Background

The “Starting Early Program” (StEP) is one of the first comprehensive child obesity prevention programs based in prenatal and pediatric primary care, representing a unique opportunity to reach low income and minority children at high risk.

Methods

RCT enrolled pregnant women in the 3rd trimester to standard care control vs. StEP intervention: prenatal and postpartum nutrition counseling and nutrition and parenting support groups coordinated with primary care visits; 15 sessions through child age 36 months(m). Hispanic women, ≥ 18 years old with an uncomplicated singleton pregnancy included. Child weight obtained from medical records, weight for age z-scores (WFAz) and 95thpercentiles (highWFAz) calculated using WHO standards. Statistical analyses: t-tests and chi square.

Results

Baseline prenatal: (n=533): 37% primiparous, 80% immigrant, 87% WIC, 31% food insecure, 34% depressive sx, 30% with obesity. 50% girls, mean birth WFAz =.14; no baseline differences. Mean number of sessions attended 7.75(4.5); highest tertile attended ≥10 by 36m. Intervention children had lower mean WFAz at 6, 12, 18 and 24m (.32 vs .47 p =.06, .34 vs .57 p=.04, .5 vs .74 p=.02, and .56 vs .81 p=.01) and no difference at 36m (.59 vs. 63 p=.62). At 24 and 36m the prevalence of highWFAz (20% vs 21% p=.7, 18% vs 17% p=.8) did not differ by group.Within intervention group analyses showed: lower WFAz (.37 vs .72 p=.04, .41 vs .81 p=.03), lower prevalence of highWFAz (10% vs 24% p=.02, 8% vs 24% p=.01) for the highest attendance tertile at 24 and 36 m.

Conclusions

StEP participants had lower WFAz from 6 through age 24m and dose dependent reduction in obesity risk at age 24 and 36m. Findings demonstrate a scalable system to potentially reduce early childhood obesity in primary care for at-risk families. USDA AFRI#: 2011-68001-30207; NIH/NICHD K23HD081077