The Journal of Primary Prevention

, Volume 33, Issue 4, pp 161–174 | Cite as

A Community-Based Intervention to Prevent Obesity Beginning at Birth Among American Indian Children: Study Design and Rationale for the PTOTS Study

  • Njeri Karanja
  • Mikel Aickin
  • Tam Lutz
  • Scott Mist
  • Jared B. Jobe
  • Gerardo Maupomé
  • Cheryl Ritenbaugh
Research Methods and Practice

Abstract

Eating and physical activity behaviors associated with adult obesity have early antecedents, yet few studies have focused on obesity prevention interventions targeting very young children. Efforts to prevent obesity beginning at birth seem particularly important in populations at risk for early-onset obesity. National estimates indicate that American Indian (AI) children have higher rates of overweight and obesity than children of other races/ethnicities. The Prevention of Toddler Obesity and Teeth Health Study (PTOTS) is a community-partnered randomized controlled trial designed to prevent obesity beginning at birth in AI children. PTOTS was developed to test the effectiveness of a multi-component intervention designed to: promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. A birth cohort of 577 children from five AI tribes is randomized by tribe to either the intervention (three tribes) or the comparison condition (two tribes). The strengths and weaknesses of PTOTS include a focus on a critical growth phase, placement in the community, and intervention at many levels, using a variety of approaches.

Keywords

Primary obesity prevention Infants Toddlers American Indians 

References

  1. Agras, W. S., Kraemer, H. C., Berkowitz, R. I., & Hammer, L. D. (1990). Influence of early feeding style on adiposity at 6 years of age. Journal of Pediatrics, 116(5), 805–809.PubMedCrossRefGoogle Scholar
  2. Airhihenbuwa, C. O. (1994). Health promotion and the discourse on culture: Implications for empowerment. Health Education Quarterly, 21(3), 345–353.PubMedCrossRefGoogle Scholar
  3. Albala, C., Ebbeling, C. B., Cifuentes, M., Lera, L., Bustos, N., & Ludwig, D. S. (2008). Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children. American Journal of Clinical Nutrition, 88(3), 605–611.PubMedGoogle Scholar
  4. American Academy of Pediatrics Committee on Nutrition. (2001). The use and misuse of fruit juice in pediatrics. Pediatrics, 107(5), 1210–1213.CrossRefGoogle Scholar
  5. Anderson, S. E., & Whitaker, R. C. (2009). Prevalence of obesity among US preschool children in different racial and ethnic groups. Archives of Pediatric & Adolescent Medicine, 163(4), 344–348.CrossRefGoogle Scholar
  6. Birch, L. L. (1999). Development of food preferences. Annual Review of Nutrition, 19, 41–62.PubMedCrossRefGoogle Scholar
  7. Birch, L. L., & Davison, K. K. (2001). Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatric Clinics of North America, 48(4), 893–907.PubMedCrossRefGoogle Scholar
  8. Birch, L. L., Fisher, J. O., Grimm-Thomas, K., Markey, C. N., Sawyer, R., & Johnson, S. L. (2001). Confirmatory factor analysis of the child feeding questionnaire: A measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite, 36(3), 201–210.PubMedCrossRefGoogle Scholar
  9. Birch, L. L., & Ventura, A. K. (2009). Preventing childhood obesity: What works? International Journal of Obesity, 33(Suppl 1), S74–S81.PubMedCrossRefGoogle Scholar
  10. Booth, S. L., Sallis, J. F., Ritenbaugh, C., Hill, J. O., Birch, L. L., Frank, L. D., et al. (2001). Environmental and societal factors affect food choice and physical activity: Rationale, influences, and leverage points. Nutrition Reviews, 59(3 Pt 2), S21–S39.PubMedGoogle Scholar
  11. Briefel, R. R., Reidy, K., Karwe, V., Jankowski, L., & Hendricks, K. (2004). Toddlers’ transition to table foods: Impact on nutrient intakes and food patterns. Journal of the American Dietetic Association, 104(1 Suppl 1), s38–s44.PubMedCrossRefGoogle Scholar
  12. Burdette, H. L., Whitaker, R. C., Hall, W. C., & Daniels, S. R. (2006). Breastfeeding, introduction of complementary foods, and adiposity at 5 y of age. American Journal of Clinical Nutrition, 83(3), 550–558.PubMedGoogle Scholar
  13. Butte, N., Cobb, K., Dwyer, J., Graney, L., Heird, W., & Rickard, K. (2004). The start healthy feeding guidelines for infants and toddlers. Journal of the American Dietetic Association, 104(3), 442–454.PubMedCrossRefGoogle Scholar
  14. Caballero, B., Clay, T., Davis, S. M., Ethelbah, B., Rock, B. H., Lohman, T., et al. (2003). Pathways: A school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. American Journal of Clinical Nutrition, 78(5), 1030–1038.PubMedGoogle Scholar
  15. Campbell, K., Waters, E., O’Meara, S., Kelly, S., & Summerbell, C. (2002). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 2, CD001871.Google Scholar
  16. Centers for Disease Control and Prevention Public Health Practice Program Office US Department of Health and Human Services. (1997). Principles of community engagement. Retrieved from: http://www.cdc.gov/phppo/pce/.
  17. Certain, L. K., & Kahn, R. S. (2002). Prevalence, correlates, and trajectory of television viewing among infants and toddlers. Pediatrics, 109(4), 634–642.PubMedCrossRefGoogle Scholar
  18. Clarke, J. (1991). A gathering of wisdoms. Tribal mental health: A cultural perspective Swinomish tribal mental health project. USA: Swinomish Indian Tribal Community.Google Scholar
  19. Cole, T. J. (2004). Children grow and horses race: Is the adiposity rebound a critical period for later obesity? BMC Pediatrics, 4, 6.PubMedCrossRefGoogle Scholar
  20. Costom, B. H., & Shore, D. (1983). Effect of a comprehensive nutritional program on the growth and ponderosity of infants. Clinical Pediatrics, 22(2), 105–111.PubMedCrossRefGoogle Scholar
  21. Dalenius, K., Borland, E., Smith, B., Polhamus, B., & Grummer-Strawn, L. (2012). Pediatric nutrition surveillance 2010 report. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  22. Dewey, K. G. (2003). Is breastfeeding protective against child obesity? Journal of Human Lactation, 19(1), 9–18.PubMedCrossRefGoogle Scholar
  23. Donner, A., & Klar, N. (2000). Design and analysis of cluster randomization in health research. London, UK: Arnold.Google Scholar
  24. Dwyer, J. T., Suitor, C. W., & Hendricks, K. (2004). FITS: New insights and lessons learned. Journal of the American Dietetic Association, 104(1 Suppl 1), S5–S7.PubMedCrossRefGoogle Scholar
  25. Ebbeling, C. B., Feldman, H. A., Osganian, S. K., Chomitz, V. R., Ellenbogen, S. J., & Ludwig, D. S. (2006). Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: A randomized, controlled pilot study. Pediatrics, 117(3), 673–680.PubMedCrossRefGoogle Scholar
  26. Economos, C. D., Hyatt, R. R., Goldberg, J. P., Must, A., Naumova, E. N., Collins, J. J., et al. (2007). A community intervention reduces BMI z-score in children: Shape up somerville first year results. Obesity (Silver Spring), 15(5), 1325–1336.CrossRefGoogle Scholar
  27. Eisenmann, J. C., Katzmarzyk, P. T., Arnall, D. A., Kanuho, V., Interpreter, C., & Malina, R. M. (2000). Growth and overweight of Navajo youth: Secular changes from 1955 to 1997. International Journal of Obesity and Related Metabolic Disorders, 24(2), 211–218.PubMedCrossRefGoogle Scholar
  28. Fieldhouse, P. (1996). Food and nutrition—customs and culture (2nd ed.). Cheltenham, PA: Stanley Thornes Ltd.Google Scholar
  29. Flynn, M. A., McNeil, D. A., Maloff, B., Mutasingwa, D., Wu, M., Ford, C., et al. (2006). Reducing obesity and related chronic disease risk in children and youth: A synthesis of evidence with ‘best practice’ recommendations. Obesity Reviews, 7(Suppl 1), 7–66.PubMedCrossRefGoogle Scholar
  30. Fogelholm, M., Nuutinen, O., Pasanen, M., Myohanen, E., & Saatela, T. (1999). Parent-child relationship of physical activity patterns and obesity. International Journal of Obesity and Related Metabolic Disorders, 23(12), 1262–1268.PubMedCrossRefGoogle Scholar
  31. Forest, C., & Palmer-House, K. (2003). Empowerment skills for family workers. Ithaca, NY: Family Development Press.Google Scholar
  32. Fox, M. K., Pac, S., Devaney, B., & Jankowski, L. (2004). Feeding infants and toddlers study: What foods are infants and toddlers eating? Journal of the American Dietetic Association, 104(1 Suppl 1), S22–S30.PubMedCrossRefGoogle Scholar
  33. Frary, C. D., Johnson, R. K., & Wang, M. Q. (2004). Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. Journal of Adolescent Health, 34(1), 56–63.PubMedCrossRefGoogle Scholar
  34. Freire, P. (1972). Pedagogy of the oppressed. New York, NY: Continuum.Google Scholar
  35. Freire, P. (1973). Education for critical consciousness. New York, NY: Continuum.Google Scholar
  36. Gittelsohn, J., & Rowan, M. (2011). Preventing diabetes and obesity in American Indian communities: The potential of environmental interventions. American Journal of Clinical Nutrition, 93(5), 1179S–1183S.PubMedCrossRefGoogle Scholar
  37. Green, L. W., Richard, L., & Potvin, L. (1996). Ecological foundations of health promotion. American Journal of Health Promotion, 10(4), 270–281.PubMedCrossRefGoogle Scholar
  38. Grummer-Strawn, L. M., & Mei, Z. (2004). Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Pediatrics, 113(2), e81–e86.PubMedCrossRefGoogle Scholar
  39. Harnack, L., Stang, J., & Story, M. (1999). Soft drink consumption among US children and adolescents: Nutritional consequences. Journal of the American Dietetic Association, 99(4), 436–441.PubMedCrossRefGoogle Scholar
  40. Hooks, B. (1994). Teaching to transgress: Education as the practice of freedom. New York, NY: Routledge.Google Scholar
  41. Jackson, M. Y. (1993). Height, weight, and body mass index of American Indian schoolchildren, 1990–1991. Journal of the American Dietetic Association, 93(10), 1136–1140.PubMedCrossRefGoogle Scholar
  42. Karanja, N., Lutz, T., Ritenbaugh, C., Maupome, G., Jones, J., Becker, T., et al. (2010). The TOTS community intervention to prevent overweight in American Indian toddlers beginning at birth: A feasibility and efficacy study. Journal of Community Health, 35(6), 667–675.PubMedCrossRefGoogle Scholar
  43. King, A. C., Stokols, D., Talen, E., Brassington, G. S., & Killingsworth, R. (2002). Theoretical approaches to the promotion of physical activity: Forging a transdisciplinary paradigm. American Journal of Preventive Medicine, 23(2 Suppl), 15–25.PubMedCrossRefGoogle Scholar
  44. Lederman, S. A., Akabas, S. R., Moore, B. J., Bentley, M. E., Devaney, B., Gillman, M. W., et al. (2004). Summary of the presentations at the conference on preventing childhood obesity. Pediatrics, 114, 1146–1165.CrossRefGoogle Scholar
  45. Lindsay, R. S., Cook, V., Hanson, R. L., Salbe, A. D., Tataranni, A., & Knowler, W. C. (2002). Early excess weight gain of children in the Pima Indian population. Pediatrics, 109(2), E33.PubMedCrossRefGoogle Scholar
  46. Maupome, G., Karanja, N., Ritenbaugh, C., Lutz, T., Aickin, M., & Becker, T. (2010). Dental caries in American Indian toddlers after a community-based beverage intervention. Ethnicity and Disease, 20(4), 444–450.PubMedGoogle Scholar
  47. McConahy, K. L., Smiciklas-Wright, H., Birch, L. L., Mitchell, D. C., & Picciano, M. F. (2002). Food portions are positively related to energy intake and body weight in early childhood. Journal of Pediatrics, 140(3), 340–347.PubMedCrossRefGoogle Scholar
  48. McCullough, N., Muldoon, O., & Dempster, M. (2009). Self-perception in overweight and obese children: A cross-sectional study. Child: Care, Health and Development, 35(3), 357–364.Google Scholar
  49. Mehta, K. C., Specker, B. L., Bartholmey, S., Giddens, J., & Ho, M. L. (1998). Trial on timing of introduction to solids and food type on infant growth. Pediatrics, 102(3 Pt 1), 569–573.PubMedCrossRefGoogle Scholar
  50. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change. New York, NY: Guilford Press.Google Scholar
  51. Miltenberger, R. G. (2008). Behavior modification: Principles and procedures (4th ed.). Pacific Grove, CA: Homson/Wadsworth.Google Scholar
  52. Must, A., & Strauss, R. S. (1999). Risks and consequences of childhood and adolescent obesity. International Journal of Obesity and Related Metabolic Disorders, 23(Suppl 2), S2–S11.PubMedCrossRefGoogle Scholar
  53. National Association for Sport and Physical Education. (2012). Active start: A statement of physical activity guidelines for children from birth to age 5 (2nd ed.). Retrieved from http://wwwperd.org/naspe/standards/nationalGuidelines/ActiveStart.cfm.
  54. O’Dea, J. A. (2005). Prevention of child obesity: ‘First, do no harm’. Health Education Research, 20(2), 259–265.PubMedCrossRefGoogle Scholar
  55. Oliveria, V., Racine, E., Olmsted, J., & Ghelfi, L. M. (2002). The WIC program: Background, trends, and issues. Food and rural economics division, economic research service, US Department of Agriculture. Food Assistance and Nutrition Research Report No. 27. Retrieved from http://www.ers.usda.gov/media/327957/fanrr27_1_.pdf.
  56. Paul, I. M., Savage, J. S., Anzman, S. L., Beiler, J. S., Marini, M. E., Stokes, J. L., et al. (2011). Preventing obesity during infancy: A pilot study. Obesity (Silver Spring), 19(2), 353–361.CrossRefGoogle Scholar
  57. Potvin, L., Desrosiers, S., Trifonopoulos, M., Leduc, N., Rivard, M., Macaulay, A. C., et al. (1999). Anthropometric characteristics of Mohawk children aged 6 to 11 years: A population perspective. Journal of the American Dietetic Association, 99(8), 955–961.PubMedCrossRefGoogle Scholar
  58. Pugliese, M. T., Weyman-Daum, M., Moses, N., & Lifshitz, F. (1987). Parental health beliefs as a cause of nonorganic failure to thrive. Pediatrics, 80(2), 175–182.PubMedGoogle Scholar
  59. Renehan, A. G., Tyson, M., Egger, M., Heller, R. F., & Zwahlen, M. (2008). Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies. Lancet, 371(9612), 569–578.PubMedCrossRefGoogle Scholar
  60. Rolland-Cachera, M. F., Deheeger, M., Guilloud-Bataille, M., Avons, P., Patois, E., & Sempe, M. (1987). Tracking the development of adiposity from one month of age to adulthood. Annals of Human Biology, 14(3), 219–229.PubMedCrossRefGoogle Scholar
  61. Rolls, B. J., Engell, D., & Birch, L. L. (2000). Serving portion size influences 5-year-old but not 3-year-old children’s food intakes. Journal of the American Dietetic Association, 100(2), 232–234.PubMedCrossRefGoogle Scholar
  62. Salbe, A. D., Weyer, C., Lindsay, R. S., Ravussin, E., & Tataranni, P. A. (2002). Assessing risk factors for obesity between childhood and adolescence: I. Birth weight, childhood adiposity, parental obesity, insulin, and leptin. Pediatrics, 110(2 Pt 1), 299–306.Google Scholar
  63. Sallis, J. F., Alcaraz, J. E., McKenzie, T. L., Hovell, M. F., Kolody, B., & Nader, P. R. (1992). Parental behavior in relation to physical activity and fitness in 9-year-old children. American Journal of Diseases of Children, 146(11), 1383–1388.PubMedGoogle Scholar
  64. Sallis, J. F., Bauman, A., & Pratt, M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15(4), 379–397.PubMedCrossRefGoogle Scholar
  65. Schiller, J. S., Lucas, J. W., Ward, B. W., & Peregoy, J. A. (2012). Summary health statistics for US adults: National Health Interview Survey, 2010. Vital and Health Statistics, 10(252), 1–207. Retrieved from http://www.cdc.gov/nchs/data/series/sr_10/sr10_252.pdf.
  66. Sepp, H. (2002). Pre-school children’s food habits and meal situation. (Unpublished doctoral dissertation). Uppsala University, Sweden.Google Scholar
  67. Srinivasan, S. R., Bao, W., Wattigney, W. A., & Berenson, G. S. (1996). Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: The Bogalusa Heart Study. Metabolism, 45(2), 235–240.PubMedCrossRefGoogle Scholar
  68. Stettlar, N. (2007). Obesity risk factors and prevention in early life: Pre-pregnancy through infancy. In S. K. Kumanyika & R. C. Brownson (Eds.), Handbook of obesity prevention. New York, NY: Springer.Google Scholar
  69. Stokols, D. (1992). Establishing and maintaining healthy environments. Toward a social ecology of health promotion. American Psychologist, 47(1), 6–22.PubMedCrossRefGoogle Scholar
  70. Stokols, D. (2000). Social ecology and behavioral medicine: Implications for training, practice, and policy. Behavioral Medicine, 26(3), 129–138.PubMedCrossRefGoogle Scholar
  71. Story, M., Holt, K., & Sofka, D. (Eds.). (2002). Bright futures in practice: Nutrition (2nd ed.). Arlington, VA: National Center for Education in Maternal and Child Health.Google Scholar
  72. Thornton, R. (1996). Tribal membership requirements and the demography of “old” and “new” Native Americans. In G. D. Sandefur, R. R. Rindfuss, & B. Cohen (Eds.), Changing numbers, changing needs: American Indian demography and public health (pp. 103–112). Washington, DC: The National Academies Press.Google Scholar
  73. Tones, K., Tilford, S., & Robinson, Y. K. (1990). Health education: Effectiveness and efficiency. London, UK: Chapman and Hall.Google Scholar
  74. Wallerstein, N., & Bernstein, E. (1988). Empowerment education: Freire’s ideas adapted to health education. Health Education Quarterly, 15(4), 379–394.PubMedCrossRefGoogle Scholar
  75. Wang, Y., & Beydoun, M. A. (2007). The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: A systematic review and meta-regression analysis. Epidemiologic Reviews, 29, 6–28.PubMedCrossRefGoogle Scholar
  76. Wang, G., & Dietz, W. H. (2002). Economic burden of obesity in youths aged 6 to 17 years: 1979–1999. Pediatrics, 109(5), E81.PubMedCrossRefGoogle Scholar
  77. Wardle, J., Cooke, L. J., Gibson, E. L., Sapochnik, M., Sheiham, A., & Lawson, M. (2003). Increasing children’s acceptance of vegetables; a randomized trial of parent-led exposure. Appetite, 40(2), 155–162.PubMedCrossRefGoogle Scholar
  78. Wardle, J., Sanderson, S., Guthrie, C. A., Rapoport, L., & Plomin, R. (2002). Parental feeding style and the inter-generational transmission of obesity risk. Obesity Research, 10(6), 453–462.PubMedCrossRefGoogle Scholar
  79. Wilson, J. F. (2000). Lunch eating behavior of preschool children. Effects of age, gender, and type of beverage served. Physiology & Behavior, 70(1–2), 27–33.CrossRefGoogle Scholar
  80. Wilson, S. E. (2002). The health capital of families: An investigation of the inter-spousal correlation in health status. Social Science and Medicine, 55(7), 1157–1172.PubMedCrossRefGoogle Scholar
  81. Wilson, A. C., Forsyth, J. S., Greene, S. A., Irvine, L., Hau, C., & Howie, P. W. (1998). Relation of infant diet to childhood health: Seven year follow up of cohort of children in Dundee infant feeding study. BMJ, 316(7124), 21–25.PubMedCrossRefGoogle Scholar
  82. Zametkin, A. J., Zoon, C. K., Klein, H. W., & Munson, S. (2004). Psychiatric aspects of child and adolescent obesity: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 43(2), 134–150.PubMedCrossRefGoogle Scholar
  83. Zephier, E., Himes, J. H., Story, M., & Zhou, X. (2006). Increasing prevalences of overweight and obesity in Northern Plains American Indian children. Archives of Pediatrics and Adolescent Medicine, 160(1), 34–39.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Njeri Karanja
    • 1
  • Mikel Aickin
    • 2
  • Tam Lutz
    • 4
  • Scott Mist
    • 4
  • Jared B. Jobe
    • 3
    • 6
  • Gerardo Maupomé
    • 5
  • Cheryl Ritenbaugh
    • 2
  1. 1.Center for Health ResearchKaiser Permanente–Northwest/Hawaii/SoutheastPortlandUSA
  2. 2.Department of Family and Community MedicineUniversity of ArizonaTucsonUSA
  3. 3.Division of Cardiovascular SciencesNational Heart, Lung and Blood InstituteBethesdaUSA
  4. 4.Northwest Portland Area Indian Health BoardPortlandUSA
  5. 5.Department of Preventive and Community DentistryIndiana University School of Dentistry, The Regenstrief Institute, IncIndianapolisUSA
  6. 6.Division of Cancer Control and Population ScienceNational Cancer InstituteRockvilleUSA

Personalised recommendations