NEW YORK (Reuters Health) – A prevention-focused home-visit parenting program reduces obesity rates among 2-year-old children living in low-socioeconomic-status communities, according to results from a prospective longitudinal study.
“Whereas the majority of obesity-lowering interventions are designed specifically to address to obesity, our Minding the Baby (MTB) intervention uses a family-centered approach to support maternal and child health outcomes,” Dr. Monica Roosa Ordway from Yale University’s School of Nursing, Orange, Connecticut, told Reuters Health by email. “We were heartened to find that this approach appears to be more effective than other more focused interventions, as obesity is a complex problem linked to a range of complex factors such as family, social, economic, and parent-child issues.”
Most overweight and obese children and adolescents already reach overweight status by age 2 years, yet most obesity-prevention interventions focus on school-age children and adolescents.
Dr. Ordway’s team examined the influence of MTB on obesity rates among 158 two-year-old children of predominantly Hispanic mothers who were followed in a 27-month randomized controlled trial.
The interdisciplinary, relationship-based MTB program aims to develop and enhance parent-child attachment and to promote a range of positive parenting behaviors. Mothers assigned to MTB received weekly visits from a social worker and pediatric nurse from the third trimester of pregnancy until the child’s first birthday – and biweekly visits through the child’s second birthday. MTB and control participants both received standard prenatal and primary care.
At 2 years, significantly more children in the MTB program (78.3%) than in the control group (63.6%) were within the normal BMI range, according to the January 16 Pediatrics online report.
The percentage of children with obesity at 24 months was significantly lower in the MTB group (3.3%) than in the control group (19.7%), whereas more children in the MTB group (16.3%) than in the control group (13.6%) were overweight at that point.
After controlling for Hispanic ethnicity and birth weight, children in the MTB group were 88% less likely than children in the control group to develop early childhood obesity at 2 years.
MTB was not associated with overweight and obesity when the full sample was examined, but when only the Hispanic children were included, those assigned to MTB were 68% less likely to be overweight or obese than children in the control group.
“Because the population of Hispanic children is growing in the United States, and Hispanic children – when compared to black and non-Hispanic white children – are disproportionately likely to be obese at age 2, these findings have crucial implications for both practice and policy,” Dr. Ordway said. “Not only did the Hispanic children in MTB have lower rate of obesity and overweight than our control group, but they also had lower rates than 2-year-olds across our state and lower rates than the goals set by Healthy People 2020.”
“Our findings support two major policy initiatives in pediatric healthcare: 1) to change the conversation about healthcare delivery by focusing on wellness rather than reactive care once illness sets in; and 2) to implement interventions focused on developing supportive, responsive parenting as a means of reducing poor health outcomes associated with toxic stress,” she said.
“The main challenges involved in starting and maintaining intensive interventions like MTB are financial resources and the training of the home visitors,” Dr. Ordway said. “Because the MTB program helps parents address health, mental health and attachment issues that often have been present over generations, the preventive approaches we use take time and are targeted at an early point when families may be most open to considering change – with the pregnancy and birth of a first child. Having both a health and mental health clinician visiting families in their homes helps reduce the stigma and barriers to mental healthcare for parents, specifically around depression and anxiety.”
“This approach most closely matches the needs of families experiencing multiple stresses, but also is more costly when compared to less intense models of care,” she explained. “That said, the focus of MTB on prevention early in life, and its impact on overweight and obesity among historically marginalized children brings true meaning to the saying ‘an ounce of prevention is worth a pound of cure.’”
SOURCE: http://bit.ly/2DgWYny
Pediatrics 2018.
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