In May, a team of researchers from the University of Minnesota Medical School was awarded a $5 million grant by the National Institutes of Health to study intervention methods to reduce racial disparities in childhood obesity.
The team will include students and faculty from the Medical School along with public health, nursing, education, organizational behavior and family science students, according to Dr. Jerica Berge, the team’s principal investigator and a professor and vice chair of research in the Department of Family Medicine and Community Health in the Medical School.
The researchers will use a combination of intervention methods in their trial designed to create better food habits at home. Over five years, these methods will include virtual and in-person home visits from community health workers to educate families about healthy food habits and ecological momentary intervention (EMI), also referred to as “mobile health.”
EMI technology tracks fluctuations in an individual’s daily life to elicit behavioral changes and is most commonly delivered via smartphones.
“This study is one of the first to use mHealth tools with community health workers to intervene on parental stress to improve the home food environment,” Berge said.
Previous research by both Berge and Dr. Angela Fertig, a social research scientist at the University and an investigator involved with the study, shows that parents from marginalized backgrounds may be more likely to experience momentary and long-term stressors in their daily lives.
Stress within households related to work, school, family conflict or financial struggles can create poor food habits at home, Berge and Fertig’s research shows.
“Primary care systems are already changing to include more services provided by community health workers and conducted virtually. This intervention capitalizes on this movement,” Fertig said.
Childhood obesity and racial disparities
Children and teens can be diagnosed with obesity if they have a body mass index at or above the 95th percentile for their age and sex, according to the Centers for Disease Control and Prevention.
Along with being linked to anxiety, depression and low self-esteem, those diagnosed with obesity as children are more likely to struggle with obesity in adulthood, putting them at a greater risk for chronic diseases like diabetes and cardiovascular disease.
“Being able to intervene on child eating behaviors could help reduce the risk for chronic disease in adulthood,” Berge said.
Childhood obesity disproportionately affects people from marginalized backgrounds and people living in low-income communities.
Over 30% of American Indian or Native Alaskan children are considered obese. In addition, 22% and 21% of Hispanic and African-American children, respectively, are considered obese as compared to 16% of white children and 13% of Asian children, according to the American Academy of Pediatrics.
“African-American, Latino and Hmong families are more likely to live in food deserts, and all of the non-white groups studied perceive significantly lower access to affordable fruits and vegetables than the white families in our study,” Fertig said.
Food deserts are geographic areas where disproportionately high-poverty residents have few to no convenient options to buy affordable healthy foods. Food deserts are connected to the United States’ long history of racial segregation, Fertig said.
“Non-white families have had less choice about where to live than white families because of historical policies, like redlining and racial covenants,” Fertig said. “The neighborhoods where most non-white families live have not been invested in historically and thus have trouble attracting future investments, like retailers of quality foods.”
Past research will influence future methods
Previous intervention methods to increase healthy eating in children have been “low to moderately effective,” Berge said. She added that the lack of success was likely because these methods did not intervene in real-time with the families, intervene for a long enough time or use community health workers to interact with the families.
“Our study uses all of these elements to try and understand which combinations will help families the most in creating a healthy home food environment,” she said.
Fertig said that this potential combination of treatment could prove more cost-effective for families.
“The idea is that if the intervention is effective and cost-effective, health care systems will adopt the intervention as an alternative to more expensive prevention efforts and treatments,” Fertig said. “Health insurance, including Medicaid, may be persuaded to cover the costs of these virtual treatments if they are lower than the costs of the alternatives.”