PROGRESS for the primary prevention of early overweight in low-income, rural families - PROJECT SUMMARY Nearly 1 in 4 US children ages 2-5 years are affected by overweight or obesity, significantly increasing their lifelong risk of overweight and related co-morbidities including type 2 diabetes and metabolic syndrome. Infancy is an opportune time to intervene as it is a period of developmental plasticity with long-lasting metabolic and behavioral consequences. While early life prevention efforts have been challenging, responsive parenting (RP) interventions have shown success in reducing obesogenic behaviors and child body mass index (BMI). RP guidance designed for overweight prevention typically emphasizes responsive feeding and responding appropriately to infant cues of hunger and satiety. Building upon this, the Parent Responsiveness Optimized – Growth, Regulation, Eating, Sleep, and Soothing (PROGRESS) randomized, controlled trial will test an enhanced RP intervention aimed at preventing overweight in rural, low-income infants, a high-risk population with limited access to healthcare. In collaboration with Pennsylvania’s Nutrition Program for Women, Infants, and Children (WIC), PROGRESS will enroll 328 first-time mother-infant dyads after delivery. All participants will receive responsive feeding education from WIC Nutritionists per standard care. Additionally, three candidate intervention components, delivered via telehealth, will be tested against a dose-matched child safety control curriculum. Candidate RP components include “sleep-soothe-play” guidance previously tested with non-rural families and novel components, “parent-child communication” and “parental mindfulness,” all hypothesized to enhance traditional RP approaches to prevent overweight. Sleep-soothe-play instruction emphasizes that food should be used for hunger, not to soothe or reward, and the importance of providing structure and routines around sleep, meals, and play time. Parent mindfulness, defined as fully attending to one's emotions and needs, can enhance RP effects by improving parent-child interactions, emotional awareness, self-regulation, and supportive responses to challenging child behaviors. Lastly, parent-child communication addresses the potential misinterpretation by parents of infant cues by using infant signing to improve infant cue clarity. Supporting early communication during the preverbal stage can help infants express emotions, desires, and needs during the key developmental period of 6-24 months characterized by the introduction of solid foods, transition to a modified adult diet, sleep independence, increased mobility, and intensifying emotions. PROGRESS will use the multiphase optimization strategy (MOST) design to advance understanding of the extent to which intervention components contribute to treatment effects. The MOST design and telehealth delivery method are steps toward scaling the intervention for future dissemination with potential high public health impact. Only infants with birthweights ≥50th percentile will be eligible for the trial, given their higher risk for overweight. PROGRESS’ primary outcome will be overweight (BMI ≥85th percentile) at age 2 years.
