January 30, 2009

Obesity study aims at children under age 2

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Russell Rothman, M.D., center, with colleagues, from left, Ayumi Shintani, Ph.D., M.P.H., Shari Barkin, M.D., Bettina Beech, Dr. P.H., M.P.H., and Sunil Kripalani, M.D. (photo by Joe Howell)

Obesity study aims at children under age 2

Vanderbilt researchers have been awarded $3 million from the National Institutes of Health to study ways physicians can help curb obesity in children younger than two.

Russell Rothman, M.D., assistant professor of Internal Medicine and Pediatrics and director of the Vanderbilt Program in Effective Health Communication, organized the five-year study, which will follow 1,000 children from age 4 months to 2 years.

“We are seeing an epidemic in pediatric obesity, and this study gives us a great opportunity to try to address that epidemic and promote healthy habits for families with young children,” Rothman said.

Rothman, an expert in how the medical profession communicates with patients, said this study is one of the few to target obesity prevention before age 2. He said it relies on key factors in the relationship between young parents and their health providers.

“Trying to impact obesity through doctors' offices has met with moderate-to-no success in the past, partly because older patients only see their doctor once or twice a year,” Rothman said. “But before age two, parents are scheduled to bring children in for about eight well-care visits. That's an excellent opportunity to teach about healthy nutrition and activity.”

When children are first enrolled in the study at age four months, they will just be starting to try solid foods and juices. At that age they are also beginning to become more physically active. The physicians involved in the study will receive training in health communication and health literacy issues, and will use a specially designed workbook to teach parents lessons, including the appropriate time to wean from the bottle, appropriate portion sizes, reducing the use of juice and limiting exposure to media like TV.

The study will take place at four medical center pediatric primary care clinics: Vanderbilt, University of Miami, University of North Carolina at Chapel Hill, and New York University. Two of the clinics will be randomized to use the study's teaching workbook, while the other two will serve as active control sites and will address injury prevention.

Vanderbilt is also the coordinating site. Rothman serves as the principal investigator with co-investigators Shari Barkin, M.D., M.P.H., Bettina Beech, Dr.P.H., Ayumi Shintani Ph.D., Sunil Kripalani, M.D., and Lisa Rawn. Rothman said the clinics participating in this study were specifically selected because they are training clinics for pediatric residents.

“Resident clinics are a safety net. They see one fifth of the socioeconomically disadvantaged families in the country. These are also the families at highest risk for childhood obesity,” Rothman said.

By design, the study will have a heavy emphasis on helping Spanish-speaking families. About 40 percent of families enrolled will be Latino. Obesity is a major problem among Latino children, and the Centers for Disease Control (CDC) currently estimates that one in two Latino Americans born today will develop diabetes in their lifetime.

“The Latino population is crucial to include and we are tailoring materials to be culturally relevant to this population,” Barkin said.

“For a Latino family, obesity is often perceived differently — a “gordito,” or chubby, baby is viewed as a healthy baby. But we know if a baby grows too quickly in the first year of life, they are two to four times more likely to become an overweight toddler. This highlights the important nature of this study.”

With support from the Tennessee Department of Health Project Diabetes, Vanderbilt, Meharry and WIC (Women Infants and Children) will begin a pilot project next month with 100 families to help develop and test the materials that will be used in the larger NIH-funded study, slated to begin this fall.