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Original Investigation
August 7, 2018

Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass IndexA Randomized Clinical Trial

Author Affiliations
  • 1Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
  • 2Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
  • 3Department of Psychology and Human Development, Vanderbilt University Peabody College, Nashville, Tennessee
  • 4Division of Gastroenterology, Hepatology, & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
  • 5Department of Psychology, Vanderbilt University, Nashville, Tennessee
  • 6Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
  • 7Department of Nutrition, The University of North Carolina at Chapel Hill Gillings School of Global Public Health
  • 8Department of Nutrition and Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health
JAMA. 2018;320(5):450-460. doi:10.1001/jama.2018.9128
Visual Abstract
Effect of a Behavioral Intervention for Underserved Preschool School-Age Children and BMI: A Randomized Clinical Trial
Effect of a Behavioral Intervention for Underserved Preschool School-Age Children and BMI: A Randomized Clinical Trial
Key Points

Question  What is the effect of a 36-month multicomponent behavioral intervention for obesity prevention on body mass index (BMI) trajectories in underserved preschool-age children at risk for obesity but not yet obese?

Findings  In this randomized clinical trial that included 610 parent-child pairs from underserved communities, the mean BMI in both the intervention and control groups was 17.8 at 36 months, with no significant difference in BMI trajectories.

Meaning  The behavioral intervention was not effective in this low-income minority population.

Abstract

Importance  Prevention of obesity during childhood is critical for children in underserved populations, for whom obesity prevalence and risk of chronic disease are highest.

Objective  To test the effect of a multicomponent behavioral intervention on child body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) growth trajectories over 36 months among preschool-age children at risk for obesity.

Design, Setting, and Participants  A randomized clinical trial assigned 610 parent-child pairs from underserved communities in Nashville, Tennessee, to a 36-month intervention targeting health behaviors or a school-readiness control. Eligible children were between ages 3 and 5 years and at risk for obesity but not yet obese. Enrollment occurred from August 2012 to May 2014; 36-month follow-up occurred from October 2015 to June 2017.

Interventions  The intervention (n = 304 pairs) was a 36-month family-based, community-centered program, consisting of 12 weekly skills-building sessions, followed by monthly coaching telephone calls for 9 months, and a 24-month sustainability phase providing cues to action. The control (n = 306 pairs) consisted of 6 school-readiness sessions delivered over the 36-month study, conducted by the Nashville Public Library.

Main Outcomes and Measures  The primary outcome was child BMI trajectory over 36 months. Seven prespecified secondary outcomes included parent-reported child dietary intake and community center use. The Benjamini-Hochberg procedure corrected for multiple comparisons.

Results  Participants were predominantly Latino (91.4%). At baseline, the mean (SD) child age was 4.3 (0.9) years; 51.9% were female. Household income was below $25 000 for 56.7% of families. Retention was 90.2%. At 36 months, the mean (SD) child BMI was 17.8 (2.2) in the intervention group and 17.8 (2.1) in the control group. No significant difference existed in the primary outcome of BMI trajectory over 36 months (P = .39). The intervention group children had a lower mean caloric intake (1227 kcal/d) compared with control group children (1323 kcal/d) (adjusted difference, −99.4 kcal [95% CI, −160.7 to −38.0]; corrected P = .003). Intervention group parents used community centers with their children more than control group parents (56.8% in intervention; 44.4% in control) (risk ratio, 1.29 [95% CI, 1.08 to 1.53]; corrected P = .006).

Conclusions and Relevance  A 36-month multicomponent behavioral intervention did not change BMI trajectory among underserved preschool-age children in Nashville, Tennessee, compared with a control program. Whether there would be effectiveness for other types of behavioral interventions or implementation in other cities would require further research.

Trial Registration  ClinicalTrials.gov Identifier: NCT01316653

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