Healthy Weight, Nutrition and Physical Fitness

 

Developing a healthy lifestyle, including optimal diet and physical activity, is established in utero and further developed through infancy and childhood. A key to maintaining and improving the health of children in RI is identifying and intervening with mothers, maternal-child dyads, and families over the course of development. Rhode Island offers a unique and resource-rich environment for developing and implementing programs to both prevent and treat the problem of obesity in children.  Proximity to healthcare and community settings, the geographic stability of the population, and rich academic and medical collaborations  combine to make this an optimal setting for program develop.  We will be conducting three studies that will collectively make a significant contribution to the science of obesity treatment and prevention. 

Healthy Eating and Physical Activity during the Summer

The first study is designed to test an intervention to prevent excess summer weight gain among children between the ages of 6 and 12 years living in under-served communities.  An emerging body of evidence documents that children are at greatest risk for decreased involvement in physical activity and weight gain during the summer months. We are developing and testing a novel community-based program to increase participation in physical activity, access to healthy food choices, and decrease weight gain among elementary school children living in two urban ethnically diverse Rhode Island communities.  Through an iterative process over the course of three summers, we will successively offer programming that targets: access to healthy lunch through the Summer Food Service Program, on-site physical activity, high school and college student counselors who serve as role models for healthy behavior, and farmer’s markets with associated educational and experiential opportunities for caregivers.   At the time of enrollment, we will measure children’s height and weight, and collect one week assessment of dietary intake, participation in moderate-to-vigorous physical activity, and sedentary behavior.  The same domains will be re-evaluated at the completion of the summer program, immediately preceding the start of the school year.  Children in intervention communities will be compared to those from a comparison group from similar sociodeomographic background.

Maternal and Newborn Health and Wellbeing

The second study tests an intervention designed to support postpartum weight loss and prevention of excess weight gain during infancy. This project will leverage the unique opportunities offered by the birth cohort study to identify women who are overweight/obese at the onset of pregnancy. Findings from multiple studies converge to suggest that parental obesity is a readily identifiable risk factor for obesity risk in children. Over the course of three years, we will identify a sample of 240 women who are overweight or obese as defined by their prenatal BMI. Women will be randomly assigned to a program that focuses on achieving a healthier weight for themselves and preventing the development of obesity in their babies.  The intervention will target established and novel domains that have been associated with excess weight gain during infancy and early childhood, including breastfeeding, delaying introduction of solid foods, providing exposure to a range of vegetables and fruits at an early age to promote taste preferences and consumption, and enriching the home environment through exposure to books and music. Content will be delivered in the homes of participants and supplemented with schedule telephone contact. Participants randomized to the comparison condition will similarly receive home-based visits. However, the content of these sessions will focus on information related to a topic unrelated to obesity prevention – i.e. infant safety.  Infants and their caregivers will be weighed and measured at 6, 12, and 24 months to provide information regarding the impact of the intervention on weight status.

Treatment of Overweight Children Identified through Primary Care 

The third study leverages electronic medical records to identify and intervene with children of healthy weight who demonstrate periods of excess weight gain.  While primary care physicians have become more vigilant about identifying children who are gaining excess weight, the rate at which these children are referred to appropriate services or counseled regarding weight control is alarming low. This pattern is of particular relevance for children who are overweight (i.e. BMI >85th%) but not yet obese (BMI>95th%), for whom effective intervention would serve to prevent the negative health consequences associated with obesity. We propose to use EMR to identify children between the ages of 6-12 years with BMIs > 85th% and < 95th% seen in the primary care pediatric clinics at Hasbro Children’s Hospital and offer them a brief intervention. Given the challenges and relative lack of knowledge regarding intervention with this group, we will conduct a series of qualitative studies to refine the content of the intervention and determine preferred modality of treatment delivery – e.g. web-based, telephonic, in-person. These studies will include focus groups conducted with pediatricians, parents of children in the targeted age and weight group, and children themselves. Once the intervention components and modality have been finalized, families will be randomly assigned to receive either the newly developed treatment or usual care through their pediatrician. The primary outcome will be changes in BMI in the intervention condition compared to usual care.

 

Contacts:
Rena Wing, Ph.D., Professor of Psychiatry & Human Behavior; Director, Weight Control & Diabetes Research Center
RWing@lifespan.org

Elissa Jelalian, Ph.D., Associate Professor of Psychiatry & Human Behavior and Pediatrics
​Elissa_Jelalian@brown.edu

 

Current studies:

Preventing Excessive Gestational Weight Gain in Obese Women
This study is testing a novel intervention to help obese women gain the recommended amount of weight during their pregnancy.

Mealtime Interactions and Risk of Obesity in Toddlers
The focus of this work is examining the association between caregiver-toddler mealtime interactions and subsequent weight trajectories in children.

TEEN JOIN: A Scalable Weight Control Intervention for Adolescents
The purpose of this study is to examine the effectiveness of a teen weight control program delivered through the YMCA.

Asthma and Physical Activity in Urban children: Cultural and Contextual Factors
The goal of this study is to examine the co-occurrence of asthma, allergic rhinitis status, physical activity, as well as sedentary behavior in a group of urban, elementary school children.

Prevention of Gestational Diabetes through Lifestyle Modification before Pregnancy
This study tests a model of preventing gestational diabetes by addressing weight control and lifestyle behaviors prior to pregnancy.