The children in the treatment group maintained significantly healthier BMIs than those in the control group in the first two years of the study. The difference between groups was not statistically significant by three years.
“With our multi-level intervention, kids and families were able to control weight over one and two years even compared to state-of-the-art health education,” Robinson said.
The children in the treatment group also had significantly better results on multiple health measures at one or two years, or both, including diastolic blood pressure, total cholesterol and LDL cholesterol. They were more physically active after school and spent less time being sedentary. They had healthier diets and eating behaviors by several measures, including total daily energy intake, percentage of dietary energy from fat and daily energy consumed while watching screens. Some improvements in eating and diet persisted throughout the three-year study period.
More than 94% of participants completed annual health evaluations throughout all three years of the study. However, participants in the treatment group spent less time working on the education modules and participating in the sports program as the study progressed, which the researchers think may explain why the effects became weaker after three years.
“A lot happens in three years,” Robinson said. Some life changes, such as moves, job losses and parental separations, made it harder for families to continue to participate in the study.
In contrast, other events could increase a family’s motivation to participate, such as when the family wanted to change what they ate because an adult member was diagnosed with diabetes. “We purposely designed the intervention to take advantage of those critical moments, so that when you needed the intervention, it was there for you,” Robinson said.
The findings will inform future efforts to help the highest-risk kids and families receive weight-management resources that work for them, Robinson said.
“The changes we saw are very positive, and good evidence that there’s a lot of promise for this community-based, multi-level model of intervention,” he said. “It motivates us: There’s more to learn, and more we can improve on.”
Other Stanford co-authors of the study are Donna Matheson, PhD, senior research scientist at the Stanford Prevention Research Center; Darrell Wilson, MD, professor emeritus of pediatrics; Dana Weintraub, MD, clinical associate professor of pediatrics; Jorge Banda, PhD, affiliate in pediatrics; Lee Sanders, MD, associate professor of pediatrics; William Haskell, PhD, professor emeritus of medicine; biostatistician Kristopher Kapphahn; and Manisha Desai, PhD, professor of medicine and of biomedical data science.
Robinson, Wilson, Weintraub, Sanders and Desai are members of the Stanford Maternal & Child Health Research Institute. Robinson, Haskell and Desai are members of the Stanford Cancer Institute. Robinson is a member of the Stanford Cardiovascular Institute and an affiliate of the Stanford Woods Institute for the Environment. Wilson is a member of Stanford Bio-X.
Scientists from Purdue University; Cruise, LLC, in San Francisco; the National Heart, Lung, and Blood Institute in Bethesda, Maryland; and the University of North Carolina-Chapel Hill also contributed to the research.
The research was supported by the National Heart, Lung and Blood Institute (grants U01HL103629 and T32 HL007034), the Stanford Maternal & Child Health Research Institute, and the Department of Pediatrics at Stanford University. The project also received support from other members of the Childhood Obesity Prevention and Treatment Research Consortium (NHLBI grants U01HL103622, U01HL103620, U01HD068990, U01HL103561), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Office of Behavioral and Social Sciences Research at the National Institutes of Health.