Preventing Childhood Obesity Through Early Guidance
Condition: Childhood Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      The goal of this study is to compare the effectiveness of structured CHW- provided home
      visits, using an intervention created through community-based participatory research, to
      standard care received through WIC office visits in preventing the development of overweight
      (weight/length >85th percentile) and obesity (weight/length >95th percentile) in infants
      during their first 2 years of life.

      Hypothesis 1: Children in the intervention group will remain within their growth centiles in
      height/weight and weight for age, while children in the control group will increase in
      height/weight percentiles and weight percentiles more rapidly (> .67 SD) during the first
      year of life.

      Hypothesis 2: Fewer children who receive the intervention will have BMI >95th percentile at
      ages 2 and 3 than the children in the control group.

      Hypothesis 3: Children who receive the intervention will exclusively breastfeed for a longer
      period of time than will children in the control group.

      Hypothesis 4: Children who receive the intervention will have a higher percentage of fruits
      and vegetables and a lower percentage of sweetened beverages, desserts, and candy in their
      diets at ages 1, 2, and 3, than will children in the control group.

      Hypothesis 5: Parents in the intervention group will be more responsive to infant feeding
      cues (hunger, satiety)than parents in the control group.
    

Detailed description: 
      Along with birth weight and parental body size, infant feeding is recognized as one of the
      most influential biological and environmental factors that affect weight gain during infancy.
      Parental feeding practices have a strong impact on children's food availability, eating
      behaviors, and weight. The Institute of Medicine's(IOM) recent report (2011) on early
      childhood obesity prevention policies recommends five approaches to preventing obesity:
      assess, monitor, and track growth from birth to age 5; increase physical activity and
      decrease sedentary behavior in young children; support breastfeeding and be responsive to
      children's feeding cues; limit screen time; and promote age-appropriate sleep for young
      children. Based on the previous work by this research team, and in collaboration with a major
      urban health department, we propose to test an intervention that incorporates all the IOM's
      recommendations to prevent the development of obesity in at-risk infants. The intervention
      will be guided by health professionals and delivered through home visits by community health
      workers (CHWs), supervised by public health nurses (PHN), to Mexican American women and
      children who are clients of the Special Supplemental Nutrition Program for Women, Infants,
      and Children (WIC) Program in Houston, TX. The intervention will occur for 2 years with 1
      year of follow-up, for a total of 3 years of measures.
    

Intervention name(s): Education Home Visits
Intervention type(s): Other
Intervention description(s): Intervention will include educational home visits on:
Growth monitoring and feedback
Feeding: support exclusive breastfeeding until 6 months; delay solid feeding until 6 months; appropriate amounts of food for age; stop bottle feeding at 12 months; have nothing but breast milk/formula/4 oz juice in bottle; limit juice amount to 4 oz day; introduce cup by 10-11 months; no sweetened beverages; limited amounts of sweets.
Parenting: recognizing hunger and satiety cues; handling colic/crying; engaging baby in play.
Activity: being active with the baby; no screen time for baby and limited to 1 hour for 1-3 year olds; promote active play while maintaining safety.
Sleep: at least 10-12 hours sleep per day needed; how to promote sleeping environment for baby.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Obesity; Breastfeeding; Educational Intervention