Fit Families Wisconsin: Results from Eight Years of Family-Focused Public Health Nutrition Programming

Introduction: In Wisconsin, nearly 15% of children have obesity (Joyner, et al., 2018). Among strategies to prevent this epidemic are family-based interventions. Fit Families is a 13-month nutrition program funded by SNAP-Ed and targeted at children aged 2 to 4 years. Families receive in-person and phone counseling from dietitians. The program is guided by three core messages: engage in play and physical activity for at least 60 minutes/day and reduce screen time; eat the recommended daily amount of fruits and vegetables; and reduce or eliminate the use of sugar-sweetened beverages. The purpose of this presentation is to summarize the reach and dose of the Fit Families program from 2010 to 2017, and to describe changes in children’s dietary behaviors and body mass index in the most recent cohort of Fit Families.

Methods: Using a prospective, short-term longitudinal design, children and their caregivers were enrolled in Fit Families at Wisconsin WIC centers, Head Starts, and other childcare centers from 2010 to 2017. At enrollment and the 13-month discharge, children’s height and weight were recorded and caregivers reported on children’s: a) 8oz servings of sweetened beverages/week, b) ½ cup servings of fruits/vegetables eaten/day, c) number of hours of screen time/day, and d) minutes of activity/day. Caregivers chose a goal related to one or more of the three core Fit Families messages and counselors set strategies to meet that goal. Families received three face-to-face counseling sessions at months 4, 7, and 10, and telephone or email contacts at months 2, 3, 5, 6, 8, 9, 11, and 12.

Results: From 2010 to 2017, 12,789 children enrolled or re-enrolled in Fit Families. Annually, on average, 1,042 children enrolled and 730 continued Fit Families from the previous year, with enrollment increasing yearly. Each year, approximately 15% of children were terminated due to inability to remain in contact. From 2010 to 2017, 71% of families received 10 or more sessions, 29% received 5 to 9 sessions, and < 1% received 2 to 4. In 2017, 33 sites offered Fit Families serving 2,782 children. From enrollment to discharge, the percent of children who ate at least 4 servings of fruits and vegetables per day significantly increased from 30.2% to 40.8%, p<.001. During this period, there was a significant decrease in caregiver-reported screen time, from 1.85 to 1.72 hours/day, p<.001. Children’s sweetened beverage intake decreased, although not significantly. Finally, children’s BMI (presented here as z-score) increased from month 1 (M=0.66, SD=1.29) to month 13 (M=0.72, SD=1.26), t(847)=-2.94, p=.003, d=0.05. However, for children whose BMI percentile was ≥ 85% at month 1, BMI significantly decreased from enrollment (M=1.99, SD =0.91) to discharge (M=1.87, SD=1.03), t(292)=2.91, p=.004, d=.12, although the effect was small.

Conclusions: Fit Families is a direct education program targeting low-income families with young children. Initial analyses from an eight-year evaluation revealed that enrollment continued to increase annually and that most families received the intended dose of programming. Caregivers reported significant changes in some of children’s dietary and health-related behaviors, including fruit and vegetable intake and screen time exposure.