Results of a community pilot intervention to prevent obesity beginning in infancy

Obesity has early antecedents. Food and physical activity preferences in children occur early, but few studies have explored ways to prevent obesity beginning in infancy. TOTS was a community-partnered study to test an intervention to prevent obesity in AI children beginning at birth. TOTS compared a community-wide intervention (CW) to a similar approach (CW+F) supplemented with family interventions delivered by lay health workers (LHW) through home visits. 205 women were enrolled before their infants were born. Tribe X (n=63 children) received the CW intervention and tribes Y&Z (n=142 children) received the CW+F intervention. CW interventions were designed to raise awareness, change public health practice, tribal policy, provide health education and change environments associated with breastfeeding, sugared beverages, and water consumption. LHW delivered interventions through 7 home visits. They were trained to use principles of behavior change including motivational interviewing and goal setting to help families increase breastfeeding, reduce the consumption of sugared beverages, and choose water as an alternative to the sugared beverages. Change in BMI Z scores (new WHO standards) from birth to 24 months was estimated for each tribe using matched children from the pediatric nutrition surveillance system to adjust for secular trends. BMI Z-scores at 24 months of age increased in all tribes, but the increase was less in CW+F tribes. Differences in height and weight for age were not significant. Results suggest that outreach techniques of using LHW and interventions that target simple behaviors can mitigate rapid increases in BMI without compromising growth in AI toddlers.