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A responsive parenting intervention for at-risk infants via integrated behavioral health in primary care is feasible and may be effective for obesity prevention.

Infant obesity prevalence has increased by more than 60% in the last few decades. Obese infants are nine times more likely to have obesity later in childhood and in adulthood. It is crucial to start obesity prevention in infancy, as its persistence into childhood substantially affects health and well-being, requiring costly and challenging treatment. 

A pilot study in the Journal of Pediatric Psychology concluded that responsive parenting for obesity prevention for high-risk infants in primary care through integrated behavioral health (IBH) is feasible and shows good preliminary effectiveness.

Study Population

The study included 65 infants. Most were African American (80%) and from low-income households (91% receiving Medicaid). The intervention group received IBH-delivered obesity prevention through a program called Teaching Healthy Responsive Parenting During Infancy to Promote Vital Growth and Regulation (THRIVE). The control group received IBH-delivered emotional and behavioral disorder prevention. Apart from the higher incidence of gestational diabetes in the THRIVE group, there were no baseline differences between the groups.

Feasibility and Acceptability

The study’s recruitment of mother–infant dyads in the pediatric primary care office was higher than hypothesized, i.e., 90% vs. 80%. The main reasons for declining participation were time commitment and a lack of interest. Of the 65 dyads enrolled, 33 were randomized to the THRIVE group and 32 to the control group. Of these, 97% were actively enrolled throughout the study duration, and dropout was low and equal between the groups (n = 1 in each group). Study retention was high, at 89%, with five families across both groups lost to follow-up. Regarding visit attendance, 81% received at least three of the four intervention sessions. Missed visits were correlated with the first year of the COVID-19 pandemic.

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Conditional Weight Gain as an Indicator of Rapid Weight Gain

Conditional weight gain (CWG) was selected as the preliminary efficacy outcome as it is an indicator of rapid weight gain, a risk factor for later obesity. Forty-nine participants were analyzed at the 6-month time point and 48 at the 9-month time point.

THRIVE Infants Showed Slower Growth, Controls Exhibited Faster Weight Gain

The mean CWG score at the six-month assessment was negative for the THRIVE infants (-0.26), indicating a slower than average, i.e., appropriate, pattern of weight gain. In contrast, the mean CWG was positive for control infants (0.27), indicating a faster weight gain. At nine months, the mean CWG remained negative for the THRIVE group (-0.27) and positive for the control group (0.29).

Lower CWG in the THRIVE Group at 9 Months

There was a medium effect size difference between the groups for CWG, with a lower CWG in the THRIVE group than the control group, which was statistically significant at 9 months but not at 6 months.


Rybak, T. M., Modi, A. C., Mara, C. A., Herbst, R. B., Lauer, B. A., Burkhardt, M. C., & Stark, L. J. (2022). A Pilot Randomized Trial of an Obesity Prevention Program for High-Risk Infants in Primary Care. Journal of Pediatric Psychology, 48(2), 123–133. https://doi.org/10.1093/jpepsy/jsac075