Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children.

BACKGROUND: This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. METHODS: Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443). RESULTS: During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31). CONCLUSIONS: Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03334669 , Registered October 2017.

Feasibility of a remotely delivered program to prevent Latino adolescent obesity in the Midwestern USA.

Adolescent obesity prevention programs focusing on Latino fathers may be useful to address Latino adolescent obesity. Adolescent obesity has become an urgent issue because of the coronavirus disease 2019 pandemic, with limited ability to deliver prevention programs in-person. This study aimed to assess the feasibility of a community-based, adolescent obesity prevention program for Latino father-adolescent dyads delivered remotely, adapted from the in-person Padres Preparados, Jóvenes Saludables program. A quasi-experimental design was used to assess the feasibility of the remotely delivered program based on criteria adapted from other feasibility studies of community-based health promotion programs for Latino families. Father-adolescent dyads were recruited at two sites in a Midwestern state during 2020; mothers were also encouraged to participate. Recruitment met the feasibility criteria (65 families expressed interest between August and October) with 26 families participating in this study. The retention ratio (percentage of participants who completed a post-session survey to those who completed the baseline survey) among fathers was acceptable (77%), while a lower percentage of adolescents were retained (68%). The session attendance ratio (number of sessions attended of the eight total sessions offered) was higher among adolescents (88%) and lower among fathers (68%) compared to the criteria. Satisfaction ratings (≥88%) and completeness of data collection at both baseline and post-session survey (≥76%) were acceptable. Favorable results were obtained for parent outcomes, while adolescent outcomes were not favorably changed. This remotely delivered adolescent obesity prevention program was feasible for Latino fathers; however, additional engagement with adolescents may be needed.

Adolescent obesity became a more urgent issue because of the coronavirus disease 2019 pandemic with less physical activity under lockdown, more food insecure families and limited in-person access to programs. Our study concluded that a remotely delivered version of a community-based, adolescent obesity prevention program for Latino father­adolescent dyads (the Padres Preparados, Jóvenes Saludables program) was feasible based on participation, satisfaction and parent outcomes. Additional engagement in activities to improve adolescent health behaviors may be needed to improve the overall effectiveness of the program.

Different Variation of Intra-familial Body Mass Index subjected to Covid-19 Lockdown.

BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID-19) lockdown has represented an inedited model of increased metabolic risk in all age groups, due to negative changes in dietary habits, physical activity, lifestyle. These effects have been generally explored at a population level in distinct age groups. Potential intra-familial, specific effects in adults and children sharing the same socio-economic, cultural level and living habits have been scarcely explored. We aimed to characterize changes of anthropometric indices in parents and in their children during COVID-19 lockdown. METHODS: A cohort of 149 couple parent/children were prospectively enrolled. By a validated questionnaire we explored changes of body mass index (BMI) and individual lifestyle during a 2-month lockdown (May- July 2020). RESULTS: BMI increased in 70.5% of parents and in 67.8% of their children, with a Δ-BMI of 1.44+0.09 kg/ m 2 and 0.36+0.02 Kg/m 2 , respectively. BMI increments, however, were only significant in adults and did not correlate in the couple parents/children. Most adults (80.5%) and children (71.4%) did not perform regular physical activity during the lockdown. Direct correlations between dietary changes and BMI variations became evident in children, mainly in terms of a decreased consumption of fresh fruit, pulses, fish, and an increased consumption of cereals, carbohydrates, dairy products, olive oil. In normal weight, overweight and obese children, but not in adults, the increase in sleep hours increased with BMI. CONCLUSIONS: Despite marked lifestyle changes imposed by the COVID-19 lockdown, BMI variations in parents were independent from those observed in their children, pointing to different outcomes in response to the same external, critical event. Thus, primary prevention measures aimed at maintaining a healthy lifestyle require different approaches according to age.

Weight Gain in Children during the COVID-19 Pandemic and the Protective Effect of Lifestyle Intervention in Children with Obesity.

INTRODUCTION: School closures due to the COVID-19 pandemic affect children's daily structure, mealtimes, physical activity, and sleeping habits, possibly exacerbating weight gain, particularly in vulnerable children with overweight and obesity. This study aimed to evaluate both perceived and objectively measured weight gain in children in the Netherlands during the COVID-19 pandemic and the effect of prior lifestyle intervention. METHODS: A total of 150 children of the Children, Obesity and Lifestyle during COVID-19 (COLC) study (cohort A) reported perceptions of weight change during the COVID-19 pandemic. Anthropometric data of 65 children with overweight and obesity were collected at the expertise Centre for Overweight Adolescent and Children's Healthcare in the same period (COACH; cohort B). RESULTS: In cohort A, 43% of children with overweight and obesity perceived weight gain during the pandemic, compared to 15% of lean children. In cohort B, the BMI z-score increased significantly (+0.065 SD) within 5 months. Participation in a lifestyle intervention for >1 year and having parents with Dutch background was associated with less weight gain, specifically in children with obesity. DISCUSSION/CONCLUSION: In particular, children with overweight and obesity seem to be at risk for accelerated weight gain during the COVID-19 pandemic. Prior long-term participation in a lifestyle intervention protects against this weight gain, which emphasizes the importance of strong support for vulnerable populations during health crises and pleads for wide implementation of lifestyle interventions for children.

The Changing Landscape of Children's Diet and Nutrition: New Threats, New Opportunities.

BACKGROUND: Over the last 30-40 years, we have seen an improvement in global child undernutrition, with major reductions in wasting and stunting. Meanwhile, childhood obesity has dramatically increased, initially in high-income populations and subsequently in the more economically vulnerable. These trends are related to significant changes in diet and external factors, including new environmental threats. SUMMARY: Obesity rates first increased in older children, then gradually in infants. And in the next couple of years, there will be more overweight and obese than moderately or severely underweight children in the world. The changes in childhood nutritional landscape are a result of poor diets. Today, almost 50% of the world's population consumes either too many or too few calories. Dietary disparities between countries result in disparities of under- and overnutrition and impact the global health landscape. Most children with obesity, wasting, and micronutrient deficiencies live in lower income countries and in lower income families within any country. High energy-low nutrient diets are contributing to the increase in non-communicable diseases, which will manifest later in this generation of children. In 1990, child wasting was the #1 leading risk factor for mortality for all ages, and high BMI was #16; today, they are #11 and #5, respectively. COVID-19 and climate change are new major threats to global nutrition. Current and future efforts to improve the state of child nutrition require multisectoral approaches to reprioritize actions which address current trends and emerging threats.

Reinventing health promotion for healthy default beverage laws in the face of COVID-19.

Shortly after a healthy default beverage (HDB) law took effect in Hawai'i, requiring restaurants that serve children's meals to offer healthy beverages with the meals, the COVID-19 pandemic struck. Efforts to contain the virus resulted in changes to restaurants' operations and disrupted HDB implementation efforts. Economic repercussions from containment efforts have exacerbated food insecurity, limited access to healthy foods, and created obstacles to chronic disease management. Promoting healthy default options is critical at a time when engaging in healthy behaviors is difficult, but important, to both prevent and manage chronic disease and decrease COVID-19 risk. This commentary discusses COVID-19's impact on restaurant operations and healthy eating, and the resulting challenges and opportunities for this promising health promotion intervention.

Weighing the Cost of Obesity: One Solution Does Not Fit All For This Complicated Disease.

Obesity causes or contributes to a range of fatal and debilitating health conditions. On top of this, obesity has emerged as one of the largest contributing factors in severe illness and death among those who contract COVID-19, according to several studies.