Parent-focused change to prevent obesity in preschoolers: Results from the KAN-DO study
Highlights
► We examined 12 month outcomes in KAN-DO, a childhood obesity prevention study. ► The intervention targeted parenting, especially in the mother. ► Instrumental feeding and snacks in front of TV decreased in the intervention arm. ► Trends toward improvement were observed in diet and activity measures. ► Changes observed may ultimately result in improved weight status for the children.
Section snippets
Background
Having an overweight parent triples the likelihood that a child will be overweight, and at young ages is a stronger predictor of the child's future obesity risk than the child's own weight (Whitaker et al., 1997). Parents can be powerful agents of change since they influence a child's weight-related behaviors through direct interactions (e.g., the manner in which they feed their child or communicate about health behaviors), via role modeling of healthy behaviors (West et al., 2010), control of
Study population, recruitment, and randomization
The target population was postpartum women who were overweight or obese (NHLBI Obesity Task Force, 1998) prior to pregnancy and their children aged 2–5 years, in the Triangle and Triad regions of North Carolina. Women were primarily identified from state birth certificates and screened for eligibility at 2–6 months postpartum (Østbye et al., 2011). To be eligible, mothers had: a preschooler aged 2–5 years, self-reported pre-pregnancy (and measured postpartum) body mass index (BMI) ≥ 25 kg/m2, no
Participant disposition
Of approximately 40,000 women initially identified through state birth records, 400 dyads were randomized into the study (Fig. 2). Of these, 308 completed first follow-up 1 assessments (156: intervention arm; 152: control arm) and were included in these analyses. The excluded 92 women either did not complete follow-up assessments (n = 6), or were lost to follow-up (refused to participate (n = 11), could not be reached (n = 50), did not show-up for scheduled visit (n = 25)).
Baseline characteristics (Table 1)
About 60% of enrolled mothers
Discussion
Making changes to dietary intake and physical activity is challenging at any time; instituting such changes in a home environment with multiple young children may be particularly overwhelming. Mothers of multiple children may face challenges in trying to change unhealthy behaviors and routines that may already be established with older children. Mothers with at least two children were selected due to their relative vulnerability, and the fact that they are often not the targets of intervention
Implications and conclusions
While parents have long been regarded as critical in the prevention of childhood obesity, the best way to integrate parents and facilitate dyadic change remains unclear. The KAN-DO intervention builds on the small, but growing, body of work incorporating parenting practices into obesity interventions.
KAN-DO was an ambitious trial; women at a challenging time in their lives, soon after the birth of a new baby, were approached to take part in a fairly complex intervention together with their
Conflict of interest statement
The authors have no conflicts to report.
Acknowledgments
This study was funded by a grant from the National Institute of Health (NIH), National Institute of Diabetes, Digestive and Kidney Diseases (R01-DK-07549). Dr. Zucker was supported by grant 1-K23-MH-070-418-01. Thanks to Anne Bowman, LaCrystal Strong, Gina Moening, and Erin Street for help with collection and analysis of dietary intake data, to Dr. Bernard Fuemmeler for helpful advice, to Jessica Revels and Hannah Harvey for delivery of the KAN-DO intervention, to Diane Glifford for database
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2022, Psychology of Sport and ExerciseCitation Excerpt :Parenting capabilities may encourage positive health behaviors and control over negative health behaviors in their children (Bandura, 1997). Grounded in SCT, increasing research has focused on parents’ self-efficacy (Hammersley, Okely, Batterham, & Jones, 2019; Ostbye et al., 2012), support (Loprinzi & Trost, 2010), perceived barriers (Jarvis, Harrington, & Manson, 2017), and other practices (Hnatiuk, DeDecker, Hesketh, & Cardon, 2017; Sherwood et al., 2015; Stark et al., 2011) in relation to the PA behaviors of preschool-aged children. For older children, particularly among elementary school children, there is substantive literature on social cognitive parental variables in relation to children’s PA (e.g., Sallis et al., 1992; Welk, Wood, & Morss, 2003).