An obesity-prevention programme for preschoolers based around minimal changes to the day care environment led to small but significant differences in how often kids asked to play outside and how much TV they watched, in a new study.
"We wanted to change the home environment without going to the home environment," said Dr Tanis Hastmann, who led the research at Oakland University in Rochester, Michigan.
"The primary aim was to teach children to pester their parents for healthy foods and physical activities and to learn what an advertisement was," she told Reuters Health.
Dr Hastmann presented the findings at the American College of Sports Medicine's annual meeting in San Francisco.
BMI did not change
For the so-called HOP'N Home Project, Dr Hastmann and her colleagues trained day care providers to add a few songs promoting nutrition and healthy behaviours to group time each week. They also set up play stations that encouraged kids to pick out healthy food at the grocery store and buy active toys at the toy store and exposed them to fake TV ads.
Over the 12-week intervention, the researchers met with teachers three times to discuss programme strategies and barriers, but never went directly to children's homes.
Findings presented at the ACSM meeting came from two studies: in one, two child care classrooms were randomized to the programme or a control (n=22; mean age, 3.5); in the other, two child care homes and two centres all received the intervention, and changes in kids' behaviour was tracked over time (n=50; mean age, 4.1).
Body mass index did not change over the 12 weeks in either study.
Home environments hard to modify
But in the first study, HOP'N Home preschoolers increased the number of times they asked to play outside per week, compared to controls (p<0.05). In the second, kids increased their number of park visits per week, from 1.0 to 1.76 visits (p=0.013) and decreased their daily screen time, from 150.6 to 129.4 minutes (p=0.035), based on parent surveys.
"I like the idea. I think that the finding that children this young, three and four years old, could influence practices and health behaviours in their parents and their home environments is promising," said Dr Pooja Tandon, a paediatrician from the University of Washington in Seattle who wasn't involved in the new study.
"Home environments are hard to modify, for so many different reasons. But if the child themselves can institute or stimulate that change, it's worth pursuing," she told Reuters Health.
However, Dr Tandon wondered how long the effects of a 12-week programme would last if healthy eating and physical activity messages weren't being continuously reinforced.
Dr Hastmann said changing some of the foods offered at the day care centres or getting parents more involved may be a way to promote lasting effects, though she added that almost 80% of parents said they made changes in the home during the programme and 90% liked it.
Address obesity across all areas
She concluded, "I think it's going to have to be a little more intensive to see some of the longer-term (benefits)."
Neither of the researchers was surprised that there was no change in BMI after just 12 weeks.
Dr Sabina Gesell, a paediatrics obesity researcher from Vanderbilt University in Nashville, emphasised the importance of heading-off obesity very early in life to prevent more problems down the road.
"The idea of targeting children where they learn, play, and live is spot on – we need to address obesity-promoting behaviours across all areas of a child's life in order to have the desired impact," she told Reuters Health in an email.
"We know it takes time for BMI to change, so changing health behaviours is critical."
(Genevra Pittman, Reuters Health, June 2012)
Preschoolers' diet in the spotlight