Promotion of Healthier Food Habits/ Choices within the family to combat Obesity


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Promotion of Healthier Food Habits/ Choices within the family to combat Obesity

  1. 1. 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
  2. 2. • Two year Pre- Post Cohort Study (119 families) • Funded by a US federal program “Head Start.” • All families with a child 2 years or older enrolled in the target Head Start centers were eligible to participate. • All analyses were performed using SAS version 9.3(Cary, NC). • McNemar’s (chi-square) test was used to compare pre-post intervention differences in the percentage of children who were obese and the percentage of children with a TV in their bedroom. • Paired t-tests were used to compare pre and post intervention differences in continuous measures including (a) children’s BMI zscore, physical activity, dietary intake, and screen time, and (b) food, physical activity, and screen-related parenting practices and attitudes. .
  3. 3. 1) 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. • Community-based participatory research (CBPR) • The Family-centered Action Model of Intervention Layout and Implementation (FAMILI) and the Family Ecological Model (FEM)
  4. 4. • Community-based participatory research (CBPR)- is a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process and in which all partners contribute expertise and share decision making and ownership. The aim of CBPR is to increase knowledge and understanding of a given phenomenon and integrate the knowledge gained with interventions and policy and social change to improve the health and quality of life of community members. • The Family-centered Action Model of Intervention Layout and Implementation, or FAMILI, draws on theories of family development to frame research and intervention design, uses a mixed-methods approach to conduct ecologically valid research, and positions family members as active participants in the development, implementation, and evaluation of family-centered obesity prevention programs. FAMILI is intended to facilitate the development of culturally responsive and sustainable prevention programs with the potential to improve outcomes. Although childhood obesity was used to illustrate the application of FAMILI, this model can be used to address a range of child health problems.
  5. 5. Community Advisory Board{CAB} (Parents, Board Members, Nutritionist, Teachers) The CAB developed and approved partnership principles to provide guiding values and codified expectations and operating guidelines to sustain active involvement To operationalized the participatory process various strategies and structural accommodations were employed to foster parents involvement throughout all phases of the research process
  6. 6. Based on the Family Ecological Model, personal definitions of health, strategies used to foster family health, chronic stressors that affect parenting and family interactions. Monthly meeting in the community, compensation provided (meals, childcare) Parents (Experts)
  7. 7. selfreport surveys Children’s Physical Activity Children’s Dietary Intake Focus Groups Community Assessment Photovoice Children’s weight status Windshield Surveys
  8. 8. • 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
  9. 9. Health Communication Campaign Children’s Health Parameter letter’s Nutritional Information Counseling Sessions Parents Connect for Healthy Living Program
  10. 10. • Health communication campaign, which integrated quotes from the focus groups conducted during the community assessment, was developed to increase parents’ awareness of childhood obesity and dispel myths around children’s weight (e.g. “it’s just baby fat, he will grow out of it” • Second letters mailed home to families by Head Start reporting children’s BMI, and other health indicators, were revised based on parent feedback to facilitate parents’ understanding of the information provided. • Third, informal nutritional counseling sessions were integrated into Head Start family engagement activities. Community nutrition graduate students from a local college attended Head Start family events, provided samples of healthy foods, and were available to answer questions parents had about their child’s (or their own) diet and weight status. • The final and central component was the Parents Connect for Healthy Living program, a 6-week, onsite, parent-led program to promote parent social networking, advocacy, communication skills, media literacy and conflict resolution-all of which were behavioral targets of interest to parents identified through the community assessment.
  11. 11. .
  12. 12. Adults • Eating too fast • Eating snacks Continuously • Inappropriate Dinners • Lack of physical activity Teens • • • • Skipping Breakfast Consuming too much processed foods Eating fast food meals outside of the home Heavy soft drink/ sugary beverage consumption Children • Parents are always busy so fast food meals are high consumed • Restaurant serving sizes for kids are increasing • Schools are cutting Physical activity from their programs • High sugar high salt foods and snacks are readly made available to children
  13. 13. • • • • • • Childhood obesity is associated with a higher chance of premature death and disability in adulthood. Obese children and adolescents suffer from both short-term and long-term health consequences. The most significant health consequences of childhood overweight and obesity, that often do not become apparent until adulthood, include: cardiovascular diseases (mainly heart disease and stroke);diabetes; musculoskeletal disorders, especially osteoarthritis; and certain types of cancer (endometrial, breast and colon). At least 2.6 million people each year die as a result of being overweight or obese. Many low- and middle-income countries are now facing a "double burden" of disease: as they continue to struggle with the problems of infectious diseases and under-nutrition; at the same time they are experiencing a rapid increase in risk factors of NCDs such as obesity and overweight, particularly in urban settings. It is not uncommon to find under-nutrition and obesity existing side-byside within the same country, the same community and even within the same household in these settings. This double burden is caused by inadequate pre-natal, infant and child nutrition which is then followed by exposure to high-fat, energy-dense, micronutrient-poor foods and a lack of physical activity as the child grows older.
  14. 14. • MEND will consist of 16 sessions delivered over 8 weeks (2 hour sessions held twice weekly during the evening time) by two MEND leaders and an assistant to groups of 10-15 children accompanied by their parents or caregivers in a community setting such as sport center or in schools • Sixty ethnically diverse obese students (BMI > or = to the 95th percentile, reference data) ages 6 to 8 in a Urban community in Trinidad • Funded by a local NGO’s or governmental subsidies • All families with a child 2 years or older enrolled • Mind, Exercise, Nutrition, Do it (MEND) Program, a multicomponent community-based childhood obesity intervention among boys and girls. • A local community advisory board will be set up • Food vouchers, food hampers, child care services will be provided as incentives to stay enrolled within the program. .
  15. 15. The MEND Program was created to help overweight and obese children improve their lifestyles and health, with the support and encouragement of their families. MEND aims to improve the children’s and families' eating and activity habits, to prevent children from becoming obese adults. MEND is a 20-session family Program that meets for two hours twice a week and is attended by the child and at least one parent or caregiver. The first hour is an interactive family session on nutrition and behavior topics, followed by one hour of fun exercise for the children while the parents meet for support and discussion on topics such as goals and rewards, label reading and problem solving. Before and after the Program, children are measured and they and their families complete questionnaires that help us monitor and evaluate improvements in body mass index (BMI), waist circumference, fitness and self-esteem. At the graduation, each family receives a directory of community resources for postProgram support such as local MEND Graduate activities, afterschool physical activity programs, follow-up measurements, and other local opportunities to help the children continue with the positive changes they made during MEND.
  16. 16. • • • • • • • • • Relative and Absolute poverty Food security Socioeconomic factors Stigma (Child and Parents) Culture and Family Traditions Religion Family Structure Attitudes and believes of parents Food Prices
  17. 17. Health Communication Campaign (WEEKS 1-2) parents are encouraged to express what are the burdens faced, stressors, food security, socioeconomic factors, Brochures, Pamphle ts on Stress management, cuttin g food cost, encouraged to find solutions and fill out questionnaires Children’s Health Parameter Letters (WEEKS 3-4) BMI, physical activity level, dietary intake, TV viewing hours of children obtained Nutritional Information Counseling Sessions (WEEKS 5-6) Importance and benefits of nutritional information, cook ing classes, Childhoo d nutrition and benefits, consequ ences of obesity, financial burden of obesity, Parents Connect for Healthy Living Program/ Kidz FOOD Fair (WEEKS 7-8) Parents establish connections with other parents, provide support, share information/ Kids learn how to help prepare meals with family members, kids learn to play fun games at home, learn the value of making good food habits.
  18. 18. • Parents are encouraged to express what are the burdens faced, stressors, food security, socioeconomic factors. • Brochures, Pamphlets on Stress management, cutting food cost, encouraged to find solutions and fill out questionnaires.
  19. 19. • BMI, physical activity level, dietary intake, TV viewing hours of children obtained
  20. 20. • Importance and benefits of nutritional information, cooking classes, Childhood nutrition and benefits, consequences of obesity, financial burden of obesity
  21. 21. • Parents establish connections with other parents, provide support, share information/ Kids learn how to help prepare meals with family members, kids learn to play fun games at home, learn the value of making good food habits.
  22. 22. From the results of Kirsten K Davison, Janine M Jurkowski Kaigang Li Sibylle Kranz and Hal A Lawson(2013) it can be expected that there will be a 14% decline in BMI, a 70.6% drop in TV viewing time, a 2% increase in physical activity in children.