Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity : outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules

OBJECTIVE: To evaluate a universal obesity prevention intervention, which commenced at infant age 4-6 months, using outcome data assessed 6-months after completion of the first of two intervention modules and 9 months from baseline. DESIGN: Randomised controlled trial of a community-based early feeding intervention. SUBJECTS AND METHODS: 698 first-time mothers (mean age 30±5 years) with healthy term infants (51% male) aged 4.3±1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over three months, that provided anticipatory guidance on early feeding practices. Outcome data reported here were assessed at infant age 13.7±1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) > +0.67. Maternal feeding practices were assessed via self-administered questionnaire. RESULTS: There were no differences according to group allocation on key maternal and infant characteristics. At follow up (n=598 [86%]) the intervention group infants had lower BMIZ (0.42±0.85 vs 0.23±0.93, p=0.009) and infants in the control group were more likely to show rapid weight gain from baseline to follow up (OR=1.5 CI95%1.1-2.1, p=0.014). Mothers in the control group were more likely to report using non- responsive feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, p=0.001) or using games ( 67% vs 29%, p<0.001). CONCLUSIONS: These results provide early evidence that anticipatory guidance targeting the ‘when, what and how’ of solid feeding can be effective in changing maternal feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.

Task constraints

Newell (1985, 1986) identified the importance of interacting constraints on the emergent behaviours of learners or performers in sport as they assemble functional states of movement organisation in achieving task goals. Constraints, related to the person, task and environment, were defined as ‘boundaries or features that limit motion of the entity under consideration at any moment in time’ (Newell, 1986, p.347). Personal (or organismic) constraints include factors such as individual anthropometrics (height, weight, and limb lengths), fitness (e.g., strength, speed, aerobic capacity, and flexibility), mental skills (e.g. concentration, confidence, emotional control and motivation), perceptual and decisionmaking skills (e.g., recognising patterns of play, anticipation by reading the movements of opponents) and personality factors (e.g., risk taking or conservative behaviours). Newell (1986, p.350) distinguished between general environmental constraints, such as gravity, ambient temperature, natural light and altitude and task constraints, which are task specific and concerned with the goals of a specific activity. More recently, socio-cultural constraints (e.g., family support, cultural expectations and access to facilities) have also been considered as environmental constraints. Application of the constraints framework to the study of sport performance has led to task constraints being defined to include factors such as rules of games, equipment used, boundary playing areas and markings, nets and goals, the number of...