Reasons for (Non)Participating in a Telephone-Based Intervention Program for Families with Overweight Children

Objective: Willingness to participate in obesity prevention programs is low; underlying reasons are poorly understood. We evaluated reasons for (non) participating in a novel telephone-based obesity prevention program for overweight children and their families. Method: Overweight children and adolescents (BMI>90th percentile) aged 3.5-17.4 years were screened via the CrescNet database, a representative cohort of German children, and program participation (repetitive computer aided telephone counseling) was offered by their local pediatrician. Identical questionnaires to collect baseline data on anthropometrics, lifestyle, eating habits, sociodemographic and psychosocial parameters were analyzed from 433 families (241 participants, 192 nonparticipants). Univariate analyses and binary logistic regression were used to identify factors associated with nonparticipation. Results: The number of overweight children (BMI>90th percentile) was higher in nonparticipants than participants (62% vs. 41.1%, p<0.001), whereas the number of obese children (BMI>97th percentile) was higher in participants (58.9% vs. 38%, p<0.001). Participating girls were younger than boys (8.8 vs. 10.4 years, p<0.001). 87.3% and 40% of participants, but only 72.2% and 24.7% of nonparticipants, respectively, reported to have regular breakfasts (p = 0.008) and 5 regular daily meals (p = 0.003). Nonparticipants had a lower household-net-income (p<0.001), but higher subjective physical wellbeing than participants (p = 0.018) and believed that changes in lifestyle can be made easily (p = 0.05). Conclusion: An important reason for nonparticipation was non-awareness of their child's weight status by parents. Nonparticipants, who were often low-income families, believed that they already perform a healthy lifestyle and had a higher subjective wellbeing. We hypothesize that even a low-threshold intervention program does not reach the families who really need it.