Childhood obesity is a serious public health problem with limited effective prevention strategies to date. Although previous nutrition and physical activity environmental approaches for obesity prevention show some promise, most studies have not shown reductions in excess weight gain. Moreover, few prevention studies significantly engage parents and focus on the home environment. To prevent childhood obesity it is essential to promote healthy behaviors in the home environment because parents are influential primary role models for healthy eating and sedentary behavior, and are gatekeepers for food and beverage availability and degree of inactivity within the home. Moreover, the home setting is where most of children's calories and energy dense foods are consumed and where children engage in much of their sedentary behavior, particularly screen time (e.g., television, computer, game system). The proposed study will test the efficacy of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus program, a year-long, family-based health promotion intervention to prevent excess weight gain among 8-12 year old children. The program is based on Social Cognitive Theory and a socio-ecological framework and promotes both regular and nutritionally-sound snacks and meals in which family members eat together (i.e., family meals) and encourages reductions in sedentary behavior, particularly screen time among children in the home setting. The efficacy of the intervention will be tested in a randomized controlled trial with 160 families randomized to two conditions (intervention or attention- only control). Two cohorts of families, recruited from before- and after-school programs and community centers, will be followed for 2.5 years. The primary hypothesis is that, by the end of the 12-month intervention, target children in the intervention families, relative to children in the control families, will have significantly lower body mass index (BMI;primary outcome) after adjustment for baseline BMI values. Secondary outcomes include frequency of weekly family meals and number of healthful foods and beverages available in the home and served at family meals and snacks (as reported by parent), target children's daily intakes of healthful foods and beverages, and target children's minutes of sedentary behavior per week, particularly screen time. Child and parent measurement will occur in their homes at baseline, post-intervention (12-months post- randomization), and follow-up (9-months post-intervention) by trained research staff. The proposed study builds upon successful methods from our HOME pilot study (2006-2008;NIH R21-DK0072997) and is innovative as it actively engages entire families in experiential activities and capitalizes on the home setting. The study will provide important information on environmental and behavioral strategies that families can use at home to prevent excess weight gain. The intervention program has high translation potential and is likely to be immediately useful to families of school-age children because it will be tested in real-world community settings and sustained across the state of Minnesota by the University of Minnesota's Extension Service.

Public Health Relevance

The goal of the proposed project is to see if an innovative family-based intervention that focuses on making healthful food changes, especially at family meals, and reducing screen time (TV, game systems) within the home can prevent children from gaining more weight than they need to as they grow. The study will provide important information on strategies that families can use at home to prevent obesity. The intervention program is likely to be immediately useful to families of school-age children because it will be tested in real-world community settings.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Study Section
Psychosocial Risk and Disease Prevention Study Section (PRDP)
Program Officer
Kuczmarski, Robert J
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Budget End
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University of Minnesota Twin Cities
Schools of Nursing
United States
Zip Code
Fulkerson, Jayne A (2018) Fast food in the diet: Implications and solutions for families. Physiol Behav 193:252-256
Fulkerson, Jayne A; Friend, Sarah; Horning, Melissa et al. (2018) Family Home Food Environment and Nutrition-Related Parent and Child Personal and Behavioral Outcomes of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus Program: A Randomized Controlled Trial. J Acad Nutr Diet 118:240-251
Myers, Michelle L; Fulkerson, Jayne A; Friend, Sarah E et al. (2018) Case study: Behavior changes in the family-focused obesity prevention HOME Plus program. Public Health Nurs 35:299-306
Kubik, Martha Y; Gurvich, Olga V; Fulkerson, Jayne A (2017) Association Between Parent Television-Viewing Practices and Setting Rules to Limit the Television-Viewing Time of Their 8- to 12-Year-Old Children, Minnesota, 2011-2015. Prev Chronic Dis 14:E06
Horning, Melissa L; Schow, Robin; Friend, Sarah E et al. (2017) Family dinner frequency interacts with dinnertime context in associations with child and parent BMI outcomes. J Fam Psychol 31:945-951
Loth, Katie A; Horning, Melissa; Friend, Sarah et al. (2017) An Exploration of How Family Dinners Are Served and How Service Style Is Associated With Dietary and Weight Outcomes in Children. J Nutr Educ Behav 49:513-518.e1
Horning, Melissa L; Fulkerson, Jayne A; Friend, Sarah E et al. (2017) Reasons Parents Buy Prepackaged, Processed Meals: It Is More Complicated Than ""I Don't Have Time"". J Nutr Educ Behav 49:60-66.e1
Draxten, Michelle; Flattum, Colleen; Fulkerson, Jayne (2016) An Example of How to Supplement Goal Setting to Promote Behavior Change for Families Using Motivational Interviewing. Health Commun 31:1276-83
Loth, K A; Friend, S; Horning, M L et al. (2016) Directive and non-directive food-related parenting practices: Associations between an expanded conceptualization of food-related parenting practices and child dietary intake and weight outcomes. Appetite 107:188-195
Horning, Melissa L; Fulkerson, Jayne A; Friend, Sarah E et al. (2016) Associations among Nine Family Dinner Frequency Measures and Child Weight, Dietary, and Psychosocial Outcomes. J Acad Nutr Diet 116:991-9

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