Ecological Characteristics of Families in a Trial to Prevent Excess Weight Gain: A Latent Profile Analysis​

Introduction: The increasing prevalence of extreme BMI in childhood, classified as ≥120% of the 95%ile of BMI for age and gender, poses dangers to children’s health in the short and long-term. Children with extreme BMI are at the highest risk for obesity-associated health issues such as hypertension, obstructive sleep apnea, and nonalcoholic fatty liver disease. Despite the health risks of extreme BMI, little is known about the individual, interpersonal, and socio-environmental factors that distinguish this group from children who are overweight/obese but not extreme BMI. This knowledge could assist providers and programs in preventing the development of health problems associated with obesity later in childhood and adulthood.

Methods: We examined 215 children ages 5 to 13 with BMI ≥85^th percentile, and their caregiver(s) participating in a randomized trial of the Family Check-Up 4 Health (FCU4Health) program for prevention of excess weight gain. Baseline surveys were used to measure caregiver report of: Parent Health Behaviors, Proactive Parenting, Limit Setting, Family Media Routines, Family Sleep Routines, Family Mealtime Routines, Child Physical Activity Habits, Child Eating Behaviors, and Child Food and Beverage Choices. Latent profile analysis was used to test whether distinct profiles existed. We hypothesized that profiles would be differentiated based on child %>95%ile and that other variables would follow in the expected direction.

Results: A three-class model with an entropy of 0.79 was selected based on conceptual interpretation as well as fit statistics compared to models with 2 and 4 classes. The analysis revealed three profiles. These were distinguished as hypothesized by child %>95%ile: high BMI (34%), higher BMI (35%), and highest BMI (31%). Further, the classes were differentiated from each other based on child physical activity levels, child eating behaviors, and family sleep, media, and mealtime routines. Children in the highest BMI class experienced lower levels of parent limit setting; loose household structure related to media, mealtime, and sleep routines; and had poorer diet, eating behaviors, and physical activity levels compared to the high and higher BMI classes. Children with high BMI had higher proactive parenting, better structured home environments, and better parent health behaviors compared to other classes. Class membership was unrelated to age, gender, minority status, and education.

Conclusions: Distinct profiles related to weight, health behaviors, and home environment existed among this largely homogenous sample of children with overweight/obesity, emphasizing the importance of tailoring interventions accordingly to engage parents in child health promoting behaviors and establishing household routines.