Childhood overweight and obesity are major public health challenges. In Denmark, 14% of
children have overweight or obesity at school entry, rising to 19% by school leaving,
with higher prevalence levels among children from low socio-economic positions and ethnic
minority backgrounds.
Early intervention is crucial since childhood obesity is hard to reverse, and infancy
presents an opportunity to address modifiable risk factors. It is well-documented that
both genetic, behavioral, psychosocial, and environmental factors play key roles.
Modifiable risk factors include feeding practices, physical activity, screen use, and
sleep. Additionally, growing evidence suggests that psychological stress in early life
due to unmet socio-emotional needs may lead to disrupted energy balance homeostasis,
resulting in weight gain.
The Bloom Study is designed to address food and meals, motor skills and movement, screen
use, sleep, and sense of security in the family. The intervention targets first-time
families, with a special focus on reaching all families across varying socio-economic
positions and ethnic backgrounds. Also, the Bloom intervention has a strong focus on
involving fathers/partners. It is delivered through the established and highly accepted
system of community health nurses in Denmark.
The intervention is initiated during pregnancy and continues until the child reaches 30
months of age. The main intervention components include: 1) an extra home visit during
pregnancy, 2) an extra home visit when the child ais 18 months, 3) an extra home visit
when the child is 30 months, 3) telephone consultations, 4) parent groups, and 5) a video
library for parents.
An important element of the implementation strategy is to ensure that the intervention
design and implementation are compatible with the existing practices, priorities, and
values within the system of Danish community health nurses. Additionally, the
implementation of the Bloom Study will be supported by five main activity components: 1)
training of community health nurses including a five-day training course, supervision,
and a comprehensive implementation manual containing instructions for standardized
delivery of the intervention, 2) selection of local program ambassadors among community
health nurses in the municipalities, 3) regular contact with the research group including
assignment of one main contact person, 4) meeting activities including start-up meetings,
network meetings across municipalities, and local staff meetings, and 5) partial economic
compensation.
The Bloom Study is evaluated within a cluster-randomized controlled trial (cluster-RCT)
with 22 municipalities randomly allocated to intervention (11 municipalities) and control
(11 municipalities). The intervention is initiated during pregnancy and continues until
the child reaches 30 months of age. Follow-up data are collected at child age of 36
months. Primary outcome is Body Mass Index (BMI) z-score at child age of 36 months.