Early and rapid growth in infants is strongly associated with early development and persistence of obesity in young children. Substantial research has linked child obesity/overweight to increased risks for serious health outcomes, which include adverse physical, psychological, behavioral, or social consequences. Recent studies have indicated that obesity has negative outcomes even on very young children and contributes to health problems as obese children age. The Institute of Medicine's (IOM) recent report (2011) on early childhood obesity prevention policies, recommends five approaches to preventing obesity: assess, monitor, and track growth from birth to age 5; increase physical activity and decrease sedentary behavior in young children; support breastfeeding and be responsive to children's feeding cues; limit screen time; and promote age appropriate sleep for young children. Based on the previous work by this research team, and in collaboration with a major urban health department, we propose to test an intervention that incorporates all the IOM's recommendations to prevent the development of obesity in at-risk infants. The intervention will be guided by health professionals and delivered through home visits by community health workers (CHW), supervised by public health nurses (PHN), to Mexican-American women and children who are clients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Program in Houston, TX. The intervention will occur for 2 years with 1 year of follow-up, for a total of 3 years of measurements. The goal of this study is to compare the effectiveness of structured CHW- provided home visits, using an intervention created through community-based participatory research, to standard care received through WIC office visits in preventing the development of overweight (weight/length >85th percentile) and obesity (weight/length >95th percentile) in infants during their first 2 years of life. The proposed study will provide prospective data on the effects of an intervention to prevent childhood obesity in children at high risk for obesity due to ethnicity, income, and maternal BMI. We will be able to demonstrate the effectiveness of a common community approach in preventing obesity during the first 2 years of life as well as the intervention's persistence from age 2 to 3. This easy to implement obesity-prevention intervention can be adopted for many locales and diverse communities.
This study will demonstrate that community health workers (CHW), supervised by public health nurses, can deliver a home-based obesity prevention intervention to low-income Mexican and Mexican-American women and children in a major urban area. The CHW will work with WIC clients to support them in breastfeeding their infants and teach them about feeding and caring for their infants. Obesity, especially among low income minority children, is a grave threat to the current and future health of our nation, and culturally congruent, community supported interventions are needed to reverse this epidemic.
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