nutrition Research Center researchers in Houston, TX, developed a brief video, in English and Spanish, demonstrating how to properly wear a physical activity monitor. Individuals viewing the online video have the potential to increase the accuracy of physical activity readings, thus making research findings in these studies more relevant. The video will be available on the Children's Nutrition Research Center website.
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