Colleen Flattum

HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children’s sedentary behavior, and prevent obesity

BackgroundInvolvement in meal preparation and eating meals with one’s family are associated with better dietary quality and healthy body weight for youth. Given the poor dietary quality of many youth, potential benefits of family meals for better nutritional intake and great variation in family meals, development and evaluation of interventions aimed at improving and increasing family meals are needed. This paper presents the design of key intervention components and process evaluation of a community-based program (Healthy Home Offerings via the Mealtime Environment (HOME) Plus) to prevent obesity.MethodsThe HOME Plus intervention was part of a two-arm (intervention versus attention-only control) randomized-controlled trial. Ten monthly, two-hour sessions and five motivational/goal-setting telephone calls to promote healthy eating and increasing family meals were delivered in community-based settings in the Minneapolis/St. Paul, MN metropolitan area. The present study included 81 families (8-12 year old children and their parents) in the intervention condition. Process surveys were administered at the end of each intervention session and at a home visit after the intervention period. Chi-squares and t-tests were used for process survey analysis.ResultsThe HOME Plus program was successfully implemented and families were highly satisfied. Parents and children reported that the most enjoyable component was cooking with their families, learning how to eat more healthfully, and trying new recipes/foods and cooking tips. Average session attendance across the ten months was high for families (68%) and more than half completed their home activities.ConclusionsFindings support the value of a community-based, family-focused intervention program to promote family meals, limit screen time, and prevent obesity.Trial registrationNCT01538615

Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial

BackgroundFamily meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth.MethodsFamilies (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011–2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score.ResultsGeneral linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts.ConclusionsThe study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding.Trial registrationThis study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.

Evaluation of an Individualized Counseling Approach as Part of a Multicomponent School-Based Program to Prevent Weight-Related Problems among Adolescent Girls

School-based interventions show inconsistent results in reducing weight-related problems. One limitation of school programs is that they do not easily allow for individualization of targeted messages. An important question regards the feasibility and effectiveness of implementing individual sessions within broader school-based programs. This article evaluates the feasibility and effectiveness of the individual counseling component of New Moves, a school-based program designed to prevent weight-related problems in adolescent girls, which was evaluated in a randomized controlled study. A total of 356 girls from six intervention and six control high schools in the St Paul/Minneapolis, MN, metropolitan area participated in the New Moves study in 2007-2009. This analysis includes the 182 girls from the intervention schools, all of whom were offered individual counseling as part of the program. The intervention girls had a mean age of 15.7 years (standard deviation 1.13) and were racially/ethnically diverse (73.1% non-white). During the individual sessions, which incorporated motivational interviewing strategies, girls set targeted behavioral goals aimed at preventing a spectrum of weight-related problems. More than 80% of the girls participated in five or more individual sessions. Girls chose goals for behavioral change based on individual needs. For example, girls with low levels of breakfast intake at baseline were most likely to set a goal to increase breakfast frequency. Satisfaction with the individual sessions was high, with 95% of the girls reporting being satisfied or very satisfied with the sessions. The addition of an individual counseling component to school-based interventions is feasible and has the potential to enhance behavior change.

An Example of How to Supplement Goal Setting to Promote Behavior Change for Families Using Motivational Interviewing

ABSTRACT The purpose of this study was to describe the components and use of motivational interviewing (MI) within a behavior change intervention to promote healthful eating and family meals and prevent childhood obesity. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus intervention was part of a two-arm randomized-controlled trial and included 81 families (children 8–12 years old and their parents) in the intervention condition. The intervention included 10 monthly, 2-hour group sessions and 5 bimonthly motivational/goal-setting phone calls. Data were collected for intervention families only at each of the goal-setting calls and a behavior change assessment was administered at the 10th/final group session. Descriptive statistics were used to analyze the MI call data and behavior assessment. Overall group attendance was high (68% attending ≥7 sessions). Motivational/goal-setting phone calls were well accepted by parents, with an 87% average completion rate. More than 85% of the time, families reported meeting their chosen goal between calls. Families completing the behavioral assessment reported the most change in having family meals more often and improving home food healthfulness. Researchers should use a combination of delivery methods using MI when implementing behavior change programs for families to promote goal setting and healthful eating within pediatric obesity interventions.

Family Home Food Environment and Nutrition-Related Parent and Child Personal and Behavioral Outcomes of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus Program: A Randomized Controlled Trial

BACKGROUND Research has demonstrated a significant positive association between frequent family meals and childrens dietary intake; however, the promotion of healthful family meals has not been rigorously tested for key food environment and nutrition-related behavioral outcomes in a randomized trial. OBJECTIVE To describe family home food environment and nutrition-related parent and child personal and behavioral outcomes of the Healthy Home Offerings via the Mealtime Environment Plus program, the first rigorously tested family meals intervention targeting childhood obesity prevention. DESIGN Randomized controlled trial. Baseline, postintervention (12 months, 93% retention), and follow-up (21 months, 89% retention) data (surveys and dietary recalls) were collected. PARTICIPANTS/SETTING Children aged 8 to 12 years (N=160) and their parents were randomized to intervention (n=81) or control (n=79) groups. INTERVENTION The intervention included five parent goal-setting calls and 10 monthly sessions delivered to families in community settings that focused on experiential nutrition activities and education, meal planning, cooking skill development, and reducing screen time. MAIN OUTCOME MEASURES Family home food environment outcomes and nutrition-related child and parent personal and behavioral outcomes. STATISTICAL ANALYSES PERFORMED Analyses used generalized linear mixed models. Primary comparisons were contrasts between intervention and control groups at postintervention and follow-up, with adjustments for child age and parent education. RESULTS Compared with control parents, intervention parents showed greater improvement over time in scores of self-efficacy for identifying appropriate portion sizes, with significant differences in adjusted means at both post-intervention (P=0.002) and follow-up (P=0.01). Intervention children were less likely to consume at least one sugar-sweetened beverage daily at post-intervention than control children (P=0.04). CONCLUSIONS The Healthy Home Offerings via the Mealtime Environment Plus program involved the entire family and targeted personal, behavioral, and environment factors important for healthful changes in the home food environment and childrens dietary intake. The intervention improved two nutrition-related behaviors and this may inform the design of future family meal interventions.