Studies show power of multi-level approaches to prevent childhood obesity in low-income communities

Childhood obesity rates are at historically high levels especially among racial/ethnic minorities and low-income families. In this issue of Obesity, three papers present outcomes from the Massachusetts Childhood Obesity Research Demonstration Project (MA-CORD), a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2–12 years old in two selected cities in Massachusetts.

Childhood Obesity Prevention in the Women, Infants, and Children Program: Outcomes of the MA-CORD Study lead author Jennifer Woo Baidal, MD, MPH, et al. examined the extent to which a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) intervention improved body mass index (BMI) z-scores and obesity related behaviors among children ages 2-4 years old. "This study is one of the first to incorporate WIC into a whole-of-community intervention which resulted in reduced prevalence of childhood obesity risk factors," said Dr. Woo Baidal, Assistant Professor of Pediatrics, Director of Pediatric Weight Management, Columbia University Medical Center & New York-Presbyterian Morgan Stanley Children's Hospital.

The second MA-CORD study was conducted by Elsie M. Taveras, MD, MPH, et al. and examined the impact of the MA-CORD multi-component clinical intervention on BMI z-scores compared to routine practice, over 2 years, using electronic health records. The clinical intervention package included: specialized training for health care providers and other clinic staff on best practices for treating childhood obesity and encouraging heathy changes; electronic support tools, including computerized alerts when physicians opened electronic health records of children with overweight or obesity during well-child visits; Healthy Weight Clinics, to which children with overweight or obesity and their parents could be referred; environmental changes at the health centers designed to encourage healthy behaviors; and a community health worker dedicated full time to the program. The study sought to examine the extent to which the clinical intervention resulted in reduced BMI z-scores among 2-12 year old children compared to routine practice. "The results of this research directly relate to children, families and the medical and community organizations that serve them. Our study reflects a best practice in the design of an effective multi-level intervention addressing childhood obesity in low-income communities," said TOS Spokesperson and lead author Dr. Taveras, Professor of Pediatrics, Harvard Medical School and incoming Executive Director of the Kraft Center for Community Health at Mass General Hospital.

The third MA-CORD study led by Rebecca Franckle, ScD, MPH, et al. reported on the school-based component of MA-CORD examining changes in prevalence of obesity and target health behaviors (food and beverage consumption, physical activity, screen time, sleep duration) for 1^st, 4^th and 7^th graders. Among 7^th graders a significant decrease in prevalence of obesity was reported in one intervention community. "Schools remain a critical environment for health promotion and obesity prevention establishing behaviors for life," asserts Dr. Franckle, Postdoctoral Fellow, Department of Nutrition Harvard TH Chan School of Public Health.

In accompanying editorials published in Obesity pertaining to the MA-CORD, Jackson P. Sekhobo, PhD, MPA, examined the WIC study in depth while Christina Economos, PhD, and Ross A. Hammond, PhD, explored all three studies and corresponding results. Overall, the conclusion from these 3 studies collectively demonstrates the potential power of multi-sector, multi-level approaches to childhood obesity prevention in low-income communities.