The Play With Me Study
Condition: High Food Reinforcement; Overeating; Obesity, Childhood
MeSH terms: Pediatric Obesity; Hyperphagia
Study type: Interventional

Summary: 
      The obesity epidemic continues to be a major public health concern, with 38% of US adults and
      17% of children obese. One factor that has been highlighted as a robust predictor of weight
      outcomes is the relative reinforcing value (RRV) of food, or how rewarding one finds eating
      compared to alternative activities. An emerging body of literature has built upon the
      observed relationship between the RRV of food and weight by hypothesizing that the promotion
      of alternative reinforcers, or rewarding activities that could take the place of eating,
      offers a novel approach to decreasing excess energy intake and combatting obesity. We aim to
      integrate distinct bodies of literature and fill a gap in the evidence by testing whether
      parenting intervention messages delivered and practiced in the context of shared activities
      can decrease the RRV of food by making parent-child interactions more rewarding. The ultimate
      goal of this research is to demonstrate that such an intervention can increase children's
      motivation to interact with their parent instead of eating a favorite food, demonstrating the
      potential for positive parent-child interactions to become an alternative source of pleasure.
    

Detailed description: 
      The modern environment is obesity-promoting, with easy access to palatable, energy-dense
      foods and appealing sedentary activities. Despite this overarching environment, some
      individuals are able to maintain a normal weight status, suggesting that there are individual
      differences in susceptibility to obesity-promoting environments. The RRV of food captures
      individual differences in the motivation to eat by measuring how hard individuals will work
      for access to food versus other activities, and it has been shown to predict weight outcomes
      among infants, children, and adults. In a pilot study with infants, Kong, Eiden, Epstein, et
      al. demonstrated support for this hypothesis as providing infants and parents with access to
      group music classes increased infants' reinforcing values of music relative to food. Compared
      to other age groups, less research has been conducted on the RRV of food in preschool
      children. Filling this gap in the literature is important, as the preschool period is a
      period of drastic transitions, including extensive learning of food preferences and habits.
      Studies have also shown that obesity during adolescence is more likely among children who are
      already overweight by age 5, further highlighting the importance of innovative approaches to
      childhood obesity prevention prior to school entry.

      In the proposed study, we aim to bring together the literature on food reinforcement and the
      literature on parenting interventions in early childhood by promoting positive, rewarding
      parent-child interactions as a novel alternative reinforcer to decrease the RRV of food.
      Positive parenting can be defined as sensitive, responsive parenting, where parents'
      responses are appropriate for and contingent upon the child's cues and developmental level.
      This style of parenting early in life has been linked to positive cognitive and
      socio-emotional outcomes in adolescence and beyond. The focus of the present study is to
      assess the initial efficacy of the present parenting intervention, as well as its
      feasibility. This study will pave the way for future testing of this intervention's effects
      on the RRV of food and other positive developmental and health outcomes.
    

Intervention name(s): Triple P Parenting Videos; Activity Boxes
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Four video clips from the online Triple P Parenting program will be used to promote specific positive parenting practices.; There will be about 4 planned activities per week within activity boxes provided to families. The activities will be a context in which the positive parenting behaviors can be practiced. Each activity will take about 15 minutes. Families can pick each week whether they'd like their parenting practice to be embedded in reading activities, nature walks/active games, or arts and crafts. Instructions will be included with each activity, including prompts to allow the parent to apply learnings from that week's parenting video and to allow interactions to be child-led.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: relative reinforcing value of food; food reinforcement; positive parenting; parenting intervention