We evaluated the efficacy of a 6-month clinic and home-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family-based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one-time PC session. Eighteen children aged 2–5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post-treatment) BMI z (−0.59 ± 0.17), BMI percentile (−2.4 ± 1.0), and weight gain (−2.7 kg ± 1.2) than PC and this difference was maintained at follow-up (month 12). LAUNCH parents also had a significantly greater weight loss (−5.5 kg ± 0.9) at month 6 and 12 (−8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.

Objective This study sought feedback from parents of over-weight preschoolers on terms for overweight and treatment strategies pediatricians could use to help parents improve diet and activity for their children. Methods Twenty-three parents of 21 children aged 2 to 6 years and between the 85th and 94th percentile body mass index participated in focus groups conducted by a pediatrician to assess 1) terms and health risks that motivate parents, 2) barriers that prevent adoption of recommended behaviors, and 3) recommendations for pediatricians on strategies to help parents improve child diet and activity. Results With regard to weight status, parents preferred the terms overweight and obese as long as pediatricians provided rationale for the classification. Parents recommended that pediatricians avoid colloquial terms to describe weight status. With regard to American Academy of Pediatrics recommendations for weight management in overweight preschoolers, parents were reluctant to restrict 100% fruit juice, needed specific strategies to increase vegetable consumption, and said limiting screen time would be difficult, especially when busy or during inclement weather. Despite identification of barriers, parents reported confidence in adopting all recommended behaviors except vegetable intake if given the rationale for the recommendation and strategies for implementation. Conclusion Parents recommended that pediatricians speak clearly about weight status, explain rationale for concern, relate that concern to family history, and provide specific advice and treatment recommendations.

Objective To examine maternal parenting behaviors, child temperament and their potential interactions in families of obese children and demographically similar families of nonoverweight children. Design A total of 77 obese youth (M body mass index (BMI) z-score values, zBMI = 2.4; ages 8–16, 59% female, 50% African American) and their parents were recruited from a pediatric weight management clinic and compared to 69 families of nonoverweight youth (M zBMI = − 0.03). Comparison youth were classmates of each obese participant matched on gender, race and age. Measurements Maternal report of child temperament, parenting style and anthropometric assessments were obtained. Results Compared to nonoverweight youth, mothers of obese youth described their child as having a more difficult temperament and their parenting style as lower in behavioral control. A logistic regression model indicated that difficult temperament, lower behavioral control and the interaction of low maternal warmth and difficult child temperament were associated with increased odds of a child being classified as obese. Conclusions Treatment-seeking obese youth and their parents are characterized by different parent and child factors when compared to nonoverweight comparison families. These findings direct investigators to test more complex models of the relation between parent and child characteristics and their mutual role in the weight-related behavior change process.

Objective To develop and test a home food and activity instrument to discriminate between the home environments of obese and healthy weight preschool children. Design A modified questionnaire about home environments was tested as an observation tool. Setting Family homes. Participants Thirty-five obese children with at least one obese caregiver were compared to forty-seven healthy weight children with no obese caregivers. Main Outcome Measures Home observation assessments were conducted to evaluate the availability of devices supporting activity behaviors and foods based on availability, accessibility, and readiness to be eaten. Analysis Agreement statistics were conducted to analyze psychometrics and MANOVAs were conducted to assess group differences, significance, P < .05. Results Home observations showed acceptable agreement statistics between independent coders across food and activity items. Families of obese preschoolers were significantly less likely to have fresh vegetables available or accessible in the home, were more likely to have a TV in the obese child’s bedroom and had fewer physical activity devices compared to healthy weight preschoolers. Conclusions and Implications Families of young children live in home environments that were discriminatively characterized based on home observations. Future tool refinement will further clarify the impact of the home environment on early growth.