Sarah Friend

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.

Reasons Parents Buy Prepackaged, Processed Meals: It Is More Complicated Than “I Don't Have Time”

Objective: To investigate reasons why parents purchase prepackaged, processed meals and associations with parental cooking self‐efficacy, meal‐planning ability, and home food availability. Methods: This secondary data analysis uses Healthy Home Offerings via the Mealtime Environment Plus study data from parents of children aged 8–12 years (n = 160). Associations between reasons why parents purchase prepackaged, processed meals and the outcomes were assessed with chi‐square, Fisher exact, and t tests. Results: The most frequently endorsed reasons for purchasing prepackaged, processed meals included lack of time (57%) and family preferences (49%). Five of 6 reasons were associated with lower parental cooking self‐efficacy and meal‐planning ability. Some reasons were associated with less‐healthful home food environments; few reasons varied by socio‐demographic characteristics. Conclusions and Implications: Because lower cooking self‐efficacy and meal‐planning ability are associated with most reasons reported for purchasing prepackaged, processed meals, strategies to increase these attributes for parents of all backgrounds may reduce reliance on prepackaged processed meals for family mealtimes.

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.

Ethnic variation in body composition assessment in a sample of adolescent girls

OBJECTIVE To compare body composition assessment by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in a multiethnic sample of adolescent girls. METHOD Data were from a physical activity intervention study among 254 14-20-year-old sedentary American girls, including 69 whites, 74 blacks, 42 Hispanics, and 69 Asians. Height and weight were objectively measured. Body composition was assessed using a foot-to-foot BIA and a fan-beam DXA. We calculated ethnic-specific estimates of percentage body fat (BF%), fat mass (FM), fat mass index (FMI), fat-free mass (FFM), and fat-free mass index (FFMI) from BIA and DXA. We used Bland-Altman plots to examine ethnic-specific agreement between BIA and DXA, and used linear regression to test whether the BIA-DXA difference varied across the mean. RESULTS Compared to DXA, BIA estimates of fat measures (BF%, FM, and FMI) were lower and lean tissue measures (FFM and FFMI) higher. For example, the BIA-estimated BF% was lower than the DXA estimate by between 4.9% (95% CI: -5.9, -3.9) in blacks and 8.7% (-7.0, -5.0) in Asians, with large limits of agreement (-15.4 to -5.4 in blacks and -16.8 to -0.4 in Asians). Regression analysis showed that BIA-DXA differences were not constant across means for any body composition measure among Asians or for any measure except BF% among whites. CONCLUSION Compared to DXA, BIA yielded lower estimates of adiposity in a multiethnic adolescent sample. BIA-DXA differences varied by ethnicity, and across mean body composition values for some ethnicities.

Body fat is differentially related to body mass index in U.S.-born African-American and East African immigrant girls

To examine ethnic differences in adiposity at a given body mass index (BMI) in a sample of U.S.‐born African‐American and East African immigrant adolescent girls.

An Exploration of How Family Dinners Are Served and How Service Style Is Associated With Dietary and Weight Outcomes in Children

Objective: To explore how families serve meals and how different service styles are associated with responsive feeding and child dietary and weight outcomes. Methods: Baseline data from a subset (n = 75) of randomized controlled trial participants (Healthy Home Offerings via the Mealtime Environment (HOME) Plus study, aged 8–12 years) were analyzed using a series of linear regression models. Adjusted means (95% confidence intervals) and beta coefficients (SEs) are presented. Results: Families were most likely to report plated meal service (36% of families), followed by family‐style (29%). Family‐style was significantly associated with a lower mean level of food restriction (P = .01). No significant associations were observed between style of meal service and child outcomes (all P > .05). Conclusions and Implications: Although plated meal service may seem like a desirable strategy for ensuring that children eat a healthier diet, the current results did not provide support for this association. Evidence was found to support the use of family‐style meal service to promote the use of responsive feeding.

Family dinner frequency interacts with dinnertime context in associations with child and parent BMI outcomes

For youth and parents, frequent family meals have been consistently associated with positive dietary outcomes but less consistently associated with lower body mass index (BMI). Researchers have speculated dinnertime context (dinnertime routines, parent dinnertime media use) may interact with family meal frequency to impact associations with BMI. The present study evaluates the associations and interactions between dinnertime context measures and family dinner frequency with parent and child BMI. This cross-sectional study uses baseline data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus randomized control trial that aimed to prevent childhood obesity. Participants (160 parent–child dyads) completed psychosocial surveys and were measured for height and weight. General linear models tested associations and interactions between dinnertime context measures and family dinner frequency with parent and child BMI, adjusted for race and economic assistance. Lower parent dinnertime media use and higher dinnertime routines were significantly associated with lower child BMI z scores but not parent BMI scores. Interaction–moderation findings suggest higher family dinner frequency amplifies the healthful impact of the dinnertime context on child BMI z scores. Additionally, findings emphasize that promoting frequent family meals along with consistent routines and reduction in parent dinnertime media use may be important for the prevention of childhood obesity.