Elsevier

Preventive Medicine

Volume 55, Issue 3, September 2012, Pages 188-195
Preventive Medicine

Parent-focused change to prevent obesity in preschoolers: Results from the KAN-DO study

https://doi.org/10.1016/j.ypmed.2012.06.005Get rights and content

Abstract

Objective

The study presents the immediate post-intervention results of Kids and Adults Now — Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother–preschooler (2–5 years old) dyads in North Carolina (2007–2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight.

Method

The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized.

Results

Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (− 0.24 vs. 0.01, p < 0.001) and TV snacks (−.069 vs. − 0.24, p = 0.001). There were also improvements in emotional feeding (p = 0.03), mother's sugary beverage (p = 0.03) and fruit/vegetable (p = 0.04) intake, and dinners eaten in front of TV (p = 0.01); these differences were not significant after adjustment for multiple comparisons.

Conclusion

KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.

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

References (56)

  • T. Østbye et al.

    Kids and Adults Now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics

    Contemp. Clin. Trials

    (2011)
  • G.C. Prkachin et al.

    Alexithymia and perception of facial expressions of emotion

    Personality and Individual Differences

    (2009)
  • K.H. Schmitz et al.

    Psychosocial correlates of physical activity and sedentary leisure habits in young adolescents: the teens eating for energy and nutrition at school study

    Prev. Med.

    (2002)
  • H.M. Snoek et al.

    Parental behaviour and adolescents' emotional eating

    Appetite

    (2007)
  • K.M. Tran et al.

    In-person vs telephone-administered multiple-pass 24-hour recalls in women: validation with doubly labeled water

    J. Am. Diet. Assoc.

    (2000)
  • R. van den Bos et al.

    Evolved to satisfy our immediate needs: self-control and the rewarding properties of food

    Appetite

    (2006)
  • F. West et al.

    Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change

    Behav. Res. Ther.

    (2010)
  • R.R. Abidin

    Parenting Stress Index

    (2004)
  • S. Alinia et al.

    The potential association between fruit intake and body weight — a review

    Obes. Rev.

    (2009)
  • A. Bandura

    Social Learning Through Imitation

  • A. Bandura

    Social Foundations of Thought and Action: A Social Cognitive Theory

    (1986)
  • A. Bandura et al.

    Vicarious reinforcement and imitative learning

    J. Abnorm. Soc. Psychol.

    (1963)
  • S.E. Barlow et al.

    Obesity evaluation and treatment: expert committee recommendations

    Pediatrics

    (1998)
  • D. Baumrind

    Parental disciplinary patterns and social competence in children

    Youth Soc.

    (1978)
  • Y. Benjamini et al.

    Controlling the false discovery rate: a practical and powerful approach to multiple testing

    J. R. Stat. Soc. B Methodol.

    (1995)
  • S.A. Bowman et al.

    Fast food consumption of U.S. adults: impact on energy and nutrient intakes and overweight status

    J. Am. Coll. Nutr.

    (2004)
  • S.A. Bowman et al.

    Effects of fast-food consumption on energy intake and diet quality among children in a national household survey

    Pediatrics

    (2004)
  • G.H. Brody et al.

    Unique and protective contributions of parenting and classroom processes to the adjustment of african american children living in single-parent families

    Child Dev.

    (2002)
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