Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial

Paul, Ian M.; Savage, Jennifer S.; Anzman-Frasca, Stephanie; Marini, Michele E.; Beiler, Jessica S.; Hess, Lindsey B.; Loken, Eric; Birch, Leann L.

doi:10.1001/jama.2018.9432

Cited by 164Obesity, Physical Activity, DietChild and Adolescent Psychosocial and Emotional DevelopmentObesity and Health Practices

Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial

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Paul, Ian M., Savage, Jennifer S., Anzman-Frasca, Stephanie, Marini, Michele E., Beiler, Jessica S., Hess, Lindsey B., Loken, Eric, Birch, Leann L.·2018·JAMA

DOI 10.1001/jama.2018.9432PMC PMC6142990

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Abstract

Importance: Rapid growth and elevated weight status in early childhood increase risk for later obesity, but interventions that improve growth trajectories are lacking. Objective: 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. Design, Setting, and Participants: 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). Interventions: 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. Main Outcomes and Measures: The primary outcome was body mass index (BMI) z score at 3 years (z 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 <95th percentile) and obesity (BMI ≥95th percentile) at 3 years. Results: 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 z 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]; P = .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]; P = .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]; P = .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]; P = .09). Conclusions and Relevance: 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 z 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. Trial Registration: ClinicalTrials.gov Identifier: NCT01167270.

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Parenting behaviors such as sensitive responsiveness and warmth have been linked to a variety of advantageous outcomes in children worldwide, including language.
“These parenting behaviors have been linked to a variety of advantageous outcomes in children worldwide, 18 -21 including in language.”
From Parenting Behavior and Child Language: A Meta-analysis. (2019) · cites this paper as [18]
The Discussion (page not provided) links positive parenting in infancy with improved emotional regulation and describes responsive parenting as relevant to several child behaviors. The paper does not establish the claimed link with language outcomes or show that these associations hold worldwide. (LLM, conf=0.86)
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STUDY PROTOCOL Open Access The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study
Paul, I. M., Williams, J. S., Anzman‐Frasca, S., Beiler, J. S., Makova, K. D., Verdiglione, C., Mindell, J. A., & Birch, L. L. (2016)
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Authors: Paul, I. M., Savage, J. S., Anzman-Frasca, S., Marini, M. E., Beiler, J. S., Hess, L. B., Loken, E., & Birch, L. L.
Affiliations: Pennsylvania State University (US)
Department of Pediatrics, University at Buffalo, Buffalo, New York
University of Connecticut (US)
University of Georgia (US)
Corresponding author: Paul, Ian M.
ORCID: Paul, Ian M.
Savage, Jennifer S.
Marini, Michele E.
Hess, Lindsey B.
Birch, Leann L.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2018-08-07
Volume: 320
Issue: 5
Pages: 461
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2018.9432
PMC: PMC6142990
OpenAlex: W2887102618
Cited by: 164
References: 32
Citations by year: 2026: 13 · 2025: 17 · 2024: 13 · 2023: 19 · 2022: 25 · 2021: 19 · 2020: 30 · 2019: 23 · 2018: 5
FWCI: 18.35
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Agriculture
National Institutes of Health (UL1TR000127, UL1TR002014)
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK088244)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Keywords: responsive parenting, childhood obesity prevention, BMI z-score, infant feeding, infant sleep, emotion regulation, home visits, mother-child dyads
MeSH terms: Adult, Child, Preschool, Female, House Calls, Humans, Infant, Male, Mother-Child Relations, Mothers, Pennsylvania, Body Mass Index, Parenting, Overweight, Pediatric Obesity

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Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial

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