We Need a New Approach to Prevent Obesity in Low-Income Minority Populations

Abstract

* Abbreviations:\n COPTR — : Childhood Obesity Prevention and Treatment Research Consortium\n CPP — : community policy and program\n CPP-Strat — : community policy and program created to assess either nutrition or physical activity strategy\n GEMS — : Girls’ Health Enrichment Multi-site Studies\n HCS — : Healthy Communities Study\n\nIn the last 2 decades, the National Institutes of Health invested in 2 major multicenter trials aimed at the prevention of obesity in high-risk populations of low-income Hispanic and African American children.1 The trials were the Childhood Obesity Prevention and Treatment Research Consortium (COPTR) and the Girls’ Health Enrichment Multi-site Studies (GEMS). Despite intensive, state-of-the-art, and often creative interventions conducted by seasoned investigators, all 5 of the studies considered below failed to alter the trajectory of weight gain in their participants compared with controls.\n\nIn this issue of Pediatrics , Moore et al2 describe the most recent of the COPTR studies. This study, conducted in Cleveland, Ohio, is 1 of 4 randomized controlled intervention trials, 2 of which have already been published. In this trial, 360 predominantly African American middle school children (mean age 11.6 years) and their parents were randomly assigned to a HealthyChange intervention, which relied on cognitive behavioral and motivational interviewing strategies that focused on goal setting, problem solving, self-monitoring, and relapse prevention. The control group was a SystemChange intervention that sought to establish family routines, restructured to develop new healthy habits. Both interventions focused on improving diet, physical activity, sleep and stress management, and reducing sedentary behavior. Both interventions included intensive engagement through 25 small-group sessions in the first year, alternating face-to-face and individualized phone sessions in year 2, and 4 face-to-face sessions and 8 individualized phone sessions in year 3. At the end of the 3-year intervention, 90% of enrolled participants remained in the study. No significant differences were observed in annual changes of BMI, waist circumference, or triceps skinfold thickness. Furthermore, no significant differences were observed in diet, physical activity measured by accelerometry, sleep, perceived stress, or cardiometabolic factors.\n\nIn 2 other COPTR studies that included randomized intensive obesity interventions in low-income, … \n\nAddress correspondence to William H. Dietz, MD, PhD, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Room 319, 950 New Hampshire Ave NW, Washington, DC 20052. E-mail: bdietz{at}email.gwu.edu