Putting family into family-based obesity prevention: enhancing participant engagement through a novel integrated knowledge translation strategy.

BACKGROUND: With 1 in 4 Canadian preschoolers considered overweight or obese, identifying risk factors for excess weight gain and developing effective interventions aimed at promoting healthy weights and related behaviours among young children have become key public health priorities. Despite the need for this research, engaging and maintaining participation is a critical challenge for long-term, family-based studies. The aim of this study is to describe the implementation and evaluation of a parent-only advisory council designed to engage participants in the implementation and evaluation of a longitudinal, family-based obesity prevention intervention. METHODS: A Family Advisory Council (n = 14 parents, 70% mothers, 64% white), was established to engage participant stakeholders in decisions related to research protocols and strategies to engage and sustain family participation. Using a mixed methods approach, including a participant survey and focus group, we examined the council members' perceptions of their role and the impact this novel integrated Knowledge Translation (iKT) strategy had on the Guelph Family Health Study (GFHS), a longitudinal family-based study. RESULTS: All members of the Family Advisory Council felt the topics discussed were appropriate, felt that their opinions were valued and that their suggestions have had an impact and direct benefit on the GFHS. The addition of the Family Advisory Council led to changes in study protocol (i.e. creation of more detailed intervention emails, creation of kid-friendly accelerometer bands) that may have contributed to the high retention rate of the GFHS (95% at 6-month follow-up). CONCLUSIONS: Engaging parents as research partners in family-based research studies may be an effective way to increase participant engagement and study retention.

Family-Based Obesity Prevention: Perceptions of Canadian Parents of Preschool-Age Children.

Our objectives were to explore the perspectives of a community-based sample of Canadian parents with 2-5-year-old children on: (i) strategies to support the development of healthful weight-related behaviours and (ii) assessment approaches to measure weight-related behaviours and outcomes among children and families. We conducted 4 focus groups with 28 parents (89% mothers and 68% identified as White). Transcripts were analyzed using conventional content analysis. Regarding parent's perceptions of strategies to support healthful behaviours, we found that parents largely valued: home-based interventions, expert opinion, practical health behaviour strategies delivered in a nonjudgmental manner, and opportunities for social support. Regarding perceptions of assessment procedures, parents had mixed views on children providing blood samples, but looked upon it more favourably if it would contribute to research on child health. Our results suggest that to increase parental engagement interventions focused on improving weight-related behaviours among families with young children should be delivered within the home and include easy-to-implement behaviour change strategies communicated by experts, such as dietitians working in the clinical or public health setting. Using social media to share information and provide a platform for social support may also be an effective way to engage parents of young children.

Dietary sugar intake among preschool-aged children: a cross-sectional study.

BACKGROUND: Excessive intake of sugar in young children is a public health concern. Our study objectives were to examine intakes of total, free and added sugar among preschool-aged children and to investigate their associations with body weight, body mass index Z-scores, percent fat mass and waist circumference. METHODS: The cross-sectional cohort study included preschool-aged children between 1.5 and 5 years of age, enrolled in pilot studies of the Guelph Family Health Study, Guelph, Ontario, from 2014 to 2016. Daily intake of total sugar was determined using a food processor software; daily intakes of free and added sugar, and food sources were determined through manual inspection of 3-day food records. Anthropometric measures were completed by trained research staff. We used linear regression models with generalized estimating equations to estimate associations between sugar intakes and anthropometric measures. RESULTS: We included 109 children (55 girls and 54 boys) in 77 families. Mean daily intakes were 86 (standard deviation [SD] 26) g for total sugar, 31 (SD 15) g for free sugar and 26 (SD 13) g for added sugar. Of participants, 80% (n = 87) had intakes of free sugar greater than 5% of their daily energy intake. The most frequent food sources of free and added sugar were bakery products. A weak inverse association between free sugar intake (kcal/1000 kcal) and waist circumference (cm) (ß = -0.02, 95% confidence interval -0.04 to -0.0009) was found, but no significant associations were noted between sugar intake and other anthropometric measures. INTERPRETATION: Most of the preschool-aged children in this study had free sugar intakes greater than current recommendations; overall, their total, free and added sugar intakes were not associated with the anthropometric measures. This study can be used to inform policy development for sugar intake in young children and apprise early intervention programs.

Guelph Family Health Study: pilot study of a home-based obesity prevention intervention.

OBJECTIVE: To examine the feasibility and preliminary impact of a home-based obesity prevention intervention among Canadian families. METHODS: Families with children 1.5-5 years of age were randomized to one of three groups: (1) four home visits (HV) with a health educator, emails, and mailed incentives (4HV; n = 17); (2) two HV, emails, and mailed incentives (2HV; n = 14); or (3) general health advice through emails (control; n = 13). Parents randomized to the 2HV and 4HV groups completed post-intervention satisfaction surveys. At baseline and post-intervention, parents reported frequency of family meals and their children's fruit, vegetable, and sugar-sweetened beverage (SSB) intake. We assessed the children's physical activity, sedentary behaviour, and sleep using accelerometers and their % fat mass using bioelectrical impedance analysis. Differences in outcomes at post-intervention, controlling for baseline, were examined using generalized estimating equations. RESULTS: Of the 44 families enrolled, 42 (96%) had 6-month outcome data. Satisfaction with the intervention was high; 80% were "very satisfied" and 20% were "satisfied." At post-intervention, children randomized to the 4HV and 2HV groups had significantly higher fruit intake and children randomized to the 2HV group had significantly lower percentage of fat mass, as compared to the control. No significant intervention effect was found for frequency of family meals, the children's vegetable or SSB intake, physical activity, sedentary behaviour, or sleep. CONCLUSIONS: Our results suggest that the delivery of a home-based intervention is feasible among Canadian families and may lead to improved diet and weight outcomes among children. A full-scale trial is needed to test the effectiveness of this home-based intervention. CLINICAL TRIALS REGISTRATION NUMBER: NCT02223234.