1. In this multisite, cluster-randomized controlled trial, a health literacy program for early childhood obesity prevention resulted in less weight gain at 18 months that was not sustained at 24 months.
2. There were differences in early childhood weight trajectories between intervention and controls groups, which may be clinically meaningful.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Childhood obesity at age 24 months has been linked to increased likelihood of being overweight during adulthood. Children from lower-income families and those with parents who have limited literacy skills are at a disproportionately greater risk of childhood weight gain. In the current study, a low-literacy, family-centered intervention was implemented with the primary outcome assessing the proportion of overweight children (i.e. BMI ≥ 85th percentile) at 24 months. The secondary outcome was analysis of BMI z scores. The intervention consisted of 2 components, which included low-literacy parent educational toolkits provided at each well-child visit, and provider training in health communication with an emphasis on clear-health communication techniques. At 18 months, there was less weight gain in the intervention group and marginally lower BMI z scores, as compared to controls. At 24 months, there was no significant difference between the intervention and control groups in the proportion of children overweight, and similarly no significant difference in BMI z scores. The study findings are strengthened by the randomized trial design, large sample size, and control of covariates such as baseline child and caregiver characteristics. Although the intervention showed improved outcomes up to 18 months of life, there is a need to further investigate optimal interventions to curb excessive childhood weight gain in the long-run.
Relevant Reading: Treatment interventions for early childhood obesity: A systematic review
In-Depth [randomized controlled trial]: In this multisite, cluster-randomized controlled trial, 865 parent-child dyads were recruited across 4 sites in the United States from 2010-2014. In total, 459 dyads were randomized to receive the intervention, and 406 were randomized to the active control arm that focused on injury prevention. Outcomes were assessed at well-child visits (i.e., 2, 4, 6, 9, 12, 15 and/or 18, and 24 months). In total, 802 dyads attended at least 1 well-child visit and were included in the analysis, 78% of total well-child visits were attended, and 540 (67%) completed the 24-month visit. At 24 months, the prevalence of children overweight (i.e. BMI ≥ 85th percentile) was 49%, compared to 41% for controls, with a median BMI z score of 1.01 in the intervention group and 0.78 for controls. There was a lower growth trajectory in the intervention group (p = 0.002). There were no statistically significant differences between the groups at 24 months.
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