Adaptation of an Evidence-based Family Program for Obesity Prevention in Health Care Context: Testing Outcomes and Mechanisms with First-time Military Parents and their Infants

PROJECT SUMMARY The proposed study will test the efficacy of a family-focused preventive intervention in improving healthy lifestyles among first-time parents in military families and reducing obesity risk among their infants. The ultimate goals of the intervention are to reduce rapid infant weight gain, an early indicator of future obesity risk, and new mothers’ postpartum weight retention, a contributor to intergenerational obesity transmission. In three trials, the Family Foundations (FF) program—consisting of a series of classes delivered in a health care context before and after birth—has demonstrated robust, replicated, long-term impact on family relationships (coparenting, parenting, family violence) and on parent and child internalizing and externalizing problems through at least 7 years after birth. The theoretical “active ingredient” of FF, validated by mediation analysis of program impact, is support for the development of a cohesive, supportive coparenting relationship. In the proposed study, we will test an adapted version of FF (termed “FF+”) that broadens the coparenting approach to help parents’ cooperate and support each other in establishing and maintaining healthy family lifestyle behaviors and specific health-promoting parenting strategies. We propose to test FF+ in military families, who experience overweight/obesity at levels similar to their civilian counterparts. Recruitment and intervention will be conducted within obstetric clinics in three Military Health System hospitals. Recruitment, intervention delivery, data collection, and follow-up will be facilitated by the military context. Aim 1. To assess the efficacy of the adapted FF+ program in a randomized trial. 250 families will be randomized to FF+ or control conditions. Data will be collected in home visits at pre-test during pregnancy, post-test at 6 months postpartum, and follow-up at 12 months postpartum, with additional data obtained from electronic health records. Aim 2. To test mediation pathways. Aim 3. To assess whether baseline parent characteristics, program delivery fidelity, or participant engagement moderate program effects on outcomes.