title: Effectiveness of differing levels of support for family meals on obesity prevention among head start preschoolers: the simply dinner study.
abstract: Despite slight decreases in obesity prevalence in children, nearly 25% of preschool-aged children are overweight or obese. Most interventions focused on promoting family meals as an obesity-prevention strategy target meal planning skills, knowledge and modeling of healthy eating without addressing the practical resources that enable implementation of family meals. There is a striking lack of evidence about what level of resources low-income parents need to implement family meals. This study will identify resources most effective in promoting family meals and, subsequently, test associations among the frequency of family meals, dietary quality and children's adiposity indices among children enrolled in Head Start.
  
  
  
  The Multiphase Optimization Strategy, employed in this study, is a cutting-edge approach to maximizing resources in behavioral interventions by identifying the most effective intervention components. We are currently testing the main, additive and interactive effects of 6 intervention components, thought to support family meals, on family meal frequency and dietary quality (Primary Outcomes) as compared to Usual Head Start Exposure in a Screening Phase (N = 512 low-income families). Components yielding the most robust effects will be bundled and evaluated in a two-group randomized controlled trial (intervention and Usual Head Start Exposure) in the Confirming Phase (N = 250), testing the effects of the bundled intervention on children's adiposity indices (Primary Outcomes; body mass index and skinfolds). The current intervention components include: (1) home delivery of pre-made healthy family meals; (2) home delivery of healthy meal ingredients; (3) community kitchens in which parents make healthy meals to cook at home; (4) healthy eating classes; (5) cooking demonstrations; and (6) cookware/flatware delivery. Secondary outcomes include cooking self-efficacy and family mealtime barriers. Moderators of the intervention include family functioning and food security. Process evaluation data includes fidelity, attendance/use of supports, and satisfaction.
  
  
  
  Results will advance fundamental science and translational research by generating new knowledge of effective intervention components more rapidly and efficiently than the standard randomized controlled trial approach evaluating a bundled intervention alone. Study results will have implications for funding decisions within public programs to implement and disseminate effective interventions to prevent obesity in children.
  
  
  
  Clincaltrials.gov Identifier NCT02487251 ; Registered June 26, 2015.
authors.affiliation: Department of Human Development and Family Studies, Michigan State University, 552 West Circle Drive, 48824, East Lansing, MI, USA. Hbrophy@hdfs.msu.edu.
authors.forename: Holly E
authors.initials: HE
authors.lastname: Brophy-Herb
authors.affiliation: College of Nursing, Michigan State University, 1355 Bogue Street, 48824, East Lansing, MI, USA.
authors.forename: Mildred
authors.initials: M
authors.lastname: Horodynski
authors.affiliation: MSU Extension, Michigan State University, 446 West Circle Drive, 48824, East Lansing, MI, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Contreras
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, 220 Trowbridge Road, 48824, East Lansing, MI, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Kerver
authors.affiliation: Center for Human Growth and Development, University of Michigan, 300 North Ingalls, 48104, Ann Arbor, MI, USA.|Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, 48109, Ann Arbor, MI, USA.
authors.forename: Niko
authors.initials: N
authors.lastname: Kaciroti
authors.affiliation: Department of Human Development and Family Studies, Michigan State University, 552 West Circle Drive, 48824, East Lansing, MI, USA.
authors.forename: Mara
authors.initials: M
authors.lastname: Stein
authors.affiliation: Center for Human Growth and Development, University of Michigan, 300 North Ingalls, 48104, Ann Arbor, MI, USA.
authors.forename: Hannah Jong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Human Development and Family Studies, Michigan State University, 552 West Circle Drive, 48824, East Lansing, MI, USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Motz
authors.affiliation: MSU Extension, Michigan State University, 446 West Circle Drive, 48824, East Lansing, MI, USA.
authors.forename: Sheilah
authors.initials: S
authors.lastname: Hebert
authors.affiliation: MSU Extension, Michigan State University, 446 West Circle Drive, 48824, East Lansing, MI, USA.
authors.forename: Erika
authors.initials: E
authors.lastname: Prine
authors.affiliation: MSU Extension, Michigan State University, 446 West Circle Drive, 48824, East Lansing, MI, USA.
authors.forename: Candace
authors.initials: C
authors.lastname: Gardiner
authors.affiliation: University Outreach and Engagement, Michigan State University, Kellogg Center, 219 South Harrison, 48824, East Lansing, MI, USA.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Van Egeren
authors.affiliation: Center for Human Growth and Development, University of Michigan, 300 North Ingalls, 48104, Ann Arbor, MI, USA.|Department of Pediatrics, Medical School, University of Michigan, 1500 East Medical Center Drive, 48109, Ann Arbor, MI, USA.|Department of Nutritional Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, 48109, Ann Arbor, MI, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lumeng
mesh_terms: D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D018479:Early Intervention, Educational; D005191:Family Characteristics; D006293:Health Promotion; D006801:Humans; D008297:Male; D062407:Meals; D063766:Pediatric Obesity / Q000517:prevention & control*; D012107:Research Design
keywords: Head start; Intervention study; Low-income children; Meals; Obesity prevention; Preschoolers