Intervention to help parents prevent obesity in firstborn children benefits siblings

An intervention shown to help first-time parents prevent childhood obesity has found spillover effects in second-born children as well, even without further training for the parents. The results are from a study funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The intervention, called responsive parenting, teaches parents how to interact constructively with their infant during feeding, bedtime, and play. Responsive parenting may be an important childhood obesity prevention strategy for families and an effective way to promote healthy growth in children. The study, called SIBSIGHT, was published Dec. 21 in Obesity.

SIBSIGHT followed a responsive parenting intervention with first-time parents, called Intervention Nurses Start Infants Growing on Health Trajectories (INSIGHT). INSIGHT was a randomized controlled trial designed to reduce unhealthy, rapid weight gain in infancy to prevent obesity in childhood. INSIGHT found that, after completing the three-year study, children in the responsive parenting group had a body mass index (BMI) in a healthier range compared to those in the control group and significantly lower rates of overweight or obesity in the responsive parenting compared to control group.

INSIGHT is now the first educational intervention for obesity prevention of first children to demonstrate spillover effect to future children. In the United States, more than 13% of children aged 2-5 have obesity, a number that rises as children age.

SIBSIGHT findings are promising because the education gets to parents at optimal times, in the first months of life and now even before a subsequent pregnancy. SIBSIGHT demonstrates the potential long-term value of this childhood obesity prevention strategy."

Dr. Voula Osganian, NIDDK program director for pediatric clinical obesity

In the observational SIBSIGHT study, 117 firstborn infants that participated in INSIGHT and their siblings were monitored for one year. The first and second children whose parents received the responsive parenting intervention had a statistically significant difference in BMI compared to children in the control group, with BMI being 0.44 and 0.36 units lower respectively or about a 2.5% difference in weight.

"The continuing benefit of responsive parenting training is remarkable because parents of second children received no INSIGHT responsive parenting booster messaging in the observation-only evaluation," said Dr. Jennifer S. Williams, lead author and director of the Center for Childhood Obesity Research at the Pennsylvania State University in University Park.

First-time parents assigned to the responsive parenting group during the INSIGHT study were educated on how to respond to their infant's needs across four behaviors: feeding, sleep, interactive play, and emotional regulation. 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 three annual research center visits.

"The vast majority of parents have multiple children, and so a parenting strategy that can be taught once and then show benefits through subsequent children may be a path forward in helping curb the rising problem of childhood obesity," Osganian said.

At 12 months of age, the benefit in second children was similar to that observed in first children. Researchers conclude that the INSIGHT training prevented the use of nonresponsive feeding practices and helped establish consistent feeding routines in second siblings.

"A child's first months are a critical period for parents and health care providers to intervene and promote healthy behaviors and growth, and the INSIGHT and SIBSIGHT results show us a potential way do this effectively," said NIDDK Director Dr. Griffin P. Rodgers. "Early and long-term obesity prevention strategies help set up our children for a healthy future."