Opportunities for the Primary Prevention of Obesity during Infancy

Pediatrics, Penn State College of Medicine, HS83, 500 University Drive, Hershey, PA 17033, USA.
Advances in Pediatrics 12/2009; 56(1):107-33. DOI: 10.1016/j.yapd.2009.08.012
Source: PubMed


Given the vast array of topics that are important to cover at infant health maintenance visits, extensive discussion about growth, growth charts, and healthy lifestyle may be challenging for providers. Nonetheless, obesity and its comorbidities threaten both individual patients and the health care system. To break the vicious cycle of obese children becoming obese adults who have obese offspring, preventing behaviors that lead to obesity must be implemented during the very earliest periods of life, the prenatal period and infancy. For pediatric care providers, there are numerous opportunities to intervene, and good communication with families about healthy growth and lifestyle are a promising beginning.

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Available from: Ian M Paul, Jul 29, 2014
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    • "With 22.8% of 2–5 year old US children already meeting criteria for overweight [39], and overweight by age 5 years strongly associated with later life overweight [40], early interventions to address this epidemic are needed. However, while modifiable factors promoting overweight and rapid growth during infancy have been identified [41-43], until recently, studies aimed at the primary prevention of obesity through infancy-based interventions have not been conducted [44,45]. "
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    ABSTRACT: Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings. Discussion With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings. Trial registration NCT01167270. Registered 21 July 2010.
    Full-text · Article · Jul 2014 · BMC Pediatrics
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    • "e l s e v i e r . c o m / l o c a t e / a p p e t complementary feeding to favour the establishment of preferences for these foods early in childhood may be a unique opportunity to prevent or reduce the risk of diet-related diseases in adulthood (Paul et al., 2009). Thus considering the potential importance of sensitive periods in establishing eating behaviour, more knowledge about these periods is needed. "
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    ABSTRACT: Complementary feeding (CF) practices vary within and across cultures but have been investigated only to a very limited extent. It is however important to understand CF practices and how they differ, as CF sets the foundation for children's later food choices. The present study was set out to examine practices, attitudes and experiences of CF including the introduction of vegetables amongst French mothers (n =18, 25-39 years). Thematic analysis of transcribed focus groups and interviews revealed the perceived importance of the weaning period, as a critical milestone for infants' development but with a sense of "now or never" for introducing new tastes including vegetables. Flavour exposure and taste discovery during weaning were identified as the beginning of a "taste journey", in which educating the palate with a variety of different foods was considered important for children's later eating habits. Weaning was described as emotional and complex, a transition period in which the baby makes progress away from milk towards the family diet and which goes beyond mere nutrition. Advice was sought from official sources, but adapted to the needs of infants. In agreement with earlier observations of French adults, pleasure and taste development were considered of primary importance. In particular, French mothers believed complementary feeding lay the foundations of taste early in life.
    Full-text · Article · Sep 2013 · Appetite
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    • "For example, in a retrospective study of 184 older overweight children (P85th% Body Mass Index (BMI)), the median age of overweight onset was 15 months, with 25% overweight by 3 months (Harrington et al., 2010). Thus, the first 2 years of life are increasingly recognized as an important target for prevention efforts (Committee on Obesity Prevention Policies for Young Children, 2011; Paul et al., 2009). "
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    ABSTRACT: Parent-child feeding interactions during the first two years of life are thought to shape child appetite and obesity risk, but remain poorly studied. This research was designed to develop and assess the Responsiveness to Child Feeding Cues Scale (RCFCS), an observational measure of caregiver responsiveness to child feeding cues relevant to obesity. General responsiveness during feeding as well as maternal responsiveness to child hunger and fullness were rated during mid-morning feeding occasions by 3 trained coders using digitally-recordings. Initial inter-rater reliability and criterion validity were evaluated in a sample of 144 ethnically-diverse mothers of healthy 7- to 24-month-old children. Maternal self-report of demographics and measurements of maternal/child anthropometrics were obtained. Inter-rater agreement for most variables was excellent (ICC>0.80). Mothers tended to be more responsive to child hunger than fullness cues (p<0.001). Feeding responsiveness dimensions were associated with demographics, including maternal education, maternal body mass index, and child age, and aspects of feeding, including breastfeeding duration, and self-feeding. The RCFCS is a reliable observational measure of responsive feeding for children <2 years of age that is relevant to obesity in early development.
    Full-text · Article · Feb 2013 · Appetite
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