Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA, USA.
Int J Behav Nutr Phys Act. 2013 Jan 5;10:3. doi: 10.1186/1479-5868-10-3.
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.
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. 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. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents' awareness of their child's weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents' communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2-5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes.
Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children's physical activity. Dose effects were observed for most outcomes.
Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.
预防儿童肥胖的无效家庭干预措施在一定程度上归因于难以接触和吸引父母的挑战。本研究特别关注家长参与，利用社区参与式研究为参加“头等大事”（Head Start）项目的低收入家庭的学龄前儿童开发并试点检验了一个以家庭为中心的干预措施。
在第 1 年（2009-2010 年），父母与研究小组一起积极且平等地参与规划和开展社区评估，并使用评估结果设计以家庭为中心的儿童肥胖干预措施。在第 2 年（2010-2011 年），父母在实施干预措施中发挥主导作用，并与研究小组合作，使用前后群组设计评估干预结果。干预措施包括：（1）修订寄给家庭的报告儿童体重指数（BMI）的信件；（2）发起一项宣传活动，提高家长对子女体重状况的认识；（3）将营养咨询纳入“头等大事”家庭参与活动；（4）开展为期 6 周的父母主导计划，以增强父母的沟通技巧、解决冲突、为健康生活方式提供与资源相关的赋权、建立社交网络和提高媒体素养。共有来自纽约州北部 5 个“头等大事”中心的 423 名 2-5 岁儿童及其家庭接受了干预，其中 154 个家庭参与了评估。儿童结果评估指标包括 BMI z 评分、加速度计评估的身体活动和使用 24 小时回顾法评估的饮食摄入。父母的结果评估指标包括与食物、身体活动和媒体相关的育儿实践和态度。
与干预前相比，干预后儿童肥胖率、轻度体力活动、每日电视观看时间和饮食摄入（能量和宏量营养素摄入）显著改善。BMI z 评分、久坐活动和中度活动也呈上升趋势。干预后父母报告称，在促进儿童健康饮食方面的自我效能感显著增强，对儿童体育活动的支持度也有所提高。大多数结果都呈现出剂量效应。
授权父母在干预设计和实施中发挥平等作用是一种有前途的以家庭为中心的肥胖预防方法，值得在更大规模的试验中进一步测试，试验设计要更严格。
