Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age

Abstract

IMPORTANCE Rapid growth and elevated weight status in early childhood increase risk for later obesity, but interventions that improve growth trajectories are lacking.OBJECTIVE To examine effects of a responsive parenting intervention designed to promote developmentally appropriate, prompt, and contingent responses to a child's needs on weight outcomes at 3 years. DESIGN, SETTING, AND PARTICIPANTSA single-center randomized clinical trial comparing a responsive parenting intervention designed to prevent childhood obesity vs a home safety intervention (control) among 279 primiparous mother-child dyads (responsive parenting group, 140; control group, 139) who enrolled and completed the first home visit from January 2012 through March 2014 with follow-up to age 3 years (completed by April 2017).INTERVENTIONS Research nurses conducted 4 home visits during infancy and annual research center visits. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. MAIN OUTCOMES AND MEASURESThe primary outcome was body mass index (BMI) z score at 3 years (z score of 0 represents the population mean; 1 and −1 represent 1 SD above and below the mean, respectively). BMI percentile at 3 years was designated previously as the primary outcome. Secondary outcomes included the prevalence of overweight (BMI Ն85th percentile and <95th percentile) and obesity (BMI Ն95th percentile) at 3 years. RESULTS Among 291 mother-child dyads randomized, 279 received the first home visit and were included in the primary analysis. 232 mother-child dyads (83.2%) completed the 3-year trial. Mean age of the mothers was 28.7 years; 86% were white and 86% were privately insured. At age 3 years, children in the responsive parenting group had a lower mean BMI z score (−0.13 in the responsive parenting group vs 0.15 in the control group; absolute difference, −0.28 [95% CI, −0.53 to −0.01]; P = .04). Mean BMI percentiles did not differ significantly (47th in the responsive parenting group vs 54th in the control group; reduction in mean BMI percentiles of 6.9 percentile points [95% CI, −14.5 to 0.6]; P = .07). Of 116 children in the responsive parenting group, 13 (11.2%) were overweight vs 23 (19.8%) of 116 children in the control group (absolute difference, −8.6% [95% CI, −17.9% to 0.0%]; odds ratio [OR], 0.51 [95% CI, 0.25 to 1.06]; P = .07); 3 children (2.6%) in the responsive parenting group were obese vs 9 children (7.8%) in the control group (absolute difference, −5.2% [95% CI, −10.8% to 0.0%]; OR, 0.32 [95% CI, 0.08 to 1.20]; P = .09).CONCLUSIONS AND RELEVANCE Among primiparous mother-child dyads, a responsive parenting intervention initiated in early infancy compared with a control intervention resulted in a modest reduction in BMI z scores at age 3 years, but no significant difference in BMI percentile. Further research is needed to determine the long-term effect of the intervention and assess its efficacy in other settings.

Interventions commenced by early infancy to prevent childhood obesity—The EPOCH Collaboration: An individual participant data prospective meta‐analysis of four randomized controlled trials

“…The outcomes of these interventions will tell us more about the effectiveness of interventions in differing contexts. Of the more recent trials, three have assessed outcomes to at least 2 years of age, and one trial has shown a similar reduction in BMI z score for infants in the intervention group, which broadly supports our findings.…”

“…Future research will need to address how best to implement these effective interventions at scale and cost implications and determine which factors characterize successful interventions. This may include the addition of a sleep component to early intervention obesity prevention programmes …”

Restrictive feeding and excessive hunger in young children with obesity: A case series

“…Studies have shown a positive association between restriction and weight, but have primarily been observational (relying on parent‐reported restriction) or laboratory‐based experimental studies. Randomized controlled trials that promote nonrestrictive feeding practices (ie, responsive feeding) have demonstrated success in reducing childhood obesity through 1‐3 years of follow‐up . However, these are multi‐component interventions, and more research is needed to establish a causal link between parent feeding and obesity risk in children.…”

“…Randomized controlled trials that promote nonrestrictive feeding practices (ie, responsive feeding) have demonstrated success in reducing childhood obesity through 1-3 years of follow-up. [25][26][27][28] However, these are multi-component interventions, and more research is needed to establish a causal link between parent feeding and obesity risk in children. Regardless, the improvements observed by our clinical program after families lifted restriction and increased structure are anecdotal evidence for the ecological validity of the empirical work to date.…”

INSIGHT Study Maternal Return to Work and Infant Weight Outcomes

“…Previous research has shown associations between demographic characteristics and infant weight, 23, 24 thus we examined potential confounding effects of maternal age, pre-pregnancy body mass index (BMI), and socioeconomic and marital status. Given previously reported positive effects of the INSIGHT responsive parenting (RP) intervention on early life weight outcomes, 25, 26 we explored study group (RP intervention vs. control) as a potential moderator. Return to work is associated with shorter breastfeeding duration.…”