The Role of the Home Environment in Pediatric Weight Management Among Low-Income, Overweight and Obese Youth

Abstract

The American Academy of Pediatrics (AAP) recommendations for childhood obesity encourage healthcare providers to tailor interventions targeting the individual child and their parents/primary caregivers. However, effective strategies to engage families as agents of change in the treatment of childhood obesity are poorly understood, particularly among youth from low-income, urban communities that are at high-risk of obesity.;This Thesis Dissertation examined the home environment in the Family Weight Management Study, a two-arm, randomized family-focused weight management program that was conducted through an urban pediatric ambulatory care center (Jacobi Medical Center, Bronx, New York). Participants were low-income, overweight and obese (body mass index, BMI, ≥85th percentile for age and sex) youth, ages 7-to-12 years old, and their parent or primary caregiver. Families were randomized to a control group that received AAP recommendations for the treatment of pediatric obesity through quarterly consults with a pediatrician, or to an experimental group that added an 8-week, family-based lifestyle coaching program with monthly follow-ups.;Cross-sectional analyses of baseline data identified several parenting practices (monitoring, limit setting of soda and snacks, limit setting of screen media, and pressure to eat) that appear to play a role in the home environment. Subsequent cross-sectional analyses revealed that home food, screen-media, and physical activity resource availability, and parent monitoring were associated with BMI z-scores and child health behaviors related to dietary intake and physical activity. Pre/post analyses from baseline to 12-months found that measures of the home environment improved in both the control and experimental groups; however, compared with the control group, the experimental group had significantly greater decreases in home sugar-sweetened beverage (SSB) availability and BMI z-scores. Reducing BMI z-scores compared to gaining or maintaining BMI z-scores was partially mediated by decreases in home SSB availability.;Collectively, this work elucidated several aspects of the home environment that should be considered when designing pediatric obesity interventions among multi-ethnic and low-income urban populations. Changes in the home environment may be facilitated by pediatricians who implement standard-of-care recommendations for pediatric weight management with or without the addition of an 8-session family-focused intervention, underscoring the importance of addressing the home environment when treating pediatric obesity in primary care settings.