A Pilot Health Promotion Program to Prevent Childhood Obesity in Head Start Children

 

 

Betty M. Kennedy

The Pennington Biomedical Research Center

 

Fatemeh Malekian

Southern University Agricultural Research

and Extension Center

 

& Mavis Henderson-Lewis

La Capitale of The Links, Inc.

 

 

ABSTRACT

The purpose of this three-month pilot health promotion program was to increase awareness through education and demonstration of the importance of healthy eating including consumption of fruits and vegetables and physical activity that may be utilized to prevent weight gain and maintain weight in African American parents/caregivers of children enrolled in a local head start center. During the course of three months, a total of 35 parents/caregivers of children 3 to 5 years of age participated in the program. Though preliminary, this pilot health promotion program was received favorably by parents/caregivers, children, and administrators within this head start center and may serve as a bridge for future funding of a considerably longer and larger scale intervention.

 

 

INTRODUCTION

 

A child has an 80% chance of being obese when both his or her parents are obese and a 40% chance when only one of his or her parents are obese (Eck, Klesges, Hanson, & Slawson, 1992). Obesity has been shown to track from childhood into adulthood (Dietz, 1998; Hood, Moore, Sundarajan-Ramamurti et al., 2000). Children who are overweight between the ages of 1 and 6 years have 2 times the odds of becoming obese (Dietz, 1998). Data from numerous sources demonstrate the efficacy of increased fruit and vegetable consumption in the management of overweight, cardiovascular disease, diabetes, and other chronic disorders (Ogden, Flegal, Carroll et al., 2002; Kennedy, Champagne, Ryan et al., 2009). Learning about appropriate eating (such as what, when, and how much) begins when a child starts to consume adult foods and to imitate parental eating habits (Chou, Grossman, & Saffer, 2004; Cutler, Glaeser, & Shapiro, 2003; Kinther, Boss, & Johnson, 1981; Sims, Paolucci, & Morris, 1972. Thus, parents/caregivers play a major role in influencing the lifestyle and eating habits of their children as they continue into adulthood. Because parents/caregivers provide a child’s contextual environment, they are considered key players in programs aimed at preventing weight gain in children.

 

From inception (1946) of The Links Incorporated, the organization has addressed its community service with a threefold purpose in the areas of education, civic, and intercultural commitment using program facets. These program facets consisted of Services to Youth, National Trends and Services, International Trends and Services, and The Arts. Their philosophy suggests that a conscious effort be made to improve the health status of all Americans—women, men, children, and youth. Emphasis is therefore focused on wellness of body, mind and spirit, and individual, family, and community. As a result, a representative (M.H.L.) from La Capitale of The Links, Inc. contacted researchers (B.M.K. and F.M.) from the Pennington Biomedical Research Center and Southern University Agricultural Research and Extension Center respectively, to conduct a small pilot health promotion program to combat childhood obesity as part of the Links national initiative.

 

The program was designed for parents/caregivers of children ages 3 to 5 years old currently enrolled in head start. The purpose of this three-month pilot health promotion program was to increase awareness through education and demonstration of the importance of healthy eating including consumption of fruits and vegetables and physical activity that may be utilized to prevent weight gain and maintain weight in African American parents/caregivers of children enrolled in a head start center.

 

METHODS

 

Participant Recruitment

 

Parents/caregivers were recruited following a presentation about the health promotion program during a Parent Involvement meeting held at the head start center. The Parent Involvement meeting was held two weeks prior to the health promotion program. Participation in the program was strictly voluntary, and returning the completed initial screening form and questionnaire implied consent.  Parents/caregivers were assured that responses to the questionnaire and initial screening form would be stored in a locked filing cabinet under the researcher’s control and that the information would not be used for any purpose except for this health promotion program. Parents/caregivers returned completed forms prior to the start of the first health promotion event.

 

Program Procedures

 

The program was conducted at a local head start center in East Baton Rouge (EBR) Parish Louisiana.  One hundred and sixty initial screening forms along with instructions were provided to the head start center’s director to distribute to parents/caregivers of children (105 girls, 95 boys) willing to participate in the program. The researchers provided and administered an initial screening form for collecting demographic information. For pretesting, two questions were taken from the Caregivers Attitudes & Childhood Obesity (CACO) questionnaire (Southern University AgCenter, 2006) designed for children ages 1-5 years old. The questions were: “approximately how many servings of fruit do you eat daily; and approximately how many servings of vegetables do you eat daily?” At the conclusion of the health promotion program, a post-test utilizing these same questions plus one additional question, “did you learn something new as a result of this health promotion program,” was asked to determine the feasibility of the program. The health promotion program included: 1) An Obesity and Communication Skills Workshop sponsored by Services to Youth, 2) “Healthy Start at Head Start” (International Child Health Bazaar) sponsored by International Trends, and 3) Cooking Demonstrations sponsored by National Trends and The Arts—all of La Capitale of The Links, Inc.

 

For all three health promotion events, parents/caregivers were assembled together in the cafeteria of the head start center with displays of fresh fruits, vegetables, grains, oils, milk, meat and beans as listed on the food pyramid guide. An overview on obesity was presented by (BMK) while displaying the Body Mass Index (BMI) chart with weight in pounds and height in feet and inches for participants to view and determine if they were under weight, at an acceptable weight, or overweight. The BMI chart also provided the opportunity to determine if participants were at low, moderate, high, or very high risk of developing certain chronic diseases as a result of being obese [BMI > 30 k/m2] (Kennedy, Paeratakul, Champagne et al, 2005). A closer look at MyPyramid for Kids (MyPyramid.gov) was presented by (FM) to help educate and guide parents/caregivers on healthy eating and becoming more physically active. Students majoring in Kinesiology or some form of Physical Education from both Louisiana State University and Southern University and A&M College provided guidance and conducted physical activity with the children and parents/caregivers on the playground of the head start center at each health promotion event.

          

Ten tips on how to “be a healthy role model for children” was distributed to parents/caregivers to set good examples for their children to develop a healthier lifestyle (MyPyramid.gov). Some of the ten tips included 1) show by example (eat fruits, vegetables, and whole grains with meals or as snacks; 2) go food shopping together (grocery shopping can teach your child about food and nutrition; and 3) get creative in the kitchen (cut food into fun and easy shapes with cookie cutters). At the end of the Obesity and Communication Skills Workshop, the Services to Youth Facet provided a healthy lunch to include one half of a small turkey Subway sandwich, fruits (apple, banana, orange), and bottled water.

 

The second health promotion event, “Healthy Start at Head Start” conducted by the International Trends Facet—provided an opportunity for parents/caregivers to taste healthy snacks as demonstrated by the aforementioned researchers. A trail mix consisting of whole grain cereal, fresh/dried fruits, and nuts were combined for a healthy snack for parents/caregivers, and especially the children. Peanuts were not used in the demonstrations due to allergies experienced by some. In addition, an Aztec salad with multi-grain baked Tostitos chips was provided along with the caloric break-down for parents/caregivers and children to taste and prepare at home for the entire family.

 

The third and final health promotion event consisted of healthy cooking as conducted by National Trends and the Arts Facet. An assortment of fresh vegetables were stir fried by (BMK) and consisted of broccoli, cauliflower, yellow onions, green/red/yellow bell peppers, carrots, and green cabbage in a large Wok. Pre-seasoned shrimp and/or boneless chicken were used to flavor the vegetables that were served on top of selected pasta (Penne, Bow Tie, etc.). In addition, a salad was prepared with shredded lettuce as the base for placing cucumbers, tomatoes, broccoli, cauliflower, red onions, and yellow squash marinated overnight in fat-free Italian dressing. Each participant received one half cup serving each of the stir fry and salad. A prepared handout listing the food source of vitamins and benefits were discussed and distributed along with the significance of each. Food safety was discussed by (FM) for the proper way to wash and store fresh fruits and vegetables. Recipes with caloric breakdowns were also provided to everyone participating.

 

Applicable door prizes were provided as incentives to parents/caregivers and children at each health promotional event and included items such as: produce vouchers, coloring books, puzzles and crayons, gift bags and certificates, and a flat screen television.

 

RESULTS

 

A total of 35 adults participated in this health promotion program. Eighty-six percent of parents/caregivers were female and ranged in age from 18-63 years; mean age 35.4. Females had a mean Body Mass Index (BMI) of 25 kg/m2 (range19.1 – 53.1 kg/m2), and the mean BMI for males was 34.4 kg/m2 (range 22.9 – 47.0 kg/m2). Seventy-one percent of females had never been married, 87% and 80% of both female and male parents/caregivers had a family history of high blood pressure and diabetes, respectively.

 

At inception and at the conclusion of the health promotion program, parents and caregivers were asked about the number of servings of fruits and vegetables consumed per day. Fifty-seven percent (n = 20) indicated eating 1-2 servings of fruits and vegetables daily, 31% (n = 11) specified 3-4 servings, and only 12% (n = 4) reported eating the recommended 5 or more servings of fruits and vegetables daily. At the close of the final health promotion event, 74% (n = 26) of parents/caregivers had increased the number of servings of fruits and vegetables to 3-4 consumed per day, and 20% (n = 7) had increased to a consumption of 5 servings or more of the recommended number of fruits and vegetables daily. Finally, 100% of parents/caregivers participating in the health promotion program responded that they learned something new as a result of their participation.

 

DISCUSSION

               

Education on the importance of consuming healthy choices such as fruits and vegetables including cooking and taste testing demonstrations using healthy food choices plus physical activity were favorably received and accepted by parents/caregivers and children attending the health promotional events at this head start center. By the completion of this pilot health promotion program, awareness was likely increased because some parents/caregivers reported an improvement in the daily consumption of fruits and vegetables and that they learned something new. Previous research has shown that providing “free” fruits and vegetables along with increased physical activity to prevent weight gain in African Americans is a feasible approach not only to prevent weight gain, but also to produce weight loss and improvements in eating healthy when combined with an educational component (Kennedy et al., 2009).

         

Although the results from this pilot program are not conclusive due to the length and duration of the three health promotional events, by having more time, using measurable outcomes, using nutrition education components, and conducting cooking and taste testing demonstrations, this may be an effective approach for conducting large scale weight gain prevention interventions focusing on families in the future.

 

REFERENCES

 

Caregivers Attitudes & Childhood Obesity (CACO) Questionnaire Ages 1-5 Years Old (2006). Southern University Agricultural Research & Extension Center.

 

Chou, S.Y., Grossman, M., Saffer, H. (2004). An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System. J Health Econ, 23:565-587.

 

Cutler, D., Glaeser, E., Shapiro, J. (2003). Why Have Americans Become More Obese?  Cambridge, Mass: National Bureau of Economic Research Inc, NBER working paper 9446.

 

Dietz, W.H. (1998). Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics, 101(suppl):S518-S525.

 

Eck, L., Klesges, R., Hanson, C., Slawson, D. (1992). Children at familiar risk for obesity: An  examination of dietary intake, physical activity, and weight status. Int J Obes Rel Metab Diso, 16:71-78.

 

Hood, M., Moore, L., Sundarajan-Ramamurti, A., Singer, M., et al. (2000). Parental eating attitudes and the development of obesity in children. The Framingham Children’s Study. Int J Obes, 24:1319-1325.

 

Kennedy, B.M., Champagne, C.M., Ryan, D.H., Newton, R. Jr., et al. (2009). The “Rolling Store:” An economical and environmental approach to the prevention of weight gain in African American women. Ethn Dis, 19:7-12.

 

Kennedy, B.M., Paeratakul, S., Champagne, C.M., Ryan, D.H., et al. (2005). A pilot church- based weight loss program for African-American adults using church members as health educators: A comparison of individual and group intervention. Ethn Dis, 15:373-378.

 

Kinther, M., Boss, P.G., Johnson, N. (1981). The relationship between dysfunctional family environments and family member food intake. J Marriage Family, 43:633.

 

Ogden, C.L., Flegal, K.M., Carroll, M.D., Johnson, C.L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA, 288:1728-1732.

 

Sims, L.S., Paolucci, B., Morris, P.M. (1972). A theoretical model for the study of nutritional status: An ecosystem approach. Ecol Food Nutr, 1:197.

 

www.MyPyramid.gov (2005). A Close Look at MyPyramid for Kids. Steps to a Healthier You. U.S. Department of Agriculture Food and Nutrition Service, September FNS-388.

 

www.MyPyramid.gov (2009). 10 Tips MyPyramid Nutrition Education Series: Be a healthy role model for children; 10 tips for setting good examples. USDA Center for Nutrition Policy and Promotion, Nutrition TipSheet No. 2, September.

 

ACKNOWLEDGEMENTS

 

The authors thank Dr.’s Peter T. Katzmarzyk (Professor and Associate Director for Population Science and Public Health), and Catherine M. Champagne (Professor and Chief of Nutrition) of the Pennington Biomedical Research Center for allowing the lead author to complete this pilot health promotion program as an Adjunct Faculty member. Thanks to all members of La Capitale of the Links, Inc., including the then President, Luverne Travis, Vice-President, Lorina Turner, Program Chairwoman, Doris Dawson, and Grant Writer/IT Manager, Ashley Shelton. Special thanks to each Facet chairperson and each committee member involved in any aspect of this project. Special thanks to Links Theta Williams, Paula Kraft, Pam Daniel, Clovier Tory, Arminta Bolden, and current President, Jacqui Vines. A very special thanks to the Freeman-Matthews Head Start Center, the then Supervisor (Ms. Kim Baker), Program Administrator (Ms. Rebecca Ferguson), and the Parent Involvement Group. Finally, thanks to all parents/caregivers, and children who participated in this pilot health promotion program.

 

Supported in part by Louisiana State University’s Improving Clinical Outcomes Network (LSU ICON).

 

Supported in part by 1 U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health which funds the Louisiana Clinical and Translational Science Center.