Focus On Mom’s Diet May Reduce Baby’s Obesity Risk

by Heidi Green
August 22, 2012

If there is one person new mothers are used to getting advice from, it is their child’s health care provider. Often, the pediatrician’s recommendations come as part of routine well-child visits. A week after your baby’s birth, advice may be given about diapers. At two months, perhaps the topic is sleep. Discussion of your baby’s diet is always front and center.

According to a new study, pediatricians who want to reduce their patients’ risk of childhood obesity might be better off giving advice about mom’s diet, than baby’s.

Research
Based on the idea that ”improving the mother’s health may improve the child’s health” and that “parents may be willing to change to improve their children’s habits,” a research team based in Columbus, Ohio recruited mother-infant dyads at three pediatric primary care clinics to participate in a cluster randomized trial. Each clinic used a different approach for all of its infant patients:

• Bright Futures—Mothers received standard care for their babies. Based on the Bright Futures pocket guide from the American Academy of Pediatrics (AAP). Handouts and advice addressed breastfeeding, the introduction of infant and table foods, and avoidance of honey and choking-hazard foods.
• Ounce of Prevention—Based on a program developed in Cincinnati, mothers were given detailed advice about infant feeding, including serving size and order of introducing different foods. They were encouraged to pay attention to their babies’ signs of fullness, not to force them to eat, and not to use food as a reward.
• Maternal-focused intervention (MOMS)—Mothers received dietary guidance on their own eating patterns, based on “the underlying concept … that mothers are role models for their children.” Messages targeted how mothers ate and the fact that children imitate their mothers. Seven behaviors were recommended:
  • Eat three meals and two snacks daily, without skipping.
  • Eat in one place in the home.
  • Turn off the TV while eating.
  • Eat together as a family whenever possible.
  • Drink two glasses of milk daily, if possible.
  • Eat five servings of fruits and vegetables.
  • Limit intake of soda and fast foods.

Study participants were English-speaking mothers and their healthy infants who had been born at full-term. Each infant had to live with the biological mother. A history of NICU stay, preterm delivery, chronic disease, foster placement, and known genetic disorder were reasons for exclusion from the study.

Mothers participated in a baseline interview at the time of enrollment, and again when their infant was 6 and 12 months of age. They provided information about their own height and weight, family and personal history of obesity-related diseases, and nutritional intake and eating habits.

Study messages were delivered at the well-child visits when the child was 2, 4, 6, 9, and 12 months of age, in conversations with the health care provider and as a handout. Infants were weighed and measured at each visit; mothers provided information about child feeding behavior.

Results
Nearly 300 mother-infant dyads enrolled in the study. At six months, 75 percent were still participating; at 12 months, the response rate fell to 64 percent. More than half (57 percent) of the study participants completed all three interviews.

Mothers in both the Ounce of Prevention group and the MOMS group gave their children less juice and more servings of whole fruit than mothers in the “standard care” group. The MOMS group also reported giving their children more servings of vegetables. The Ounce of Prevention group reported fewer family meals, perhaps because of the strict and measured nature of the recommended infant diet. There was no difference in TV watching while eating.

This study has some limitations. As the study authors note, the patients were randomized at the clinic level; it is possible that there were some unaccounted-for differences between the patients who attended the different clinics. The study also relied heavily on self-report data from the mothers; feeding choices and eating behaviors were not validated—a fact that is complicated by the six-month intervals between study interviews.

Also, this report follows the dyads only through infancy. No data is available for these children after the age of 1, and it is impossible to know if any behavioral change that occurred would be sustained through the toddler years and childhood.

In addition, the delivery of study messages was reported by study physicians to be just 60 percent, and only 40 percent of mothers who responded to the six-month interview said they had read the handouts.

Interestingly, none of the programs seem to recommend holding off on introducing solids until 6 months of age, despite previous research showing that starting solids at an earlier age can increase a child’s risk of obesity.

Recommendations
As parents, we all want what’s best for our children. The MOMS program suggestions listed above are a good starting point.

Below are a few additional tips for improving your child’s eating habits and reducing the risk of obesity:

• Skip the soda—and the juice. Children under 1 need only their mother’s milk or formula. After that, offer small amounts of water as another beverage.
• Stock the pantry for health. Keep fruits and vegetables handy, and choose packaged snacks selectively.
• Think “healthy” when you think “dessert.” Healthy foods—inducing “snooze foods” that combine a carbohydrate with some protein and perhaps calcium (such as whole grain toast with peanut butter or an oatmeal-raisin cookie with a small glass of milk)—can satisfy your child’s after-dinner munchies.
• Keep mealtime positive, from the start. Infants need very little “solid” food at the start, but should be involved in mealtime—sitting at the table, engaging in conversation, and eating with family members.
• Most importantly, be a good role model. Plan healthy meals and snacks, and enjoy them with your children.

Whether or not your child’s health care provider decides to counsel you about what and when you eat, know that you significantly influence your child’s eating habits. So make sure you set a good example.

As the study authors note, “the ecology of family eating is one that is built on over time.” Even if your habits have been poor to date, it’s never too late to start building a healthy future.