Building Healthy Families

Obesity is a serious problem in the United States for both children and adults, particularly among low-income groups. Studies have shown that children's dietary behaviors are influenced by the availability of different foods at home and by parenting behaviors related to food and eating. Parents choose what foods are available at home, select the foods and amounts served at meals and snacks, serve as role models, and interact with children during meals. Among low-income overweight mothers, improving maternal dietary behaviors has been shown to improve dietary behaviors among their children. However, there are a variety of barriers to promoting healthful food and eating behaviors in the home, including parental perceptions of too little time, costs of healthy foods, low social support for healthy eating, lack of control over meals, and child preference for fast foods and unhealthy foods. Obesity prevention efforts for families should address these barriers in addition to promoting the availability of healthful food in the home and improving parenting behaviors and skills associated with food and eating. 

Building Healthy Families (BHF) is an augmented version of the Expanded Food and Nutrition Education Program (EFNEP), a program funded by the U.S. Department of Agriculture's National Institute of Food and Agriculture. EFNEP provides food and nutrition education, including food budgeting and food preparation, to parents of limited-resource families, who often have higher rates of obesity. The traditional EFNEP program consists of six class sessions conducted by a trained paraprofessional (peer educator). Each session includes an introduction, delivery of class content, brief discussion, and food preparation. Topics covered in the sessions include (1) nutrition basics and portion size; (2) breakfast and snacks; (3) fruits and vegetables; (4) dairy and meat; (5) breads and grains; and (6) smart shopping. Through formative research conducted with EFNEP clients in Texas, the curriculum was expanded to target childhood obesity through the inclusion of materials addressing factors related to child body weight and growth. The following three components were added to the curriculum, each developed based on social cognitive theory constructs of modeling, self-regulation, self-efficacy, behavioral skills, and environmental conditions:

-- Series of six 5-minute videos: During each BHF class, participants watch a 5-minute video depicting a fictitious class dealing with home food and eating issues related to the topic of that class session. The class members in the video discuss their families' problems with food and eating while modeling the use of problem-solving and goal-setting skills to overcome those problems. After viewing the video, the BHF class is encouraged to discuss the issues faced by the class depicted in the video.

--Weekly goal setting and goal review: After the video and discussion, the BHF class receives a preprinted weekly goal sheet and uses a problem-solving mnemonic (TALK: Think of the solutions, Ask others for help, Look at all the ideas, and Keep the ones that might work for you and try them out) to discuss barriers to achieving their goal and possible solutions to overcome those barriers. Class members are asked to monitor their daily goal attainment and return the goal sheet the following week. At the beginning of each session, class members briefly discuss their success in meeting the previous week's goal. Problems meeting goals are identified, and class members share solutions.

--New handouts and recipes: BHF class members receive a binder with handouts and recipes to support the existing EFNEP materials. Two recipes are selected for preparation during each session. 

One-hour sessions are conducted once per week over a period of 6 weeks. 

Building Healthy Families is designed for limited-resource families.

Building Healthy Families can be implemented in community settings.

The curriculum can be downloaded free from the program website. 

For costs associated with this program, please contact the developer, Karen Weber Cullen. (See products page on the EBCCP website for developer contact information.)

One hundred EFNEP classes in Texas with a total of 1,252 participants were recruited for the study. Classes were randomly assigned by city to the intervention condition (Building Healthy Families, an expanded version of EFNEP) or the comparison condition (EFNEP).  Of the initial sample, 246 participants were excluded because they did not provide consent for height and weight measurement or were pregnant. The final sample included 1,006 participants, 582 in the intervention group and 424 in the comparison group. Most participants were women (97%) and Hispanic (89%); 8% were Black, and 3% were White. Mean participant age was 35 years. 

Data were collected the week before the first class session (pre-test), the week after the last class session (post-test), and at 4-month follow-up. It was hypothesized that, compared with participants in comparison classes, participants in the BHF intervention classes would have a lower body mass index (BMI, calculated using weight and height); report greater home availability and consumption of fruit, vegetables, and low-fat milk products; and show more positive changes in menu planning, parent self-efficacy, home food preparation practices, barriers, and parental feeding styles. Improved dietary intake was also expected. Because the study focused on parent behavior as a mediating factor affecting child obesity, no data were collected on the BMI or dietary intake of the children of participating families.

• BMI decreased significantly from pre-test to post-test among parents in the intervention group (p<.05), while parents in the comparison group showed no change in BMI. The significant change in BMI in the intervention group was not maintained at 4-month follow-up.

Additional Findings

• All parents in the study, regardless of study group, showed statistically significant improvements over time for consumption of most food items and nutrients and for nearly all psychosocial variables.