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Simple Suppers: Findings from a Family Meals Childhood Obesity Prevention Intervention

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Simple Suppers: Findings from a Family Meals Childhood Obesity Prevention Intervention Simple Suppers: Findings from a Family Meals Childhood Obesity Prevention Intervention Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Catherine Ann Rogers, MS, RDN, LD Ohio State University Nutrition Graduate Program The Ohio State University 2017 Dissertation Committee: Carolyn W. Gunther, PhD (Advisor) Sarah Anderson, PhD Carla Miller, PhD, RD Keeley Pratt, PhD, IMFT Copyright by Catherine Ann Rogers 2017 Abstract Background: Given the ongoing childhood obesity public health crisis and potential protective effect of family meals, there is need for additional family meals research specifically experimental studies with expanded health outcomes that focus on the at-risk populations in highest need of intervention. Future research, specifically intervention work, would also benefit from an expansion of the target age rage to include younger children who are laying the foundation of their eating patterns and are capable of participating in family meal preparations. The purpose of this dissertation research was to address this research gap by developing and assessing the effectiveness of a 10-week multi-component family meals intervention targeting underserved families with children 4-10 years old, aimed at eliciting positive changes in child diet and weight status. Methods: A 10-week family meals program (Simple Suppers) designed for underserved families with 4-10 year old children from racially diverse backgrounds was implemented as a pre-test-post-test, multi-cohort, quasi-experimental trial with waitlist control. The 10, 90-minute program lessons were delivered weekly over the dinner hour at a faith- based community center. Session components included: a) interactive group discussion of strategies to overcome family meal barriers, plus weekly goal setting for caregivers; b) engagement in age- appropriate food preparation activities for children; and c) group ii family meal for caregivers and children. Main outcome measures were change in: child diet quality and child standardized body mass index (BMI). Caregiver diet and BMI, along with frequency of family meals, were also assessed. Results: At baseline, 95 families (children: n=126; caregivers: n=95) enrolled in the study. Among child participants, approximately 62% were female, 60% identified as Black, mean age was 6.9 years old, and mean BMI z-score was 0.69. Among caregiver participants, 98% were female, 62% identified as Black, 50% were between 31-40 years old, and mean BMI was 33.0. Approximately 40% of participating families were reliant on the Special Supplemental Nutrition Assistance Program for Women, Infants, and children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and/or the National School Lunch Program (NSLP). Generalized linear models, adjusted baseline values and demographics, demonstrated a program attendance intervention effect on child BMI z-score, with children attending >7 classes having a significant decrease in BMI z- score post-test, which was maintained during the follow-up period. Similarly, a significant decrease in caregiver BMI was observed among intervention caregivers at post-test, regardless of level of attendance, and maintained during the follow-up period. Conclusions: Participation in Simple Suppers at a 70% level led to a decreased child BMI z-score, which was maintained at the 10-week follow-up. In addition, participation in the Simple Suppers program led to a decreased BMI among caregivers, regardless of iii level of attendance, which was maintained at the 10-week follow-up. Results from this study demonstrate the potential for engagement in an evidence-based family meals program to positively impact child weight status among a racially diverse sample of school-aged children, of significance given the ongoing childhood obesity epidemic. iv Dedication May the road rise to meet you, may the wind be ever at your back. May the sun shine warm upon your face, and the rains fall soft upon your fields. And until we meet again, may God hold you in the palm of his hand. This dissertation is dedicated to a man who has taught me the strength of positivity & has shown me that in every situation we face, we are presented with an opportunity to learn. I love you from the bottom of my heart, Grampie. v Acknowledgements A sincere thank you to my adviser, Carolyn Gunther, and dissertation committee members, Sarah Anderson, Carla Miller, and Keeley Pratt, for their continuous guidance, support, and encouragement. I also thank our community collaborator Vineyard Community Center (VCC) and VCC staff, Daniel Nathan and Maria Broeckel for their support of and dedication to the Simple Suppers program. I would also like to extend unending gratitude to the dozens of undergraduate and graduate students and dietetic interns who invested endless hours to help make this study a success. Lastly, thank you to the Cardinal Health Foundation for making this study possible through their provision of funding. vi Vita Education 2009................................... M.S. Human Nutrition, Case Western Reserve University 2005.................................... B.S. Dietetics, The Ohio State University Research Experience Aug, 2013 to Present…...... Graduate Research Assistant, The Ohio State University Apr, 2014-July, 2014……... Research Dietitian, The Ohio State University Jan, 2012-Mar, 2013…….... Research Associate, Case Western Reserve University Aug, 2009-Dec, 2010…....... Graduate Associate, Case Western Reserve University Professional Experience Aug, 2016-Dec, 2016…..... Nutrition Intern, Nestlé Research & Development Center Aug, 2009-Aug, 2010…...... Dietetic Intern, University Hospitals of Cleveland Higher Education Teaching Experience Fall, 2013-Present……........ Undergraduate Student Mentor, The Ohio State University Fall, 2013-2016…................. Guest Lecturer (Medical Nutrition Therapy, Type I Diabetes & Gestational Diabetes), The Ohio State University Fall, 2013…………………….... Guest Lecturer (Public Health Nutrition, Maternal & Child Nutrition), The Ohio State University vii Jan, 2011-Dec, 2011……..... Adjunct Professor, The Art Institute of Pittsburgh Certifications Sept, 2010-Present……....... Registered Dietitian (accreditation: Academy of Nutrition & Dietetics Publications Rogers C, Anderson S, Dollahite J, Hill T, Holloman C, Miller C, Pratt K, Gunther C. Methods and Design of a 10-week multi-component family meals intervention: a two group quasi- experimental effectiveness trial. BMC Public Health, 2017. 17:50. Rose AM, Wagner AK, Kennel JA, Pennywitt J, Battista-Hesse M, Miller CK, Murray RD, Rogers C, Gunther CW. Determining the feasibility and acceptability of a nutrition education and cooking program for preschoolers and their families delivered over the dinner hour in a low-income day care setting. Infant, Child, and Adolescent Nutrition, 2014. 6;3:144-151. Major Field of Study Ohio State University Nutrition Graduate Program viii Table of Contents Abstract…………………………………………………………………… ii Dedication………………………………………………………………… v Acknowledgements………………………………………..……………… vi Vita………………………………………………………..……………… vii List of Tables……………………………………………..………………. x List of Figures………………………………………………..................... xii Chapter 1: Introduction ………………………………………………….. 1 Chapter 2: Literature Review…………………………………………….. 15 Chapter 3: Theoretical Framework…………………………...................... 59 Chapter 4: Methods and Design of a 10-Week Multi-Component Family Meals Intervention: a Two Group Quasi- Experimental Effectiveness Trial…………………………………………… 67 Chapter 5: Child Findings from a 10-Week Multi-Component Family Meals Intervention for Underserved Families with Children 4-10 Years Old………………………………………………. 109 Chapter 6: Caregiver and Family Findings from a 10-Week Multi- Component Family Meals Intervention for Underserved Families with Children 4-10 Years Old…………………….... 169 Chapter 7: Discussion…………………………………………………..... 245 Bibliography……………………………………………………………… 261 Appendix A: Simple Suppers Intervention Participant Recruitment Recruitment Materials……………………..………………. 283 Appendix B: Simple Suppers Intervention Informed Consent and Assent Forms………………………..…........................ 286 Appendix C: Simple Suppers Intervention: Data Collection Materials…………………………………………………… 294 ix List of Tables Table 1. Family Meals and Child Diet Quality………………………….. 18 Table 2. Child Involvement in Food Preparation and Child Diet Quality.. 28 Table 3. Home Environment and Child Diet Quality…………………….. 38 Table 4. Table 4. Parent Self-Efficacy for Healthy Dietary Practices……. 52 Table 5. Simple Suppers Intervention Study Design: Two- Group, Staggered Cohort, Quasi-Experimental Design…………………. 74 Table 6. Overview of Formulated Program Objectives at Each Level of Intervention……………………………………………………… 79 Table 7. Matrix of Change Objectives by Level of Intervention for Program Objective 1 of the Simple Suppers Intervention………. 80 Table 8. Matrix of Change Objectives by Level of Intervention for Program Objective 2 of the Simple Suppers Intervention………. 82 Table 9. Theory-Based Methods and Practical Strategies to Achieve the Change Objectives for Selected Program Objectives of the Simple Suppers Intervention…………………………………….. 87 Table 10. Simple Suppers Topics and Goals by Weekly Lesson…………. 101 Table 11. Baseline Child Participant Characteristics……………………… 122 Table 12. Intervention Period: By-Group Child Outcomes at Baseline T0 and Post-Test, T1……..………………………………………… 127 Table 13. Intervention
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