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• W2720343224 abstract "As we approach the end of the second decade of the 21st century, childhood obesity has not only become a top public health issue for elected and public health officials alike, but it is now the target of many broad-based policies and legislations (1). The accumulated evidence to date lends support to the importance of beginning childhood obesity prevention early in life and using a combination of multilevel and multisector interventions that target entire populations and high-risk populations. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is in a unique position to contribute to childhood obesity prevention because of several programmatic attributes: (a) the program serves more than half of infants born in the US (2); (b) through nutrition risk assessment, nutrition education, supplemental food packages, and breastfeeding promotion and support, WIC has an opportunity to promote healthy weight status during pregnancy, infancy, early childhood, and interconception (3); and (c) the research-quality height and weight measures that are obtained in WIC clinics using a standard protocol provide an opportunity to monitor and evaluate effects of both population-based and high-risk obesity prevention strategies among participating children (4). Research by Woo Baidal and colleagues (5) in this issue of Obesity further lends support for the inclusion of WIC in cross-sector, multi-level interventions aimed at preventing obesity among low-income preschool (0-5 years) children. The results reported by Woo Baidal et al. come from the evaluation of a systems-level WIC intervention implemented in two communities as part of the Massachusetts Childhood Obesity Research Demonstration project (MA-CORD). Using a quasi-experimental, pretest-posttest evaluation design, the authors found improvements in prevalence of obesity-related health behaviors such as the intake of sugar-sweetened beverages, daily physical activity, TV avoidance in bedrooms, and sleep duration at Intervention Site #1 and sugar-sweetened beverage intake, juice intake, and sleep at Intervention Site #2. In sensitivity analyses that excluded Asian-American children, the authors noted statistically significant decreases in BMI z scores at Intervention Site #2 compared to the comparison site. Attributing causation and effects to childhood obesity prevention interventions is inherently a difficult undertaking because of several real challenges that confront researchers: (a) there are often multiple interventions being implemented simultaneously at the individual, family, community, state, and national levels; thus, isolating effects of any single intervention is not always possible (6); (b) there is often a lack of adequate resources to conduct rigorous process evaluations along with outcome evaluations to measure important process indicators such as adaptations, fidelity, reach, and dose that can enable researchers to assess the extent to which interventions were implemented as planned and thus created the potential for observing meaningful short-term and long-term outcomes; and (c) there are significant fluctuations in the BMI of healthy children, with generally rapid increases during infancy and subsequent declines during early childhood (1-5 years). Related to the challenge posed by the multiplicity of interventions, Woo Baidal et al. (5) correctly point out that they are “unable to quantify the effect of sector-specific doses of MA-CORD intervention components on BMI or to account for other initiatives to promote healthy behaviors in MA-CORD or comparison communities during the intervention period.” Nonetheless, by training staff at intervention sites to overcome challenges that often face WIC staff and parents in regard to preventing obesity in preschool children (7), the MA-CORD WIC intervention created the potential for observing meaningful improvements in obesity-related health behaviors beyond those that could have been observed with the use of usual care alone. Relevant to the resources challenge, the MA-CORD WIC intervention was implemented and evaluated through a strong and mutually beneficial partnership between the Massachusetts Department of Public Health and the Harvard University School of Public Health. This partnership meant that the state health department's infrastructure and existing cross-sector collaborators could be enlisted by the academic research team during the conduct of the MA-CORD study. Similarly, partnering with an academic research center meant that the state health department would benefit from the research and scientific expertise of the academic researchers during the design, implementation and evaluation of the systems-level WIC intervention. Academic-government partnerships in obesity prevention have long been recognized as having the potential to lead to the identification of population-based strategies that may have meaningful and lasting impacts on the behavioral and environmental risk factors for obesity (8). Beyond the possible roles of the sample size, the efficiency of the study design, or the true effect size of the intervention, the failure by Woo Baidal et al. to observe statistically significant decreases in BMI z scores after a 2-year intervention period also highlights the third challenge presented by the known fluctuations of BMI in early childhood. Even with the use of a multilevel, mixed-effects, repeated-measures analysis approach to account for within-person and within-community changes in BMI over time, the MA-CORD research team still faced the challenge of distinguishing BMI z score changes that would have naturally occurred due to fluctuations in the BMI of healthy preschool children from those changes that could have occurred as a result of the MA-CORD WIC intervention. The use of a comparison site contributed to mitigating against this challenge; in theory, larger differences between pretest-posttest BMI z scores at any of the intervention sites compared to those at the comparison site approximate changes that occurred because of the intervention. Notwithstanding the challenges associated with estimating the effects of WIC in multilevel, multisector obesity prevention interventions, the MA-CORD results contribute to the growing evidence that supports the integration of WIC in high-risk obesity prevention strategies. The MA-CORD results are consistent with NY Fit WIC (7) pretest-posttest comparisons that showed a decrease in the average “amount of time children spend watching TV daily” and an increase in the average “amount of time children spend playing outdoors daily” (9). To expedite the translation of evidence from MA-CORD and similar interventions, future outcomes research should incorporate qualitative research methods (10) to assess factors and processes that contribute to effective stakeholder engagement and sustainable cross-sector partnerships in childhood obesity prevention." @default.
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• W2720343224 date "2017-06-26" @default.
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• W2720343224 title "Estimation of WIC effects in multilevel, cross-sector obesity prevention interventions" @default.
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