2. Ineffective family interventions for the prevention of childhood obesity
have, in part, been attributed
to the challenges of reaching and engaging parents. With a particular
focus on parent engagement, this study
utilized community-based participatory research to develop and pilot
test a family-centered intervention for low-income families with
preschool-aged children enrolled in Head Start

3. • Two year Pre- Post Cohort Study (119 families)
• Funded by a US federal program “Head Start.”
• All families with a child 2 years or older enrolled in the target Head Start
centers were eligible to participate.
• All analyses were performed using SAS version 9.3(Cary, NC).
• McNemar’s (chi-square) test was used to compare pre-post intervention
differences in the percentage of children who were obese and the
percentage of children with a TV in their bedroom.
• Paired t-tests were used to compare pre and post intervention
differences in continuous measures including (a) children’s BMI zscore, physical activity, dietary intake, and screen time, and (b)
food, physical activity, and screen-related parenting practices and
attitudes.
.

5. 1) During year 1 (2009–2010), parents played an active and equal role
with the research team in planning and conducting a community
assessment and using the results to design a family-centered
childhood obesity intervention.
• Community-based participatory research (CBPR)
• The Family-centered Action Model of Intervention Layout and
Implementation (FAMILI) and the Family Ecological Model (FEM)

6. •
Community-based participatory research (CBPR)- is a partnership approach to research
that equitably involves, for example, community members, organizational
representatives, and researchers in all aspects of the research process and in which all
partners contribute expertise and share decision making and ownership. The aim of
CBPR is to increase knowledge and understanding of a given phenomenon and integrate
the knowledge gained with interventions and policy and social change to improve the
health and quality of life of community members.
•
The Family-centered Action Model of Intervention Layout and Implementation, or
FAMILI, draws on theories of family development to frame research and intervention
design, uses a mixed-methods approach to conduct ecologically valid research, and
positions family members as active participants in the development, implementation,
and evaluation of family-centered obesity prevention programs. FAMILI is intended to
facilitate the development of culturally responsive and sustainable prevention programs
with the potential to improve outcomes. Although childhood obesity was used to
illustrate the application of FAMILI, this model can be used to address a range of child
health problems.

7. Community Advisory Board{CAB} (Parents, Board
Members, Nutritionist, Teachers)
The CAB developed and approved partnership
principles to provide guiding values and codified
expectations and operating guidelines to sustain
active involvement
To operationalized the participatory process various
strategies and structural accommodations were
employed to foster parents involvement throughout
all phases of the research process

8. Based on the Family Ecological Model, personal
definitions of health, strategies used to foster
family health, chronic stressors that affect
parenting and family interactions.
Monthly meeting in the
community, compensation
provided (meals, childcare)
Parents
(Experts)

9. selfreport
surveys
Children’s
Physical
Activity
Children’s
Dietary
Intake
Focus
Groups
Community
Assessment
Photovoice
Children’s
weight
status
Windshield
Surveys

11. • During year 2 (2010–2011), parents played a leading role in
implementing the intervention and worked with the research
team to evaluate its results using a pre-post cohort design

12. Health
Communication
Campaign
Children’s
Health
Parameter
letter’s
Nutritional
Information
Counseling
Sessions
Parents Connect
for Healthy
Living Program

13. • Health communication campaign, which integrated quotes from the focus groups
conducted during the community assessment, was developed to increase parents’
awareness of childhood obesity and dispel myths around children’s weight (e.g.
“it’s just baby fat, he will grow out of it”
• Second letters mailed home to families by Head Start reporting children’s
BMI, and other health indicators, were revised based on parent feedback to
facilitate parents’ understanding of the information provided.
• Third, informal nutritional counseling sessions were integrated into Head Start
family engagement activities. Community nutrition graduate students from a local
college attended Head Start family events, provided samples of healthy
foods, and were available to answer questions parents had about their child’s (or
their own) diet and weight status.
• The final and central component was the Parents Connect for Healthy Living
program, a 6-week, onsite, parent-led program to promote parent social
networking, advocacy, communication skills, media literacy and conflict
resolution-all of which were behavioral targets of interest to parents identified
through the community assessment.

15. .

17. Adults
• Eating too fast
• Eating snacks Continuously
• Inappropriate Dinners
• Lack of physical activity
Teens
•
•
•
•
Skipping Breakfast
Consuming too much processed foods
Eating fast food meals outside of the home
Heavy soft drink/ sugary beverage consumption
Children
• Parents are always busy so fast food meals are high consumed
• Restaurant serving sizes for kids are increasing
• Schools are cutting Physical activity from their programs
• High sugar high salt foods and snacks are readly made available to children

19. •
•
•
•
•
•
Childhood obesity is associated with a higher chance of premature death and
disability in adulthood.
Obese children and adolescents suffer from both short-term and long-term health
consequences.
The most significant health consequences of childhood overweight and
obesity, that often do not become apparent until adulthood, include:
cardiovascular diseases (mainly heart disease and stroke);diabetes;
musculoskeletal disorders, especially osteoarthritis; and certain types of cancer
(endometrial, breast and colon).
At least 2.6 million people each year die as a result of being overweight or
obese.
Many low- and middle-income countries are now facing a "double burden" of
disease: as they continue to struggle with the problems of infectious diseases
and under-nutrition; at the same time they are experiencing a rapid increase in
risk factors of NCDs such as obesity and overweight, particularly in urban
settings. It is not uncommon to find under-nutrition and obesity existing side-byside within the same country, the same community and even within the same
household in these settings.
This double burden is caused by inadequate pre-natal, infant and child nutrition
which is then followed by exposure to high-fat, energy-dense, micronutrient-poor
foods and a lack of physical activity as the child grows older.

21. • MEND will consist of 16 sessions delivered over 8 weeks (2 hour sessions held
twice weekly during the evening time) by two MEND leaders and an assistant to
groups of 10-15 children accompanied by their parents or caregivers in a
community setting such as sport center or in schools
• Sixty ethnically diverse obese students (BMI > or = to the 95th
percentile, reference data) ages 6 to 8 in a Urban community in Trinidad
• Funded by a local NGO’s or governmental subsidies
• All families with a child 2 years or older enrolled
• Mind, Exercise, Nutrition, Do it (MEND) Program, a multicomponent
community-based childhood obesity intervention among boys and girls.
• A local community advisory board will be set up
• Food vouchers, food hampers, child care services will be provided as incentives
to stay enrolled within the program.
.

22. The MEND Program was created to help overweight and obese children improve
their lifestyles and health, with the support and encouragement of their families.
MEND aims to improve the children’s and families' eating and activity habits, to
prevent children from becoming obese adults.
MEND is a 20-session family Program that meets for two hours twice a week
and is attended by the child and at least one parent or caregiver. The first hour is
an interactive family session on nutrition and behavior topics, followed by one
hour of fun exercise for the children while the parents meet for support and
discussion on topics such as goals and rewards, label reading and problem
solving.
Before and after the Program, children are measured and they and their families
complete questionnaires that help us monitor and evaluate improvements in
body mass index (BMI), waist circumference, fitness and self-esteem. At the
graduation, each family receives a directory of community resources for postProgram support such as local MEND Graduate activities, afterschool physical
activity programs, follow-up measurements, and other local opportunities to
help the children continue with the positive changes they made during MEND.

23. •
•
•
•
•
•
•
•
•
Relative and Absolute poverty
Food security
Socioeconomic factors
Stigma (Child and Parents)
Culture and Family Traditions
Religion
Family Structure
Attitudes and believes of parents
Food Prices

24. Health
Communication
Campaign
(WEEKS 1-2)
parents are
encouraged to express
what are the burdens
faced, stressors, food
security, socioeconomic
factors,
Brochures, Pamphle
ts on Stress
management, cuttin
g food
cost, encouraged to
find solutions and
fill out
questionnaires
Children’s Health
Parameter Letters
(WEEKS 3-4)
BMI, physical
activity
level, dietary
intake, TV
viewing hours
of children
obtained
Nutritional
Information
Counseling Sessions
(WEEKS 5-6)
Importance and
benefits of
nutritional
information, cook
ing
classes, Childhoo
d nutrition and
benefits, consequ
ences of
obesity, financial
burden of obesity,
Parents Connect for
Healthy Living
Program/ Kidz FOOD
Fair
(WEEKS 7-8)
Parents establish
connections with
other parents,
provide support,
share
information/ Kids
learn how to help
prepare meals
with family
members, kids
learn to play fun
games at home,
learn the value of
making good food
habits.

25. • Parents are encouraged to express what are the burdens faced, stressors,
food security, socioeconomic factors.
• Brochures, Pamphlets on Stress management, cutting food cost,
encouraged to find solutions and fill out questionnaires.

26. • BMI, physical activity level, dietary intake, TV viewing hours of children
obtained

27. • Importance and benefits of nutritional information, cooking
classes, Childhood nutrition and benefits, consequences of
obesity, financial burden of obesity

28. • Parents establish connections with other parents, provide support, share
information/ Kids learn how to help prepare meals with family
members, kids learn to play fun games at home, learn the value of making
good food habits.

29. From the results of Kirsten K Davison, Janine M Jurkowski Kaigang
Li Sibylle Kranz and Hal A Lawson(2013) it can be expected that
there will be a 14% decline in BMI, a 70.6% drop in TV viewing
time, a 2% increase in physical activity in children.