Reducing obesity through play: A randomized control trial - Obesity and related chronic diseases that result from years of poor diet and physical activity (PA) may be prevented by wellness programs for toddlers (18–36 months) and their parents. Research shows children from low socioeconomic (SES) backgrounds, African American race, and Hispanic ethnicity are at greater risk of lifelong obesity than their peers. It is difficult to engage at-risk families in such programs, but we successfully engaged 50 at risk parent-toddler dyads in our FUNPALs Playgroup pilot study. Typical toddler obesity prevention programs (e.g., WIC, SNAP Ed) instruct parents to improve the nutritional quality of meals and snacks and to find ways to increase toddler physical activity. However, attempts to improve toddler health behaviors are less effective if not delivered within a warm and nurturing parent-child relationship, and parents are often uncertain how to feed their children a healthy diet and encourage physical activity when toddlers resist (e.g., food refusal, tantrums, whining, etc.). To address this need, our team, using the Intervention Mapping Framework, created the FUNPALs Playgroup, which includes educational, but fun interactive programming to help parents reduce obesity risk among toddlers by addressing general parenting skills in conjunction with traditional nutrition and physical activity content. Playgroups—parent-child groups that meet regularly for social, physical, and educational play—present an opportunity to engage families in obesity prevention efforts while offering positive parenting instruction. Our pilot study (n=50) showed toddlers (>70% were African American or Hispanic) in the FUNPALs Playgroup, particularly those with overweight/obesity (OW/Ob; 52%), experienced desirable changes in weight, diet, sleep, and parenting. The FUNPALs Playgroup was feasible and as effective or more effective (e.g., reducing sugar sweetened beverages) than the standard health education control group on most outcomes. Further, the FUNPALs Playgroup was superior in terms of engagement. The goal of this study is to test the efficacy of the FUNPALs Playgroup using RE-AIM, an implementation framework, as a guide. The central hypothesis is that the FUNPALs Playgroup will be better than no treatment and not inferior to standard care for reducing obesity risk among a diverse sample of toddlers. In this multi-methods 3-arm, non-inferiority, randomized controlled trial (RCT), 300 toddlers (18-36 months) and parents of toddlers at risk for obesity will be randomly assigned (2:2:1) to receive: 1) 10-weekly sessions of the FUNPALs Playgroup, 2) 10-weekly sessions of a standard parent health education class, or 3) no treatment. Weight status, diet, and activity will be assessed at baseline (T1), 10- weeks after baseline (immediate post, T2), and 36-weeks after baseline (follow up, T3). The RE-AIM framework will be used to determine key elements for maximizing external validity and implementation.
