by Kristina Woods Butler
Researchers from Various Disciplines Converge to Prevent and Control Childhood Obesity in West Texas
The Transformación Para Salud project was a transdisciplinary project that involved more than a dozen researchers from various TTU campuses and areas of expertise. Watch Esperat and Feng discuss the project and its significance for future obesity research.
It’s one of the leading preventable causes of death worldwide and often called “the silent killer.” According to the Centers for Disease Control and Prevention (CDC), obesity affects approximately 34 percent of adults and 17 percent of children in the United States. Since 1980 the number of childhood obesity cases has more than tripled, and experts say those children diagnosed as obese have an 80 percent chance of remaining obese their entire lives.
These statistics are only part of the reason why obesity prevention and intervention remain high priorities for many researchers at Texas Tech University (TTU) and the Texas Tech University Health Sciences Center (TTUHSC). From nutrition and exercise to education and neuroscience, TTU researchers continue to address the growing epidemic head-on.
In 2006, through a transdisciplinary effort, more than a dozen researchers from TTU, TTUHSC-Lubbock and TTUHSC-El Paso joined together for an in-depth obesity research study. With the help of a $1.5 million grant from the U.S. Department of Agriculture, the team developed Transformación Para Salud (Transformation for Health), a multilevel, community-based participatory program targeting low-income Hispanic children between the ages of 5 and 8 at selected independent school districts in Lubbock and El Paso. The program assisted children, their families and communities in childhood obesity and overweight control and prevention through community outreach, education and research.
“It is documented that obesity is a multifactorial problem, and therefore what we envisioned was the combining of expertise from various disciplines in order to have a much more comprehensive approach to the project itself but as well as to the science of the problem,” said Christina Esperat, Transformación Para Salud project director, and professor and associate dean for clinical services and community engagement at the TTUHSC School of Nursing.
“We want this to be a model that can be implemented by anyone in a school setting.” — Christina Esperat.
Go back three years earlier to 2003. That’s when the project actually began with the formation of the East Lubbock Community Coalition for Health Improvement (ELCCHI). The group, consisting of various community professionals and Parent Teacher Organization members, identified childhood obesity as a major health problem in Lubbock that needed to be dealt with immediately. ELCCHI played a major role in the early stages of the Transformación Para Salud project by helping with the needs assessment to identify appropriate interventions and the research design in general.
They decided on a three-part research design composed of an educational curriculum implemented in selected schools in El Paso and Lubbock; an intensive intervention with a smaller portion of the population, involving home visits and working with Promotoras, or certified community health workers; and community engagement through various programs and events.
As part of the curriculum, children experienced hands-on gardening lessons, including planting, caring for and even harvesting the gardens.
The educational portion of the project consisted of three components: Comidos Para Salud (Food for Health), Pasos Para Salud (Steps for Health) and Jardines Para Salud (Gardens for Health). These programs were first introduced in the classroom by trained graduate students with classroom teachers observing. During the second year, the classroom teachers were trained and then were able to implement the intervention alone, allowing researchers to observe classroom interactions.
The nutrition curriculum was adapted from Bienestar, a bilingual health curriculum specifically developed for children of Hispanic background. Additions were made to emphasize healthful eating habits and address other contributing factors. For example, a lesson was introduced on accepting different body sizes based on an afterschool program developed by Debra Reed, TTU professor and Helen DeVitt Jones chair in the Department of Nutrition, Hospitality and Retailing.
“We found in our afterschool program that even young children can have distorted body images,” said Reed. “Bienestar is a basic nutrition curriculum, but we felt that for children to be interested and motivated to make changes in their eating and physical activity, they needed to feel good about themselves. It’s been a really powerful lesson.”
For the physical activity curriculum, researchers chose martial arts for its ability to engage children, help them lose weight, enhance psychomotor skills, build stamina and encourage self-confidence. Martial arts also did not require a competitive spirit like team sports. The curriculum was one that transitioned easily from school to home, not requiring expensive equipment or a specific arena.
The third component, Jardines Para Salud, was adapted from the University of Iowa “Grow in the Garden” curriculum and the Master Gardener program. Researchers engaged the services and expertise of a master gardener to develop and implement the gardening curriculum. Children not only learned about growing food during science classes; they experienced hands-on lessons with their families by planting, caring for and even harvesting the gardens.
Meet the Researchers
Christina Esperat is professor and associate dean for clinical services and community engagement at the Texas Tech University Health Sciences Center School of Nursing.
Du Feng is a professor in the Department of Human Development and Family Studies in the College of Human Sciences.
Debra Reed is professor and Helen DeVitt Jones Chair of nutrition sciences in the Department of Nutrition, Hospitality and Retailing in the College of Human Sciences.
In addition to the educational curriculum, a more intensive intervention was implemented for at-risk children within the target population whose body mass indexes (BMI) were above 85 percent. Certified Promotoras conducted one-on-one home visits with the children, parents and caretakers to reinforce what they learned in school.
“Our community health workers, or Promotoras, are specialized in obesity prevention and control, particularly intensive intervention with families and caregivers,” said Esperat. “They are certified by the state and undergo a curriculum, which is quite intensive, and develop core competencies that will help them to be more successful in promoting some enabling services toward the families that are identified as needing their services.”
Researchers are continuing to sift through the data to find new outcomes generated from the study. The results of the intervention are being evaluated in terms of primary and secondary outcomes. The primary outcomes include subjects’ BMI-for-age, based on measurements taken five times before, during and after the intervention period. Secondary outcomes stem from measurements of behavioral, cognitive and psychosocial factors, including children’s sugar-sweetened beverage, and fruit and vegetable intake; sedentary behaviors; parents’ subjective nutrition knowledge and support for physical activity; as well as the availability of healthy foods in the home.
“In terms of the primary outcomes, we didn’t find a lot of significant changes,” said Du Feng, principal investigator for the program and professor of human development and family studies at TTU. “We found that as children aged, their BMI percentile increased as part of their normal growth, and the intervention didn’t significantly reduce the BMI percentile or body fat percentage. But there were a lot of significant findings in the secondary outcomes.”
One positive finding was the decrease in the intake of sugar-sweetened beverages among children involved in the study.
“As part of the normal growth and as children grew older, especially when they went from kindergarten to first grade, there was a significant increase in their intake of sugar-sweetened beverages,” said Feng. “But kids in the intervention group didn’t show such a big increase. So in other words the intervention slowed down or controlled the increase in the intake.”
Other secondary outcomes from Transformación Para Salud also have proved interesting. Environmental factors–such as televisions in children’s bedrooms and amounts of “screen time,” or TV watching and computer usage–were used to measure sedentary behavior. Seventy percent of children in the sample studied had a TV in their bedroom. These children watched more television and had increased sedentary behavior. Additionally, they reported less family support for physical activity and more fast-food consumption.
The Research Continues
Although results from the data are still being processed, researchers are beginning new projects. The TTUHSC School of Nursing is piloting a childhood obesity-prevention project funded with a $50,000 grant from the Aetna Foundation. The project, a modified continuation of Transformación Para Salud, is focused on preschoolers from low-income Hispanic families in Lubbock. Feng believes that lowering the age group in this study will establish good eating habits, encourage higher levels of physical activity and reduce sedentary behavior–conventions that should last throughout their lives.
“The adiposity of children that occurs from ages 7-9, children’s eating habits, and their pattern of physical activity all are established very early,” Feng said. “So it is a consensus in the literature that the earlier the age of intervention, the better.”
Over a 6- to 12-week period, Promotoras will visit the children’s homes to provide individualized, culturally appropriate education and social support to encourage healthful eating habits and active lifestyles.
“We want this to be a model that can be implemented by anyone in a school setting,” said Esperat.
Part of the mission at the TTUHSC School of Nursing is to improve access to quality health services for health-disparate populations, which Esperat believes is an intractable problem at this time in our society. But she believes that through the unceasing efforts of researchers and community members they can reach those vulnerable populations.
“When we started out the project, we were aware of obesity and overweight as a problem intellectually, cognitively; but I think as we got ourselves immersed in the development and refinement of the intervention, as well as particularly in the implementation, I think we became passionate spokespersons for it,” said Esperat.
The results of the study will be compared with the results from Transformación Para Salud to gain a better understanding of the optimal age for children to be engaged in obesity-prevention efforts, which could affect obesity-prevention programs nationwide.
More Obesity Research at Texas Tech University
Using Video Games to Decrease Childhood Obesity
Texas Tech researcher Zan Gao, assistant professor in the Department of Health, Exercise, and Sports Sciences thinks video games could save future generations from childhood obesity. Gao has found a way to include forms of “extainment,” the combination of exercise and entertainment, into schools’ physical activity programs. He uses fitness video games like Wii Fit, Wii Sport and Dance Dance Revolution (DDR) to encourage children to incorporate fun with fitness. Gao said the DDR video game has proven especially effective in encouraging physical activity among Latino children. He plans to continue conducting intervention studies with ethnically diverse elementary and junior high students in the Lubbock school districts.
Metabolic and Hormonal Effects of High-fat Diets in Normal Weight and Obese
Although high-fat diets are implicated in the development of excess fat mass gain and obesity in the U.S., little is known about the metabolic and hormonal effects of different types of dietary fatty acids in normal weight or obese adults. Jaime Cooper, Texas Tech assistant professor of nutrition sciences in the College of Human Sciences is working to determine the effects of dietary fatty acid composition in a high-fat meal on post-prandial fat metabolism, and hunger and satiety hormones.
Using a Supermarket to Reduce Obesity
Conrad Lyford in the College of Agricultural Sciences and Natural Resources is using a local supermarket in Lubbock to reduce obesity risk factors as part of a community obesity effort. Specific items are highlighted for purchase as consumers “Trade up for Health.” This research seeks to develop a model for other communities to follow in their efforts to reduce obesity.
Kristina Woods Butler is Associate Director of Research and Academic Communications for the Office of the Vice President for Research at Texas Tech University. Video produced by Scott Irlbeck, Senior Editor of Research & Academic Communications for the Office of the Vice President for Research at Texas Tech University.