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

Project Summary/Abstract Unprecedented rates of obesity are occurring in childhood and disproportionally affect Black youth, Hispanic/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. These risk factors are higher among Black, Hispanic/Latinx, and economically marginalized infants. Thus, obesity prevention starting in infancy has been advocated. The proposed research project addresses a novel opportunity for prevention in pediatric primary care, by pilot testing a promising, innovative infant obesity prevention intervention that utilizes a responsive parenting paradigm (e.g. promotes healthy infant regulation) to target the development of healthy feeding and sleep behaviors in infancy. The intervention will be delivered within pediatric primary care via an emerging model of integrated behavioral health. A responsive parenting approach to obesity prevention is strengths-based and focuses on accurate caregiver interpretation of infant cues, feeding behaviors, soothing, and sleep, rather than potentially stigmatizing messaging related to obesity, and thus, is more salient to caregivers of infants than an obesity-focused intervention. We will conduct a pilot RCT comparing our responsive parenting intervention to treatment as usual in 138 infants who are from communities of color (e.g., non-White; Hispanic/Latinx) 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 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.