Outcomes from a Pediatric Primary Care Weight Management Program: Steps to Growing Up Healthy.

OBJECTIVE: To examine the efficacy of Steps to Growing Up Healthy, an obesity prevention intervention in preschool-age, urban-dwelling minority children. STUDY DESIGN: Thirty-two pediatric primary care clinicians used a brief (3- to 5-minute) evidence-based behavior change intervention with low-income mothers of children aged 2-4 years during each regularly scheduled clinic visit over a 12-month period to target 4 specific obesogenic behaviors (milk consumption, juice and sugar-sweetened beverage consumption, television/screen time, and physical activity). A written contract, self-monitoring calendar, and telephone follow-up at 5-7 days after the clinic visit reinforced the intervention. Body mass index (BMI) percentile over 12 months and obesogenic behaviors were compared with those of a sex- and age-matched historical control group drawn from the same clinic. RESULTS: Between January 2009 and November 2012, 418 mother-child dyads (82% Hispanic and 18% African American; mean child age, 35.8 ± 8.6 months; 21% overweight and 21% obese children) participated (218 in the control group and 200 in the intervention group). At 12 months, BMI percentile decreased by 0.33 percentile in the intervention group, compared with a mean increase of 8.75 percentile in the control group (P < .001). In participants with an initial BMI <85th percentile, BMI percentile did not change over time in the intervention group but increased in the control group (from the 48th ± 21 to 63th ± 29 percentile; P < .01). At 12 months, consumption of juice and milk were decreased in the intervention group (P < .001). CONCLUSION: A brief, evidence-based intervention targeting 4 behaviors, coupled with a written contract and telephone follow-up, decreased the rate of increase in BMI percentile in young children, especially in normal weight children.

Acculturation determines BMI percentile and noncore food intake in Hispanic children.

Hispanic children in the United States are disproportionately affected by obesity. The role of acculturation in obesity is unclear. This study examined the relation between child obesity, dietary intake, and maternal acculturation in Hispanic children. We hypothesized that children of more acculturated mothers would consume more unhealthy foods and would have higher body mass index (BMI) percentiles. A total of 209 Hispanic mothers of children aged 2-4 y (50% female, 35.3 ± 8.7 mo, BMI percentile: 73.1 ± 27.8, 30% obese, 19% overweight) were recruited for an obesity prevention/reversal study. The associations between baseline maternal acculturation [Brief Acculturation Rating Scale for Mexican Americans-II (Brief ARSMA-II)], child BMI percentile, and child diet were examined. Factor analysis of the Brief ARSMA-II in Puerto Rican mothers resulted in 2 new factors, which were named the Hispanic Orientation Score (4 items, loadings: 0.64-0.81) and U.S. Mainland Orientation Score (6 items, loadings: -0.61-0.92). In the total sample, children who consumed more noncore foods were more likely to be overweight or obese (P < 0.01). Additionally, children of mothers with greater acculturation to the United States consumed more noncore foods (P < 0.0001) and had higher BMI percentiles (P < 0.04). However, mothers with greater Hispanic acculturation served fewer noncore foods (P < 0.0001). In the Puerto Rican subgroup of mothers, Puerto Rican mothers with greater acculturation to the United States served more noncore foods (P < 0.0001), but there was no association between acculturation and child BMI percentile in this subgroup. These mothers, however, served fewer sugar-sweetened beverages (P < 0.01) compared with non-Puerto Rican mothers, and this may have negated the effect of noncore food consumption on BMI percentile. These data suggest a complex relation between acculturation, noncore food consumption, and child BMI percentile in Puerto Rican and non-Puerto Rican Hispanic children.

Youth knowledge of physical activity health benefits: a Brazilian case study.

This study presents the findings of a questionnaire-based investigation of knowledge about the relationship of physical activity to health among adolescent participants of a community-based physical activity intervention program in São Paulo, Brazil. Qualitative (inductive content analysis) and quantitative methods were applied to examine the participants' responses to two open-ended questions concerning the health benefits of physical activity and the educational goals of the intervention. More than 75% of all participants stated that health benefits (of some type) are attained through participation in physical activity. More than 50% of participants reported that the goal of the intervention was to educate people about the importance of a healthy, active lifestyle. Adolescents understand the relationship of physical activity to health as reflected in their knowledge assessments; their lifestyle choices support these beliefs. These findings offer encouragement for the development and implementation of educationally oriented interventions aimed at providing physical activity information and programming.