An Early Feeding Practices Intervention for Obesity Prevention

Abstract

OBJECTIVE: Report long-term outcomes of the NOURISH randomized controlled trial (RCT), which evaluated a universal intervention commencing in infancy to provide anticipatory guidance to first-time mothers on "protective" complementary feeding practices that were hypothesized to reduce childhood obesity risk. METHODS:The NOURISH RCT enrolled 698 mothers (mean age 30.1 years, SD = 5.3) with healthy term infants (51% female). Mothers were randomly allocated to usual care or to attend two 6-session, 12-week group education modules. Outcomes were assessed 5 times: baseline (infants 4.3 months); 6 months after module 1 (infants 14 months); 6 months after module 2 (infants 2 years) and at 3.5 and 5 years of age. Maternal feeding practices were self-reported using validated questionnaires. BMI Z-score was calculated from measured child height and weight. Linear mixed models evaluated intervention (group) effect across time.RESULTS: Retention at age 5 years was 61%. Across ages 2 to 5 years, intervention mothers reported less frequent use of nonresponsive feeding practices on 6 of 9 scales. At 5 years, they also reported more appropriate responses to food refusal on 7 of 12 items (Ps # .05). No statistically significant group effect was noted for anthropometric outcomes (BMI Z-score: P = .06) or the prevalence of overweight/obesity (control 13.3% vs intervention 11.4%, P = .66).CONCLUSIONS: Anticipatory guidance on complementary feeding resulted in first-time mothers reporting increased use of protective feeding practices. These intervention effects were sustained up to 5 years of age and were paralleled by a nonsignificant trend for lower child BMI Z-scores at all postintervention assessment points.WHAT'S KNOWN ON THIS SUBJECT: "Protective" complementary feeding practices that promote self-regulation of intake and development of healthy food preferences have been positively associated with healthy child eating patterns and growth. There are few high-quality trials evaluating feeding practice interventions; none has reported long-term outcomes. WHAT THIS STUDY ADDS:This large randomized controlled trial demonstrates that anticipatory guidance on the "how" of complementary feeding resulted in more protective feeding practices. These intervention effects were sustained for 3 years and translated into commensurate trends in obesity risk. Dr Daniels conceived the study; led the design, successful funding applications, and overall implementation of the study; and wrote the first draft of the paper; Dr Mallan undertook the statistical analysis and drafted the Results and Methods sections; Dr Nicholson contributed to funding applications, intervention development, and design of outcome assessments; Dr Thorpe contributed to funding application and measure development; Dr Nambiar coordinated study implementation and contributed to data collection and entry; Ms Mauch contributed to the design and delivery of the intervention modules and data collection; Dr Magarey contributed to the design, funding applications, developme...

Feeding Practices and Parenting: A Pathway to Child Health and Family Happiness

“…Clearly, we cannot work directly with young children to influence their early eating behaviours. However, food parenting is modifiable [40-42]. Ensuring that parents have realistic expectations of the early feeding dynamic as well as the confidence and skills to respond appropriately to “normal” and changing child eating behaviour in the context of overall child development has great potential to reduce anxiety and conflict.…”

“…The intervention was evaluated by a randomised controlled trial designed and implemented according to standard recommendations. The protocol, intervention content and process and outcomes have been reported in detail [40-42, 59]. Briefly, first-time mothers of healthy term infants were initially approached on post-natal wards.…”

“…Outcomes were assessed 6 months and 2 and 3.5 years after completion of the intervention/module 2 and corresponding to child ages 2, 3.5 and 5 years, respectively [31, 41, 42, 55]. Validated maternal-report tools were used to assess child intake (24-h recall), food preferences and eating behaviours and maternal feeding practices, strategies to manage food refusal and parenting skills.…”

Motivational Interviewing to Prevent Childhood Obesity: A Cluster RCT

“…Indeed washout of an intervention effect over time seems more plausible. 11,43,44 So far, there has been no other study with a comparable long intervention period as in the PRIMROSE trial. A too short intervention period seen in many studies might explain the lack of effect maintenance.…”

Reducing childhood obesity: opportunities to influence transitional infant feeding

“…Current early childhood nutrition interventions are frequently based on responsive feeding practices, 80,205,206 however recruitment and participation issues 28,186 suggest a lack of appreciation of the context in which feeding behaviours develop and/or the needs of parents. The origins of feeding practices are inextricably intertwined with the social and cultural factors that govern family life.…”