Friday 11 January 2013

Home visits by nurse reduce childhood obesity




                Image source: cliff1066 - cc

Obesity is a growing epidemic associated with a large number of medical conditions, resulting in significant impact on quality and quantity of life, and also health care cost.

The combat against obesity should start from childhood. Studies have demonstrated that excess weight and fast weight gain in early childhood are related to overweight later in life.

Amongst the various strategies of reducing childhood obesity, LM Wen, VM Flood and
coauthors have described another effect approach, as outlined in their article published in BMJ June 26 2012 (BMJ 2012;344:e3732)


  • Randomized controlled trial
  • Participants from antenatal clinics in Sydney, Australia. 2007-2010
    • Age 16 years or older (mean age 26yo, age range 16-47 yo)
    • First time mother, English-speaking
    • 24-34 weeks gestation
  • 667 women
    • 337 randomly allocated to home based early intervention
    • 330 randomly allocated to control group
  • Intervention
    • Promote breast-feeding, "tummy time", active play, appropriate introduction of solid foods, family nutrition and physical activity
    • Description of program and resources can be found here
    • 8 home visits (1-2 hours each) from trained community nurses to mothers 30-36 weeks pregnant, and at children's ages of 1, 3, 5, 9, 12, 18, and 24 months
  • 6 month outcome from telephone interview
  • 12 month outcome from home visit


RESULTS

  • Children in the intervention group vs those in the control group showed the following improvements in behaviors regarding nutrition and activity:
    • Eating at least 1 serving of vegetables per day (89% vs 83%; P = 0.03)
    • Receiving food as reward (62% vs 72%; P = 0.03)
    • Watching TV during meal (66% vs 76%; P = 0.02)
    • Eating dinner in front of television (56% vs 68%; P = 0.01)
    • Watching TV more than 60 minutes per day (14% vs 22%; P = 0.02)
  • Mean BMI at age 2 years was lower in the intervention group vs the control group (16.53 vs 16.82 kg/m2; Difference of 0.29 kg/m2; P = 0.04).


  • Mothers in the intervention group vs those in the control group showed the following improvements in behaviors regarding nutrition and activity:
    • Eating more than 2 servings of vegetables per day (52% vs 36%; P < 0.001)
    • Eating processed meat 3 or more times per week (20% vs 28%; P = 0.03)
    • Engaging in physical activity for 150 minutes or more per week (48% vs 38%; P = 0.04)



Therefore home based early intervention has the following benefits:

  • Children
    • More likely to eat at least 1 serving of vegetables per day.
    • Less likely to receive food as reward, watch TV during meal, eat dinner in front of TV, watch TV more than 60 minutes per day.
    • Lower BMI (Body Mass Index)
  • Mother
    • More likely to eat more than 2 servings of vegetables per day, and engage in physical activity for 150 minutes or more per week
    • Less likely to eat processed meat 3 or more times per week


Summary: Home visit by trained nurse during the late pregnancy and early childhood period has the benefit of promoting healthier eating in children and mother, as well as reducing childhood obesity.


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