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Parenting Intervention Improves Child Weight Through Age 3

NIH-funded study results may inform efforts to prevent childhood obesity.

An intervention designed to help first-time mothers effectively respond to their infant's cues for hunger, sleep, feeding, and other infant behaviors significantly improved the BMI z-scores (adjusted for age and sex) of the child through age 3 compared with the control group. Results of the study, called Intervention Nurses Start Infants Growing on Health Trajectories (INSIGHT), are published online in JAMA.

Funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a component of the National Institutes of Health, INSIGHT randomly assigned first-time mothers and their infants into two groups to determine whether an intervention in "responsive parenting" delivered during infancy and early childhood promoted healthful weight gain leading to improved BMI z-scores through age 3 compared with a control group who didn't receive the responsive parenting intervention. The 279 mothers who participated were an average age of 28, mostly white, married, well educated, and privately insured, although INSIGHT researchers aimed for a racially and economically diverse study population. Overall, retention over three years was 83%.  

First-time mothers assigned to the responsive parenting group were educated on how to respond to their infant's needs across four behaviors: feeding, sleep, interactive play, and emotional regulation. Responsive parenting encourages parents to interact with their child in a way that's appropriate for their age, is prompt, and meets the child's needs. This group also learned such strategies as how to put infants to bed drowsy but awake and avoid feeding infants to sleep, how to anticipate and respond to infants waking up at night, when to introduce solid foods, how to use growth charts, and how to limit sedentary time.

The control group received a home safety intervention. Both groups received four home visits from a research nurse during infancy, followed by annual research center visits at age 1, 2, and 3.        

"Educating first-time mothers about responsive parenting practices can promote healthy weight gain," says Voula Osganian, MD, PhD, MPH, director of NIDDK's pediatric clinical obesity program. "By helping parents to understand how to respond to their infant's cues when drowsy, sleeping, fussy, and alert, we can help them to instill healthy behaviors in the child during a critical period of development."

The INSIGHT study found that, after completing the three-year study, children in the responsive parenting group had a lower average BMI z-score than those in the control group. There were significantly lower rates of overweight or obesity in the responsive parenting compared with control group at age 2, and these differences were still favorable but not statistically significant at age 3.

At age 3, in the responsive parenting group, 11.2% of children were overweight, compared with 19.8% in the control group. Furthermore, only 2.6% of children in the responsive group were considered obese, whereas 7.8% were considered obese in the control group.       

"The effects of the INSIGHT intervention appeared early and were sustained through age 3, something that had not been achieved before," says Ian M. Paul, MD, MSc, a professor of pediatrics and public health sciences at Penn State Health Milton S. Hershey Medical Center, who led the study with coprincipal investigator Leann Birch, PhD, of the University of Georgia, Athens. "Although INSIGHT participants were primarily white and of a higher socioeconomic status, we believe components of the intervention can be successfully implemented in more diverse and lower income populations, and this is currently being studied," Paul adds.

Previous reports from the INSIGHT study demonstrated that a responsive parenting intervention reduced rapid weight gain during the first six months after birth and overweight status at age 1, promoted developmentally appropriate infant sleep-related behaviors and sleep duration, and was associated with more healthful dietary patterns at 9 months of age.

Obesity affects 13.9% of children aged 2 to 5. Children who have obesity are at increased risk of developing type 2 diabetes, heart disease, high blood pressure, asthma, and other serious health problems in early childhood and later in life.   

"Infancy is a critical period for parents and health care providers to intervene and promote healthful behaviors, and INSIGHT results show us a way to do this effectively," says NIDDK Director Griffin P. Rodgers, MD, MACP. "These important findings help us better understand the important role that infancy and early childhood play in developing healthful habits and preventing obesity."

— Source: National Institutes of Health