Intervention for first-time moms and their infants 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 body mass index (BMI) z-scores of the child through age 3 years compared with the control group. Results of the study, call Intervention Nurses Start Infants Growing on Health Trajectories (INSIGHT), published August 7 online in JAMA.

Funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a component of the National Institutes of Health (NIH), INSIGHT randomly assigned first-time mothers and their infants into two groups to determine if an intervention in “responsive parenting” delivered during infancy and early childhood promoted healthy weight gain leading to improved body mass index (BMI) z-scores through age 3 compared to a control group who did not receive the responsive parenting intervention. The 279 mothers who participated were an average of 28 years old, 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 percent.

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 is appropriate for their age, 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; 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 1, 2, and 3 years old.

“Educating first-time mothers about responsive parenting practices can promote healthy weight gain,” said Voula Osganian, M.D., Ph.D., M.P.H., 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 to control group at age 2 years, and these differences were still favorable but not statistically significant at age 3 years.

At age 3 years, in the responsive parenting group, 11.2 percent of children were overweight, compared to 19.8 percent in the control group. Further, only 2.6 percent of children in the responsive group were considered obese, whereas, 7.8 percent 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,” said Ian M. Paul, M.D., M Sc., professor of pediatrics and public health sciences at Penn State Health Milton S. Hershey Medical Center, who led the study with co-principal investigator Leann Birch, Ph.D., of the University of Georgia, Athens. “Although INSIGHT participants were primarily white and of 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,” added Paul.

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 year, promoted developmentally appropriate infant sleep-related behaviors(link is external) and sleep duration, and was associated with healthier dietary patterns at 9 months of age.

Obesity(link is external) affects 13.9 percent of children ages 2 to 5 years. Children who have obesity are at increased risk for 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 healthy behaviors, and INSIGHT results show us a way to do this effectively,” said NIDDK Director Griffin P. Rodgers, M.D., M.A.C.P. “These important findings help us better understand the important role that infancy and early childhood play in developing healthy habits and preventing obesity.”

The INSIGHT study (NCT01167270) was conducted at the Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, and supported through NIDDK grant R01DK088244 and NIH’s National Center for Advancing Translational Sciences grant UL1TR000127.

The NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe, and disabling conditions affecting Americans. The Institute’s research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. For more information, visit www.niddk.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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