An intervention to decrease parental stress and increase healthy nutrition reduced both early childhood obesity risk and parent stress, according to a new study in Pediatrics. 

As childhood obesity rates rise at alarming rates, 12.7% of children ages 2-5 years meet criteria for overweight, with implications for both child and adult health, noted Rajita Sinha, PhD, a professor of psychiatry and neuroscience at Yale School of Medicine and director of the Yale Interdisciplinary Stress Center in New Haven, Connecticut, and colleagues in Pediatrics. 

Although stress and obesity in parents are known risk factors for early childhood obesity, effective ways to lower this risk have not been clear, the authors noted. They say the findings from their randomized controlled trial are the first to show that a novel, manual-guided parenting mindfully for health plus nutrition (PMH+N) intervention over 12 weeks reduced child obesity risk and also improved positive parenting and child food intake. The findings support further evaluation of PMH+N for potential sustained long-term effects on early childhood obesity risk.

“Our hypothesis came out of a critical observation that current parent-focused early childhood obesity prevention programs mainly focus on increasing healthy nutrition and reducing sedentary physical activity in children and ignore the crucial role of parent stress on child eating behaviors and weight,” Sinha told Medscape Medical News. “We propose that parent stress is the critical third leg of the stool for balanced and stable child weight and growth and needs to be directly addressed in early childhood obesity prevention programs.” 

The trial’s parent stress reduction intervention plus healthy nutrition and physical activity counseling was compared with healthy nutrition and physical activity counseling (control) alone for the prevention of early childhood weight gain. 

The Trial 

The parallel trial studied overweight parents and their young children from November 2018 to July 2022. The study cohort consisted of 114 parent-child dyads (parents’ mean BMI, 34.7 [± 6.6]), with the children’s ages ranging between 2 and 5 years. Parents were assigned to either the parent stress intervention or the control intervention. 

Both intervention groups met weekly for up to 2 hours in a group setting. Parent stress and child weight were assessed during the 12 weeks, and child weight was measured 3 months after treatment was completed.

“In addition, positive parenting behaviors, such as parent warmth, listening, patience, and positive affect, as well as child healthy and unhealthy food intake, were tracked before and after treatment,” Sinha explained.

Changes in child BMI and parent stress were co-primary outcomes, while secondary outcomes were observed parenting in a laboratory-based parent-child Toy-Wait Task (TWT) and child food intake. 

Over the 3-month follow-up, child BMI z-score increased significantly by 0.41 in the control group while in the PMH+N arm it remained unchanged. Parent stress decreased only in the PMH+N arm, and TWT-measured positive parenting increased while unhealthy child food intake decreased.

“Parents in the control intervention did not show similar improvements in parent stress, positive parenting, or unhealthy child food intake, and their children showed significant weight increases, with a sixfold increased risk of moving into the overweight/obesity weight risk group,” Sinha said. “PMH intervention broke the negative effect and tight coupling of high parent stress to lower positive parenting and lower healthy child food intake.”

No significant differences emerged by child age, gender, ethnicity, or socioeconomic status in this ethnically diverse sample of low-to-medium income families, but this will need to be tested further in larger studies. 

“The 2 to 5-year-old window is critical for obesity prevention, particularly for at-risk children, and there are relatively few interventions in this young age group. I applaud the authors for filling this gap,” Denise E. Wilfley, PhD, a professor of psychiatry, medicine, pediatrics, psychological and brain sciences, and public health at Washington University in St Louis, told Medscape Medical News. 

Wilfley, who was not involved the trial, said, “What’s particularly exciting is the opportunity to change parenting behavior when children are very young, before habits and family dynamics become entrenched.” Many individuals who later develop eating disorders have experienced adverse childhood experiences that contribute to problematic eating, she added. Larger, longer-term studies are needed to confirm these findings and explore underlying mechanisms.

Most work at Wilfley’s center has been done in children over age 5. In 2023, her group implemented a parent-directed intervention targeting positive parenting to improve child weight status. “Parents shaped the home environment, modeled healthy eating and activity behaviors, and learned to support and praise the child for positive changes they made,” Wilfley said. 

According to Sinha, interest in the mindfulness trial from researchers, pediatricians, and public health experts has been significant.

Her group wants to scale up the PMH intervention to make it available more broadly and specifically as a digital health intervention. “Childhood obesity prevention is critical as [obesity] predisposes young children to childhood chronic diseases and adult obesity-related illnesses and so this has broad implications for the worldwide obesity epidemic,” Sinha said. As to the durability of the intervention, her group has been testing 2-year outcomes in a larger cohort, with findings forthcoming soon.

As to future research, said Wilfley, “Studies could include measures of body composition, more quality measures of physical activity and dietary intake, and other parenting behaviors, such as household routine, environmental changes in the home such as more board games, fun activities, and books as well as changes in other individuals in the home.” 

They might also examine whether stress reduction mediates mood and child weight outcomes. Examining sibling spillover would be valuable, she added. “Including diverse families, such as those experiencing food insecurity, would help identify how intervention effects vary across contexts.”

This research was supported by the National Institute of Diabetes and Diseases of the Kidney (NIDDK). Sinha has served as a scientific consultant for Imbrium Therapeutics and Embera Neurotherapeutics and received research support from Ct Pharmaceutical Solutions, AELIS Farma, and Tenacia Biotechnology. Coauthor Jastreboff conducts trials with Amgen, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, and Rhythm Pharmaceuticals, and serves on scientific advisory boards for many pharmaceutical companies. She receives institutional grant funding from NIDDK. Wilfley reported having a patent for a copyright issued for family-based therapy curricula and has consulted for Shire Pharmaceuticals, Sunovion Pharmaceuticals, and Weight Watchers.