Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City

Background: Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. Methods: We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. Results: 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. Conclusions: Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. Trial registration ClinicalTrials.gov NCT01539070. Comisión Nacional de Investigación Científica del IMSS: 2009-785-120

Association of Proinflammatory and Proinsulinemic Food Groups With Maternal Postpartum Weight Retention

Few studies have examined associations of maternal intake of proinflammatory and proinsulinemic food types with substantial postpartum weight retention (SPPWR; $5 kg) at 6 months

Three-Year Improvements in Weight Status and Weight-Related Behaviors in Middle School Students: The Healthy Choices Study.

Few dissemination evaluations exist to document the effectiveness of evidence-based childhood obesity interventions outside the research setting.Evaluate Healthy Choices (HC), a multi-component obesity prevention program, by examining school-level changes in weight-related behaviors and weight status and the association of implementation components with odds of overweight/obesity.We compared baseline and Year 3 school-level behavioral and weight status outcomes with paired t-tests adjusted for schools' socio-demographic characteristics. We used generalized estimating equations to examine the odds of overweight/obesity associated with program components.Consecutive sample of 45 of 51 middle schools participating in the HC program with complete baseline and follow-up survey data including a subsample of 35 schools with measured anthropomentry for 5,665 7th grade students.Schools developed a multi-disciplinary team and implemented an obesity prevention curriculum, before and after school activities, environmental and policy changes and health promotions targeting a 5-2-1 theme: eat ≥ 5 servings/day of fruits and vegetables (FV), watch ≤ 2 hours of television (TV) and participate in ≥ 1 hours/day of physical activity (PA) on most days.1) School-level percent of students achieving targeted behaviors and percent overweight/obese; and 2) individual odds of overweight/obesity.The percent achieving behavioral goals over three years increased significantly for FV: 16.4 to 19.4 (p = 0.001), TV: 53.4 to 58.2 (p = 0.003) and PA: 37.1 to 39.9 (p = 0.02), adjusting for school size, baseline mean age and percent female, non-Hispanic White, and eligible for free and reduced price lunch. In 35 schools with anthropometry, the percent of overweight/obese 7th grade students decreased from 42.1 to 38.4 (p = 0.016). Having a team that met the HC definition was associated with lower odds of overweight/obesity (OR = 0.83, CI: 0.71-0.98).The HC multi-component intervention demonstrated three-year improvements in weight-related behaviors and weight status across diverse middle schools. Team building appears important to the program's effectiveness

Percent across Schools Achieving Behavioral Goals^a and Percent Overweight and Obese at Baseline and 3-Year Follow-up^b.

<p>^a Percent of students in school achieving behavior, averaged across schools</p><p>^b Student’s paired t-test of significant difference from baseline to follow-up, adjusted for school % free and reduced price school lunch, % white, % female and mean age</p><p>^c Including 100% fruit juice; fruits and vegetables</p><p>^d n = 35 schools, 7th grade students only; overweight = BMI ≥ 85th percentile and < 95th percentile; obese = BMI ≥ 95th percentile of NCHS/CDC 2000 growth reference</p><p>Percent across Schools Achieving Behavioral Goals<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134470#t002fn001" target="_blank">^a</a> and Percent Overweight and Obese at Baseline and 3-Year Follow-up<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134470#t002fn002" target="_blank">^b</a>.</p

Change in school-level percent overweight and obese and percent obese from baseline to follow-up, Massachusetts Healthy Choices (n = 35).

<p>Change in school-level percent overweight and obese and percent obese from baseline to follow-up, Massachusetts Healthy Choices (n = 35).</p

Distribution of Intervention Components implemented in Year 2 in Massachusetts Middle Schools Participating in the Healthy Choices Program (N = 35).

<p>Distribution of Intervention Components implemented in Year 2 in Massachusetts Middle Schools Participating in the Healthy Choices Program (N = 35).</p

Baseline Socio-demographic Characteristics of Schools Participating in Massachusetts Healthy Choices (n = 45).

<p>Baseline Socio-demographic Characteristics of Schools Participating in Massachusetts Healthy Choices (n = 45).</p