Interventions Can Combat Obesity in Low-Income Children, but Barriers Affect Results

Results from interventions to fight obesity among low-income children in Massachusetts show they can work, but it’s an uphill battle. Everything from economic downturns to staff disruptions can set back the cause.

Still, success is possible with efforts that reach low-income children early and use team approaches to target not only health metrics but also behavior, according to a trio of papers published this week in the journal Obesity.

Taken together, the papers on the Massachusetts Childhood Obesity Research Demonstration, known as MA-CORD, show that the battle against obesity will require intense, sustained commitment, but that efforts pay off.

Overall, childhood obesity appears to be leveling off among the youngest children after steadily rising for 30 years. However, this progress is not equal—the nation’s poor remain hard hit by the crisis, and it is here that sustained efforts are needed to prevent an ongoing intergenerational crisis of obesity, along with diabetes, cardiovascular disease, and disability. MA-CORD sought to leverage contact with at-risk children with a Special Supplemental Nutrition Program for those enrolled in the Women, Infants and Children (WIC) Program.

“This study is one of the first to incorporate WIC into a whole-of-community intervention, which resulted in reduced prevalence of childhood obesity risk factors,” said Jennifer A. Woo Baidal, MD, MPH, assistant professor of pediatrics at Columbia University Medical Center, New York Presbyterian Morgan Stanley Children’s Hospital.

One part of the effort engaged families seeking care at federally qualified health centers (FQHCs) to improve weight and behavior scores for the youngest children (those ages 2-4 years old), while another effort focused on school-age children.

Here is what the results showed:

• Baidal implemented practice changes in WIC at 2 Massachusetts sites, using another WIC program as a comparison. After a follow-up of 2 years, results showed that the children in intervention sites drank less in sugar-sweetened beverages and had better sleep duration. Overall, there was no improvement in body mass index (BMI) scores; however, there was a small decline in BMI scores in the intervention group once researchers performed analyses excluding Asian children.¹
• In a study led by Elsie A. Taveras, MD, MPH, researchers studied the effects of a multi-part initiative at FQHCs, which featured pediatric weight management training, electronic decision support for clinicians, healthy weight clinics, and an integration of community health workers. Another demographically matched FQHC served as a comparison. Researchers used electronic health records to measure BMI scores over 2 years, and found that 1 of the intervention sites had a significant BMI decline relative to the comparison site. The other, which had several disruptions that affected early program implementation, did not see a difference.²
• An intervention with school-age children in the same communities, which focused particularly on seventh graders, found declines in obesity in both. However, the decline was significant in 1 community, and was not significant in the other.³

References

1. Woo Baidal JA, Nelson CC, Perkins M, et al. Childhood obesity prevention in the Women, Infants, and Children Program: outcome of MA-CORD study. Obesity. 2017;25(7):1167-1174. doi:10.1002/oby.21865.

2. Taveras EM, Perkins M, Anand S, et al. Clinical effectiveness of the Massachusetts Childhood Obesity Research Demonstration initiative among low-income children. Obesity. 2017;25(7):1159-1166. doi:10.1002/oby21866.

3. Franckle RL, Fable J, Gortmaker S, et al. Student obesity and behavioral outcomes for the Massachusetts Childhood Obesity Research Demonstration project. Obesity. 2017;25(7):1175-1182. doi:1002/oby.21867.