Native Americans are disproportionately impacted by early childhood obesity. Can home visits help turn the tide?
Obesity in early childhood has been on the rise and this has disproportionately occurred in Native American communities. An investigation in JAMA Pediatrics asks whether using home visits to discuss nutrition can help change parental behaviors and lead to healthy feeding and growth.1
The investigators ran a 1:1 randomized clinical trial that compared Family Spirit Nurture, a home visit intervention, and an injury prevention education control in a reservation-based community in the Navajo Nation. The participants were Navajo mothers aged 13 years and older who had infants aged younger than 14 weeks. They were followed up through 12 months postpartum. The intervention’s curriculum was given at 3 to 6 months postpartum and delivered by Navajo paraprofessionals. It included information on complementary feeding practices and avoidance of sugar-sweetened beverages. Women in the control group received 3 injury prevention lessons.
There were 134 mothers enrolled in the study with 68 randomized into the intervention group and 66 randomized into the control group. The researchers found that mothers in the intervention group reported statistically significantly lower consumption of sugar-sweetened beverages by their infants through 12 months postpartum (mean, 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Additionally, researchers observed improvement in responsive feeding practices through 9 months postpartum (mean, 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group (difference, 0.26; 95% CI, 0.06-0.47), but by 12 months’ postpartum it was no longer statistically significant. Infants in the intervention group were given their first food sooner than the control group (mean age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, −0.67; 95% CI, −0.04 to −1.29). They also lower body mass index z-scores at 6 and 9 months (mean at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, −0.54; 95% CI, −0.94 to −0.14) and at 12 months it was meaningful, but not statistically significant (mean, 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, −0.46; 95% CI, −0.92 to 0.01).
The investigations concluded that participation in home visits led to lower sugar-sweetened beverage consumption and improvements in responsive feeding practices. These improvements suggest that home visits are effective at promoting healthy eating and growth for infants.
1. Rosenstock S, Ingalls A, Foy Cuddy R, et al. Effect of a home-visiting intervention to reduce early childhood obesity among native american children. JAMA Pediatr. November 9, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.3557