Addressing Health Literacy and Numeracy to Prevent Childhood Obesity
Condition: Obesity Prevention
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      In 2003, Surgeon General Richard Carmona suggested that low health literacy is "one of the
      largest contributors to our nation's epidemic of overweight and obesity." Over 26% of
      preschool children are now overweight or obese, and children who are overweight by age 24
      months are five times as likely as non-overweight children to become overweight adolescents.
      The aim of the study is to assess the efficacy of a low-literacy/numeracy-oriented
      intervention aimed at teaching pediatric resident physicians to promote healthy family
      lifestyles and prevent overweight among young children (age 0-2) and their families in
      under-resourced communities.
    

Detailed description: 
      In 2003, Surgeon General Richard Carmona stated that low health literacy was "one of the
      largest contributors to our nation's epidemic of overweight and obesity." This assertion is
      supported by recent studies which have found that low health literacy or numeracy is
      associated with poorer caregiver breastfeeding knowledge, incorrect mixing of infant formula,
      difficulty understanding food labels and portion sizes, and higher Body Mass Index (BMI) in
      adults and children. Of particular concern is the impact of the obesity epidemic on our
      youngest children. Over 26% of preschool children are now overweight (BMI≥85%) or obese
      (BMI≥95%) (based on 2007 Health and Human Services/Centers for Disease Control Expert Panel
      definitions). Rates of obesity in preschool children have doubled over the past decade, with
      the highest increases among low income and minority children-- the same communities most
      affected by low health literacy.

      To date, clinical efforts to prevent or treat childhood obesity have had limited efficacy.
      Efforts need to start early, because children who are overweight by age two are five times as
      likely to become overweight adolescents, and subsequently at higher risk for obesity-related
      complications including early-onset Type-2 Diabetes and cardiovascular disease. No published
      clinical studies have rigorously addressed obesity prevention prior to age 2 with a specific
      low-literacy and numeracy focus. Addressing caregiver health literacy in early childhood is
      an innovative strategy to promote healthy nutrition and activity among these families and
      prevent unhealthy weight gain across the child's life, which would have great public health
      significance by preventing both child and adult chronic illness.

      The proposed study is a multi-site randomized, controlled trial to assess the efficacy of a
      low-literacy/numeracy-oriented intervention designed to promote healthy family lifestyles and
      to prevent early childhood obesity. The intervention will be delivered through pediatric
      resident physicians in primary care settings in under-resourced communities. Four academic
      medical centers will be randomized: Vanderbilt University, the University of Miami, the
      University of North Carolina at Chapel Hill, and New York University. Two centers will
      receive the intervention, while the other two centers will receive an active control. At each
      site, a cohort of 250 English- or Spanish-speaking caregiver-child dyads will be enrolled and
      followed from the child's 2 month well-child visit through the 24-month well-child visit. The
      intervention will include a low-literacy-oriented toolkit for pediatric residents to use with
      families and clear health communication training for the pediatric residents. At control
      sites, pediatric residents will provide "usual care" with respect to lifestyle counseling,
      but they will also receive an injury-prevention education program to act as an attention
      control. The primary hypotheses are that the intervention will improve family dietary and
      physical activity behaviors and that it will reduce the rate of childhood overweight
      (BMI≥85%) at age 24 months.
    

Intervention name(s): Health Communication and Obesity Prevention; Injury Prevention Arm
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Pediatric residents will be training in effective health communication skills and given a literacy/numeracy sensitive toolkit (GreenLight) to use with parents during all well child visits from 2 months to 18 months.; Pediatric residents will be trained to address injury prevention using the American Academy of Pediatrics (AAP) TIPP materials.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Obesity prevention; Health Literacy; Health Communication