Preventing Childhood Obesity Through Early Guidance

Along with birth weight and parental body size, infant feeding is recognized as one of the
most influential biological and environmental factors that affect weight gain during
infancy. Parental feeding practices have a strong impact on children's food availability,
eating behaviors, and weight. The Institute of Medicine's(IOM) recent report (2011) on early
childhood obesity prevention policies recommends five approaches to preventing obesity:
assess, monitor, and track growth from birth to age 5; increase physical activity and
decrease sedentary behavior in young children; support breastfeeding and be responsive to
children's feeding cues; limit screen time; and promote age-appropriate sleep for young
children. Based on the previous work by this research team, and in collaboration with a
major urban health department, we propose to test an intervention that incorporates all the
IOM's recommendations to prevent the development of obesity in at-risk infants. The
intervention will be guided by health professionals and delivered through home visits by
community health workers (CHWs), supervised by public health nurses (PHN), to Mexican
American women and children who are clients of the Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC) Program in Houston, TX. The intervention will occur
for 2 years with 1 year of follow-up, for a total of 3 years of measures.

Inclusion Criteria:

MATERNAL - Self-described as Mexican American, pre-pregnant BMI of 25 or greater, speaks
English or Spanish, is between the ages of 18 and 40, lives in a home where she can
receive home visitors, has no diagnosed chronic diseases that can affect the growth of a
fetus (cardiac, respiratory, etc.), have a telephone contact, and is not intending to move
from the area. Gestational diabetes will be noted but is not an exclusion criterion;
however, Type 1 diabetics will be excluded. Exposure to tobacco smoke (either maternal or
household smoking) will be noted as it is associated with infant obesity, but will not be
an inclusion or exclusion criteria.

INFANT - We will enroll the full-term singleton infants of enrolled mothers. The infants
will be enrolled if they are > 38 weeks gestation, have a birth weight > 2500 gm, and are
without endocrine/chromosomal/genetic abnormality that could interfere with growth.

Exclusion Criteria:

MATERNAL - Not enrolled in WIC clinic or does not plan to continue with WIC clinic after
delivery, high-risk pregnancy, hospitalized after discharge of infant, separated from
infant, or experiencing significant postpartum complications. If these criteria develop in
an enrolled mother, she will remain in the study per CONSORT guidelines, but her infant
will not be followed for study outcomes. We have sufficient power with our sample size to
allow for these events.

INFANT - Not discharged home with the mother or who are otherwise separated from their
mothers or who has a severe illness that can affect growth. CONSORT guidelines will apply
in these cases as well as in maternal cases.