In-home intervention improves routines that reduce risk of childhood obesity

This is one of the pieces sent to parents as part of the "Healthy Habits, Happy Homes" program. Credit: Healthy Habits, Happy Homes Study Group, Harvard Pilgrim Healthcare Institute

In the battle to reduce childhood overweight and obesity, several in-home factors have been identified as reducing those risks – participation of children in regular family dinners, getting enough sleep and less time watching television or other "screen time." A new study appearing in JAMA Pediatrics describes how a home-based program that helped at-risk families improve household routines was able to slow weight gain in a group of young children.

"While childhood may have stabilized in some population subgroups, overall rates remain stubbornly high, and racial/ethnic and socioeconomic disparities persist. For these reasons, seeking solutions that will particularly influence high-risk families is important." says Elsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children who led the study. "Our findings demonstrate that relatively simple, no-cost changes in routines within the home can help maintain or achieve a healthful weight."

The study was conducted at four community health centers in Boston, Cambridge, and Somerville, Mass., all of which serve predominantly low-income, . The research team enrolled 121 families – each with a child aged 2 to 5 who slept in a room with a television – that were randomly divided into two groups. At the beginning and end of the 6-month study period, each family received an in-home visit during which research assistants administered surveys about household routines, measured the child's height and weight, and observed other aspects of the home environment. Throughout the study period, the control group received monthly packages with educational information on early childhood development.

Families in the intervention group participated in a program called "Healthy Habits, Happy Homes," designed to encourage families to have regular meals together, ensure for children, limit the time children spend and remove television from rooms where children sleep. The intervention also encouraged parenting practices such as role modeling and limit setting. Parents were not told that these changes were designed to limit weight gain in their child. Interventions were delivered in four home visits that addressed project goals and checked in on progress, monthly coaching phone calls, and frequent text messages to encourage healthy practices. Mailings included newsletters for the parents and, for the children, toys focused on the program goals – such as stickers, coloring books, a copy of Good Night Moon for bedtime reading, and toys for active play.

At the end of the study period, children in the intervention group were sleeping about 45 minutes longer than children in the control group. Time spent watching television on weekends dropped about an hour per day in the intervention group, leading to a significant difference from the control group, which increased weekend TV viewing. Both groups had a small reduction in weekday TV viewing, with a greater decrease in the intervention group. Neither group had any significant change in the frequency of family meals together – which may reflect the fact that participating families already shared an average of six meals per week together – and there was little change in the presence of television sets in the rooms where children slept, possibly because 80 percent of parents reported that their child slept in the parents' bedrooms.

At the end of the study period, the body mass index of children in the dropped an average of 0.18, while it rose 0.21 in the control group. Taveras explains that increasing height, weight, and body mass index would be expected among children in this age group, as they are developing and growing. "The Healthy Habits, Happy Homes intervention was able to slow weight gain relative to height increase in these children, which is important because – as our earlier research has shown – rapid weight gain in these early years can lead to higher rates of obesity later in life."

Jess Haines, PhD, MHSc, RD, University of Guelph, Ontario, lead author of the study, adds, "Our findings suggest that, by encouraging parents to establish household routines that increase children's sleep and decrease TV viewing, health professionals can help prevent children from becoming overweight or obese. Almost 90 percent of participating parents reported they were satisfied with the program, and 98 percent said they would recommend it to family and friends. A longer-term study, currently being planned by our research group,will tell us how long the changes we observed here can be maintained. We also need to investigate how large an interventional 'dose' is required to change these behaviors – for example, could they be accomplished with a single visit or just with phone calls?"

Taveras, an associate professor of Pediatrics and Population Medicine at Harvard Medical School, adds, "For now, interventions such as ours can be one way of keeping young children off an obesity trajectory that would be hard to alter by the time they enter middle school."

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