A randomized trial to reduce sugar-sweetened beverage and juice intake in preschool-aged children: description of the Smart Moms intervention trial

Brooke T Nezami, Leslie A Lytle, Deborah F Tate, Brooke T Nezami, Leslie A Lytle, Deborah F Tate

Abstract

Background: Obesity in young children remains a public health concern, and maternal weight is one of the strongest predictors of obesity in early childhood. However, parental adherence in interventions for young children is often low and existing programs have had mixed success. An innovative approach to treatment is needed that increases adherence among mothers and improves weight-related behaviors simultaneously in mothers and children. The objective of the Smart Moms randomized controlled trial (RCT) is to test the efficacy of a 6-month primarily smartphone-delivered program to reduce sugar-sweetened beverage and juice consumption among children ages 3-5 whose mothers are overweight or obese. This paper describes the study design and intervention.

Methods/design: Mother-child dyads were eligible if the mother was overweight or obese, owned a smartphone, and if the child was between the ages of 3-5 and consumed 12 oz or more per day of sugar-sweetened beverages (SSBs) and 100 % fruit juice. Participants were randomly assigned to the Smart Moms intervention or a waitlist control group. The intervention consisted of theoretically grounded and evidence-based behavioral strategies delivered through one group session, lessons on a mobile-optimized website, and text messages. Mothers submitted self-monitoring information via text message and received regular tailored feedback emails from interventionists. The primary outcome is change in child SSB and juice consumption and a secondary outcome is change in maternal weight.

Discussion: This Smart Moms study was designed to determine if a low-burden intervention delivered using mobile methods and targeted towards mothers could be effective at changing child sugar-sweetened beverage intake. Results will indicate if mobile-based methods can be a feasible way to engage mothers in family-based studies and will inform successful strategies to prevent childhood obesity through parent-targeted approaches.

Trial registration: Clinicaltrials.gov NCT02098902 (Registered March 25, 2014).

Keywords: Early childhood; Intervention; Maternal obesity; Obesity; Sugar-sweetened beverages.

Figures

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Flow of participants

References

    1. CDC . Obesity among low-income preschool children. 2010.
    1. Harrington JW, et al. Identifying the “tipping point” age for overweight pediatric patients. Clin Pediatr. 2010;49(7):638–643. doi: 10.1177/0009922809359418.
    1. Burke V, Beilin LJ, Dunbar D. Family lifestyle and parental body mass index as predictors of body mass index in Australian children: a longitudinal study. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 2001;25(2):147–157. doi: 10.1038/sj.ijo.0801538.
    1. Flores G, Lin H. Factors predicting severe childhood obesity in kindergarteners. Int J Obes. 2013;37(1):31–39. doi: 10.1038/ijo.2012.168.
    1. Davison KK, Birch LL. Childhood overweight: a contextual model and recommendations for future research. Obesity reviews : an official journal of the International Association for the Study of Obesity. 2001;2(3):159–171. doi: 10.1046/j.1467-789x.2001.00036.x.
    1. Johnson BA, et al. Multilevel analysis of the Be active Eat well intervention: environmental and behavioural influences on reductions in child obesity risk. Int J Obes. 2012;36(7):901–907. doi: 10.1038/ijo.2012.23.
    1. Ogden CL, et al. Consumption of sugar drinks in the United States, 2005–2006. NCHS data brief. Hyattsville, MD: National Center for Health Statistics; 2011. p. 71.
    1. Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100 % fruit juices among US children and adolescents, 1988–2004. Pediatrics. 2008;121(6):e1604–e1614. doi: 10.1542/peds.2007-2834.
    1. de Ruyter JC, et al. A trial of sugar-free or sugar-sweetened beverages and body weight in children. N Engl J Med. 2012;367(15):1397–1406. doi: 10.1056/NEJMoa1203034.
    1. Golan M. Parents as agents of change in childhood obesity--from research to practice. International journal of pediatric obesity : IJPO : an official journal of the International Association for the Study of Obesity. 2006;1(2):66–76. doi: 10.1080/17477160600644272.
    1. Epstein LH, et al. Family-based obesity treatment, then and now: 25 years of pediatric obesity treatment. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2007;26(4):381–391. doi: 10.1037/0278-6133.26.4.381.
    1. Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity (Silver Spring, Md) 2010;18(Suppl 1):S27–35. doi: 10.1038/oby.2009.429.
    1. Ostbye T, et al. Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study. Prev Med. 2012;55(3):188–195. doi: 10.1016/j.ypmed.2012.06.005.
    1. Stark LJ, et al. A pilot randomized controlled trial of a clinic and home-based behavioral intervention to decrease obesity in preschoolers. Obesity (Silver Spring, Md) 2011;19(1):134–141. doi: 10.1038/oby.2010.87.
    1. O’Dwyer MV, et al. Effect of a family focused active play intervention on sedentary time and physical activity in preschool children. The international journal of behavioral nutrition and physical activity. 2012;9:117-5868-9-117.
    1. Fitzgibbon ML, et al. Family-based hip-hop to health: outcome results. Obesity (Silver Spring, Md) 2013;21(2):274–283. doi: 10.1002/oby.20269.
    1. Hartman MA, Hosper K, Stronks K. Targeting physical activity and nutrition interventions towards mothers with young children: a review on components that contribute to attendance and effectiveness. Public Health Nutr. 2011;14(8):1364–1381. doi: 10.1017/S1368980010001941.
    1. Jordan KC, et al. A nutrition and physical activity intervention promotes weight loss and enhances diet attitudes in low-income mothers of young children. Nutrition research (New York, NY) 2008;28(1):13–20. doi: 10.1016/j.nutres.2007.11.005.
    1. Ostbye T, et al. Active mothers postpartum: a randomized controlled weight-loss intervention trial. Am J Prev Med. 2009;37(3):173–180. doi: 10.1016/j.amepre.2009.05.016.
    1. Sonneville KR, et al. Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial. Obesity (Silver Spring, Md) 2012;20(7):1449–1454. doi: 10.1038/oby.2012.43.
    1. Strauss RS, Knight J. Influence of the home environment on the development of obesity in children. Pediatrics. 1999;103(6):e85. doi: 10.1542/peds.103.6.e85.
    1. Berge JM, et al. Are parents of young children practicing healthy nutrition and physical activity behaviors? Pediatrics. 2011;127(5):881–7. doi: 10.1542/peds.2010-3218.
    1. Laroche HH, et al. Weight gain among Men and women Who have a child enter their home. J Acad Nutr Diet. 2013;113(11):1504–10.
    1. Duggan M, Smith A. Cell internet use 2013. Washington, D.C: Pew Research Center’s Internet and American Life Project; 2013.
    1. Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA : the journal of the American Medical Association. 2003;289(14):1833–1836. doi: 10.1001/jama.289.14.1833.
    1. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006;166(15):1620–1625. doi: 10.1001/archinte.166.15.1620.
    1. Napolitano MA, et al. Using facebook and text messaging to deliver a weight loss program to college students. Obesity (Silver Spring, Md) 2013;21(1):25–31. doi: 10.1002/oby.20232.
    1. Patrick K, et al. A text message-based intervention for weight loss: randomized controlled trial. Journal of medical Internet research. 2009;11(1):e1. doi: 10.2196/jmir.1100.
    1. Beech BM, et al. Child- and parent-targeted interventions: the Memphis GEMS pilot study. Ethn Dis. 2003;13(1 Suppl 1):S40–53.
    1. Klohe-Lehman DM, et al. Low-income, overweight and obese mothers as agents of change to improve food choices, fat habits, and physical activity in their 1-to-3-year-old children. J Am Coll Nutr. 2007;26(3):196–208. doi: 10.1080/07315724.2007.10719602.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents. N Engl J Med. 2005;352(20):2100–2109. doi: 10.1056/NEJMcp043052.
    1. Epstein LH. Development of evidence-based treatments for pediatric obesity in evidence-based psychotherapies for chidlren and adolescents. 2003. pp. 374–388.
    1. Head KJ, et al. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013;97:41–48. doi: 10.1016/j.socscimed.2013.08.003.
    1. Cdc . A SAS Program for the CDC Growth Charts. 2011.
    1. Paffenbarger RS, Jr, Wing AL, Hyde RT. Physical activity as an index of heart attack risk in college alumni. Am J Epidemiol. 1978;108(3):161–175.
    1. Corder K, et al. Is it possible to assess free-living physical activity and energy expenditure in young people by self-report? Am J Clin Nutr. 2009;89(3):862–70. doi: 10.3945/ajcn.2008.26739.
    1. Taveras EM, Mitchell K, Gortmaker SL. Parental confidence in making overweight-related behavior changes. Pediatrics. 2009;124(1):151–8. doi: 10.1542/peds.2008-2892.
    1. Lampard AM, Jurkowski JM, Davison KK. Social-cognitive predictors of low-income parents’ restriction of screen time among preschool-aged children. Health education & behavior: the official publication of the Society for Public Health Education. 2013;40(5):526–530. doi: 10.1177/1090198112467800.
    1. Hesketh K, et al. Mediators of the relationship between maternal education and children’s TV viewing. Am J Prev Med. 2007;33(1):41–47. doi: 10.1016/j.amepre.2007.02.039.
    1. Cullen KW, et al. Availability, accessibility, and preferences for fruit, 100 % fruit juice, and vegetables influence children’s dietary behavior. Health education & behavior : the official publication of the Society for Public Health Education. 2003;30(5):615–626. doi: 10.1177/1090198103257254.
    1. Anderson SE, et al. Meals in Our household: reliability and initial validation of a questionnaire to assess child mealtime behaviors and family mealtime environments. J Acad Nutr Diet. 2012;112(2):276–84. doi: 10.1016/j.jada.2011.08.035.
    1. Rosenberg DE, et al. Reliability and validity of the Sedentary Behavior Questionnaire (SBQ) for adults. J Phys Act Health. 2010;7(6):697–705. doi: 10.1123/jpah.7.6.697.
    1. Dennison BA, et al. An intervention to reduce television viewing by preschool children. Archives of Pediatrics & Adolescent Medicine. 2004;158(2):170–176. doi: 10.1001/archpedi.158.2.170.
    1. Wardle J, et al. Parental feeding style and the inter-generational transmission of obesity risk. Obes Res. 2002;10(6):453–462. doi: 10.1038/oby.2002.63.
    1. Turvey CL, Wallace RB, Herzog R. A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. International psychogeriatrics / IPA. 1999;11(2):139–148. doi: 10.1017/S1041610299005694.
    1. Whitaker RC, et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869–873. doi: 10.1056/NEJM199709253371301.

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