Preventing Weight Gain and Obesity: Indirect Effects of a Family-Based Intervention in Early Childhood

Introduction: There is increasing recognition that strategies for the prevention of pediatric obesity that involve the family, particularly the parents, are preferred but empirical support for the family’s role is lacking. The mechanisms of family-based programs are thought to be parent support of dietary habit change and increased physical activity levels, but the broad parent behaviors linked to these two dimensions of weight gain in childhood are not well established. Empirically linking broad parenting practices to obesogenic behaviors is critical for the development of effective family-based obesity prevention programs. This study evaluated the effects of an evidence-based parenting intervention, the Family Check-Up (FCU), on the trajectory of children’s weight gain from toddlerhood into late childhood. As obesity and weight gain were not an explicit target of this trial, we hypothesized that intervention effects would be mediated by changes in parenting practices, specifically positive behavior support (PBS) and its relationship with the nutritional quality of meals served to the child.

Methods: 731 indigent caregiver-child dyads from a multisite randomized intervention trial of the FCU were examined. Observational assessment of parenting and mealtime behaviors occurred from age 2 to 5. PBS was assessed observationally at ages 2 and 3. During home-based observational assessments, families completed a meal preparation task. Coders rated the nutritional quality of the food items served to the child on a 9-point Likert scale (1 = not at all nutritious, 9 = very nutritious). The child’s BMI was assessed yearly from age 5 to 9. World Health Organization reference data was used to create z-scores of BMI based on gender and age.

Results: Path analysis using a latent growth model revealed a significant indirect effect of the FCU on the trajectory of BMI in late childhood (β = .012, SE = .00). Intervention effects on caregivers’ PBS in toddlerhood and its relationship with the nutritional quality of the meals served to the child, functioned as the intervening process. The model provided good fit to the data: χ²(60) = 121.55, CFI = .956, RMSEA = .042, SRMR = .040. Additional analyses of changes in weight status supported the findings of the path model.

Conclusion: The findings add to the growing evidence demonstrating that family-based programs that target general positive parenting practices are effective at preventing weight gain. We also identified a salient parenting behavior that is amenable to change that is linked to growth in children’s weight. These results will inform an evidence-based approach to adapting the FCU to explicitly prevent pediatric obesity in conjunction with medical treatment.