4 behavior targets help prevent obesity

A 3- to 5-minute intervention delivered during routine pediatric visits and targeting 4 behaviors related to obesity-milk consumption, juice and sugar-sweetened beverage consumption, television/screen time, and physical activity-decreased the rate at which body mass index (BMI) percentile increased in young children in a recent trial. Participants, who received care at an urban medical center, were low-income Hispanic or African American mother-child pairs. The children were aged 2 to 4 years and included those who were normal weight, overweight, and obese.  

Recommended: Advice mothers receive is often inadequate in quality and quantity

Investigators compared 200 caregiver-child dyads who participated in the study with 218 age- and sex-matched historic controls, observing BMI changes in the 2 groups over 12-month periods. For the intervention group, physicians and nurses provided a 12-question survey about the 4 behaviors as well as counseling (using a “motivational interviewing” framework) about desirable changes, culminating in a contract that stated the mother’s goal to change a single agreed-upon behavior at each encounter. Practitioners also provided educational materials for implementing the behavior change, a self-monitoring calendar to track progress, and a “toolkit” that included such items as a measuring cup and pedometer. In the study group, investigators followed up each clinic visit and “dose” of counseling-each participant had a total of 2 or 3 during the year long study period-with a phone call to provide support. The control group received usual care, including height and weight measurements, calculation of BMI, and any counseling the clinician deemed appropriate.

After 12 months, BMI percentile had decreased by 0.33 percentile in the intervention group, compared with a mean increase of 8.75 percentile in the control group.  For participants of normal weight, the intervention had a particularly significant effect, with mean BMI percentile in normal-weight controls increasing from 47.6 to 61.3 between baseline and 12 months while remaining unchanged in similar individuals in the intervention group (Cloutier MM, et al. J Pediatr. 2015;167[2]:372-377).

Commentary: This study’s weakness is that it compares the study group with historic controls.  This sequential design might attribute BMI changes to the interventions when, in fact, societal or other changes may have been at play. The strength of the study design, however, is the practical, achievable scope of the program. The 3- to 5-minute motivational interview with goal setting might realistically be incorporated into the routine of a busy office practice.

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.