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

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.

Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program.

BACKGROUND: Postpartum weight retention is a risk factor for long-term weight gain. Encouraging new mothers to consume a healthy diet may result in weight loss. OBJECTIVE: To assess predictors of diet quality during the early postpartum period; to determine whether diet quality, energy intake, and lactation status predicted weight change from 5 to 15 months postpartum; and to determine whether an intervention improved diet quality, reduced energy intake, and achieved greater weight loss compared with usual care. DESIGN: Randomized clinical trial (KAN-DO: Kids and Adults Now-Defeat Obesity), a family- and home-based, 10-month, behavioral intervention to prevent childhood obesity, with secondary aims to improve diet and physical activity habits of mothers to promote postpartum weight loss. PARTICIPANTS: Overweight/obese, postpartum women (n=400), recruited from 14 counties in the Piedmont region of North Carolina. INTERVENTION: Eight education kits, each mailed monthly; motivational counseling; and one group class. METHODS: Anthropometric measurements and 24-hour dietary recalls collected at baseline (approximately 5 months postpartum) and follow-up (approximately 10 months later). Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). STATISTICAL ANALYSES: Descriptive statistics, χ(2), analysis of variance, bi- and multivariate analyses were used. RESULTS: At baseline, mothers consumed a low-quality diet (HEI-2005 score=64.4 ± 11.4). Breastfeeding and income were positive, significant predictors of diet quality, whereas body mass index was a negative predictor. Diet quality did not predict weight change. However, total energy intake, not working outside of the home, and breastfeeding duration/intensity were negative predictors of weight loss. There were no significant differences in changes in diet quality, decreases in energy intake, or weight loss between the intervention (2.3 ± 5.4 kg) and control (1.5 ± 4.7 kg) arms. CONCLUSIONS: The family-based intervention did not promote postpartum weight loss. Reducing energy intake, rather than improving diet quality, should be the focus of weight-loss interventions for overweight/obese postpartum women.

Diet quality of overweight and obese mothers and their preschool children.

BACKGROUND: Children of obese parents are more likely to become obese than children of normal-weight parents. However, there is little information regarding the diet intakes of children of obese parents. OBJECTIVE: Our objective was to determine the diet quality of preschoolers and their overweight/obese mothers, whether maternal and child diet quality were correlated, and predictors of child's diet quality. DESIGN: Results are from baseline measurements from a randomized controlled behavioral intervention. PARTICIPANTS: Participants were English-literate, postpartum mothers and their preschoolers (n=177 mother-child dyads) in North Carolina. Visits took place in the Triangle and Triad regions of North Carolina between September 2007 and November 2009. MAIN OUTCOME MEASURES: We measured diet quality of mothers and preschoolers using the Healthy Eating Index-2005. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, χ(2), analysis of variance, Pearson correlations, and stepwise regression models were used. RESULTS: Only 11% of children and 7% of mothers had Healthy Eating Index-2005 scores ≥80. Most children did not meet recommendations for fruits, vegetables, whole grains, meat and beans, sodium, saturated fat, and energy from solid fat and added sugars. Child diet quality was correlated with maternal diet quality (r=0.44; P<0.001). However, children and mothers differed in the proportion that met food-group recommendations: children vs mothers: total fruit (50% vs 14%), whole fruit (46% vs 28%), total vegetables (6% vs 18%), dark green and orange vegetables and legumes (7% vs 19%), total grains (57% vs 71%), milk (63% vs 22%), and meat and beans (33% vs 60%). Maternal diet quality and household income were positively correlated with child diet quality. CONCLUSIONS: The diets of children of overweight/obese mothers need improvement in several areas. Mother's diet quality and household income are important contributors to child's diet quality and should be considered in efforts to improve the diets of these children.

Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics.

BACKGROUND: Prevention of childhood obesity is a public health priority. Parents influence a child's weight by modeling healthy behaviors, controlling food availability and activity opportunities, and appropriate feeding practices. Thus interventions should target education and behavioral change in the parent, and positive, mutually reinforcing behaviors within the family. METHODS: This paper presents the design, rationale and baseline characteristics of Kids and Adults Now! - Defeat Obesity (KAN-DO), a randomized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight, and weight reduction in overweight children. 400 children aged 2-5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are randomized equally to control or the KAN-DO intervention, consisting of mailed family kits encouraging healthy lifestyle change. Eight (monthly) kits are supported by motivational counseling calls and a single group session. Mothers are targeted during a hypothesized "teachable moment" for health behavior change (the birth of a new baby), and intervention content addresses: parenting skills ((e.g., emotional regulation, authoritative parenting), healthy eating, and physical activity. RESULTS: The 400 mother-child dyads randomized to trial are 75% white and 22% black; 19% have a household income of $30,000 or below. At baseline, 15% of children are overweight (85th-95th percentile for body mass index) and 9% are obese (≥ 95th percentile). CONCLUSION: This intervention addresses childhood obesity prevention by using a family-based, synergistic approach, targeting at-risk children and their mothers during key transitional periods, and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change.