Community-based interventions, economic incentives may help curb obesity

 At times, the national obesity epidemic may seem intractable, as our cities become more sprawling and unwalkable, and low-income communities are disproportionately affected by obesity. An optimistic new paper published by UC Davis researchers in the journal Pediatric Obesity tells a different story.

This paper is one of many to come out of a five-year project, Niños Sanos, Familia Sana (NSFS), designed to combat childhood obesity among Mexican-origin children. Researchers studied two towns in the Central Valley with populations of over 80 percent Mexican origin and an agricultural employment base, with one receiving community-based health interventions and one serving as a control.

During the first year of the three-year interventional study of Mexican-origin children, the authors observed a significant decrease in body mass index (BMI) and a reduced increase in waist circumference in obese boys. These results were achieved using a community participatory approach, in which the researchers consulted community members on what health outcomes they were hoping to accomplish.

“We were…in the community talking with stakeholders about what they wanted to see,” said Dr. Sara Schaeffer, an author on the paper and the associate director of Children’s Health and Education Programs at the Foods for Health Institute.

The overarching goal of the project was “to see if it is possible to prevent childhood obesity,” said Dr. Banafsheh Sadeghi, an assistant professor at the the UC Davis School of Medicine and a co-principle investigator on the project.

To accomplish this goal, the authors of the study used behavioral interventions including updated physical education curricula in schools and market-based interventions such as produce vouchers.

Schaeffer indicated that in the study population, and in general, the current mindset of young people is to receive professional healthcare when they get sick, not for preventive care. It was the researcher’s’ goal to see if community-based interventions could shift younger people toward seeking healthcare before they get sick.

They found that community education and engagement may have meaningful impacts on health.

“[It was surprising] that we might actually be able to slow-down weight gains and improve diets through mainly a program that was educational and provided a small (but important) economic incentive,” said Dr. Lucia Kaiser, an author on the paper and an emeritus specialist in cooperative extension in an email interview.

Researchers found that although the timeline for their study was relatively short, the impact on boys was immediate.

”I wondered whether it would take a more intensive intervention or a longer time frame to make any difference. But, we did see an impact in the heaviest group of children.”

“In general it is shown that heavier children respond faster to interventions,” Sadeghi said, but these results showed a significant decrease in BMI growth, rather than just a trend.

Similar interventions to the ones used in this study have been shown to improve health outcomes, although typically these measure health outcomes over a longer period of time. This style of intervention and education has the potential to affect communities over a short amount of time.

In addition to the education participants received about nutrition and physical activity, some participants’ individual activity levels were tracked using wearable activity monitoring devices.

According to Schaeffer, the availability of these devices has drastically improved researchers’ ability to track children’s activity levels, because they typically cannot accurately answer questionnaires about their daily habits. The data collected from wearable monitoring devices helps researchers track study participants’ activity, but it can also be a useful educational tool.

“We are looking at all the things you can measure to help young kids learn about themselves,” Schaeffer said.

Wearable devices are able to track heart rate, hydration and calories burned. When children learn to interpret data from the device, they can better understand how their bodies are unique, empowering and educating them. Schaeffer indicated that this education in turn can be used to gauge interest in certain physical activities or specific nutritional requirements.

Schaeffer’s plans for future research include studying how how different feeding regimens affect an infant’s development, activity and sleep, using wearable technologies specifically made for infants.

For Kaiser, the NSFS project is a capstone of her career.

“I had worked for many, many years studying the social and economic factors that determine health outcomes, especially in Latino populations. Having grown up in California, I have always been drawn to work that might in some way improve the lives of these people who work hard to put the food on our tables.”

Researchers involved with this project are planning further studies to investigate the potential of community based-interventions to limit obesity across age groups, not just in the target group (young children).

“We want to understand how we can help teenagers. We want to see how we can get the whole family involved,” Sadeghi said.

Written by: Sarah Silverman–science@theaggie.org