Feasibility of a family-focused YMCA-based diabetes prevention program in youth: The E.P.I.C. Kids (Encourage, Practice, and Inspire Change) Study

Abstract

Efficacious lifestyle modification programs for children at risk of type 2 diabetes (T2D) have not been well established outside of clinical settings. In this study, the feasibility of a family-focused, YMCA-based prevention program for children at risk of T2D was evaluated between September 2015 and July 2016 in Tucson, Arizona. A 12-week YMCA-led lifestyle intervention was adapted for 9–12-year-old children and their families to encourage healthy eating, physical activity, and supportive home environments. Two YMCA locations were randomized to offer either a face-to-face lifestyle coach-led intervention or an alternating face-to-face and digitally-delivered intervention. Program feasibility and preliminary effects on child anthropometric and behavioral outcomes were assessed at baseline and post-intervention. Changes were assessed using linear regression combining delivery formats, with adjustment for clustering of participants within site/format. Forty-eight children (10.9 ± 1.2 years old; 45% female; 40% Hispanic; 43% White; 87% obese) and their parents enrolled, and 36 (75%) completed 12-week measures. Weekly program attendance averaged 61%. Participants and coaches highly rated program content and engagement strategies. Statistically significant changes in child BMI-z score (−0.05, p = 0.03) and family food and physical activity environment (+5.5% family nutrition and physical activity score, p = 0.01) were observed. A YMCA-led family-focused T2D intervention was feasible for the YMCA and participants and effects on child weight, behavior, and the home environment warranted further investigation.

Usual Dietary Intake and Adherence to Dietary Recommendations among Southwest American-Indian Youths at Risk of Type 2 Diabetes

“…These findings will inform the development of targeted nutrition education focused on the energy density of foods, how to choose tasty low-calorie beverages and drink less sugary drinks, how to find the best items at the grocery store or convenience store, for example. Targeted nutrition education in a family-focused diabetes prevention program for diverse youths aged 9–12 y has been successfully implemented (20, 21). These findings also support the need to incorporate more native traditional approaches (22) and foods including plant-based diet interventions, historically staple foods for native people.…”

Supporting and Engaging Families: An Examination of Publicly-Funded Health Promotion Programs in the Intermountain West, USA

“…In public health practice, successes have been seen in familycentered programming for traditional public health problems, such as poor nutrition, diabetes prevention, and adolescent risk-taking behaviors that contribute to HIV. Multiple studies have demonstrated that when family practices, values, and responsibilities are included in public health interventions, there is a much higher likelihood of positive change for both individuals and families and lasting success (28)(29)(30). Programs like Healthy Home Offerings via the Mealtime Environment Plus Higher scores denote more family support and involvement in programs.…”

“…(HOME Plus) or Strong African American Families (SAAF) are examples of programs that work with families to promote healthy eating habits in childhood to prevent obesity in adulthood. Evaluations of these programs have shown significant and sustained healthy eating habits for individual family members while also creating a healthier food environment in family homes (28)(29)(30)(31).…”

Evaluating a pragmatic estimate of insulin sensitivity in Latino youth with obesity

“…Considerable efforts are underway to take diabetes prevention programs to scale, 13,[17][18][19] and increasing insulin sensitivity is an important physiologic target for health promotion among populations at high risk. 20 Therefore, it is critical to identify biologically relevant estimates of insulin sensitivity that can be practically applied within the context of population health.…”