Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Obesity prevention in early childhood
group at the six - month follow - up ( P = 0.0027) after
adjustment for sex and baseline performance.
These interventions achieved significant behavioral
changes, yet only two produced some effects on prevention
of obesity — one had a directed exercise
program, 41 the other included both diet and exercise
components. 39 However, the effect was significant
only among girls and not sustainable after six months
post intervention in one study, 41 while it was effective
and sustainable only among Blacks 39 not the Latinos 40
in the other, suggesting that gender and cultural difference
should be addressed in designing the intervention
activities. The two studies that did not report
significant reductions in weight status had similar
intervention approaches and intensity, and a comparable
number of participants in one study (but less in
the other). However, the duration of follow - up was
shorter. These equivocal results highlight the need for
more studies to provide further evidence on effectiveness
of these promising strategies.
Innovative e ducational p rogram
For a young child, health and education are inseparable.
There is no published evaluation of an educational
program for young children on preventing
obesity. The only published report, the “ Color Me
Healthy ” intervention, evaluated program acceptability
and implementation and children ’ s knowledge and
some behaviors. 44 This educational program was
implemented widely in North Carolina and was
designed to increase physical activity and promote
healthy eating in 4 – 5 - year - old children through the
development of fun, colorful and innovative educational
materials. The content development was guided
by social cognitive theory and the socio - ecological
model. Trained child - care providers (1338 participants
in 53 training sessions) delivered the program
in a range of care settings and the eight - week follow -
up evaluation showed that over 90% of providers
reported increases in children ’ s physical activity,
knowledge about movement and knowledge about
healthy eating. 44 The train - the - trainer model in this
intervention holds promise as a way of improving the
child - care environment on a large scale and in a range
of child - care settings. It will be important to determine
the sustainability of the program and its ability
to positively influence children ’ s risk and protective
behaviors related to childhood obesity.
Interventions with an e nvironmental f ocus
Child - care settings should provide an environment in
which young children are offered nutritious foods and
regular physical activity through structured and
unstructured play, so that they learn these healthy
lifestyle behaviors at an early age. 20 Thus child care
plays a critical role in laying a foundation for healthy
weight. Currently, there are four published studies of
45 – 48
environmental interventions in child care. One
study reported self - assessment of the nutrition and
physical activity child - care environment and its
implementation, feasibility and acceptability; and
found a variety of environmental improvements post -
intervention. 45 Food and nutrition environments were
46 – 48
the focus of interventions in the other studies.
Leahy et al 46 altered the energy density of a lunch
entr é e and determined the effect on 2 - to 5 - year - old
children ’s subsequent ad libitum intake of lunch. This
intervention was found to be effective in reducing
children ’ s energy intake from the entr é e and total
lunch energy intake. Matwiejczyk et al 47 evaluated an
incentive initiative — the “ Start Right Eat Right ”
award — that aimed to improve the nutrition provided
to children attending child - care centers in South
Australia. Substantial changes were reported in the
food policies of the child - care centers and there was a
resulting improvement in food provision and nutrition
practices in these settings.
Children ’s anthropometric measurement was
included as the outcome in only one study. Williams
et al 48 examined how a change in the school food
service aimed at reducing saturated fat intake, without
compromising energy intake or nutrient content of
the available diet, modified serum cholesterol and
weight status. The intervention was based on the
Piaget Stage 2 Model, Social Learning Theory and
High/Scope Active Learning. Nine Head Start Centers,
which served predominantly minority children from
families with incomes below the US poverty level.
Children were assigned to one of the three study
groups: a control group with a safety education curriculum
but without food service modification (350
children aged 49.3 ± 6.1 months), an intervention
group with food service modification plus a child/
family nutrition education program (242 children
aged 48.3 ± 6.9 months), or an intervention group
with food service modification plus a safety curriculum
(195 children aged 47.9 ± 6.4 months). Behavioral
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