Differences in home food and activity environments between obese and healthy weight families of preschool children.

OBJECTIVE: To develop and test a home food and activity instrument to discriminate between the home environments of obese and healthy weight preschool children. DESIGN: A modified questionnaire about home environments was tested as an observation tool. SETTING: Family homes. PARTICIPANTS: A total of 35 obese children with at least 1 obese caregiver were compared with 47 healthy weight children with no obese caregivers. MAIN OUTCOME MEASURES: Home observation assessments were conducted to evaluate the availability of devices supporting activity behaviors and foods based on availability, accessibility, and readiness to be eaten. ANALYSIS: Agreement statistics were conducted to analyze psychometrics and MANOVAs were conducted to assess group differences, significance, P < .05. RESULTS: Home observations showed acceptable agreement statistics between independent coders across food and activity items. Families of obese preschoolers were significantly less likely to have fresh vegetables available or accessible in the home, were more likely to have a television in the obese child's bedroom, and had fewer physical activity devices compared with healthy weight preschoolers. CONCLUSIONS AND IMPLICATIONS: Families of young children live in home environments that were discriminatively characterized based on home observations. Future tool refinement will further clarify the impact of the home environment on early growth.

Developing a Treatment Program for Obesity in Preschool Age Children: Preliminary Data.

We developed and tested the feasibility of a behavioral intervention that utilizes clinic and home visitations to reduce overweight in preschool children above the 95(th) BMI percentile. Five families of preschool children ages 2 to 5 years with a BMI above the 95(th) percentile and one overweight parent were enrolled in a 24-week behavioral weight management program. Phase I, Intensive Treatment included 12 weekly sessions, alternating group-based clinic sessions and home settings. Phase II, Maintenance included 6 bi-weekly sessions alternating between the clinic and home setting. Treatment focused on teaching parents to use behavioral child management strategies to systematically implement dietary changes across beverages and snacks, meals, and to increase physical activity. Home visits focused on modifying the home food environment and in vivo use of child behavior management skills. Treatment targeted either weight maintenance or a small weight loss. Outcome measures were obtained at baseline (week 0), end of treatment (week 24), and at 6 month follow up after treatment ended (week 52). Three participants completed 24 weeks of treatment and were compared to two participants who did not complete treatment. Treatment completers showed reductions in zBMI and percent overweight while two noncompleting families increased their percent overweight and maintained their zBMI at 6 month follow up. These results suggest initial support for development of a behavior-based weight management intervention for obese preschool children and their families. Intervention targets appear to be enhanced by the inclusion of home visitations, in which food environments are changed to facilitate treatment goals.