Development of an Early Intervention for the Prevention of Childhood Obesity

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DESCRIPTION (provided by applicant): The long-term aim of this project is to develop an effective method to prevent childhood overweight thus helping to reduce the health burden associated with overweight and obesity in children, adolescents, and adults. The effects of the increase in overweight over the past 20 years on children's health in terms of higher blood pressure, insulinemia, Type 2 diabetes, and cholesterol levels are already evident, and will undoubtedly grow over time. The proposed project tests an innovative approach to the early prevention of childhood overweight based on the results of a recently completed prospective risk factor study. The findings from that study suggested that the risk for children with one or two overweight/obese parents was more than doubled if the child had a highly reactive temperament. This group, at the highest risk of becoming overweight in childhood, comprised 42 percent of those with an overweight parent or parents, and is the focus of this study. The central hypothesis is that parents faced with the behavior problems posed by a child with this temperament tend to over-control the child's behavior, including feeding. Laboratory studies have shown that such over-control may lead to the child developing inadequate self-regulation of food intake putting them at risk for the development of overweight. The specific aims of this study are to develop and then test an intervention in children aged 2-3 years to ascertain in a controlled study whether parental over-control of their child's eating behavior can be modified. The first phase of the study will involve data collection both by questionnaire and through focus groups from families of high and low- risk children, leading to the development of an intervention to reduce parental over- control of their children's feeding. The second phase will consist of a randomized controlled study with 100 families with a high-risk child, comparing the intervention with a standard weight control/healthy living program. If the intervention is found successful then the next step would be test it in a larger longer-term controlled study to ascertain whether change in parental control over eating reduces the prevalence of overweight in later childhood, and to explore the mechanism through which the intervention works. The prevalence of childhood overweight has doubled over the past 10-years posing a major threat to the nation's health, and additional costs to health services, as many of these children become obese adults with the associated health problems. These changes present a major public health challenge. Prevention of obesity is a multi-level task with no one approach likely to produce success. Hence, prevention programs may include regulatory changes, e.g., affecting nutritional labeling and advertising of food products; population based information and education programs; educational and behavior change programs aimed at groups e.g., schools, and individuals across the age span, including high-risk groups: and attempts to modify family environments that predispose to overweight and obesity. This study attempts to translate basic findings from laboratory and risk factor studies and is aimed at modifying a specific aspect of the family environment.