Abstract
BackgroundChildhood overweight and obesity is a persistent public health issue in the US. Risk for obesity and obesity-related morbidity throughout the life course begins in utero. Native Americans suffer the greatest disparities in the US in childhood overweight and obesity status of any racial or ethnic group. Existing early childhood home-visiting interventions provide an opportunity for addressing obesity during the first 1000 days. However, to date, no evidence-based model has been specifically designed to comprehensively target early childhood obesity prevention.MethodsThis study is a randomized controlled trial to test the efficacy of home-visiting intervention, called Family Spirit Nurture, on reducing early childhood obesity in Native American children. Participants are expectant Native American mothers ages 14–24 and their child, enrolled from pregnancy to 24 months postpartum and randomized 1:1 to receive the Family Spirit Nurture intervention or a control condition. The intervention includes 36 lessons delivered one-on-one by locally-hired Native American Family Health Coaches to participating mothers from pregnancy until 18 months postpartum. A mixed methods assessment includes maternal self-reports, maternal and child observations, and physical and biological data collected at 11 time points from 32 weeks gestation to 2 years postpartum to measure the intervention’s primary impact on maternal feeding behaviors; children’s healthy diet and physical activity; children’s weight status. Secondary measures include maternal psychosocial factors; household food and water security; infant sleep and temperament; and maternal and child metabolic status.DiscussionNone of the 20 current federally-endorsed home-visiting models have demonstrated impacts on preventing early childhood obesity. The original Family Spirit program, upon which Family Spirit Nurture is based, demonstrated effect on maternal and child behavioral health, not including obesity related risk factors. This trial has potential to inform the effectiveness of home-visiting intervention to reduce obesity risk for tribal communities and other vulnerable populations and expand public health solutions for the world’s obesity crisis.Trial registrationClinicaltrials.gov (Identifier: NCT03334266 - Preventing Early Childhood Obesity, Part 2: Family Spirit Nurture, Prenatal - 18 Months; Retrospectively registered on 07 November 2017).
Highlights
Introduction of complementary foodsStudies indicate early introduction of complementary foods (< 6 months of age) increases infants’ risk of obesity [31]
Obesity disparities among Native American (NA) children persist from birth through early childhood, adolescence, and adulthood
Data support that children introduced to sugar-sweetened beverage (SSB) before 6 months of age are 92% more likely to be obese at age 6
Summary
Introduction of complementary foodsStudies indicate early introduction of complementary foods (< 6 months of age) increases infants’ risk of obesity [31]. Studies of NA mothers have indicated lack of understanding of the proper timing of introduction to complementary foods [34]. It is well-known that early dietary patterns (before 24 months postpartum) impact lifelong food preferences [36]. Expected benefits of responsive feeding include children’s increasing attention to internal signals of hunger and satiety [14,15,16, 42,43,44,45,46] and reduced risk of rapid weight gain and pediatric obesity [38]. NA adults have the highest age-adjusted rates of obesity (43.7%) and diabetes (17.6%) among all racial groups in the US [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
