Sustainability of Effects of an Early Childhood Obesity Prevention Trial Over Time

Abstract

IMPORTANCE Little evidence exists on whether effects of an early obesity intervention are sustainable.OBJECTIVE To assess the sustainability of effects of a home-based early intervention on children's body mass index (BMI) and BMI z score at 3 years after intervention. DESIGN, SETTING, AND PARTICIPANTSA longitudinal follow-up study of the randomized clinical Healthy Beginnings Trial was conducted with 465 participating mothers consenting to be followed up at 3 years after intervention until their children were age 5 years. This study was conducted in socially and economically disadvantaged areas of Sydney, Australia, from March 2011 to June 2014. INTERVENTIONSNo further intervention was carried out in this Healthy Beginnings Trial phase 2 follow-up study. The original intervention in phase 1 comprised 8 home visits from community nurses delivering a staged home-based intervention, with one visit in the antenatal period and 7 visits at 1, 3, 5, 9, 12, 18, and 24 months after birth. MAIN OUTCOMES AND MEASURES Primary outcomes were children's BMI and BMI z score. Secondary outcomes included dietary behaviors, quality of life, physical activity, and TV viewing time of children and their mothers. RESULTSIn total, 369 mothers and their children completed the follow-up study, a phase 2 completion rate of 79.4% (80.9% for the intervention group and 77.7% for the control group). The differences between the intervention and control groups at age 2 years in children's BMI and BMI z score disappeared over time. At age 2 years, the difference (intervention minus control) in BMI (calculated as weight in kilograms divided by height in meters squared) was −0.41 (95% CI, −0.71 to −0.10; P = .009), but by age 5 years it was 0.03 (95% CI, −0.30 to 0.37). No effects of the early intervention on dietary behaviors, quality of life, physical activity, and TV viewing time were detected at age 5 years. CONCLUSIONS AND RELEVANCEThe significant effect of this early life home-visiting intervention on child BMI and BMI z score at age 2 years was not sustained at age 5 years without further intervention. Obesity prevention programs need to be continued or maintained during the early childhood years. erect against the backboard, and the back of the head, shoulder blades, buttocks, and heels made contact with the backboard of the stadiometer. Two measurements were taken by a research assistant and recorded to the nearest 0.1 cm. A third measure was taken if the first 2 measurements differed by 0.5 cm or more, and the mean of these 2 or 3 values was calculated.b Adjusted for mother's marital status, mother's employment status, and child's BMI (or BMI z score) at 2 years.sumably because obesogenic factors within communities that put families and young children at risk of engaging in weight-related behaviors remain in place. Future research needs to explore early interventions beyond individual behaviors and family conditions that are related to overweight and obesity.Early Childhood Obesity Prevention Trial Effects

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