Learning to Love Mealtime Together
Condition: Infant Obesity; Parenting; Feeding Behavior
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      Infancy is an important target period for obesity prevention because once obese as an infant,
      the relative risk of remaining obese appears to rise with increasing age at great cost to
      both individuals and society. The ability to self-regulate energy intake (eating when hungry
      and stopping when full) is vital to obesity prevention and it is thought that this ability
      can be derailed by a chronic mismatch between parental feeding behavior and the infant's
      state (feeding in the absence of hunger and/or feeding beyond fullness). The study will test
      a novel intervention to help parents and pre-verbal infants better understand one another
      during feeding and it will offer new insight into how self-regulation of energy intake
      develops during infancy.
    

Detailed description: 
      Once obese as an infant, the relative risk of remaining obese appears to rise with increasing
      age. Thus, the early years of life have been posited as an important target period for
      obesity prevention. Widely viewed as a response to genetic, interpersonal, and environmental
      factors, obesity fundamentally reflects an imbalance between energy intake and expenditure.
      Self-regulation of energy intake aligned with physiologic need is essential to this balance.
      The process(es) by which infants begin to disassociate eating behavior from physiologic need
      is unclear, thus it is crucial to better understand predictors of individual differences in
      self-regulation of energy intake. It is well established that autonomic regulation may
      support infant behavioral regulation, suggesting that autonomic function may be a critical
      area to consider here. Moreover, self-regulation is strongly influenced by dyadic interaction
      quality during infancy, and findings reveal that more responsive interactions are associated
      with more effective autonomic regulation. A chronic mismatch between a caregiver's feeding
      behavior and the infant's state (feeding in the absence of hunger and/or feeding beyond
      fullness), is thought to contribute to obesity by undermining the infant's capacity to
      self-regulate intake; the current proposal will be the first to examine the effects on
      autonomic regulation. The investigators propose an intervention to enrich the capacity of
      mother-infant dyads to perform their respective interactive tasks. The investigators plan to
      teach mothers American Sign Language (ASL) signs indicative of hunger, thirst, and satiety,
      which they will in turn teach their preverbal infant. This training in ASL will be augmented
      with targeted information for mothers about infants' capacities to self-regulate energy
      intake in response to hunger and satiety and communicate those states with intention. Mothers
      also will be taught about expected development of infants' eating behaviors and nutritional
      requirements to support healthy growth.

      Using a two-group randomized repeated measures design, this study aims to 1) evaluate the
      feasibility and acceptability of the intervention and study methods, including recruitment,
      enrollment, and data collection (self-report, anthropometrics, video observations, and
      respiratory sinus arrhythmia [RSA]) for infants and their mothers; 2) evaluate the initial
      impact of the intervention on observed feeding interactions, reported infant feeding
      behaviors and maternal feeding behaviors/beliefs, and infant nutritional intake and growth;
      and, 3) explore preliminary data on concordance between dyadic feeding interactions and
      autonomic regulation in both mothers and infants (RSA). In addition to a variety of
      self-report and anthropometric measures, this study will use integrated behavioral (video)
      and physiologic (RSA) measures to better understand feeding dynamics and their relationship
      with obesity risk. Understanding these processes is essential for developing appropriate
      preventions, or interventions, that will help reduce the prevalence of early childhood
      obesity and its extension into later childhood and beyond.

      Study Phases:

      Screening: screening for eligibility and obtaining consent

      Study Treatment: study intervention/experimental treatment from baseline visit ([Time 1
      (T1)]: age 4-9-months) monthly until 3-months post-baseline ([Time 2 (T2)]: age 7-12-months)

      Follow-up: 6-months post-baseline ([Time 3 (T3)]: age 10-15-months)
    

Intervention name(s): Responsive Feeding Training
Intervention type(s): Behavioral
Intervention description(s): Families will receive 4 monthly 1-hour sessions: (1) Signing with infants; (2) infant communication and responsive feeding; (3) nutrition, portion sizes, and neophobia; and, (4) infant intentionality.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention
Keywords: Infant Obesity; Parenting; Feeding Behavior; Responsive Feeding