What's Known on This Subject:
The evidence base for obesity prevention is extremely limited. Although minority youth are at higher risk of obesity, and early childhood is a critical period for prevention, only 1 program has demonstrated sustained effects on obesity in young minority children.
What This Study Adds:
Among youth at high risk for obesity based on income, minority status, and child behavior problems, early intervention that promotes effective parenting led to meaningful differences in obesity in preadolescence. Early family intervention is an innovative and promising approach.
Childhood obesity is a costly public health problem.1,2
The growing epidemic of obesity is associated with increasing prevalence of hypertension and diabetes,2–5
particularly in low-income and minority children.6
Rates of overweight (BMI ≥ 85th percentile) have doubled among 2- to 5-year-olds over the past 3 decades; overweight preschool-aged children are 5 times more likely to be obese (BMI ≥ 95th percentile) at age 12 than nonoverweight children.7
Early childhood has been identified as a critical period for obesity prevention based on developmental patterns related to “adiposity rebound,”8–11
stabilization of health behaviors that contribute to obesity,12–14
and the growing influence of environmental factors (eg, portion size, prompts from parents) on children’s regulation of eating in response to satiety cues.15
Evidence from a randomized controlled trial (RCT) of nutrition education and physical activity suggests the potential of obesity prevention during early childhood. Specifically, intervention resulted in a significant reduction in BMI z
scores over 2 years among low-income African American children;16
there was, however, no effect on BMI z
scores in a second cohort of Latino children from similar backgrounds.17
No other interventions have demonstrated sustained obesity prevention effects in young minority children. The limited impact of existing interventions may be, in part, because of the failure to promote key aspects of the early family environment that influence children’s health behaviors and risk for obesity.
Two fundamental aspects of effective parenting influence a broad range of developmental outcomes including obesity: responsiveness (ie, warmth, sensitivity, involvement) and control (ie, expectations for self-control by child, parental discipline).18–25
Preschool-aged children of parents who exhibited low responsiveness and high control were 5 times more likely to be overweight than children of parents with appropriate levels of responsiveness and control.23
Furthermore, children with behavior problems, such as impulsivity, or a family history of behavior problems are at increased risk for poor health, including obesity.26–28
A 21-year prospective study of more than 2200 children demonstrated that behavior problems at age 5 more than doubled the odds of adult obesity, independent of childhood overweight, diet, family meals, television, and exercise.29
Given that ineffective parenting increases the risk of both child behavior problems and obesity, strengthening parenting for children at risk for behavior problems may result in lower rates of obesity.
We conducted 2 RCTs of family interventions aimed at promoting effective parenting for low-income, minority children at risk for behavior problems, and documented improvements in parental responsiveness and control.30–35
We expected that study participants were also at risk for obesity and hypothesized that family intervention in early childhood would mitigate this risk, resulting in lower rates of obesity. The current study takes advantage of 2 RCTs with prospective follow-up studies of behavioral outcomes to examine intervention effects on obesity and related health behaviors as high-risk youth approach adolescence.19