Linda Schiffer

Hip-Hop to Health Jr. for Latino Preschool Children

Objective: Hip‐Hop to Health Jr. was a diet/physical activity intervention designed to reduce gains in BMI (kilograms per meter squared) in preschool minority children.

Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: postintervention results.

The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children. The Hip‐Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group‐randomized controlled trial assessing the feasibility and effectiveness of a teacher‐delivered weight control intervention for black preschool children. The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools. Children enrolled in the nine schools randomized to the intervention group received a 14‐week weight control intervention delivered by their classroom teachers. Children in the nine control schools received a general health intervention. Height and weight, physical activity, screen time, and diet data were collected at baseline and postintervention. At postintervention, children in the intervention schools engaged in more moderate‐to‐vigorous physical activity (MVPA) than children in the control schools (difference between adjusted group means = 7.46 min/day, P = 0.02). Also, children in the intervention group had less total screen time (−27.8 min/day, P = 0.05). There were no significant differences in BMI, BMI Z score, or dietary intake. It is feasible to adapt an obesity prevention program to be taught by classroom teachers. The intervention showed positive influences on physical activity and screen time, but not on diet. Measuring diet and physical activity in preschool children remains a challenge, and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision.

Obesity Reduction Black Intervention Trial (ORBIT): Six-Month Results

The Obesity Reduction Black Intervention Trial (ORBIT) is a randomized controlled trial designed to assess the efficacy of a culturally proficient 6‐month weight loss intervention followed by a 1‐year maintenance intervention. This article describes the results of the 6‐month weight loss intervention. Two hundred thirteen obese black women aged 30–65 years were randomized to the intervention group or a general health control group. The intervention consisted of a 6‐month culturally adapted weight loss program that targeted changes in diet and physical activity patterns. Weight, dietary intake, and physical activity were measured at baseline and 6 months. A total of 198 women (93%) completed both the baseline and postintervention assessments. Women in the intervention group lost significantly more weight than women in the control group (P < 0.001). However, weight change was variable within the intervention group, with a maximum weight loss of 19.4% of initial body weight and a maximum weight gain of 6.4% of initial body weight. Women in the intervention group also showed significant improvements in fruit intake (P < 0.01), Healthy Eating Index score (P < 0.001), and moderate (P = 0.05), and vigorous (P < 0.001) physical activity compared to women in the control group. This study demonstrates that a culturally adapted program can successfully promote weight loss in obese black women. However, average weight loss was relatively modest, and weight change varied widely within the intervention group. Further research is needed in order to develop programs that will allow more black women to achieve their weight loss goals.

Hip-Hop to Health Jr., an obesity prevention program for minority preschool children: baseline characteristics of participants

BACKGROUND The prevalence of obesity in the United States is a significant public health problem. Many obesity-related risk factors are more prevalent in minority populations. Given the recalcitrant nature of weight loss interventions for adults, prevention of overweight and obesity has become a high priority. The present study reports baseline data from an obesity prevention intervention developed for minority preschool children. METHODS Hip-Hop to Health Jr. is a 5-year randomized controlled intervention that targets 3- to 5-year-old minority children enrolled in 24 Head Start programs. Our primary aim is to test the effect of the intervention on change in body mass index. Data were collected on sociodemographic, anthropometric, behavioral, and cognitive variables for the children and parents at baseline. RESULTS Participants included 416 black children, 337 black parents, 362 Latino children, and 309 Latino parents. Using body mass index for age and sex > or = the 95th percentile as the definition of overweight, 15% of the black children and 28% of the Latino children were overweight. More than 75% of the parents were either overweight or obese. DISCUSSION The development of interventions to effectively prevent or control obesity early in life is crucial. These data highlight the escalating problem of weight control in minority populations.

Evaluating the initial impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on dietary intake and home food availability in African-American and Hispanic families.

OBJECTIVE The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dietary intake and home food availability in low-income African-American and Hispanic parent/child dyads. DESIGN A natural experiment was conducted to assess if the revised WIC food package altered dietary intake, home food availability, weight and various lifestyle measures immediately (6 months) following policy implementation. SETTING Twelve WIC clinics in Chicago, IL, USA. SUBJECTS Two hundred and seventy-three Hispanic and African-American children aged 2-3 years, enrolled in WIC, and their mothers. RESULTS Six months after the WIC food package revisions were implemented, we observed modest changes in dietary intake. Fruit consumption increased among Hispanic mothers (mean = 0·33 servings/d, P = 0·04) and low-fat dairy intake increased among Hispanic mothers (0·21 servings/d, P = 0·02), Hispanic children (0·34 servings/d, P < 0·001) and African-American children (0·24 servings/d, P = 0·02). Home food availability of low-fat dairy and whole grains also increased. Dietary changes, however, varied by racial/ethnic group. Changes in home food availability were not significantly correlated with changes in diet. CONCLUSIONS The WIC food package revisions are one of the first efforts to modify the nutrition guidelines that govern foods provided in a federal food and nutrition assistance programme. It will be important to examine the longer-term impact of these changes on dietary intake and weight status.

Family-Based Hip-Hop to Health: Outcome Results

This pilot study tested the feasibility of Family-Based Hip-Hop to Health, a school-based obesity prevention intervention for 3–5 year old Latino children and their parents, and estimated its effectiveness in producing smaller average changes in body mass index at one year follow-up. Four Head Start preschools administered through the Chicago Public Schools were randomly assigned to receive a Family-Based Intervention (FBI) or a General Health intervention (GHI). Parents signed consent forms for 147 of the 157 children enrolled. Both the school-based and family-based components of the intervention were feasible, but attendance for the parent intervention sessions was low. Contrary to expectations, a downtrend in BMI Z score was observed in both the intervention and control groups. While the data reflect a downward trend in obesity among these young Hispanic children, obesity rates remained higher at one-year follow-up (15%) than those reported by the National Health and Nutrition Examination Survey (2009–2010) for 2–5 year old children (12.1%). Developing evidence-based strategies for obesity prevention among Hispanic families remains a challenge.

Racial/Ethnic Differences in Dietary Intake among WIC Families Prior to Food Package Revisions

OBJECTIVE To compare the diets of African American and Hispanic families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prior to the 2009 food package revisions. METHODS Mother-child dyads were recruited from 12 WIC sites in Chicago, IL. Individuals with 1 valid 24-hour recall were included in the analyses (n = 331 children, n = 352 mothers). RESULTS Compared to their African American counterparts, diets of Hispanic mothers and children were lower (P < .001) in percentage of calories from fat, added sugars, sodium, and sweetened beverages, but higher (P < .001) in vitamin A, calcium, whole grains, fruit, and total dairy. However, no groups met national recommendations for percentage of calories from saturated fat, fiber, sodium, whole grains, vegetables, and total dairy. CONCLUSIONS AND IMPLICATIONS There are racial/ethnic differences in dietary intake, and future research is needed to determine whether diets improve as a result of package revisions and whether uptake of these changes varies by race/ethnicity.

Obesity Reduction Black Intervention Trial (ORBIT): Design and Baseline Characteristics

BACKGROUND Obesity is associated with many chronic diseases, and weight loss can reduce the risk of developing these diseases. Obesity is highly prevalent among Black women, but weight loss treatment for black women has been understudied until recently. The Obesity Reduction black Intervention Trial (ORBIT) is a randomized controlled trial designed to assess the efficacy of a culturally proficient weight loss and weight loss maintenance program for black women. This paper describes the design of the trial, the intervention, and baseline characteristics of the participants. METHODS Two hundred thirteen obese black women aged 30-65 years were randomized to the intervention group or a general health control group. The intervention consists of a 6-month weight loss program followed by a 1-year maintenance program. Weight, dietary intake, and energy expenditure are measured at baseline, 6 months, and 18 months. RESULTS More than 40% of participants had a baseline body mass index (BMI) >40 kg/m(2) (class III obesity). Intake of fat and saturated fat was higher and consumption of fruit, vegetables, and fiber was lower than currently recommended guidelines. Self-reported moderate to vigorous physical activity was high (median 85 min/day). However, objectively measured physical activity among a subgroup of participants was lower (median 15 min/day). CONCLUSIONS Weight loss among obese black women has received inadequate attention in relation to the magnitude of the problem. Factors that contribute to successful weight loss and more importantly, weight loss maintenance need to be identified.

The 18-Month Impact of Special Supplemental Nutrition Program for Women, Infants, and Children Food Package Revisions on Diets of Recipient Families

BACKGROUND Beginning in 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) revised its food packages and provided more whole grains, fruits, and vegetables and fewer foods with high saturated fat content. However, knowledge of the impact of this policy shift on the diets of WIC participants remains limited. PURPOSE To examine the longer-term impact of the 2009 WIC food package change on nutrient and food group intake and overall diet quality among African American and Hispanic WIC child participants and their mothers/caregivers. METHODS In this natural experiment, 24-hour dietary recalls were collected in the summer of 2009, immediately before WIC food package revisions occurred in Chicago IL and at 18 months following the food package change (winter/spring 2011). Generalized estimating equation models were used to compare dietary intake at these two time points. Data were analyzed in July 2013. RESULTS Eighteen months following the WIC food package revisions, significant decreases in total fat (p=0.002) and saturated fat (p=0.0004) and increases in dietary fiber (p=0.03) and overall diet quality (p=0.02) were observed among Hispanic children only. No significant changes in nutrient intake or diet quality were observed for any other group. The prevalence of reduced-fat milk intake significantly increased for African American and Hispanic children, whereas the prevalence of whole milk intake significantly decreased for all groups. CONCLUSIONS Positive dietary changes were observed at 18 months post policy implementation, with the effects most pronounced among Hispanic children.

Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results

INTRODUCTION The preschool years provide a unique window of opportunity to intervene on obesity-related lifestyle risk factors during the formative years of a childs life. The purpose of this study was to assess the impact of a preschool-based obesity prevention effectiveness trial at 1-year follow-up. DESIGN RCT. SETTINGS/PARTICIPANTS Primarily African American children (aged 3-5 years, N=618) attending Head Start preschool programs administered by Chicago Public Schools. METHODS Eighteen preschools were randomly assigned in 2007-2008 to receive either (1) a 14-week teacher-delivered intervention focused on healthy lifestyle behaviors or (2) a 14-week teacher-delivered general health curriculum (control group). MAIN OUTCOME MEASURES The primary outcome, BMI, was measured at baseline, postintervention, and 1-year follow-up. Diet and screen time behaviors were also assessed at these time points. Multilevel mixed effects models were used to test for between-group differences. Data were analyzed in 2014. RESULTS Significant between-group differences were observed in diet, but not in BMI z-score or screen time at 1-year follow-up. Diet differences favored the intervention arm over controls in overall diet quality (p=0.02) and in subcomponents of diet quality, as measured by the Healthy Eating Index-2005, and in fruit intake (servings/day, excludes juice) (p=0.02). Diet quality worsened more among controls than the intervention group at 1-year follow-up. CONCLUSIONS The adaptation of Hip-Hop to Health Jr. produced modest benefits in diet quality but did not significantly impact weight gain trajectory. Not unlike other effectiveness trials, this real-world version delivered by Head Start teachers produced fewer benefits than the more rigorous efficacy trial. It is important to understand and build upon the lessons learned from these types of trials so that we can design, implement, and disseminate successful evidence-based programs more widely and effectively. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00241878.