Growing Right Onto Wellness (GROW): Changing Early Childhood Body Mass Index (BMI) Trajectories

Increases in sedentary lifestyle and high calorie food consumption, among other factors, have
contributed to epidemic levels of childhood obesity in the US. Children who are overweight
during the preschool period are more likely to become overweight adolescents and obese
adults. Food preferences and activity habits set in early childhood can profoundly influence
lifelong trajectories for Body Mass Index (BMI) and health. Specifically, rapid BMI gain in
early childhood has been established to affect adulthood mortality and morbidity.
Unfortunately, the longer such unhealthy patterns are in place, the more difficult it can be
to reverse them. Therefore, healthy lifestyle interventions targeted at children as early as
preschool have enormous potential to affect lifelong health. Furthermore, nutrition and
activity patterns are determined not only at the child level, but within the family and the
community.

This study will assess the impact of a family-based and community centered multilevel
behavioral intervention addressing nutrition and physical activity with high risk
parent-preschool children dyads to promote pediatric obesity prevention. The 7 year study
will follow 600 parent preschool child dyads, half of whom will be randomized into the
intervention condition which will utilize a health literate approach, build new social
networks, utilize behavior modification tools including goal setting, self monitoring, and
problem solving, and create behavior-environmental synergy with cues to action for use of the
built environment for healthy behaviors. Both the intervention and control group (separately)
will receive the control condition in which parent-child dyads will receive a literacy
promotion/school success curriculum.

The primary outcome of interest will be early childhood BMI trajectories measured at multiple
time points over the three year RCT. Additional measures collected throughout the study from
children and parents will include: tricep skin fold, waist circumference, actigraphy, 3-day
diet recalls, questionnaires, social network data, and saliva to assess a
genetics/epigenetics associated with obesity. Consistent with a multilevel systems approach,
the investigators will develop and assess built environment changes related to obesity
prevention. Moreover, working with the study's community partners, the investigators will
evaluate how this approach affects local policy.

Inclusion Criteria:

- English or Spanish speaking

- Address in select zip code regions around participating Metro community centers

- Parental commitment to consistent participation

- Consistent phone access for 3 years

- Child aged 3-5 years old

- Child BMI ≥ 50% and < 95% (no diagnosis of failure to thrive or difficulty with
appropriate weight gain)

- Healthy parent and child (without medical conditions necessitating limited physical
activity)

- Parent ≥ 18 years of age

Exclusion Criteria:

- Non English or Spanish speaking

- Address outside select zip code regions around participating Metro community centers

- Lack of parental commitment to consistent participation

- Lack of consistent phone access

- Child outside specified age range

- Child BMI < 50% or ≥ 95%

- Parents and/or children who are diagnosed with medical illnesses where regular
exercise might be contraindicated

- Parent < 18 years of age