Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age
Authors: Ian M. Paul, Jennifer S. Savage, Stephanie Anzman-Frasca, Michele E. Marini, Jessica S. Beiler, Lindsey B. Hess, Eric Loken, Leann L. Birch
Journal: JAMA (2018)

<h3>Importance</h3> Rapid growth and elevated weight status in early childhood increase risk for later obesity, but interventions that improve growth trajectories are lacking. <h3>Objective</h3> To examine effects of a responsive parenting intervention designed to promote developmentally appropriate, prompt, and contingent responses to a child's needs on weight outcomes at 3 years. <h3>Design, Setting, and Participants</h3> A single-center randomized clinical trial comparing a responsive parenting intervention designed to prevent childhood obesity vs a home safety intervention (control) among 279 primiparous mother-child dyads (responsive parenting group, 140; control group, 139) who enrolled and completed the first home visit from January 2012 through March 2014 with follow-up to age 3 years (completed by April 2017). <h3>Interventions</h3> Research nurses conducted 4 home visits during infancy and annual research center visits. The responsive parenting curriculum focused on feeding, sleep, interactive play, and emotion regulation. The control curriculum focused on safety. <h3>Main Outcomes and Measures</h3> The primary outcome was body mass index (BMI)<i>z</i>score at 3 years (<i>z</i>score of 0 represents the population mean; 1 and −1 represent 1 SD above and below the mean, respectively). BMI percentile at 3 years was designated previously as the primary outcome. Secondary outcomes included the prevalence of overweight (BMI ≥85th percentile and &lt;95th percentile) and obesity (BMI ≥95th percentile) at 3 years. <h3>Results</h3> Among 291 mother-child dyads randomized, 279 received the first home visit and were included in the primary analysis. 232 mother-child dyads (83.2%) completed the 3-year trial. Mean age of the mothers was 28.7 years; 86% were white and 86% were privately insured. At age 3 years, children in the responsive parenting group had a lower mean BMI<i>z</i>score (−0.13 in the responsive parenting group vs 0.15 in the control group; absolute difference, −0.28 [95% CI, −0.53 to −0.01];<i>P</i> = .04). Mean BMI percentiles did not differ significantly (47th in the responsive parenting group vs 54th in the control group; reduction in mean BMI percentiles of 6.9 percentile points [95% CI, −14.5 to 0.6];<i>P</i> = .07). Of 116 children in the responsive parenting group, 13 (11.2%) were overweight vs 23 (19.8%) of 116 children in the control group (absolute difference, −8.6% [95% CI, −17.9% to 0.0%]; odds ratio [OR], 0.51 [95% CI, 0.25 to 1.06];<i>P</i> = .07); 3 children (2.6%) in the responsive parenting group were obese vs 9 children (7.8%) in the control group (absolute difference, −5.2% [95% CI, −10.8% to 0.0%]; OR, 0.32 [95% CI, 0.08 to 1.20];<i>P</i> = .09). <h3>Conclusions and Relevance</h3> Among primiparous mother-child dyads, a responsive parenting intervention initiated in early infancy compared with a control intervention resulted in a modest reduction in BMI<i>z</i>scores at age 3 years, but no significant difference in BMI percentile. Further research is needed to determine the long-term effect of the intervention and assess its efficacy in other settings. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT01167270