The St. Louis Children's Hospital Head to Toe family-based weight management program helps children, teens, and their parents learn to make healthier lifestyle choices to address risk factors for high blood pressure and diabetes.

Participants are referred to the program through their pediatrician, through the hospital's call center, or through St. Louis Children’s Hospital’s Healthy Start Clinic. The program is implemented in twelve 60-minute sessions and monthly follow-up calls with trained experts. Each lesson is led by a team of trained professionals consisting of a registered dietitian, exercise specialist, and a licensed social worker. Participants are taught how to manage their weight and are encouraged to have a positive self-image as their bodies grow. Participants set goals to increase regular exercise, practice healthy eating, and increase the child's self-esteem.

The curriculum was developed using CDC guidelines for physical activity and USDA Center for Nutrition Policy and Promotion guidelines for nutrition. In addition to the curriculum, instructors utilize a variety of tools to implement the program, including multi-media presentations, incentives, and pre- and post-assessments of behavior, fitness, and healthy lifestyle knowledge.

The mission of Head to Toe is to teach children and their families the skills to manage body weight as they grow by living a healthy lifestyle that includes regular physical activity, healthy eating habits, and a positive self-image.

From August 2011 to May 2016, 485 children and their parents or guardians have enrolled in the Head to Toe program. Head to Toe has effectively increased knowledge of nutrition, physical activity and emotional health among participants.

The evaluation of this program was a pre-test, post-test single group design. Participants completed pre- and post-intervention assessments of BMI, knowledge and behavior.

From August 2011 to May 2016, 485 children and their parent or guardian were enrolled in the program and 263 children completed the pre-assessment and one or more of the post-assessment. Using SPSS 22.0, results from pre- and post-assessments were compared using a paired t-test. Those with missing data for one measure were excluded from analysis. Knowledge of nutrition, physical activity, and emotional health significantly improved from pre-test to post-test by 17% (p<0.001, 95% CI: -0.21, -0.13).

Participants significantly increased the number of days they report eating five or more servings of fruits and vegetables by 1.0 days per week (p=0.001, 95% CI: -1.60, -0.44). Participants significantly increased the number of days they reported taking part in physical activity or exercise by 0.67 days per week (p=0.004, 95% CI: -1.12, -0.22). Participants significantly increased the number of daily cups of water they reported consuming by 3.32 cups per day (p<0.001, 95% CI: -4.53, -2.12) as well as significantly decreased the number of daily soda consumption by 0.45 cups per day (p=0.049, 95% CI: 0.01. 0.90). Participants significantly increased the number of days they reported taking part in positive self-talk by 2.31 days per week (p<0.001, 95% CI: -3.26, -1.36). Chi-Square analysis showed that participants significantly increased their readiness to engage in physical activity (p=0.036). Chi-Square analysis showed that participants significantly increased their readiness to increase their fruit and vegetable consumption (p=0.002). Days that participants performed at least 30 minutes of physical activity increased from pre-assessment to post-assessment, although the difference was not statistically significant. There was no statistically significant difference in the pre- and post-intervention BMI or weight of program participants, which is consistent with the program's message of managing weight and growing into a healthy body. A limitation in this evaluation is the low-response rate for post-assessments. A new follow up survey has been introduced to the intervention. Every six months the survey is emailed to past participants and their parents. 9 past participants have completed the survey and 31 past parents have completed the survey.

Additionally, Head to Toe has helped participants increase their knowledge in mental health and goal setting through S.M.A.R.T. goals management (p=0.001), sending an email or text as a first step in family conversation (p=0.021), positive ways of coping with stress (p=0.003), and limiting screen time to less than 2 hours a day (p=0.002).

The results of this evaluation show that Head to Toe is effective in providing information and increasing knowledge of nutrition, physical activity and emotional health. Head to Toe also plays a role in changing eating behaviors among its participants. Participants in Head to Toe are able to maintain and manage their weight throughout the program.