A Novel Obesity Prevention Program for High-Risk Infants in Primary Care

Unprecedented rates of obesity are occurring in childhood and disproportionally affect Black or African American youth, Hispanic or Latinx youth, and youth from economically marginalized backgrounds beginning as early as infancy. Obesity in infancy is not outgrown, tracks into adulthood, and places infants and children with obesity at a higher risk for significant medical comorbidities (e.g., cardiometabolic complications) in adulthood. The healthcare cost of obesity is \~$260 billion annually across the lifespan. Recent evidence suggests that infancy may be a critical period for the development of this high weight trajectory, as 10% of infants meet criteria for high weight-for-length; with the incidence being even higher among infants of color (16.3%), infants of Hispanic/Latinx ethnicity (12.1%), and economically marginalized infants (12.2%). Several modifiable predictors of obesity risk have been identified in infancy, including rapid weight gain in the first year, parental use of food to regulate infant distress, early introduction to solid foods, and insufficient infant total cumulative sleep. Given the greater risk for obesity, there is a critical need to identify and improve access to the most effective obesity prevention treatments for this population as a means of reducing the long-term healthcare burden.

This pilot RCT will compare a responsive parenting intervention to treatment as usual in pediatric primary care with 144 infants who are from communities of color (e.g., non-White; Hispanic or Latinx) and/or economically marginalized backgrounds (i.e., publicly insured). Families will receive four prevention sessions with the integrated behavioral health specialist at their routine primary care well-child visits during the first six months of life. The primary outcome measured is conditional weight gain (an indicator of rapid weight gain) at 9 months of age. The responsive parenting approach, delivered by an integrated behavioral health expert, has been culturally adapted for infants and caregivers who are economically marginalized and/or from communities of color through focus groups. The delivery of this intervention via integrated behavioral health in a pediatric primary care setting has the potential to have a significant public health impact in terms of preventing pediatric obesity later in life; and thus, improving health outcomes and reducing health disparities.

• Conditional Weight Gain [Time frame: At infant age 12 months (follow-up)]
• The Baby Eating Behavior Questionnaire [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• The Infant Feeding Style Questionnaire [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• The Food Frequency Questionnaire [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• Baby Day Diary [Time frame: During active treatment at infant age: 2 months, 4 months, and 6 months]
• Baby Basic Needs Questionnaire [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• The Baby Care Questionnaire [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• Infant Behavior Questionnaire - Revised - Very Short Form [Time frame: At Infant Age: 9 months (post-treatment)]
• Brief Infant Sleep Questionnaire - Revised [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• Maternal Self Efficacy [Time frame: At infant age 1 month (baseline), 9 months (post-treatment), and 12 months (follow-up)]
• The Philadelphia Urban Adverse Childhood Experiences (ACES) [Time frame: At infant age 1 month (baseline)]
• Edinburgh Postnatal Depression Scale (EPDS) [Time frame: At infant age 1 month (baseline)]