Background Few successful treatment modalities exist to address childhood obesity. Given Latinos’ strong identity with family, a family-focused intervention may be able to control Latino childhood obesity. Purpose To assess the feasibility and effectiveness of a family-centered, primary care–based approach to control childhood obesity through lifestyle choices. Design Randomized waitlist controlled trial in which control participants received the intervention 6 months after the intervention group. Setting/participants Forty-one Latino children with BMI >85%, aged 9–12 years, and their caregivers were recruited from an urban community health center located in a predominantly low-income community. Intervention Children and their caregivers received 6 weeks of interactive group classes followed by 6 months of culturally sensitive monthly in-person or phone coaching to empower families to incorporate learned lifestyles and to address both family and social barriers to making changes. Main outcomes measures Caregiver report on child and child self-reported health-related quality of life (HRQoL); metabolic markers of obesity; BMI; and accelerometer-based physical activity were measured July 2010–November 2011 and compared with post-intervention assessments conducted at 6 months and as a function of condition assignment. Data were analyzed in 2012. Results Average attendance rate to each group class was 79%. Socio-environmental and family factors, along with knowledge, were cited as barriers to changing lifestyles to control obesity. Caregiver-proxy and child-self-reported HRQoL improved for both groups with a larger but not nonsignificant difference among intervention vs control group children (p=0.33). No differences were found between intervention and control children for metabolic markers of obesity, BMI, or physical activity. Conclusions Latino families are willing to participate in group classes and health coaching to control childhood obesity. It may be necessary for primary care to partner with community initiatives to address childhood obesity in a more intense manner. Trial registration This study is registered at Clinicaltrials.partners.org 2009P001721.

Objective Conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Design Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012–October 2013) to the five month intervention period (December 2013–April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and the end of intervention. Setting Chelsea, Massachusetts, a low-income urban community. Subjects 575 adult customers completing store exit interviews. Results During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both the intervention and control stores by $16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $40/month but decreased in control stores by $23/month (difference in trends $63/month, 95% CI, $4–121/month; p=0.036); WIC non-fruit/vegetable sales were not different (p=0.45). Comparing baseline to intervention period exit interview responses by customers participating in WIC (N=134), intervention store customers reported increased fruit/vegetable purchases compared to control store customers (18% vs. −2%), but this did not achieve statistical significance (p=0.11). Conclusions Placement of fruit/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good quality produce could promote healthier food choices of low-income families.

Background: In 2009, the Special Supplemental Nutrition program for Women, Infants, and Children (WIC) increased access to healthy foods by providing cash-value vouchers for fruit/vegetables, but improving access alone is not sufficient to reduce disparities in food choices and obesity among low-income families. We hypothesized that making fresh produce more visible and of better quality in corner stores would increase their WIC fruit/vegetable sales. Methods: We conducted a randomized, controlled trial of 6 WIC-certified corner stores in a low-income, Latino community. Three stores were assigned to “choice architecture” intervention that increased visibility and quality of fresh fruit/vegetables. Primary outcome was WIC fruit/vegetable voucher (FVV) sales, comparing changes in sales trends from baseline (Dec. 2012-Oct. 2013) to follow-up (Dec. 2013-Apr. 2014) for intervention vs. control stores. Secondary outcomes, from customer exit surveys at all 6 stores (N=575), were changes between baseline and follow-up in self-reported fresh fruit/vegetable purchases by customers on WIC or Supplemental Nutrition Assistance Program (SNAP). Results: WIC FVV sales decreased in both intervention and control stores during baseline but increased in the 3 intervention stores after implementing choice architecture (Figure). In exit surveys, 23% of all corner store customers reported using WIC, and 37% used SNAP. Compared to baseline, intervention store customers on SNAP increased purchase of fruit/vegetables at follow-up more than SNAP customers at control stores (6% vs. -15%, p=0.007). For WIC customers, there was a similar but not statistically significant difference between intervention and control (18% vs. -2%, p=0.11). Conclusion: A simple choice architecture intervention increased purchases of fruit/vegetables by corner store customers using WIC. Policies that incentivize WIC-certified stores to stock and prominently display good quality fresh produce could improve healthy choices of low-income families.