Early Food for Future Health. A randomized controlled trial evaluating the effects of an eHealth intervention aiming to promote healthy food habits from early childhood

Abstract

The World Health Organization (WHO) has defined obesity as one of today's greatest threats to public health. In Norway, 15-20 % of children aged 8-9 years are either overweight or obese. A substantial literature now relates early infant nutrition to development of later non-communicable diseases (NCD) like overweight and obesity. The early feeding environment is critical for establishing eating habits that may influence weight development and healthy growth in the long term. Since parents are gate-keepers of food and contribute to the child’s eating in numerous ways, primary prevention initiatives targeting parents have been called for to facilitate development of healthy eating habits. Barriers to fos tering healthy eating habits in children include parental feeding practices that prevent the child from using hunger and satiety signals to initiate and stop eating. This may undermine the innate capacity to self-regulate energy intake which develops during infancy. Other influential early feeding practices are repeated exposures to unfamiliar foods in order to develop a broader range of taste preferences, and parental strategies to improve dietary variety facilitating infant acceptance for healthy foods. In 2014, when the current study was planned, only a few randomized controlled trials had investigated methods of primary prevention of obesity commencing during infancy, the largest being the Australian NOURISH study. NOURISH targeted responsive early feeding practices through educational group sessions in first-time Australian parents. Responsive feeding is characterized by caregiver guidance and recognition of the child’s cues of hunger and satiety. During the last years, several randomized controlled trials focusing on responsive parenting and feeding have shown a positive impact on child eating outcomes, child growth and child feeding practices. However, in these trials the interventions were delivered using traditional approaches like home-visits or face-to-face group settings, which is expensive and hence potentially cost-prohibitive at the level necessary for a national primary preventive public health strategy. Today, the Internet has become increasingly important for parents as a place to seek support and information about parenthood and children’s health and well-being. Yet, so far only very few studies have evaluated the effectiveness of web-based interventions targeted at feeding practices and eating behaviors during infancy.