Family-Based Healthy Eating Interventions for Southeast Asian Children

Overseen By Akilah Dulin, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Brown University

Must not be taking: Weight, Metabolism

Disqualifiers: Type 2 diabetes, Disabilities, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 11

150 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, children on medications affecting weight or metabolism cannot participate.

What data supports the effectiveness of the treatment Family-Based Approaches to Improve Healthy Eating for Southeast Asian children?

Research shows that family-based programs can promote healthy weight and lifestyles in children, as seen in a study with Chinese American children. Additionally, understanding and aligning with parents' mealtime goals can improve children's eating behaviors, suggesting that family-focused interventions may be effective in encouraging healthy eating habits. ^{1 2 3 4 5}

Is the Family-Based Healthy Eating Intervention safe for Southeast Asian children?

The research articles reviewed do not provide specific safety data for Family-Based Healthy Eating Interventions, but they focus on improving children's eating habits with parental involvement, which is generally considered safe. ^{6 7 8 9 10}

How does the Family-Based Approaches to Improve Healthy Eating treatment differ from other treatments for promoting healthy eating in Southeast Asian children?

This treatment is unique because it focuses on involving the whole family in promoting healthy eating habits, which can be more effective than individual approaches. It emphasizes interactive and hands-on activities, such as setting family-based goals and modifying the home food environment, to encourage healthy eating behaviors among children. ^{2 3 11 12 13}

What is the purpose of this trial?

This small scale healthy eating study provides Southeast Asian families with children ages 6 to 11 with a family-based nutrition education, one-on-one interviews to help with motivation to eat health, text messaging, and coupons to purchase health foods and beverages. Since this is a small scale study that is a pilot intervention, the main goal of this intervention is to determine if it is feasible, meaning, can it be done. The second goal of this intervention is to determine if there are meaningful improvements in children's healthy eating patterns, body mass index and HbA1c. The third goal is to see if the intervention improves parent's diet quality, HbA1c and the home food environment. These study findings will be used to determine whether a larger clinical trial is needed, and if so, how it should be done.

Research Team

Akilah Dulin, PhD

Principal Investigator

Brown University

Kim Gans, PhD, MPH, LDN

Principal Investigator

University of Connecticut

Eligibility Criteria

This trial is for Southeast Asian families with children aged 6-11, focusing on Hmong, Cambodian, Laotian or Vietnamese parents or grandparents who are involved in the child's diet and food preparation. Participants must be over 18, speak English or their native language, own a smartphone and shop at a specific SEA grocery store.

Inclusion Criteria

Adults: live with the child

Adults: Hmong, Cambodian, Laotian or Vietnamese

Adults: own a smartphone

Exclusion Criteria

My child is not on medication that affects weight or metabolism.

I have not participated in any weight-related studies in the past year.

I have not been hospitalized for conditions like type 2 diabetes in the past year.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive financial incentives, nutrition education, motivational interviewing, and dietary norms messaging

6 months

11 group sessions (in-person), 3 MI calls (virtual), weekly text messages

Follow-up

Participants are monitored for changes in diet quality, BMI, HbA1c, and home food environment

6 months

Treatment Details

Interventions

• Family-Based Approaches to Improve Healthy Eating

Trial Overview The study tests a family-based nutrition program that includes education, motivational interviews, text reminders and coupons for healthy foods to improve children’s eating habits. It aims to assess feasibility for larger trials by observing changes in kids' diets, BMI and HbA1c levels as well as parents’ diet quality.

Participant Groups

Group I: Financial incentive only Experimental Treatment 1 Intervention

Participants will receive weekly financial incentive coupons to purchase eligible foods at the partnering Southeast Asian grocery store. Research Assistants will explain the coupon procedures during the randomization phone call. Research Assistants will mail the adult a schedule of coupon disbursement dates. RAs will mail one month's worth of coupons (4, $15 coupons) to each adult's home. Coupons will be used at point-of-sale. Participants' will receive an automated weekly text message via Qualtrics directing them to upload their photos to the system if they used coupons during that week.

Group II: Financial incentive + nutrition education, motivational interviewing, dietary norms messages Experimental Treatment 1 Intervention

The intervention consists of a) four $15 financial incentive coupons each month; b) twice-monthly group-based nutrition education at the Center for SEA; c) motivational interviewing (months 1, 3, 5); and d) weekly dietary norms text messages sent to adults and twice-monthly dietary norms infographics presented at nutrition education sessions for children. The research assistants will disburse one months' worth of the financial incentive coupon at the nutrition education sessions (or home mailings for absent participants). Families will attend 11 fortnightly, group-based nutrition education sessions lasting one hour. Southeast Asian community health workers will lead the sessions. Research assistants trained in motivational interviewing will call the adults. The calls will last 15-20 minutes. Adults will receive a series of weekly, interactive descriptive dietary norms text messages. Children will see descriptive dietary norms infographics at children's nutrition education sessions.

Group III: Attention control: Academic Engagement Experimental Treatment 1 Intervention

This intervention will be delivered using a similar format and schedule as the financial incentive+nutrition education, motivational interviewing and dietary norms intervention group (i.e., 11 community health worker led in-person group based sessions at the Center for Southeast Asians, 3 MI phone calls, and text messages). The content will focus on family-specific family engagement methods to improve children's academic outcomes.

Who Is Running the Clinical Trial?

Brown University

Lead Sponsor

Trials

480

Recruited

724,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Center for Southeast Asians

Collaborator

Trials

1

Recruited

150+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

University of Connecticut

Collaborator

Trials

194

Recruited

162,000+

Findings from Research

In a study involving 71 parents of fourth-grade students, the availability of fruits and vegetables (FV) at home was found to significantly predict higher Healthy Eating Index (HEI) scores for total fruit and vegetables, indicating that access to healthy foods is crucial for improving dietary quality.

Parent modeling of FV eating behavior also positively influenced fruit HEI scores, suggesting that parents' eating habits can impact their children's dietary choices, while self-efficacy in preparing FV did not show a significant association with overall HEI scores.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Parent Food and Eating Behavior Assessments Predict Targeted Healthy Eating Index Components. Ruder, EH., Lohse, B., Mitchell, DC., et al.[2020]

The study involved 67 Chinese American children aged 8-10 and demonstrated that a family-based program effectively reduced body mass index and improved health behaviors over 8 months.

Participants showed significant improvements in dietary habits, such as increased fruit and vegetable intake, and enhanced physical activity levels, indicating the program's efficacy in promoting healthier lifestyles.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study. Chen, JL., Weiss, S., Heyman, MB., et al.[2022]

A review of 14 observational studies found that non-responsive parental feeding practices and unhealthy eating behaviors in children are linked to an increased risk of overweight and obesity among Southeast Asian children aged 2-12 years.

The studies highlighted a need for more research across a broader range of Southeast Asian countries to better understand the factors contributing to childhood obesity and to develop targeted interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Non-Responsive Feeding Practices, Unhealthy Eating Behaviors, and Risk of Child Overweight and Obesity in Southeast Asia: A Systematic Review. Lindsay, AC., Sitthisongkram, S., Greaney, ML., et al.[2018]

The study developed the Family Mealtime Goals Questionnaire, which is a reliable tool for measuring parents' mealtime goals, based on responses from 1,140 parents of children aged 1 to 16 years.

The most commonly endorsed goal across all age groups was stress and conflict avoidance, highlighting the importance of understanding parents' motivations to improve children's eating behaviors and inform healthier eating interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Parental Feeding Goal Measure: The Family Mealtime Goals Questionnaire. Snuggs, S., Houston-Price, C., Harvey, K.[2020]

Parents define family meals as those that are homemade, prepared by caregivers, and enjoyed at home with most family members present, emphasizing conversation and a pleasant atmosphere.

In contrast, meals considered non-family meals often involve distractions like TV or tablets, include non-family members, and are characterized by a rushed or chaotic environment, highlighting the importance of meal context for family bonding.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals. Daragan, C., Tate, AD., Trofholz, AC., et al.[2023]

A feasibility study involving 1,090 children aged 6-8 years in Birmingham showed that a culturally tailored intervention to prevent obesity was generally acceptable and feasible, with some components like physical activity opportunities and family cooking workshops being particularly effective.

Children who participated in the intervention were less likely to be obese and had a lower BMI z-score compared to the control group, indicating that the intervention had a positive impact on weight status and supports the need for a larger definitive trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS. Adab, P., Pallan, MJ., Cade, J., et al.[2022]

The 'Red Apple' intervention, which included multiple parental group sessions and activities, significantly improved healthy food intake in children compared to minimal intervention and control groups, indicating its effectiveness in promoting better eating habits.

Parents in the complete intervention group maintained their self-efficacy in regulating their children's eating behaviors, while those in the control group experienced a decrease, highlighting the positive impact of the intervention on parental confidence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of a parental school-based intervention to improve young children's eating patterns: a pilot study. Gomes, AI., Barros, L., Pereira, AI., et al.[2023]

In a study involving 34 children aged 7-11, it was found that while guardians contributed to the breadth of dietary data collected during recalls, the children themselves demonstrated significant knowledge about their own diets and sometimes rejected guardian input.

The interactions between guardians and children during dietary recalls revealed complex dynamics of power and cultural understandings, suggesting that relying solely on guardian presence may not always enhance data accuracy and that improvements in dietary recall methods are needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"You ate all that!?": caretaker-child interaction during children's assisted dietary recall interviews. Sobo, EJ., Rock, CL.[2019]

A pilot study involving 45 mothers and their 4- to 6-year-old children showed that after receiving nutrition information and portion-related activities, both the calories served by mothers and the calories consumed by children significantly decreased, indicating a positive change in dietary habits.

The study suggests that interventions focusing on practical skills rather than just increasing nutrition knowledge may be more effective in changing children's dietary intake.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A parent-directed portion education intervention for young children: Be Beary Healthy. Small, L., Bonds-McClain, D., Vaughan, L., et al.[2016]

The study reviewed 49 articles on child dietary interventions involving parents, finding that effectiveness was the most reported aspect (72.5%), while maintenance was the least reported (2.5%), indicating a need for better reporting practices.

Only six studies directly compared the effectiveness of interventions with and without parental involvement, leaving the impact of parental participation on dietary outcomes unclear and highlighting the need for more focused research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework. Schlechter, CR., Rosenkranz, RR., Guagliano, JM., et al.[2018]

Regular family meals are linked to healthier eating habits and reduced obesity risk in children and adolescents, highlighting their importance in health promotion efforts.

Four out of six reviewed interventions successfully increased family meal frequency, using strategies like goal setting and interactive activities, while also identifying barriers such as time constraints and food preferences that future programs should address.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting family meals: a review of existing interventions and opportunities for future research. Dwyer, L., Oh, A., Patrick, H., et al.[2022]

The study identified 14 key themes related to family influences on healthy eating among adolescents, highlighting the importance of parental knowledge, attitudes, and food parenting practices in promoting better dietary habits.

Effective strategies for improving adolescent nutrition include empowering parents with practical cooking skills and nutrition knowledge, as well as involving children in food preparation and providing a variety of healthy food options at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent-Adolescent Dyads. Liu, KSN., Chen, JY., Sun, KS., et al.[2023]

A review of eight randomized controlled trials found that family-based nutrition interventions can effectively improve dietary behaviors in children aged 5-18, highlighting the importance of setting family goals and modifying the home food environment.

Successful interventions often included hands-on teaching methods, such as games and group activities, as well as providing incentives like fruit and vegetable vouchers, although concerns about study quality, such as blinding and instrument reliability, were noted.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review. Perdew, M., Liu, S., Naylor, PJ.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Parent Food and Eating Behavior Assessments Predict Targeted Healthy Eating Index Components. [2020]

2. England pubmed.ncbi.nlm.nih.gov

Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Non-Responsive Feeding Practices, Unhealthy Eating Behaviors, and Risk of Child Overweight and Obesity in Southeast Asia: A Systematic Review. [2018]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Development of a Parental Feeding Goal Measure: The Family Mealtime Goals Questionnaire. [2020]

5. England pubmed.ncbi.nlm.nih.gov

Exploration of parent-reported family meal dinner characteristics to inform a definition of family meals. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Preventing childhood obesity, phase II feasibility study focusing on South Asians: BEACHeS. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Effectiveness of a parental school-based intervention to improve young children's eating patterns: a pilot study. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

"You ate all that!?": caretaker-child interaction during children's assisted dietary recall interviews. [2019]

9. United States pubmed.ncbi.nlm.nih.gov

A parent-directed portion education intervention for young children: Be Beary Healthy. [2016]

10. United States pubmed.ncbi.nlm.nih.gov

A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework. [2018]

11. New Zealand pubmed.ncbi.nlm.nih.gov

Promoting family meals: a review of existing interventions and opportunities for future research. [2022]

12. Switzerland pubmed.ncbi.nlm.nih.gov

Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent-Adolescent Dyads. [2023]

13. England pubmed.ncbi.nlm.nih.gov

Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review. [2021]