The INSIGHT Study

Preventing Obesity through Interventions during Infancy (The INSIGHT Study)

• National Institute of Health
• Co-PI’s: Drs. Ian Paul, Hershey Medical Center, & Leann Birch, University of Georgia
• Co-I: Dr. Jennifer Savage Williams, CCOR

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing prospective, randomized, controlled trial evaluating the efficacy of an intervention designed to prevent rapid infant weight gain and childhood obesity among 276 first-born infants.

Participants were recruited in labor and delivery and 1-2 weeks after birth were randomized to an intervention group (parenting) or a control group (safety). The parenting intervention messages were related to responsive feeding, division of feeding responsibility, and healthy dietary choices designed for the prevention of obesity that extend from infancy through age 3 years. These materials also contained messages relating to sleep, active social play, and child fussiness/soothing. The control group received messages focused on the safety of the child’s environment and interaction with parents.

The parenting intervention program is hypothesized to show efficacy in both breast and formula fed infants as measured by the primary outcome, body mass index (BMI) at age 3 years. Secondary parental and infant behavior outcomes include sleep duration, feed duration, fussing and crying duration, feeding practices and attitudes and parenting sense of competence.

In 2018, a renewal application was funded to follow the INSIGHT participants from age 3 years through the developmentally important time at school-entry around age 6 years and into middle childhood at age 9. It is hypothesized that there will be a persistence of the main effect for the intervention group on growth (BMI) seen from 0-3 years through age 9 years. Similar secondary parental and child behavior outcomes will be examined, and researchers hypothesized that, compared to controls, the intervention children will exhibit greater self-regulation, better sleep, more physical activity and less sedentary behavior as they enter middle school. 

Referenced below are papers published from the INSIGHT Study:

• Ruggiero CF, Marini ME, Llewellyn CH, McHale SM, Paul IM, Savage JS. Differences in sibling temperament are associated with differences in maternal use of food to soothe during infancy: a sibling analysis. (2022). 
• Hunter KE, Johnson BJ, Askie L, Golley RK, Baur LA, Savage JS, et al. Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity. (2022). 
• Johnson BJ, Hunter KE, Golley RK, Chadwick P, Barba A, Savage JS, et al. on behalf of the Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration. Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol. (2022).
• Nandy D, Craig SJ, Cai J, Tian Y, Paul IM, Savage JS, Marini ME, Hohman EE, Reimherr ML, Patterson AD, Makova KD, Chiaromonte F. Metabolomic profiling of stool of two-year old children from the INSIGHT study reveals links between butyrate and BMI. (2022).
• Savage JS, Hochgraf AK, Loken E, Marini ME, Craig SJ, Makova KD, Birch LL, Paul IM. INSIGHT responsive parenting educational intervention for firstborns is associated with growth of secondborn siblings. (2022). 
• Hyczko AV, Ruggiero CF, Hohman EE, Anzman-Frasca S, Savage JS, Birch LL, Paul IM. Sex differences in maternal restrictive feeding practices in the INSIGHT study. (2021).
• Ruggiero CF, Hohman EE, Birch LL, Paul IM, Savage JS. INSIGHT responsive parenting intervention effects on child appetite and maternal feeding practices through age 3 years. (2021). 
• Hohman EE, Savage JS, Birch LL, Paul IM. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting intervention for firstborns affects dietary intake of secondborn infants. (2020).
• Roy M, Haszard JJ, Savage JS, Yolton K, Beebe DW, Xu Y, Galland B, Paul IM, Mindell JA, Mihrshahi S, Wen LM, Taylor B, Richards R, Te Morenga L, Taylor RW. Bedtime, body mass index and obesity risk in preschool-aged children. (2020). 
• Ruggiero CF, Hohman EE, Birch LL, Paul IM, Savage JS. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting intervention for firstborns impacts feeding of secondborns. (2020).
• Harris HA, Anzman-Frasca S, Marini ME, Paul IM, Birch LL, Savage JS. Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: the INSIGHT RCT. (2020).
• Paul IM, Hohman EE, Birch LL, Shelly A, Vallotton C, Savage JS. Exploring Infant Signing to Enhance Responsive Parenting: Findings from the INSIGHT Study. Maternal & Child Nutrition. (2019).
• Eagleton SG, Hohman EE, Verdiglione BS, Birch LL, Paul IM, Savage JS. INSIGHT Study Maternal Return to Work and Infant Weight Outcomes. Academic Pediatrics. (2018).
• Adams EL, Marini ME, Stokes J, Birch LL, Paul IM, Savage JS. INSIGHT Responsive Parenting Intervention Reduces Infant’s Screen Time and Television Exposure. International Journal of Behavioral Nutrition and Physical Activity.(2018)
• Craig SJ, Blankenberg D, Parodi ACL, Paul IM, Birch LL, Savage JS, Marini ME,  Stokes JL, Nekrutenko A, Reimherr M, Chiaromonte F, Makova KD. Child Weight Gain Trajectories Linked to Oral Microbiota Composition. Scientific Reports. (2018). 
• Anzman-Frasca SL, Paul IM, Moding KJ, Savage JS, Hohman EE,  Birch LL. Effects of the INSIGHT Obesity Preventive Intervention on reported and observed infant temperament. Journal of Developmental and Behavioral Pediatrics.(2018)
• Savage JS, Hohman EE, Marini ME, Shelly A, Paul IM, Birch LL.  INSIGHT Responsive Parenting Intervention and Infant Feeding Practices: randomized clinical trial. International Society of Behavioral Nutrition and Physical Activity.(2018)
• Paul IM, Savage JS, Anzman-Frasca S, Marini ME, Beiler J, Hess LB, Loken E, Birch LL. Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial. JAMA Pediatrics. (2018)
• Hohman EE, Paul IM, Birch LL, Savage JS. INSIGHT Responsive Parenting Intervention is Associated with Healthier Patterns of Dietary Exposures in Infants. Obesity.(2017)
• Paul IM, Hohman EE, Loken E, Savage JS, Anzman-Frasca S, Carper P, Marini ME,  Birch LL. Mother-Infant Room Sharing and Sleep Outcomes in the INSIGHT Study. Pediatrics.(2017)
• Hohman EE, Savage JS, Birch LL, Beiler JS, Paul IM. Pacifier Use and Early Life Weight Outcomes in the INSIGHT Study. Childhood Obesity.(2017) 
• Paul IM, Savage JS, Anzman-Frasca S, Marini ME, Mindell JA, Birch LL. INSIGHT Responsive Parenting Intervention and Infant Sleep. Pediatrics.(2016)
• Savage JS, Marini ME, Anzman-Frasca S, Birch LL, Paul IM. Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial. JAMA Pediatrics.(2016)
• Paul IM, Williams JS, Anzman-Frasca S, Beiler JS, Makova KD, Marini ME, Hess LB, Rzucidlo SE, Verdiglione N, Mindell JA, Birch LL. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. BMC Pediatrics.(2014)