Elsevier

Preventive Medicine

Volume 61, April 2014, Pages 90-99
Preventive Medicine

The ‘Healthy Dads, Healthy Kids’ community randomized controlled trial: A community-based healthy lifestyle program for fathers and their children

https://doi.org/10.1016/j.ypmed.2013.12.019Get rights and content

Highlights

  • Effectiveness of the Healthy Dads, Healthy Kids program tested with trained facilitators.

  • Lifestyle program targeting overweight/obese fathers and their children

  • Two-arm randomized controlled trial with 93 fathers and 132 children

  • Significant intervention effects (P < 0.05) for fathers' weight, waist, diet and activity

  • Significant intervention effects (P < 0.05) for children's activity level and adiposity

Abstract

Objective

To evaluate the effectiveness of the ‘Healthy Dads, Healthy Kids (HDHK)’ program when delivered by trained facilitators in community settings.

Method

A two-arm randomized controlled trial of 93 overweight/obese fathers (mean [SD] age = 40.3 [5.3] years; BMI = 32.5 [3.8] kg/m2) and their primary school-aged children (n = 132) from the Hunter Region, Australia. In 2010–2011, families were randomized to either: (i) HDHK intervention (n = 48 fathers, n = 72 children) or (ii) wait-list control group. The 7-week intervention included seven sessions and resources (booklets, pedometers). Assessments were held at baseline and 14-weeks with fathers' weight (kg) as the primary outcome. Secondary outcomes for fathers and children included waist, BMI, blood pressure, resting heart rate, physical activity (pedometry), and self-reported dietary intake and sedentary behaviors.

Results

Linear mixed models (intention-to-treat) revealed significant between-group differences for fathers' weight (P < .001, d = 0.24), with HDHK fathers losing more weight (− 3.3 kg; 95%CI, − 4.3, − 2.4) than control fathers (0.1 kg; 95%CI, − 0.9,1.0). Significant treatment effects (P < .05) were also found for fathers' waist (d = 0.41), BMI (d = 0.26), resting heart rate (d = 0.59), energy intake (d = 0.49) and physical activity (d = 0.46) and for children's physical activity (d = 0.50) and adiposity (d = 0.07).

Discussion

HDHK significantly improved health outcomes and behaviors in fathers and children, providing evidence for program effectiveness when delivered in a community setting.

Introduction

Obesity is a serious public health concern and is associated with numerous adverse health consequences (Barr et al., 2006). Internationally, its prevalence is high and increasing (Finucane et al., 2011), especially among men (Australian Bureau of Statistics, 2011). This is concerning given that, compared to women, men are less likely to perceive themselves as overweight (Lemon et al., 2009), attempt weight loss, or enroll in weight loss programs (French and Jeffery, 1994, Morgan et al., 2011e, Pagoto et al., 2012).

An additional consequence of male obesity is the potential impact overweight and obese fathers may have on their children. Emerging evidence suggests that fathers have a unique and key role in shaping their children's dietary and physical activity behaviors (Freeman et al., 2012, Hall et al., 2011, Wake et al., 2007). For example, a recent longitudinal study of more than 3200 families identified that children with a healthy weight mother were substantially more at risk of becoming obese if their father was overweight (odds ratio 4.18; 95%CI, 1.01–12.33) or obese (odds ratio 14.88; 95%CI, 2.61–84.77) (Freeman et al., 2012). However, the reverse scenario (having an overweight or obese mother with a healthy weight father) was not a significant predictor of childhood obesity. Given that a large proportion of children are not meeting current diet and physical activity recommendations (Australian Bureau of Statistics, 2013a, Australian Bureau of Statistics, 2013b), this provides a clear rationale to explore the efficacy of behavioral interventions that target fathers to improve the health and healthy lifestyle behaviors of both fathers and their children.

Despite this, little is known about how best to engage fathers in lifestyle interventions. Recent systematic reviews have not explored the representation of fathers in parenting interventions for physical activity and nutrition (e.g. Hingle et al., 2010, Marsh et al., 2013, O'connor et al., 2009). As such, researchers have called for greater numbers of fathers in future research (e.g. Patrick et al., 2013, Rodenburg et al., 2013, Sleddens et al., 2011). To the authors' knowledge, we conducted the only published experimental study focusing on physical activity and nutrition that specifically targeted fathers and their children (Morgan et al., 2011b). The Healthy Dads, Healthy Kids (HDHK) efficacy trial examined the impact of a lifestyle program targeting overweight or obese fathers to role model and influence their children's physical activity and dietary habits. Children of any weight status were eligible for participation in the study, provided they were in primary school (i.e. typically aged 5–12 years). Relative to the control group, fathers achieved clinically important weight loss and children significantly improved their physical activity levels and dietary intake. Feasibility was established with high levels of recruitment, retention, attendance and satisfaction of participants (Morgan et al., 2011b).

However, these promising efficacy results were obtained from a university-based research study delivered by highly qualified staff in a closely monitored trial. While efficacy is an essential first step to evaluate outcomes under ideal conditions, effectiveness measures the impact of an intervention when implemented in a real-world setting. This represents a more realistic evaluation of the likely intervention effect (Stevens et al., 2007). There is an urgent need to translate obesity prevention and treatment programs with demonstrated efficacy into real-world settings (Green and Glasgow, 2006). Therefore, the aim of the current study was to implement and evaluate the HDHK intervention, when delivered by trained local facilitators in a community setting. This effectiveness study addresses the recent call for more high quality RCTs conducted for child obesity prevention (Waters et al., 2011) and male only weight loss studies (Young et al., 2012).

Section snippets

Study design

The study was a two-armed randomized controlled trial (RCT). Family units (fathers and their child[ren]) were randomly allocated to one of two groups: the HDHK intervention (treatment) or a wait-list control group. Outcome measures were obtained from all participants at baseline and 14-weeks (post-test). Measurements were taken at an after school setting by trained staff, using the same instruments at each time point. Participants and assessors were blind to group allocation at baseline

Participant flow

Fig. 1 illustrates the flow of participants through the trial. A total of 116 families were recruited, 101 men were eligible; however eight men were not randomized as no consent was received. In total, 93 fathers and 132 children attended baseline assessments and were randomized by family into intervention (n = 47) or control groups (n = 46). The mean number of children per family was 1.4. One family did not attend any information sessions. Mean attendance rate for the 7 sessions was 71%. In terms

Discussion

The primary aim of the current study was to evaluate the effectiveness of the ‘Healthy Dads, Healthy Kids’ (HDHK) intervention in a community setting delivered by trained facilitators, as a unique approach to reduce obesity prevalence in men and improve lifestyle behaviors in children. To the authors' knowledge, this is the first community RCT to demonstrate the effectiveness of targeting overweight fathers in effecting changes in their own lifestyle behaviors and those of their children.

Conclusion

Within the child development literature there is considerable evidence that fathers play a key role in their child's social, academic, cognitive and behavioral development (Lundahl et al., 2008). While there is limited research examining paternal influences on children's lifestyle behaviors, there is consistent evidence that parents influence their child's patterns through their own behaviors, role modeling and parenting practices (Edwardson and Gorely, 2010, Patrick and Nicklas, 2005). The

Conflict of interest statement

The authors declare that they have no competing interests.

Funding source

The Healthy Dads, Healthy Kids community program is funded by a Coal and Allied Community Development Fund grant (2010–2012) and the Hunter Medical Research Institute. The funding bodies did not have any input into the design of the study, the collection or analysis of data, the preparation of this manuscript, or the decision to submit this manuscript for publication. C.E. Collins is supported by an Australian National Health and Medical Research Council Career Development Fellowship. R.C.

Authors' contributions

The study chief investigators PJM, DRL, CEC, RCP, RC, TB, RF and ADO were responsible for identifying the research question, design of the study, obtaining ethics approval, and acquisition of funding and overseeing study implementation. Research assistants MDY, AM, JBC, ATC, KLS and PhD student ABL have contributed to the development of intervention materials, recruiting participants and study implementation. All authors were responsible for the drafting of this manuscript and have read and

Acknowledgments

We would also like to thank Belinda Avis, Danielle Ballantyne, Rebecca Blenkin, Gary Pomplun, Leah Philpott, Jodie Rauch, Tahlia Rutherford, Amanda Williams, Tracy Schumacher, Rebecca Williams, Emma Merceica, Jodie Pullman, Ashley Schmahl, Jacqeline Dutton, David Robertson, Larina Robinson, Tamika Small, Angela Humphery, Siobhan Handley, Mikhaila Tomlinson and Elroy Aguiar.

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