• By Laura Whybra
  • Posted on Monday 24th November, 2014

Learning how preschool can help prevent obesity

strong>Obesity among children holds debilitating, lifelong implications for their health and wellbeing and is a growing international problem. Preschool settings have a potentially crucial contribution to make towards prevention, but research among black children in Chicago shows up the implementation challenges as well as opportunities.In the US, levels of disease related to obesity are especially marked among minority populations. The scope for early intervention is indicated by data showing that while 11.4 per cent of non-Hispanic black children aged 2 to 5 are considered obese, the proportion rises to 19.4 per cent among 6 to 11 year olds and 24.4 per cent of teenagers.Acknowledging this, public health researchers in Chicago devised a program for 3 to 5-year olds titled Hip-Hop to Health Jr. Obesity Prevention. This was based on a similar intervention for 5 to 7-year olds that showed success over two years by slowing the average rate of increase in children’s body mass index, adjusted for sex and age (BMI-Z). Having delivered the original program using specially trained early childhood educators, the research team wanted to find out whether classroom teachers could be trained to provide it and still achieve promising results. This was an important step, intended to test whether the program could reach more children by being integrated into the everyday preschool curriculum.Healthy eating and exerciseThe 14-week intervention consisted of a program of education on healthy eating and exercise as well as physical activity sessions two or three times a week. Parental involvement was encouraged, using a small financial incentive to complete homework tasks, plus the provision of recipes, a CD and other home-use resources.Eighteen Head Start centers were randomly allocated to either provide the obesity prevention program or act as a control group, where children took part in a general health and safety program. In all, measurements were obtained more than 600 participating children and 590 parents.The results – comparing children before the intervention started with those obtained just after the 14 weeks – showed that those who had taken part in the program engaged in considerably more moderate-to-vigorous physical activity than the control group. They also spent significantly less time in front of a screen, whether watching TV or playing computer games. There were no significant differences found at this stage in BMI measurements or diet. However, this was also the case with the earlier trial of Hip-Hop to Health Jr., leaving researchers hopeful that a follow-up data collection will show a positive, preventive impact after a year.Teachers and parentsEncouragingly, preschool teachers were able to incorporate the program into their daily schedule and deliver most of the 28-lesson preventive curriculum. However, the level of training and supervision required proved more time-consuming than expected. Teachers, many of whom were unaccustomed to physical exercise themselves, found it easier to deliver classroom sessions on healthy eating than the required activity sessions. In response to these difficulties, the researchers created a CD mirroring the weekly curriculum.The study also encountered problems collecting data from children on their levels of activity and movement. This followed a decision to replace survey questions to parents (used in the previous study) with direct data gathering from children using accelerometers (a type of pedometer). While few children and parents refused the use the equipment, they found it hard to remember to fit the accelerometer every day. For this and other reasons only 323 valid baseline measurements were collected.A further limitation of the study was that no data was gather on the social context in which people were living and making daily decisions affecting their own health and that of their children. Strikingly, more than 50 per cent of the parents of children in the study were obese themselves, suggesting the need for even stronger parental involvement in any program attempting to change young children’s diets and eating habits.*********Reference: Fitzgibbon, M. L., Stolley, M. R., Schiffer, L. A., Braunschweig, C. L., Gomez, S. L., Van Horn, L., & Dyer, A. R. (2011). Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Postintervention Results. Obesity, 19 (5) 994-1003.

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