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A long-running study in low income Nashville neighborhoods found how challenging it is to intervene in young children’s lives to prevent obesity.

Photo by Joshua Ness on Unsplash

A study spanning the better part of a decade, in low-income parts of Nashville, found three years of sustained intervention could improve the nutrition in the diets of young children and improve parents’ healthy behaviors. The intervention, however, did not change the trajectory of the kids’ body mass index.

More than 600 parent and children pairs were tracked as part of the Growing Right Onto Wellness program created by Vanderbilt University School of Medicine in partnership with Metro Parks and Recreation and Nashville Public Library.

Children in the intervention group consumed a median of 100 calories less a day than the control group. Families in the intervention group used the community centers more than the control group. Yet, at the end of the study, the median BMI was 17.8 for both groups.

“I think it’s very clear that obesity is not the result of one thing. It’s a complex phenotype,” said Dr. Shari Barkin, lead author and Chief of General Pediatrics at the Monroe Carrel Jr. Children’s Hospital at Vanderbilt. “We saw we could make a difference in nutrition. We could change how people use their built environment— for the better. But it didn’t result in a difference.”

Tennessee ranked last in the nation for childhood obesity, according to the 2018 Commonwealth Fund Scorecard on State Health System Performance.

Substantial research, planning and programming were done prior to the study — the longest and largest on obesity prevention — to make sure it was designed to be as helpful to participants and as engaging as possible, said Barkin. The study was published in JAMA on Aug. 7.

There was a short-term reduction in obesity, as measured through BMI, which did not sustain over the three-year study. Children who enrolled were at normal or high weight but not yet obese.

Different ethnic and socioeconomic groups will need different approaches to get long-term behavior change that results in healthier outcomes. Results indicate that a higher amount of sustained intervention, and for longer, would be needed to impact BMI growth, said Barkin.

“That a 100 kcals a day difference could change weight outcomes is well documented but the thing I find to be quite interesting is that it’s different for different populations,” said Barkin.

Creating programming a ‘huge paradigm shift,’ and future research should focus on obesity link to food insecurity

Barkin wanted to work with community recreation centers and libraries so the intervention could be replicated in other parts of the country. Participating families had to live within five miles of the parks and recreation center and had to receive some sort of federal assistance, such as Medicaid or WIC.

The parks department developed programming designed to get parents engaged with younger children — “a huge paradigm shift,” said Barkin.

The study focused on practical skills building, such as how to use a $10 grocery budget to buy healthier foods. Barkin said many were using their money to buy soda rather than turning on the tap so tackling that change was an easy way to impact both spending and health. 

The Vanderbilt team reached out to parents a year after the last data collection point to see whether any of the behaviors were still in place.

Parents were still using the library and treating the home as a learning zone, Barkin said. Parents also appreciated skills about how to talk to teachers and principals to be engaged at school.

Three-fourths of the families in the study had never been in a library before the study, yet 60 percent used it regularly over the course of the three years.

“It’s not enough to have beautiful infrastructure but you have to know how to use it,” said Barkin.

There were interesting findings from her team’s work regarding the correlation between food insecurity and obesity but the study wasn’t designed to look at the impact of food insecurity.

In Tennessee an estimated 17 percent of households in 2014 were considered food insecure (meaning they don’t have access to healthy foods) compared to 13.4 percent across the U.S., according to the Sycamore Institute. Households with children are more likely to be food insecure than those without.

“We’re going to dive a lot deeper,” said Barkin. “I think that (the food insecurity findings) will guide us for what the next studies could and should look like.”

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