ERIC EJ795887: The Role of Parents in Preventing Childhood Obesity

2006·0.11 MB·English

by  ERIC

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The Role of Parents in Preventing
Childhood Obesity
Ana C. Lindsay, Katarina M. Sussner, Juhee Kim,
and Steven Gortmaker
Summary
As researchers continue to analyze the role of parenting both in the development of childhood
overweight and in obesity prevention, studies of child nutrition and growth are detailing the
ways in which parents affect their children’s development of food- and activity-related behav-
iors. Ana Lindsay, Katarina Sussner, Juhee Kim, and Steven Gortmaker argue that interven-
tions aimed at preventing childhood overweight and obesity should involve parents as impor-
tant forces for change in their children’s behaviors.
The authors begin by reviewing evidence on how parents can help their children develop and
maintain healthful eating and physical activity habits, thereby ultimately helping prevent child-
hood overweight and obesity. They show how important it is for parents to understand how their
roles in preventing obesity change as their children move through critical developmental peri-
ods, from before birth and through adolescence. They point out that researchers, policymakers,
and practitioners should also make use of such information to develop more effective interven-
tions and educational programs that address childhood obesity right where it starts—at home.
The authors review research evaluating school-based obesity-prevention interventions that in-
clude components targeted at parents. Although much research has been done on how parents
shape their children’s eating and physical activity habits, surprisingly few high-quality data exist
on the effectiveness of such programs. The authors call for more programs and cost-effective-
ness studies aimed at improving parents’ ability to shape healthful eating and physical activity
behaviors in their children.
The authors conclude that preventing and controlling childhood obesity will require multifaceted
and community-wide programs and policies, with parents having a critical role to play. Successful
intervention efforts, they argue, must involve and work directly with parents from the earliest
stages of child development to support healthful practices both in and outside of the home.
www.futureofchildren.org
Ana C. Lindsay is a research scientist in the Department of Nutrition at the Harvard School of Public Health. Katarina M. Sussner is a doc-
toral candidate in the Department of Biological Anthropology at the Harvard Graduate School of Arts and Sciences. Juhee Kim is a research
fellow in the Department of Nutrition at the Harvard School of Public Health. Steven Gortmaker is a professor of the practice of health so-
ciology in the Department of Society, Human Development, and Health at the Harvard School of Public Health.
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Ana C. Lindsay, Katarina M. Sussner, Juhee Kim, and Steven Gortmaker
P
arents are key to developing a fants, and Children (WIC) public health and
home environment that fosters educational program.3 Because research
healthful eating and physical ac- shows how the parents’ roles in influencing
tivity among children and adoles- the development of overweight and obesity
cents. Parents shape their chil- differ at different stages of their children’s
dren’s dietary practices, physical activity, development, these parenting components
sedentary behaviors, and ultimately their will be most effective if they are targeted at
weight status in many ways. Parents’ knowl- children in particular age groups.
edge of nutrition; their influence over food
selection, meal structure, and home eating Parental Roles during
patterns; their modeling of healthful eating a Child’s Development
practices; their levels of physical activity; and Parenting influences the development of
their modeling of sedentary habits including overweight and obesity in various ways at dif-
television viewing are all influential in their ferent stages of a child’s development. The
children’s development of lifelong habits that following discussion is structured around
contribute to normal weight or to overweight three time periods in children’s lives: gesta-
and obesity.1 tion and early infancy; early childhood, when
children are toddlers or preschoolers; and
Because the parents’ roles at home in pro- middle childhood and adolescence, when
moting healthful eating practices and levels children are attending school.4
of physical activity—and thus in preventing
obesity—are so critical, they should also be Gestation and Infancy
central to collective efforts to combat the na- Before an infant is even born, aspects of his
tion’s childhood obesity epidemic. L. Epstein mother’s pregnancy can put him at risk of
offers three reasons for involving parents in overweight in childhood and later in life.5An
obesity-prevention interventions. First, obe- unfavorable intrauterine environment, for
sity runs in families, and it may be unrealistic example, can increase a fetus’s future risk of
to intervene with one member of a family developing adult metabolic abnormalities,
while other family members are modeling including obesity, hypertension, and non-
and supporting behaviors that run counter to insulin-dependent diabetes mellitus.6 The
the intervention’s goals. Second, parents children of mothers who suffer from diabetes
serve as models and reinforce and support mellitus, gestational diabetes, and undernu-
the acquisition and maintenance of eating trition and overnutrition during pregnancy
and exercise behaviors. Finally, to produce are at particular risk for obesity, with the
maximal behavior change in children, it may greatest risk factor being gestational dia-
be necessary to teach parents to use specific betes.7 A key strategy for obesity prevention
behavior-change strategies such as positive at this stage of a child’s development, there-
reinforcement.2 Several successful school- fore, is to focus on screening for and prevent-
based health-promotion interventions, such ing diabetes during pregnancy.
as Planet Health and Eat Well and Keep
Moving, already include a component tar- Parents also have an important role to play
geted at improving parenting behaviors, as during infancy, when a child is establishing
does the well-established Special Supple- the foundation for dietary habits and nutri-
mental Nutrition Program for Women, In- tional adequacy over a lifetime.8 Although
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The Role of Parents in Preventing Childhood Obesity
debate over whether breast-feeding can help differences.14Current data, although limited,
prevent obesity later in life continues, many suggest that the way parents feed their chil-
researchers believe that breast-feeding in- dren contributes to individual differences in
fants does have a protective effect against how well children can regulate their food in-
obesity. Several studies, for example, have take and perhaps to the origins of energy im-
documented lower rates of overweight balance.15 Especially in the early years of a
among children who were breast-fed for child’s life, parents have a direct role in pro-
longer durations.9 Their findings, however, viding experiences that encourage the child’s
were limited to non-Hispanicwhites and did control of food intake. Around preschool age,
not apply to other racial or ethnic groups.10 when children particularly dislike new foods,
One explanation for the protective effect of it is important for parents to model healthful
breast-feeding is that it helps infants better eating habits and to offer a variety of health-
regulate their food intake than does bottle- ful foods to their children. When parents
feeding. Encouraging an infant to empty a provide early exposure to nutritious foods,
bottle and using formulas more concentrated even fruits and vegetables, children like and
in energy and nutrients than breast milk may eat more of such foods.16 But parents should
make it more difficult for the baby to attend observe a clearly defined role in offering the
to his or her own normal feelings of satiety. If foods to their children. As described by W.
such experiences occur early in infancy and Dietz and L. Stern, parents “are responsible
continue, an infant may not develop reliable for offering a healthful variety of foods,”
control over food intake. None of the recent while children themselves “are responsible
studies of breast-feeding, however, rules out for deciding what and how much they want to
the possibility that the protective effect of eat from what they are offered.”17
breast-feeding on obesity later in life may be
due to confounding factors such as parental Although children are predisposed to re-
weight status or social and economic status.11 spond to the energy content of foods in con-
trolling their intake, they are also responsive
Toddlers and Preschool Children to their parents’ control attempts. Research
As toddlers and preschoolers develop habits has shown that these attempts can refocus
related to eating and physical activity, parents the child away from responsiveness to inter-
can shape their early environments in ways nal cues of hunger and satiety and toward
that encourage them to be more healthful.12 such external factors as the presence of palat-
able foods.18 Parents who control or restrict
Parents and Healthful Food Behaviors what their young children eat may believe
Children come equipped with a biological set they are doing what is best for their child, but
of taste predispositions: they like sweet and recent research challenges this assumption.
salty tastes and energy-dense foods, and they Imposing stringent controls can increase
dislike bitter and sour tastes.13 But they de- preferences for high-fat, energy-dense foods,
velop most of their food habits through expo- perhaps causing children’s normal internal
sure and repeated experience. Research sug- cues to self-regulate hunger and satiety to be-
gests that individual differences in the come unbalanced.19
physiologic regulation of energy intake ap-
pear as early as the preschool years and that Parents should also be aware of the social
parents have enormous influence on these contexts in which foods are consumed. Stud-
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Ana C. Lindsay, Katarina M. Sussner, Juhee Kim, and Steven Gortmaker
ies have found that children develop prefer- creased their odds of becoming overweight.25
ences for foods offered in positive contexts These findings are consistent with those of
and, conversely, are more likely to dislike long-term studies and interventions focused
foods offered in negative contexts.20Offering on sugar-sweetened beverages among school-
healthful foods in positive contexts will en- aged children, although some smaller long-
courage youngsters to enjoy and eat such term studies in children found no significant
foods. link between fruit juice intake and over-
weight.26
Another important influence on the types of
food young children consume is a household’s Parents and Physical Activity during
food choices. At an early age children will eat Early Childhood
Physical activity is a key component of energy
balance, and keeping small children active is
Parents who control or an essential part of preventing child over-
weight.27 Research has found that physical
restrict what their young
activity is associated with lower risks of accel-
children eat may believe they erated weight gain and excess adiposity
among preschool-aged children.28 An eight-
are doing what is best for
year study of three- to five-year-old children
their child, but recent found that the most active children had sig-
nificantly lower body mass index (BMI) than
research challenges this
their less active counterparts.29 A study of
assumption. three- to five-year-old children attending
preschool found that overweight boys were
significantly less active than normal-weight
what their parents, especially their mothers, boys during the preschool day.30
eat.21 And if parents overeat, their children
may too. Thus the parents’ own eating behav- Few studies have examined the relationship
iors may contribute to the development of between the activity levels of parents and
overweight in their children.22 The types of their young children. The Framingham Chil-
food available and accessible in the home are dren’s Study, however, monitored physical ac-
also linked with the weight status of pre- tivity with a mechanical device—the Caltrac
school children. Research suggests, for exam- accelerometer—in four- to seven-year-old
ple, that increased consumption of sugar- children and their parents and found that the
sweetened drinks, like fruit juice, might raise children of active mothers were twice as
the risk of overweight among preschool chil- likely to be active as children of inactive
dren.23 One study found that children aged mothers. When both parents were active,
two to five years who drank more than twelve these children were 5.8 times more likely to
ounces of fruit juice a day were more likely to be active than the children of two sedentary
be overweight than those who drank less.24 parents.31
More recently, a study of two- to three-year-
old children found that for those who are at A few studies of preschool children have
risk for overweight, consuming sweet drinks found that the more time children spend out-
as infrequently as once or twice daily in- doors, the higher their activity levels.32These
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The Role of Parents in Preventing Childhood Obesity
findings suggest that parents can and should their own diet and physical activities. When
encourage outdoor play. Questions of safety children make critical decisions about nutri-
and accessibility, however, may make it more tion and physical activity on their own, par-
difficult for some parents and children to ents’ roles become even more challenging.
spend time outdoors. Minority and lower- Nevertheless, parents and family members
income parents, for example, are more likely can still provide a healthful home nutrition
to live in communities with fewer parks, and physical activity environment.
sports facilities, bike paths, and other places
for children to be active and safe.33 Parents and Healthful Eating
in School-Aged Children
Although most research on television view- Parents can encourage healthful eating habits
ing’s influence on child obesity has been con- at home by increasing the number of family
ducted among older children and adolescents, meals eaten together, making healthful foods
some studies have focused on preschool-aged available, and reducing the availability of
children. A study of five- and six-year-old His- sugar-sweetened beverages and sodas.
panic (predominantly Mexican American)
children in Chicago found a link between TV Studies show that eating dinner together as a
viewing and overweight.34 R. H. DuRant and family promotes healthful eating among chil-
several colleagues directly observed three- dren and adolescents by increasing their con-
andfour-year-old children in their homes and sumption of fruits, vegetables, and whole
found that children who watched TV more grains andreducing their consumption of fats
hours a day and children who watched for and soft drinks.38 These same studies, how-
longer periods of time at one sitting were less ever, show that families eat dinner together
likelyto engage in physical activity.35 Another less often as children grow older. One study
study of 2,761 adults with children aged one found that nine-year-olds ate dinner with
to five years from forty-nine New York State their family roughly half the time, while four-
WIC agencies found that viewing TV and teen-year-olds ate dinner with their families
videos and having a TV in the bedroom were only a third of the time.39 It is crucial, there-
both linked with the prevalence of child over- fore, that parents maintain family eating
weight.36 These studies indicate that parents practices throughout adolescence.
should limit preschoolers’ TV and video view-
ing and keep televisions out of their As with preschool-aged children, the avail-
bedrooms. ability of foods at home is a major influence
on older children’s diets. Studies have found
School-Aged Children and Youth that making fruits and vegetables available at
National data indicate that 16 percent of chil- home increases children’s consumption of
dren aged six to nineteen years are over- these foods.40And parents must not only pro-
weight.37 As children grow older and as they vide healthful foods at home, but also eat
focus less on family and more on school, these foods themselves.
peers, and different media, parental influ-
ence wanes. As adolescents, children spend Between 1965 and 1996, adolescents’ soft
increasingly more time away from home, be- drink consumption increased 150 percent
come more exposed to environments that en- while their consumption of fruit drinks in-
courage obesity, and have greater choices in creased 89 percent. As with young children,
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Ana C. Lindsay, Katarina M. Sussner, Juhee Kim, and Steven Gortmaker
several studies indicate that sugar-sweetened exposing them to commercials for unhealth-
beverages may play an important role inthe ful foods.48 Experimental results suggest
childhood obesity epidemic.41 A long-term both factors are at work.49 According to a re-
study of children that began when they were cent nationally representative survey, chil-
eleven and twelve years old found that their dren from third through twelfth grade spend
odds of becoming overweight increased 60 an estimated eight hours a day of media time
percent for each additional servingof sugar- —using computers, listening to music,
sweetened drinks consumeddaily.42A second watching movies, playing computer and
long-term study, this one beginning when video games, and watching TV. About 26 per-
children were nine to fourteen years old, cent of children are “media multitaskers”
linked consumption of sugar-added bever- who go online while they watch TV, resulting
ages with increased weight gains.43 In a ran- in more exposure to the media environment
domized controlled trial in England, reduc- simultaneously.50
ing consumption of carbonated beverages
lowered the prevalence of overweightamong Studies of the contents of television adver-
seven- to eleven-year-olds.44 Such findings tisements document that children are ex-
show how important it is for parents to limit posed to a vast number of TV ads for sodas,
their children’s consumption of these bever- cereal, candy, and fast food.51 And other re-
ages at home. Now that many schools are search suggests that exposure to food com-
making a commitment to soda-free hallways mercials influences children’s preferences
and cafeterias, parents can follow their lead and food requests and can contribute to con-
and keep their homes free of sugar-sweet- fusion among children about the relative
ened beverages as well. health benefits of foods.
Parents and Older Children’s Recent data indicate that 68 percent of chil-
Activity Levels dren have a TV in their bedroom, and half
Children and adolescents spend more time have a video game player and a VCR or DVD
watching television than they do in almost player as well. Increasing numbers of chil-
any other activity. By the time they reach dren also have cable or satellite TV, com-
school-age, about half of U.S. children watch puter, and Internet access in their bedrooms.
television more than two hours a day, and 17 Despite such widespread access, more than
percent of African American children watch half of children report that they have no
more than five hours a day.45 Many studies parental rules on TV watching hours. Among
link TV viewing with overweight.46 Random- those reporting such rules, only 20 percent
ized controlled trials indicate that watching said parents enforce them “most” of the
fewer hours of TV can reduce children’s body time.52 Limiting physical access to TV may
mass index and obesity risk.47 TV viewing, help children reduce their TV viewing.53
therefore, may be one important cause of Children with a TV in their room spend an
childhood obesity that parents can modify at estimated 1.5 hours more a day watching TV
home. than do those without a set in their room.54
TV viewing may increase overweight both by Parents can also help by limiting their own
reducing children’s physical activity and by TV watching and sedentary behavior. Studies
encouraging poor eating habits in children by show that when parents are sedentary, their
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The Role of Parents in Preventing Childhood Obesity
A Word of Caution to Parents about Encouraging Child Dieting
Even though childhood obesity experts discourage dieting, parents who feel the need to control a
child’s weight commonly encourage dieting. Studies on dieting behaviors consistently report that
their parents’ inducement to diet is the most significant factor in causing children to begin dieting.
Their parents’ direct verbal encouragement is more influential than the parents’ own dieting
behaviors.
Many adolescents whose parents urged them to diet report engaging in unhealthful dieting behav-
iors. Focusing on dieting for weight control may overemphasize the thinness ideal and over time
may even lead to an increased risk for obesity. It is important for parents of overweight children to
learn about the dangers of dieting and to talk with their child’s doctor or health care provider
about ways to promote healthful habits.
Sources: L. L. Birch and J. O. Fisher, “Development of Eating Behaviors among Children and Adolescents,” Pediatrics 101, no. 3, pt. 2
(1998): 539–49; K. G. Strong and G. F. Huon, “An Evaluation of a Structural Model for Studies of the Initiation of Dieting among Adoles-
cent Girls,” Journal of Psychosomatic Research44, no. 3–4 (1998): 315–26; R. Dixon, V. Adair, and S. O’Connor, “Parental Influences on
the Dieting Beliefs and Behaviors of Adolescent Females in New Zealand,” Journal of Adolescent Health19, no. 4 (1996): 303–07; G. B.
Schreiber and others, “Weight Modification Efforts Reported by Black and White Preadolescent Girls: National Heart, Lung, and Blood Insti-
tute Growth and Health Study,” Pediatrics98, no. 1 (1996): 63–70; S. Saarilehto and others, “Connections between Parental Eating Atti-
tudes and Children’s Meagre Eating: Questionnaire Findings,” Acta Paediatrica90 (2001): 333–38; L. Smolak, M. P. Levine, and F. Scher-
mer, “Parental Input and Weight Concerns among Elementary School Children,” International Journal of Eating Disorders25, no. 3 (1999):
263–71; J. A. Fulkerson and others, “Weight-Related Attitudes and Behaviors of Adolescent Boys and Girls Who Are Encouraged to Diet by
Their Mothers,” International Journal of Obesity and Related Metabolic Disorders 26, no. 12 (2002): 1579–87.
children are more likely to be sedentary as parental support.60 Many studies show that
well.55 Adolescents whose parents watch TV parents can promote children’s physical activ-
more than two hours a day are more than ity by providing support and encourage-
twice as likely to be physically inactive as ment.61 Further, those parents who realize
those children whose parents watch less.56 the importance of physical activity may offer
even greater support.62That support can take
During the transition from childhood to ado- many forms: arranging access to after-school
lescence, children’s physical activity drops off or community sports and activity programs,
dramatically.57 Although current guidelines watching children’s activities, or simply play-
recommend at least sixty minutes of physical ing with their children.63Parents’ views about
activity for older children on most, preferably their children’s competence and task orienta-
all, days of the week, only 63 percent of ado- tion may also affect their physical activity.64
lescents reported meeting those guidelines in Concerns about traffic, drug dealers, crime,
1999.58Parents can encourage older children and violence may cause parents to limit places
to be more active. Studies suggest that partic- where their child can play, thereby reducing
ipating in sports teams or exercise programs their opportunities for activity.65
can help adolescents reduce their body mass
index.59 Family-Based Obesity-Prevention
Programs
Some studies have found that children are Although a great deal of research has been
more likely to be active if their parents are ac- done on how parents shape their children’s
tive, while others do not find this relationship eating and physical activity habits, surprisingly
and rather emphasize the importance of few high-quality data exist on the effectiveness
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Ana C. Lindsay, Katarina M. Sussner, Juhee Kim, and Steven Gortmaker
of obesity-prevention programs for children programs would be most effective if they
that center on parental involvement. One rea- were targeted at children of various ages
son for the paucity of data is that, despite based on research that shows how parents
some studies that indicate promising results, can best help children at different develop-
few programs are solely parent-based. Most mental stages. Researchers should carefully
efforts to involve parents are components of evaluate the programs’ effectiveness.
more comprehensive interventions. For exam-
ple, many school-based programs aimed at Solely Parent-Based Interventions
preventing childhood obesity are targeted at One solely parent-based intervention con-
children within school settings but include sisted of twenty-eight families of seven- to
parental components that help parents set lim- twelve-year-old African American children
who received primary care at an urban com-
munity clinic serving a low-income popula-
Creating more programs to
tion. Families were randomly selected to re-
ceive counseling alone or counseling plus a
improve parenting behaviors
behavioral intervention that included an elec-
relevant to childhood
tronic television time manager. Both groups
reported similar decreases in their children’s
overweight is a highly
use of television, videotapes, and video
promising strategy.
games. The behavioral intervention group re-
ported significantly greater increases in or-
ganized physical activity and somewhat
its on TV viewing and provide electronic greater increases in playing outside. Changes
“lock-out” devices.66 Likewise, health care– in overall household television use and in
based interventions may add a parenting meals eaten while watching television also ap-
focus. Meanwhile, a WIC-sponsored nutrition peared to favor the behavioral intervention,
intervention will take place within the context with small to medium effect sizes, but these
of WIC, but it might add a parental compo- differences were not statistically significant.69
nent aimed at reducing TV time.67
Another recent solely family-based interven-
As yet little to no information is available on tion tested two versions of a culturally rele-
the cost-effectiveness of obesity-prevention vant program to prevent excess weight gain in
interventions that have a parenting compo- pre-adolescent African American girls. The
nent. One middle-school program called girls, aged eight to ten years, were divided
Planet Health was found to be highly cost- into two groups, both of which participated in
effective—in fact, more cost-effective even highly interactive weekly group sessions. In
than commonly accepted preventive inter- one group, the sessions targeted the girls; in
ventions such as screening and treatment for the other, the sessions were geared toward
hypertension.68 Precisely what influence the their parents or caregivers. Girls in both
program’s parental component specifically groups demonstrated a trend toward reduced
generated, however, is unclear. Nevertheless, body mass index and waist circumference. In
creating more programs to improve parent- addition, girls in both groups reduced their
ing behaviors relevant to childhood over- consumption of sugar-sweetened beverages,
weight is a highly promising strategy. Such increased their level of moderate to vigorous
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The Role of Parents in Preventing Childhood Obesity
activity, and increased their daily serving of ious general health concepts, such as dental
water.70 health, immunization, seat belt safety, and
911 procedures. Their parents’ weekly
Comprehensive Interventions with a newsletters mirrored these sessions. A recent
Parenting Component two-year follow-up study found that the in-
Most interventions aimed at preventing over- tervention group’s children had significantly
weight and obesity have been school-based, smaller increases in body mass index than did
and all have improved health knowledge and those in the control group.72
health-related behaviors to some extent.71
Some of the most successful school-based in- Another recent study assessed the impact of
terventions, however, have included a parent- the school-based Child and Adolescent Trial
ing component. These interventions have re- for Cardiovascular Health (CATCH) inter-
sulted in dramatic changes in health vention among primarily Hispanic, low-
behaviors associated with child obesity and income elementary school children. The in-
overweight as well as in changes in body mass tervention tested the effectiveness of changes
index or obesity. in school food service, physical education,
classroom curricula, and family activities.
School-based interventions at the preschool The family component consisted primarily of
level are scarce, but one study’s findings pro- skill-building activity packets that students
vide strong support for establishing such pro- took home to complete with their parents.
grams. The Hip-Hop to Health Jr. program Third and fourth graders and their families
targeted three- to five-year-old minority chil- were also invited to participate in Family Fun
dren enrolled in Head Start programs in Nights at the school. The family component
Chicago, with the aim of reducing the ten- supplemented the classroom curriculum,
dency toward overweight and obesity in which focused on improving the children’s di-
African American and Latino preschool chil- etary and physical activity knowledge, atti-
dren. The intervention presented a develop- tudes, and self-reported behaviors, and rein-
mentally, culturally, and linguistically appro- forced the concepts, activities, and skills of
priate dietary and physical activity the curriculum. Among both boys and girls,
curriculum for preschoolers, and a parent the intervention reduced overweight or the
component addressed the families’ dietary risk of overweight.73
and physical activity patterns. Each week of
the intervention covered a particular topic, Another successful elementary school–based
such as the importance of “Go and Grow” health behavior intervention on diet and
foods, eating fruit, and reducing TV viewing. physical activity was the Eat Well and Keep
Parents received weekly newsletters with in- Moving program. Classroom teachers in
formation that mirrored the children’s cur- math, science, language arts, and social stud-
riculum on healthful eating and exercise as ies classes taught the quasi-experimental,
well as a five- to fifteen-minute homework two-year field trial among children in grades
assignment that reinforced concepts pre- four and five, with six intervention and eight
sented in the weekly newsletters. During the matched control schools. The intervention
fourteen-week intervention, children in a provided links to school food services and
control group attended a twenty-minute class families and provided training and wellness
once a week in which they learned about var- programs for teachers and other staff mem-
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Ana C. Lindsay, Katarina M. Sussner, Juhee Kim, and Steven Gortmaker
bers. Its aim was to decrease the consump- dle school–aged boys and girls in sixth
tion of foods high in total and saturated fat, to through eighth grades. Students participated
increase fruit and vegetable intake, to reduce in a school-based interdisciplinary program
television viewing, and to increase physical that used existing classroom teachers and
activity. Compared with students in the con- took place in four major subjects and physi-
trol schools, students in the intervention cal education classes. Sessions focused on
schools reduced their share of total energy decreasing both television viewing and the
from fat and saturated fat. They also in- consumption of high-fat foods and on in-
creased their fruit and vegetable intake, vita- creasing both fruit and vegetable intake and
physical activity, with no explicit discussion
of obesity. Compared with girls in the control
A systematic review of group, girls in the intervention group re-
duced their prevalence of obesity; no differ-
research on family
ences were found among boys. The interven-
involvement in weight control tion reduced television hours among both
girls and boys, increased fruit and vegetable
recently found that relatively
consumption among both girls and boys, and
few intervention studies exist, reduced total energy intake among girls in
the intervention group compared with girls
but those few suggest that
in the control group. Among girls, obesity
parental involvement helps prevalence was reduced for each hour that
television viewing was reduced. Although not
children lose weight.
primarily a parent-focused program, Planet
Health had several family components, in-
cluding an activity called “Power Down,”
min C intake, and fiber consumption. They where the household together engaged in a
reduced their television viewing marginally.74 TV charting exercise to reduce TV time.76
Further analysis of Planet Health found a re-
Recently, a pilot study divided children in duced risk of disordered, or unhealthy,
four elementary schools into an intervention weight control behaviors in girls. An eco-
group and a control group and evaluated how nomic analysis found the program substan-
a school-based health report card affected tially cost-effective.77
family awareness of and concerns about child
weight status, plans for weight control, and Obesity-related interventions have also fo-
preventive behaviors. Parents of overweight cused on limiting television viewing.78 A re-
children (including those at risk of over- cent randomized control trial called “Switch-
weight) in the intervention group had greater Play” aimed to replace TV viewing time with
awareness of their children’s weight status more physical activities. More than half the
and initiated more activities to control weight children reported reducing their TV viewing
than did the parents of children in the con- while less than half increased physical activ-
trol group.75 ity. Most of the children enjoyed alternative
activity programs, and only 7 to 17 percent
Planet Health was a two-year, school-based had difficulty turning off their favorite TV
health behavior intervention targeting mid- shows.79
178 THE FUTURE OF CHILDREN