Open Access Research article

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City

Gloria Oliva Martínez-Andrade1, Elizabeth M Cespedes23*, Sheryl L Rifas-Shiman2, Guillermina Romero-Quechol1, Marco Aurelio González-Unzaga1, María Amalia Benítez-Trejo4, Samuel Flores-Huerta4, Chrissy Horan2, Jess Haines5, Elsie M Taveras36, Ricardo Pérez-Cuevas7 and Matthew W Gillman23

Author Affiliations

1 Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, CMN Siglo XXI, Av. Cuauhtémoc 330, Colonia Doctores, Delegación Cuauhtémoc, México, D.F. 06720, México

2 Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 3rd Floor, Boston, MA 02215, USA

3 Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA

4 Community Health Department, Hospital Infantil de México Federico Gómez, Secretaria de Salud, Dr. Márquez No.162, Col. Doctores, Delegación: Cuauhtémoc, México D.F. 06720, México

5 Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada

6 Division of General Pediatrics, MassGeneral Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA

7 División de Protección Social y Salud, Banco Inter Americano de Desarrollo, Avenida Paseo de la Reforma Nº 222 Piso 11, Colonia Juárez, Delegación Cuauhtémoc, México D.F. 6600, México

For all author emails, please log on.

BMC Pediatrics 2014, 14:77  doi:10.1186/1471-2431-14-77

Published: 20 March 2014

Abstract

Background

Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics.

Methods

We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values.

Results

93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program.

Conclusions

Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI.

Trial registration

ClinicalTrials.gov NCT01539070.

Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.

Keywords:
Obesity prevention; Intervention; Trial; Pediatrics; Primary care; Mexico; Preschool