Early Intervention Reduces Obesity Risk in Children

Larry Hand

June 27, 2012

June 27, 2012 — A home-based intervention for specially trained nurses to teach new mothers healthy infant nutrition and activity habits significantly reduced the risk for obesity in children aged 2 years in Australia, according to a study published online June 26 in BMJ.

Li Ming Wen, MD, from the Health Promotion Service, South Western Sydney, Sydney Local Health Districts, Sydney Medical School, University of Sydney, Australia, and colleagues conducted a randomized controlled trial of first-time mothers and their infants from 2007 to 2010. They recruited 667 first-time mothers, 170 of whom were lost to follow-up, ending with a total study population of 497 mothers and their infant children.

The researchers recruited and trained 4 community nurses to deliver 8 staged, home-based educational sessions with the mothers, starting with 1 visit at the antenatal period followed by visits at 1, 3, 5, 9, 12, 18, and 24 months after birth, with the timing of the visits based on early childhood development milestones. The intervention was based on an established Australian program called Healthy Beginnings and promoted breast-feeding, correct timing of solid food introduction, active play, and family nutrition and physical activity.

Key intervention messages were "breast is best," "no solids for me until 6 months," "I eat a variety of fruit and vegetables every day," "only water in my cup," and "I am part of an active family."

Of the 667 starting mothers, 337 were randomly assigned to the intervention group and 330 to a control group. Mothers' ages ranged from 16 to 47 years, and most (88%) were married or living with a partner. Although the primary outcome was body mass index (BMI) of the child at age 2 years, the researchers also measured nutrition, physical activity, and television-watching habits for both the mother and the child.

For the 497 completed cases, the mean BMI at age 2 years was significantly lower for the intervention group (16.49 kg/m2; standard deviation [SD], 1.76 kg/m2) compared with the control group (16.87 kg/m2; SD, 1.62 kg/m2; P = .01), making a difference of 0.38 kg/m2 (95% confidence interval [CI], 0.08 - 0.68). When the researchers imputed the mean BMIs for the entire 667 initial participants, they calculated the BMI for the intervention group at 16.53 and that for the control group at 16.82, with a difference of 0.29 (95% CI, −0.55 to −0.02; P = .04). Healthy BMI ranges at age 2 years are from 14.12 to 18.41 for boys and from 13.9 to 18.02 for girls. In all, 11.2% of the intervention group and 14.1% of the control group were categorized as overweight or obese, with a difference of 2.9% (95% CI, −3.0% to 8.3%).

Children in the intervention group were more likely to eat vegetables daily than children in the control group (89% vs 83%; P = .03) and were less likely to have received food as a reward (62% vs 72%; P = .03). As for television habits, children in the intervention group were less likely to eat in front of the television (56% vs 68%; P = .01), were less likely to have the television on during a meal (66% vs 76%; P = .02), and showed a significantly lower percentage of watching television more than 60 minutes a day (14% vs 22%; P = .02).

Study limitations include the use of self-report; that there was a large percentage lost to follow-up; the lack of generalizability; the inability to account for all social, cultural, economic, and environmental factors that may have influenced lifestyle habits and childhood obesity; and the inability to blind participating mothers.

The researchers conclude that health promotion programs are effective when started as early as possible and are family focused. Although the costs of a home-based program could be an argument against it, they write, "It is possible that the intervention nurse home visits have in turn saved the cost of the clinic visits."

In an accompanying editorial, Mary Rudolf, MD, professor of child health at the University of Leeds and Leeds Community Healthcare Trust, United Kingdom, writes, "The study is important for two reasons. Firstly, because the authors show that it is possible to engage young mothers, at least in Australia, in an obesity prevention programme during pregnancy; and, secondly, for the results they have achieved."

The costs are significant, she writes. However, "it is becoming clear that if we are to work towards primary prevention of obesity through interventions in the early years we need highly trained staff with adequate time and resources to work effectively with mothers of infants," Dr. Rudolf notes.

An estimated 43 million school-age children (worldwide prevalence, 6.7%) were either overweight or obese in 2010, and overweight and obesity in early years has been associated with obesity in later years, according to the study.

This research was funded by the Australian National Health and Medical Research Council. The authors and the editorialist have disclosed no relevant financial relationships. Dr. Rudolf is the academic lead for Health Nutrition for the Really Young, a training organization that aims to help community and health professionals work more effectively around obesity prevention. She also is co-principal investigator of EMPOWER, a specialist health visitor intervention for babies at high risk for obesity.

BMJ. Published online June 26, 2012. Article full text, Editorial extract

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