Assessing the effectiveness of the America On the Move family program in a real-life setting through Colorado Extension

Roark, Constance Mary, author; Anderson, Jennifer, advisor; Hill, James, committee member; Barrett, Karen, committee member; Bellows, Laura, committee member

Assessing the effectiveness of the America On the Move family program in a real-life setting through Colorado Extension

Date

2013

Authors

Roark, Constance Mary, author

Anderson, Jennifer, advisor

Hill, James, committee member

Barrett, Karen, committee member

Bellows, Laura, committee member

Abstract

Background: More than 30% of the U.S. adult population and 17% of children between the ages of 2-19 years are considered to be obese; representing 72 million adults and 12.5 million children [1, 2]. Although Colorado currently holds the leanest state in the nation status, with an obesity rate of 21% [3], the state is not exempt from increasing rates of obesity in its population. According to the Colorado Department of Public Health and Environment, more than 50% of the population is considered overweight and the percentage of obese adults has doubled since 1996 to 21.4% [4]. In addition, the state ranks 29th in the U.S. in childhood obesity, with one out of every eight children 2-14 years of age being obese, and an obesity rate of 14.2% for youth between the ages of 10-17 years [4-6]. Rural communities suffer from many of the same health challenges facing the rest of the country; however, differences in overweight and obesity may exist between rural and urban areas. In one study, the risk for becoming overweight or obese for children in rural communities was 25% higher as compared to their urban-living counterparts [7]. Significant challenges are associated with the large changes required to reverse overweight and obesity. An approach that is focused on prevention and based on small changes has been proposed. It is suggested that smaller changes may be more doable and sustainable to prevent weight gain from occurring initially or reducing further weight gain in those who are currently overweight and obese [8-12]. The health-related consequences of obesity are numerous and of particular concern is the potential relationship between body-mass index (BMI) in adolescence and health complications in adulthood. One of the most significant predictors of obesity in children is the obesity status of their parents [13]. While heredity may be a contributing factor, evidence suggests that the influence of parents and the home environment play significant roles [13-21]. It is suggested that family-based approaches to treating and preventing obesity are not only efficacious, but may be a necessary component for success [22-26]. The America On the Move (AOM) Family program is one such approach. The AOM Program is a free, self-administered web-based program in which individuals learn to take control of their health through small sustainable changes in their diet and exercise routines and to manage their weight through energy balance [27]. Objective: The focus of this research study was to address phase three of the USDA funded grant, The America On the Move (AOM) Family Program for Weight Gain Prevention, in which the AOM Family Program was disseminated to families in Colorado through Extension in order to evaluate its usefulness for participating families. Methods: Eleven Family and Consumer Science Extension agents recruited families from Colorado communities to participate in this study. Participating families were given the AOM Family Program Toolkit together with pedometers and were asked to follow the program over a six month period. Families provided self-reported baseline (month 1) and final (month 6) assessments that included height, weight and seven day step results in addition to pre- and post- questionnaires. Changes in step activity and weight status outcomes using BMI and BMI percentiles (BMIp) for adults and children, respectively, were determined from baseline to final assessment. Additionally, feedback from the participants and the Extension agents was collected and relationships between behaviors and weight status outcomes were assessed. Results: Thirty-six families from nine communities completed the study, including 50 adults and 55 children. At the end of the six month study the adults had achieved a statistically significant reduction in mean body weight and BMI and the children demonstrated no statistically significant changes in mean BMI percentile; consistent with the AOM Family Program objective of weight gain prevention. The majority of the participants (86%) rated the program as either good or better and would recommend it to others. In contrast, only half of the Extension agents rated the program as good and most would not continue to offer it in their communities without changes. Conclusions: With further exploration and adjustments it is feasible that the AOM Family Program could become a valued tool in support of a more healthful lifestyle for families living in Colorado, with Extension serving as the conduit within their respective communities.