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TOPS - Program Description

TOPS is a two phase program designed to implement strategies that will prevent overweight among toddlers. Overweight, defined as a BMI > 95th percentile, in early childhood has reached epidemic proportions with 14% of 2-5 year olds overweight and 26.2% "at risk of overweight," defined as a BMI > 85th percentile.

The first phase, in collaboration with the Anne Arundel County, MD WIC Program, and the second phase, which consist of participants in the Baltimore City area, allow for comparisons between urban and suburban populations.

Dietary and physical activity patterns established early in life track over time, making the first few years of life an ideal time to help families establish healthy eating and physical activity behaviors and avoid overweight. This project works to identify techniques that could prevent overweight.

The project focuses on the dietary, physical activity, and growth patterns of WIC toddlers. We are conducting a 3-cell randomized trial consisting of: 1) a maternal intervention focusing on healthy diet and physical activity patterns for mothers; 2) a toddler parenting intervention focusing on parenting, limit setting, and development strategies; and 3) an intervention on child safety. The interventions are implemented over 3 months, with 8 sessions.

The study has enrolled 277 mother-child pairs. Toddlers, who were recruited at the WIC clinic and the University of Maryland Pediatrics at the Harbor, are between the ages of 12-30 months at baseline. Information is collected from the toddlers and their primary caregivers at baseline and at follow-up evaluations 6 months and 12 months later.

We hypothesize that altering maternal behavior will have a positive impact on the growth and development of the toddler by preventing behaviors that lead to overweight among children. The parenting intervention will improve parenting skills by offering information on proper approaches to feeding, discipline and educational play. We will compare the growth patterns of toddlers whose mothers were randomized to the maternal and parenting interventions with those in the safety intervention. This study design allows us to examine the mechanisms linking the interventions to improvements in diet, physical activity, and growth.