Article Figures & Data
Figures
- Figure 1.
Choices consort diagram.
- Figure 2.
Body mass index (BMI) and BMI z score. Top: light dashed line represents the predicted increase in BMI if the children were to continue at the same Centers for Disease Control and Prevention z score (percentile). Bottom: The BMI age-specific z score. In both panels, the heavy dashed line represents the intervention periods, and the dots are the 3 measurements points after the intervention for each group.
- Figure 3.
Weight and weight for age z score. Top: The dashed line represents the predicted weight increase if the children were to continue at the same Centers for Disease Control and Prevention z score (percentile). Bottom: The age-specific z score for weight. In both panels, the heavy dashed line represents the intervention periods, and the dots are the 3 measurement points after the intervention.
Tables
Class Content and Objectives Physical Activity (PA) 1 Get acquainted; learn about the program (why and what); pedometers Pedometers: using, logging; family activity Orientation to importance for children's health; need for whole family to be involved Guide 2 How active am I? What's fun? How can I do more? Why is it important? Barriers and facilitators to family PA, child's PA; enhancing PA for all; pedometer goals Pedometer challenge What are the connections between cognition and emotion and behavior? Chalk for hopscotch and sidewalk games Between what I think and what I feel and do? How does this work for children? Adults? 4 Why is it important to drink water for thirst? How much sugar is in beverages? Jump ropes 5 How can I challenge my thinking habits that do not help me? Recognize inaccurate thinking and change it? Ways to support children and family Nerf soccer 6 How much food is enough? Portion sizes Frisbee 7 Television: when more is not better; the TV turn-off challenge TV turn-off 8 Time in the park: family games and review Yoga cards 9 Fast foods: the truth about fat in food Dance video 10 Fast foods: making other choices for the long term Juggling scarves 11 Making active choices: living my life TaiBo video 12 Choosing food and beverage that fits my lifestyle: putting it all together Celebration/graduation Characteristic March September Total Boys Girls Boys Girls Sample size, n 7 8 9 8 32 Age (yrs) 9.7 ± 0.4 9.7 ± 0.8 9.6 ± 0.6 9.3 ± 0.6 9.6 ± 0.6 Weight (kg) 56.0 ± 9.1 53.1 ± 8.8 56.8 ± 15.6 58.8 ± 15.9 56.2 ± 12.6 Weight/age Z* 2.35 ± 0.44 2.10 ± 0.58 2.31 ± 0.70 2.46 ± 0.71 2.31 ± 0.61 Height (cm) 144.1 ± 4.1 143.4 ± 5.7 146.4 ± 8.0 146.0 ± 10.1 145.1 ± 7.2 Height/age Z* 1.07 ± 0.62 1.03 ± 0.69 1.50 ± 0.04 1.67 ± 0.06 — BMI (kg/m2) 26.9 ± 3.6 25.8 ± 4.0 26.3 ± 6.2 27.5 ± 6.8 26.6 ± 5.2 BMI/age Z* 2.19 ± 0.33 2.00 ± 0.45 2.07 ± 0.42 2.11 ± 0.53 2.09 ± 0.43 Body fat (%)† 41.3 ± 14.3 36.9 ± 5.3 35.4 ± 9.5 39.4 ± 8.8 38.1 ± 9.6 Mother's education (n) High school/GED 3 0 3 Some college or vocational training 4 5 9 College degree 5 2 7 >College 2 5 7 Father's education (n) <High school/GED 4 3 7 Some college or vocational training 5 4 9 College degree 3 2 5 >College 2 3 5 Family income, $ (n) <50,000 6 4 10 ≥50,000–100,000 4 4 8 >100,000 3 4 7 Ethnicity (n) American Indian/Alaska Native 0 1 1 Asian/Pacific Islander 2 1 3 Hispanic 4 3 7 Non-Hispanic white 9 12 21 Values provided as mean ± standard deviation unless otherwise indicated.
↵* Centers for Disease Control and Prevention.
† Tanita.
Outcome† Intervention effect‡ (SDE) P§ Z score BMI −0.046 (0.022) .017 Weight −0.029 (0.022) .090 Height 0.041 (0.027) .127 BMI (kg/m2) −0.34 (0.17) .025 Weight (kg) −0.64 (0.39) .053 Height (cm) 0.59 (0.21) .006 METs¶ Low −1.04 (0.60) .084 Medium 0.13 (1.08) .904 High 1.82 (1.42) .197 ↵* The other variables in the equation were baseline value, male indicator, and growth trend.
↵† N = 32 for weight, body mass index, and height; n = 22 for physical activity.
↵‡ Per 3-month period after intervention.
↵§ One-sided for weight and body mass index (BMI); 2-sided for all other variables.
↵¶ Shift from low metabolic equivalents (METs) to high METs significant at P = .037; see text for details.
SDE, standard deviation of the estimate (sometimes called standard error).
Food-related choices N Smaller portions 9 Drinking more water 7 Eating healthier in general 6 Drinking less soda 4 Eating less fast food 4 Making better choices when eating out 3 Trying new fruits and vegetables 3 Snacking less between meals, and improving snack choices 3 Implementation of the Choices model Parent 1: “They said, ‘This is not what you have to do, this is the way it is. If you choose to do this, it leads to some ramifications. Do you want this or not? It's up to you.’ …It was constantly stressed that we're not telling you what to do…we're just showing you, giving you bits of information so that you can make choices.… As a parent, that's exactly what I try and do with [my daughter].” Parent 2: “…When [child's name] will say to me, ‘Can I have this or that?’ what I try and say is it's your body, it's your choice what you put into your body, you are in control or what goes into your body, you know, and so I try and evoke…I think that the name Choices for the program is a great name.” Parent 3: “I thought Choices was great…good lifestyle information that everyone Can benefit from, not just people that are struggling with weight issues….” Interviewer: So you like going outside a lot, and you got into the program to learn about that? Child 1: Yeah, and to learn how I can get fit, just be more confident with who I am, and just make better choices. Child 2: [Making better food choices] made me…feel better, like, on the holidays, that I don't eat as much. And that I'm watching over myself, instead of just my parents watching over me. And it has made me feel good that I have gotten more active and stuff like that. Parent 4: “…Before I came to Choices classes I had all those problems, a lot of the conflicts for food, [child] wants some bad foods, as a parent I try to be nice and then…sometimes I get angry, and behave angry, all those…we have family conflicts, and then when I came to Choices classes and talked to other parents, I realized it's not only my problem, it's everyone's problem. We feel like friends, even though we only met a couple of times, we already feel the same way.” Resilience Parent 5: “My wife was very…supportive, she liked us coming to the Choices project because she's also concerned about [child]'s health, and she knows that all those pamphlets, all [that] information, that I bring from the Choices project, she takes a look at the reading materials.” Parent 6: “Everyday in the beginning when we would come to the class, [the nutritionist] would have some kind of low-calorie snack, which was good…now I'm putting more vegetables in his lunch.” Parent 7: “Her mother tends to like chicken nuggets and Easy Macs, but I know she took information back, and I noticed because Monday she packs a lunch for [child's name], [whispering] so I always check, and there actually gets to some fresh fruit in there and vegetables now.” Parent 8: “…When I am with [child's name] I always try and encourage her, you know, watch her portions, think about what you are putting in your body, drink more water, and I don't think that a lot of that is happening when she is with her mom.…” Parent 9: “…Some kids had been teasing her at school before we got here, and so she was very self-conscious.… And then, the other thing is that I think the class gave her a little more confidence…” Parent 10: “I think seeing other kids heavy helped him accept that it's okay to be heavier because [before] he would wear sweatshirts in May when it was like 95 degrees outside…and he doesn't do that anymore, this year he is not wearing his hoodie.” Suggested Time in Class 1 Activities Materials Needed 20 min I. Check-in, sharing, snacks, and group rules • Snacks, poster board for group rules 20 min II. What is CHOICES? • Handout What is family support? What is safety when active? • General safety guidelines 30 min III. Pedometer introduction, logging, pedometer practice • Pedometers • Lifestyle Activity Estimate sheets 5–10 min IV. Lesson summary and next week's home activity assignment • Pedometer Log sheet
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