Toddler obesity prevention: A two‐generation randomized attention‐controlled trial

Abstract

Rapid weight gain increases risks of obesity and associated co‐morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler–mother physical activity, mealtime interactions and fruit/vegetable intake. The randomized three‐arm, eight‐session, 4‐month trial, conducted 2009–2013, included two intervention arms (responsive parenting and maternal lifestyle) and an attention control (home safety). Baseline and 6‐ and 12‐month follow‐up evaluations included weight and length/height, ankle accelerometry, video‐recorded mealtime interactions (Emotional Availability Scales) and 24‐h diet recalls (Healthy Eating Index‐2015 [HEI‐2015]). Analyses used linear mixed‐effects models with repeated measures comparing intervention versus control changes in BMI z score. We recruited 277 racially mixed (70% African American) toddler–mother dyads (mean ages 20.1 months and 27.3 years) from US WIC and primary care clinics and randomized them into intervention versus control; 31% toddlers and 73% mothers were overweight/obese. At follow‐up, changes in the rate of toddler BMI z score and maternal BMI were non‐significant. Maternal lifestyle group toddlers and mothers spent 24.43 and 11.01 more minutes in physical activity (95% confidence interval [CI]: 2.55, 46.32, and 95% CI: 1.48, 20.54, respectively). Fruit intake increased in both intervention groups. Hostile mealtime interactions increased in the maternal lifestyle group, and in supplementary analyses, mealtime interactions were significantly higher in the responsive parenting group than in the maternal lifestyles group, suggesting that toddler dietary interventions include responsive parenting. Intervention effects were stronger among older versus younger toddlers. Despite no impact on weight gain, additional research should examine integrated two‐generation responsive parenting and maternal lifestyle interventions among toddler–mother dyads.

Strategies to promote health behaviors in parents with small children—A systematic review and realist synthesis of behavioral interventions

“…51 Of the included interventions, seven out of 17 showed statistically significant results for dietary improvements in mothers 37,41,42,47,48,50,54 and four out of 17 showed statistically significant results for improved physical activity in mothers. 42,51,52,55 Only one intervention reported on fathers' health behaviors and found no statistically significant effect. 53…”

“…Of the 17 interventions, three received a "strong" methodological quality rating, 48,54,55 nine interventions were rated as "moderate", 37,39,41,43,[45][46][47]49,52 , and five were rated as "weak" 38,40,42,44,50 (See Tables S3 and S4). Non-RCT studies were deemed of lowest quality due to higher risk of confounding and selection bias.…”

An ecological momentary assessment study of physical activity behaviors among mothers of toddlers from low-income households

“…Baseline data from the Toddler Overweight Prevention Study (TOPS), collected from 2007 to 2010, were used for this study [ 22 ]. TOPS is a randomized controlled trial that tested the effects of maternal lifestyle or responsive parenting interventions on reducing the rate of BMI increase among toddlers and mothers from urban and semi-urban areas in a Mid-Atlantic USA state [ 22 ].…”

“…We recruited samples from two sites: (1) an urban site (city of > 250,000) from a primary care clinic serving a low-income community and (2) an adjacent semi-urban site (city of < 100,000) from a WIC Clinic (Supplemental Nutrition Program for Women, Infants, and Children), a federal program that provides supplemental food, nutrition counseling, and referrals to women, infants, and children up to age five at nutritional risk and living below 185% of the federal poverty level [ 22 , 23 ]. Recruitment strategies included promotional flyers and in-person recruitment in clinic waiting rooms.…”

“…At baseline, mothers were electronically surveyed on demographics and health history for themselves and their toddlers [ 22 ]. In the demographic survey, mothers reported their age, toddler age, number of children, race, marital status (i.e., unmarried, married, divorced), level of education, employment status (i.e., employed/part-time or unemployed), and annual household income.…”