“FAMILIA” Program

The prevalence of childhood obesity and overweight – factors that significantly increase the risk of cardiovascular diseases – has increased. A number of health interventions in school children have been carried out in an attempt to deal with this problem. In this context and based on two previous successful experiences in Spain and Colombia, Dr. Valentín Fuster decided to expand the SI! Program (his project for acquiring healthy habits from childhood) to the United States creating the “FAMILIA” Program. The program enrolled 562 children aged 3-5 in 15 of New York City’s preschools and Head Start programs in the high-risk community of Harlem along with 1,000 adults with the aim of demonstrating that education in healthy living habits from an early age reduces the risk of cardiovascular diseases and improves quality of life in adulthood.

In response to this problem, New York City has launched different initiatives over the last decade, such as the “Eat Well, Play Hard” Program, for the prevention of obesity in childhood through the promotion of positive messages related to healthy physical activity and encouragement of the consumption of fruit, vegetables, and skimmed dairy products.

A number of studies have evaluated the impact of school health education interventions upon health behavior in children [1-8]. Most such interventions were unable to reach the pre-established goals referred to weight loss or the adoption of healthy habits among the children.

Based on these data, and with the experience of two previously consolidated programs, Dr. Valentín Fuster decided to expand the “FAMILIA” Program. This program was funded by the American Heart Association with the aim of demonstrating that training in healthy living habits from early ages reduces the risk of suffering cardiovascular diseases and improves quality of life in adulthood. The “FAMILIA” Program was coordinated by Mount Sinai Hospital in New York, in collaboration with the programs of the New York City Administration for Children’s Services (ACS) and the Head Start initiative of the Division of Early Care and Education.

Three different inter-related and synergic research projects were proposed within the “FAMILIA” Program:

Project 1 

The first project included four levels of intervention: the school’s environment, the teachers, the parents or caregivers, and the pre-school children.

Questionnaires were used to evaluate prior knowledge among the participants of the body and heart, and their habits and attitudes towards healthy physical activity and foods. Finally, measurements included body weight and height. There were teaching activities for the children in the classrooms, informative sessions targeted to the parents or caregivers, and training programs for the teachers. Subsequently, the acquired knowledge was re-evaluated through interviews with the participants in the program, and body weight and height were measured once again.

Project 2

Se implementó un programa de intervención en el estilo de vida de los padres o tutores del Head Start y se midió su respuesta en el tiempo.

El estudio contó con tres secciones en las que se incluyeron a los participantes: un grupo de discusión sobre el estilo de vida saludable, formado por 10-15 padres o tutores del Head Start; sesiones individuales sobre estilo de vida con un orientador y acceso a información sobre salud a través de ferias de salud o materiales educativos impresos. El impacto de estas intervenciones se evaluó mediante cuestionarios con preguntas sobre el nivel de actividad física, la ingesta de alimentos, el nivel de fumar y la calidad de vida. Además, se midieron parámetros físicos (altura, peso, presión arterial, ecografías de las arterias y muestras de sangre para medir los niveles de glucosa, colesterol y triglicéridos).

Project 3

The third project contained in the “FAMILIA” Program in Harlem aimed to explore the following aspects:

  • Whether some people need additional help (apart from training) to improve their lifestyle and avoid cardiovascular diseases.
  • Whether genes (DNA fragments responsible for the transmission of hereditary traits) can help find new treatments and methods for preventing cardiovascular diseases.
  • Whether there are genetic changes linked to changes in lifestyle.


The results of the school-based intervention (project 1) showed that compared with the control group, the mean relative change from baseline in the overall KAH score in children was approximately fold higher in the intervention group (average absolute difference of 2.86 points; 95% confidence interval: 0.58 to 5.14; p = 0.014) [9].  The maximal effect was observed in children who received >75% of the curriculum. Physical activity and body/heart awareness components, and knowledge and attitudes domains, were the main drivers of the effect (p values <0.05). In addition, changes in emotion comprehension trended toward favoring intervened children.

Regarding the project 2, a total of 635 parents/caregivers were enrolled. The mean within-group change in Fuster-BEWAT score from baseline to 12 months was approximately 0.20 points in all groups, with no overall between-group differences [9].  However, high-adherence participants to the intervention exhibited a greater change in the score than their low-adherence counterparts. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months.

Although overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlighted that high adherence rates to lifestyle interventions may improve health outcomes.

The results of the project 3 are currently being analyzed.


  1. Almeida-Pittito B et al. Braz J Med Biol Res, 2010, 43(11):1088-94. Impact of a 2-year intervention program on cardiometabolic profile according to the number of goals achieved. 
  2. Broekhuizen K et al, BMC Public Health, 2010, 10:69. A tailored lifestyle intervention to reduce the cardiovascular disease risk of individuals with Familial Hypercholesterolemia (FH): design of the PRO-FIT randomised controlled trial. 
  3. Castelnuovo G et al. BMC Public Health, 2010, 10:204. TECNOB: study design of a randomized controlled trial of a multidisciplinary telecare intervention for obese patients with type-2 diabetes. 
  4. Foster GD et al. N Engl J Med, 2010, 363(5):443-53.A school-based intervention for diabetes risk reduction. 
  5. Ritchie, LD et al. Trials, 2010, 11:60. Taking Action Together: a YMCA-based protocol to prevent type-2 diabetes in high-BMI inner-city African American children. 
  6. Draper CE et al. BMC Public Health, 2010, 10:398. HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings. 
  7. Galvez MP et al, AcadPediatr, 2009, 9(5):339-43. Childhood obesity and neighborhood food-store availability in an inner-city community. 
  8. Shah P et al. Br J Nutr, 2010, 104(3):427-36.Improvement in nutrition-related knowledge and behaviour of urban Asian Indian school children: findings from the ‘Medical education for children/Adolescents for Realistic prevention of obesity and diabetes and for healthy aGeing’ (MARG) intervention study. 
  9. Fernandez-Jimenez R, Fuster V et al. J Am Coll Cardiol, 2019, 73(16):2011-2021. Child health promotion in underserved communities: The FAMILIA Trial.