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Using a health literacy approach with childhood obesity


Becoming overweight at a young age can lead to long-term obesity and represents an important challenge to tackle in childhood. An investigation looks at the impact of a health literacy intervention on reducing overweight children.

Childhood obesity remains one of the most important issues in pediatrics and it’s most pressing when a child is overweight by his or her second birthday, due to a greater risk of health problems and long-term obesity. Health literacy programs can help ensure that children and families are following medical guidance and understand why such guidance is important. An investigation in Pediatrics examines whether using a health literacy approach can help reduce overweight and obesity in very young children.1

The investigators ran a cluster-randomized trial. The sites participating in the trial were randomly assigned to either be a control site or use the Greenlight Intervention. At the sites, infant-caregiver pairs were enrolled at the 2-month well-child visit. The caregiver had to speak either English or Spanish and the child had to have a birth weight of ≥1500 g. The intervention provided each parent a toolkit at every well-child visit and the providers were given training in communicating clearly with patients and family. Primary outcome of the study was the proportion of children overweight (body mass index [BMI] ≥85th percentile) at age 24 months and the secondary outcomes were weight status (BMI z score).

A total of 868 pairs were enrolled with 459 in the intervention arm and 406 in the enrolled arm. Forty-nine percent of the children were overweight at 24 months of age. The adjusted odds for being overweight at 24 months (treatment vs control) was 1.02 (95% CI: 0.63 to 1.64). When looking at the BMI z score, the adjusted average score differences (treatment minus control) were −0.04 (95% CI: −0.07 to −0.01), −0.09 (95% CI: −0.14 to −0.03), −0.19 (−0.33 to −0.05), −0.20 (−0.36 to −0.03), −0.16 (95% CI: −0.34 to 0.01), and 0.00 (95% CI −0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively.

Investigators concluded that using the intervention resulted in less weight gain in children through age 18 months, however, that effect was not sustained through 24 months of age. They noted that using greater intervention intensity may be required to keep the early positive effects seen with the clinic-based intervention.


1. Sanders L, Perrin E, Yin H. A health-literacy intervention for early childhood obesity prevention: a cluster-randomized controlled trial. Pediatrics. April 28, 2021. Epub ahead of print. doi:10.1542/peds.2020-049866

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