MedicalResearch.com Interview with:
Shari Barkin, MD, MSHS
William K. Warren Foundation Endowed Chair
Professor of Pediatrics
Division Chief of Academic General Pediatrics
Director of Pediatric Obesity Research
Vanderbilt University Medical Center
MedicalResearch.com: What is the background for this study?
Response: Obesity often begins in childhood and disproportionately affects some populations, including underserved children. Given the challenges associated with achieving effective obesity treatment, the focus needs to be on prevention and needs to start early. Barkin et al conducted the longest behavioral intervention obesity prevention trial with 610 underserved parent-preschool child pairs, testing a three-year pragmatic approach that focused on families based in the communities in which they lived, and partnering with both Metro Parks and Recreation and the Nashville Public Library Foundation. Eligible children were high normal weight or overweight but not obese and lived in neighborhoods with access to neighborhood built environments that included parks and recreation and library branches.
MedicalResearch.com: What are the main findings?
Response: The Growing Right Onto Wellness (GROW) trial resulted in high participation throughout the 3-year study with a >90% retention rate. Participating families had a household income of <$ 25,000 and 42% of families were food insecure. The intervention resulted in a statistically significant reduction in mean child daily energy intake compared to the control group, which persisted across the 3 yearly time-points. At 36 months, regression models demonstrated that children in the intervention group consumed close to 100 kcal fewer than the control group. It also resulted in higher use of the community recreation center, by intervention versus control families that was sustained over three years. However, these behavior changes did not result in a difference in body mass index (BMI) over the three years when comparing the intervention to the control group. In post-hoc outcomes, there was a decreased risk of becoming obese immediately after the first phase of the intervention but this was not sustained over time.
MedicalResearch.com: What should readers take away from your report?
Response: A family-based, community-centered behavioral obesity prevention trial for underserved preschoolers can lead to some sustained healthy behavior change, but this was not sufficient to result in differences in early BMI growth trajectories. Childhood obesity prevention in low-income underserved populations could require a higher amount of sustained behavioral change to affect BMI growth in early childhood
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Obesity is not the result of one thing at a time; instead it is a complex problem, affected by the dynamic interaction of biology and behavior in one’s social and physical environment over multiple developmental periods. GROW participants were from low-income families with high food insecurity. This underscores the importance of measuring biological-level mediators as well as larger contextual environments, such as access to food.
MedicalResearch.com: Is there anything else you would like to add?
Response: In post-hoc analysis, the intervention appeared to be effective with those families with higher food insecurity at baseline. These are post-hoc analysis and require further examination.
The GROW team is currently analyzing data related to multiple levels of potential influence when further understanding how the GROW trial affected participating families, including epigenetics, social networks, and the effect of intervention dose.
Barkin SL, Heerman WJ, Sommer EC, et al. Effect of a Behavioral Intervention for Underserved Preschool-Age Children on Change in Body Mass Index A Randomized Clinical Trial. JAMA. 2018;320(5):450–460. doi:10.1001/jama.2018.9128
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