Development of a digital intervention to promote healthy growth during the first 2 years of life
Lead Research Organisation:
University College London
Department Name: Behavioural Science and Health
Abstract
Context
According to the National Childhood Measurement Programme, more than 1/5 children in England have developed overweight or obesity by the time they start primary school. Children living in the most deprived areas are more than twice as likely to be affected by obesity as those living in the least deprived areas. Children with obesity are over five times more likely to have obesity as adults, and are at increased risk of developing asthma, type 2 diabetes, cancer, heart and liver disease, and associated mental health problems - even from childhood. Obesity costs the NHS more than £5.1 billion, and employers approximately £7 billion.
Once developed, obesity is difficult to reverse, and a substantial body of evidence has established that rapid infant weight gain (from birth to 2 years) is causally linked to future obesity. Infancy is therefore a key window of opportunity for obesity prevention. In high incomes countries, rapid infant weight gain is common, especially among formula fed infants, with large studies estimating up to 40% of healthy full-term infants experiencing it. Managing rapid infant weight gain is challenging for parents: many infants have an avid appetite and a preference for sweet tasting foods, predisposing them to excessive milk and food intake; many parents use feeding to calm their unsettled infant or promote longer sleep duration; and parents and healthcare professionals often view rapid weight gain as healthy or advantageous. Three behavioural feeding interventions have succeeded in changing target behaviours among infants during the period of exclusive milk-feeding and/or weaning (starting solid foods): BABY MILK (UK), NOURISH (Australia) and INSIGHT (US). However, all were delivered face-to-face, with additional written materials and phone support. Due to increasing workload pressures on healthcare providers, there is a need for a behavioural intervention that does not require face-to-face delivery, and is cost effective and sustainable. A digital intervention would support parents who are increasingly being signposted to self-help materials, and would allow the intervention to be scalable to the population level. 'Baby Buddy' is the UK charity Best Beginnings' free, multi-award winning app, which provides information and tools to support parents in infant care. It has been downloaded >200,000 times (~1200 downloads per week), is accredited by the DHSC (and a large number of other organisations), available for download in the NHS apps library, and has a very wide reach with younger and more deprived mothers over-represented, making it an ideal platform for such an intervention.
Aims and objectives
In collaboration with Best Beginnings, we will adapt BABY MILK, NOURISH and INSIGHT for digital delivery in the UK, via Baby Buddy. Currently, Baby Buddy has very limited information about managing the key behaviours related to infant weight gain (milk-feeding, weaning, sleep, crying, activity, and understanding healthy weight gain). We will develop new interactive information on these topics, focusing on the first 2 years of infancy, based on the best available evidence of what works. We will work with Best Beginnings' network of parents and health professionals to review and advise on all stages of the intervention development, to ensure the content is user-friendly, engaging, persuasive and salient.
Potential applications and benefits
This digital intervention will provide parents with much-needed support on managing key behaviours related to infant weight gain, and will also offer a source of information for healthcare professionals to signpost families to, in order to free up their time. An effective and scalable intervention that optimises infant growth and nutrition has the potential to be rolled out on a population level and reduce the health and economic burdens of obesity both in childhood and adulthood.
According to the National Childhood Measurement Programme, more than 1/5 children in England have developed overweight or obesity by the time they start primary school. Children living in the most deprived areas are more than twice as likely to be affected by obesity as those living in the least deprived areas. Children with obesity are over five times more likely to have obesity as adults, and are at increased risk of developing asthma, type 2 diabetes, cancer, heart and liver disease, and associated mental health problems - even from childhood. Obesity costs the NHS more than £5.1 billion, and employers approximately £7 billion.
Once developed, obesity is difficult to reverse, and a substantial body of evidence has established that rapid infant weight gain (from birth to 2 years) is causally linked to future obesity. Infancy is therefore a key window of opportunity for obesity prevention. In high incomes countries, rapid infant weight gain is common, especially among formula fed infants, with large studies estimating up to 40% of healthy full-term infants experiencing it. Managing rapid infant weight gain is challenging for parents: many infants have an avid appetite and a preference for sweet tasting foods, predisposing them to excessive milk and food intake; many parents use feeding to calm their unsettled infant or promote longer sleep duration; and parents and healthcare professionals often view rapid weight gain as healthy or advantageous. Three behavioural feeding interventions have succeeded in changing target behaviours among infants during the period of exclusive milk-feeding and/or weaning (starting solid foods): BABY MILK (UK), NOURISH (Australia) and INSIGHT (US). However, all were delivered face-to-face, with additional written materials and phone support. Due to increasing workload pressures on healthcare providers, there is a need for a behavioural intervention that does not require face-to-face delivery, and is cost effective and sustainable. A digital intervention would support parents who are increasingly being signposted to self-help materials, and would allow the intervention to be scalable to the population level. 'Baby Buddy' is the UK charity Best Beginnings' free, multi-award winning app, which provides information and tools to support parents in infant care. It has been downloaded >200,000 times (~1200 downloads per week), is accredited by the DHSC (and a large number of other organisations), available for download in the NHS apps library, and has a very wide reach with younger and more deprived mothers over-represented, making it an ideal platform for such an intervention.
Aims and objectives
In collaboration with Best Beginnings, we will adapt BABY MILK, NOURISH and INSIGHT for digital delivery in the UK, via Baby Buddy. Currently, Baby Buddy has very limited information about managing the key behaviours related to infant weight gain (milk-feeding, weaning, sleep, crying, activity, and understanding healthy weight gain). We will develop new interactive information on these topics, focusing on the first 2 years of infancy, based on the best available evidence of what works. We will work with Best Beginnings' network of parents and health professionals to review and advise on all stages of the intervention development, to ensure the content is user-friendly, engaging, persuasive and salient.
Potential applications and benefits
This digital intervention will provide parents with much-needed support on managing key behaviours related to infant weight gain, and will also offer a source of information for healthcare professionals to signpost families to, in order to free up their time. An effective and scalable intervention that optimises infant growth and nutrition has the potential to be rolled out on a population level and reduce the health and economic burdens of obesity both in childhood and adulthood.
Technical Summary
The 2018 SACN report 'Feeding in the First Year of Life' highlighted excess energy intake and weight gain in infants as a concern, as this is an established risk factor for obesity. Modifying energy intake and weight gain is challenging because many infants have inherent tendencies towards higher than optimal appetite and a preference for sweet tasting foods. Furthermore, many parents use feeding to calm their unsettled infant or promote longer sleep duration, and may view rapid weight gain as healthy or advantageous. 3 interventions have succeeded in changing target behaviours among infants during exclusive milk-feeding and/or complementary feeding - BABY MILK (UK), NOURISH (Australia) and INSIGHT (US) - but all were delivered face-to-face. Due to increasing workload pressures on healthcare providers, there is a need for a behavioural intervention that does not require staff time, is cost effective, sustainable, widely accessible and scalable to the population level. We will use a person-based, evidence-based approach to develop a digital intervention to encourage and support parents to feed their infants appropriately to promote healthy growth from birth to 2 years. The intervention will target behaviours associated with infant weight gain (milk-feeding, complementary feeding, sleep, crying and activity), and will adapt BABY MILK, NOURISH and INSIGHT for digital delivery. Feeding is an emotive subject for parents, and variation in infant traits pose unique challenges; hence the intervention will be developed with parents using a person-based approach. This goes beyond assessments of acceptability, usability and satisfaction; the intervention will be modified during the process to make it more persuasive, feasible, and salient in order to enhance initial and sustained engagement by users. It will be designed as new content for a widely-used app (Baby Buddy) and will include information appropriate to the infant's age and developmental stage, and enable interaction.
Planned Impact
The development of this intervention has the potential to benefit several groups:
Families with infants and young children, including those from disadvantaged backgrounds
This intervention will provide young families with freely available, evidence-based information and advice about key behaviours during the first two years of their child's life that will help to optimise their infant's weight gain, and reduce their risk of future obesity and its associated health problems. Baby Buddy is already very widely used (>200,000 downloads; ~1200 downloads/week) and has an over-representation of younger mothers from disadvantaged backgrounds; developing the intervention on this app will therefore help to ensure that it reaches the children at highest risk of obesity, and will help to reduce social inequalities in health. A recent survey undertaken by Best Beginnings highlighted that parents wanted advice on key components targeted in this intervention (milk-feeding, complementary feeding, sleeping and crying), and the person-based approach to developing the intervention will ensure that the final content is acceptable, engaging, salient and persuasive, and that the advice offered is feasible to follow.
The NHS, healthcare professionals and public health practitioners working with young families
The NHS currently spends over £5.1 billion on obesity-related health costs. An evidence-based early life obesity prevention intervention therefore has the potential for enormous cost saving to the NHS. Due to scarce resources and increasing pressure on the workloads of healthcare providers, there is a need for interventions that do not require face-to-face contact, are cost effective, sustainable, and scalable to the population level. An evidence-based digital intervention that supports parents in optimising their infant's early growth and nutrition provides a valuable resource that could be rolled out at a population level at low cost. Baby Buddy is accredited by the DHSC (and a large number of other organisations) and available for download within the NHS library; developing the intervention within this app will provide a free, easy-to-access self-help resource for health professionals to signpost parents to.
Policymakers
The 2018 SACN report 'Feeding in the First Year of Life' highlighted the high prevalence of excess energy intake and infant overweight as a concern. Currently there are no UK guidelines for how to prevent or manage rapid infant weight gain. Evidence-based interventions of behavioural techniques that succeed in preventing or managing rapid infant weight gain are needed to develop guidelines. The development of this intervention will therefore contribute importantly to the evidence base that is needed.
Charities and not-for-profit organisations such as Best Beginnings
Following their recent survey of the topics that parents reported they want advice about during the early years, Best Beginnings have committed to develop new evidence-based content on milk-feeding, introducing solid foods, sleep and crying for Baby Buddy. We will develop this in collaboration with them. The intervention will be publicly available via Baby Buddy for other not-for-profit organisations to signpost young families to.
The broader economy
McKinsey estimates the cost of obesity to employers in the UK to be £7 billion. Developing an obesity prevention intervention with the potential to reduce adult obesity could therefore benefit employers in the future. In addition, UK taxpayers will benefit from the development of a low cost digital intervention that can replace more intensive face-to-face interventions, which require substantial public funds.
Families with infants and young children, including those from disadvantaged backgrounds
This intervention will provide young families with freely available, evidence-based information and advice about key behaviours during the first two years of their child's life that will help to optimise their infant's weight gain, and reduce their risk of future obesity and its associated health problems. Baby Buddy is already very widely used (>200,000 downloads; ~1200 downloads/week) and has an over-representation of younger mothers from disadvantaged backgrounds; developing the intervention on this app will therefore help to ensure that it reaches the children at highest risk of obesity, and will help to reduce social inequalities in health. A recent survey undertaken by Best Beginnings highlighted that parents wanted advice on key components targeted in this intervention (milk-feeding, complementary feeding, sleeping and crying), and the person-based approach to developing the intervention will ensure that the final content is acceptable, engaging, salient and persuasive, and that the advice offered is feasible to follow.
The NHS, healthcare professionals and public health practitioners working with young families
The NHS currently spends over £5.1 billion on obesity-related health costs. An evidence-based early life obesity prevention intervention therefore has the potential for enormous cost saving to the NHS. Due to scarce resources and increasing pressure on the workloads of healthcare providers, there is a need for interventions that do not require face-to-face contact, are cost effective, sustainable, and scalable to the population level. An evidence-based digital intervention that supports parents in optimising their infant's early growth and nutrition provides a valuable resource that could be rolled out at a population level at low cost. Baby Buddy is accredited by the DHSC (and a large number of other organisations) and available for download within the NHS library; developing the intervention within this app will provide a free, easy-to-access self-help resource for health professionals to signpost parents to.
Policymakers
The 2018 SACN report 'Feeding in the First Year of Life' highlighted the high prevalence of excess energy intake and infant overweight as a concern. Currently there are no UK guidelines for how to prevent or manage rapid infant weight gain. Evidence-based interventions of behavioural techniques that succeed in preventing or managing rapid infant weight gain are needed to develop guidelines. The development of this intervention will therefore contribute importantly to the evidence base that is needed.
Charities and not-for-profit organisations such as Best Beginnings
Following their recent survey of the topics that parents reported they want advice about during the early years, Best Beginnings have committed to develop new evidence-based content on milk-feeding, introducing solid foods, sleep and crying for Baby Buddy. We will develop this in collaboration with them. The intervention will be publicly available via Baby Buddy for other not-for-profit organisations to signpost young families to.
The broader economy
McKinsey estimates the cost of obesity to employers in the UK to be £7 billion. Developing an obesity prevention intervention with the potential to reduce adult obesity could therefore benefit employers in the future. In addition, UK taxpayers will benefit from the development of a low cost digital intervention that can replace more intensive face-to-face interventions, which require substantial public funds.
Publications
Rhodes A
(2023)
Using the Person-Based Approach to Develop a Digital Intervention Targeting Diet and Physical Activity in Pregnancy: Development Study
in JMIR Formative Research
Rhodes A
(2021)
Investigating partner involvement in pregnancy and identifying barriers and facilitators to participating as a couple in a digital healthy eating and physical activity intervention.
in BMC pregnancy and childbirth
| Title | BRIGHT interevtion - Parenting videos |
| Description | A collection of 9 new videos was created in close collaboration between the UCL/UCam team, Best Beginnings, and an experienced filmmaker (z=Zan Baberton). The 9 videos cover topics such as: (1) Welcome to BRIGHT. (2) Trying new foods, (3) What are Growth charts etc. The videos will be nested in the intervention prototype and act as a communication channel to convey evidence-based and clear guidance to parents on baby growth, formula milk feeding, complementary feeding and the use of growth charts. |
| Type Of Art | Film/Video/Animation |
| Year Produced | 2023 |
| Impact | The videos have been through PPI to check for clarity of content/language and shared with the families that participated in the films https://vimeo.com/showcase/9974363 (PW: Boundary) |
| Title | Digital app protoype (Whimsical) |
| Description | This is a digital representation of the app and intended app User journey of the app intervention |
| Type Of Art | Artefact (including digital) |
| Year Produced | 2022 |
| Impact | The creation of this platform has facilitated multiple research workshops and streamlined communication between the Investigator team and the partner charity (Best Beginnings) |
| URL | https://whimsical.com/mrc-baby-buddy-intervention-workshop-space-CK7rLEtfZUkwYU5WCAJo2w |
| Description | Invited member of Action on Sugar's Expert Advisory Board |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Invited member of Nesta's 'Blueprint for Halving Obesity' Expert Advisory Group |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Description | Invited member of the Euoprean Association for the Study of Obesity's 'Obesity Taxonomy Initiative' |
| Geographic Reach | Europe |
| Policy Influence Type | Contribution to new or improved professional practice |
| Description | Online training for Children and Young People's Eating Disorders Whole Team Training, commissioned by Health Education England |
| Geographic Reach | National |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Description | Training of early career researchers - MSc student, PhD student, RA |
| Geographic Reach | Local/Municipal/Regional |
| Policy Influence Type | Influenced training of practitioners or researchers |
| Impact | The MSc student, PhD student and Research Assistant have all received training in qualitative research methods (in particular, the 'person-based approach', for which they attended a training workshop), development of a digital intervention for a national charity, and the sign-off and regulatory processes involved. They will also acquire knowledge of the literature related to the core modules for the intervention. The MSc student is focusing her research dissertation on the sleep component and, as part of this, will undertake a systematic review of sleep interventions in infancy. The PhD student will summarise the intervention development for one of her PhD thesis chapters. |
| Description | Family Food Experience study: how can local authorities improve the efficiency and effectiveness of interventions to address inequality in childhood obesity? |
| Amount | £1,080,310 (GBP) |
| Funding ID | NIHR129771 |
| Organisation | National Institute for Health Research |
| Sector | Public |
| Country | United Kingdom |
| Start | 08/2020 |
| End | 06/2024 |
| Description | Healthy Weight Policy Research Unit |
| Amount | £5,499,269 (GBP) |
| Organisation | University College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 01/2024 |
| End | 12/2028 |
| Description | Parenting pre-schoolers with avid appetites: Understanding differential susceptibility to obesogenic environments for future intervention efficacy. |
| Amount | £783,510 (GBP) |
| Funding ID | ES/V014153/1 |
| Organisation | Economic and Social Research Council |
| Sector | Public |
| Country | United Kingdom |
| Start | 11/2021 |
| End | 10/2024 |
| Description | The power of parental feeding and genetic risk for childhood obesity |
| Amount | £30,211 (GBP) |
| Funding ID | MRF-CPP-R2-2022-100004 |
| Organisation | Medical Research Council (MRC) |
| Department | Medical Research Foundation |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 04/2023 |
| End | 05/2024 |
| Title | Infant Appetite Screening Tool |
| Description | We used ROC analyses to develop a screening tool for predicting high weight centile at 1 year of age from parent-reported infant appetite at 3 months of age. The parent-reported appetite questionnaire used was the Baby Eating Behaviour Questionnaire. A cut-off score was derived statistically which distinguishes infants whose appetite puts them at increased risk of achieving a high weight centile at 12 months of age. This screening tool can be used to give parents tailored advice on optimal infant feeding, that is specific to infant appetite. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2022 |
| Provided To Others? | No |
| Impact | None yet |
| Title | Infant Interactive Digital Growth Tracker |
| Description | This feature in the Baby Buddy app allows parents to enter their infant's or toddler's weight and age, and to get tailored feedback on their current weight centile, and signposting to relevant feeding-related information that we developed. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | This feature will be available to all users of Baby Buddy once it has been evaluated in future research. There is no other such digital interactive platorm available in the UK, as far as we are aware. |
| Title | Psychometric tool of Infant Feeding Stigma (Infant Feeding Experiences Study) |
| Description | Infant care is associated with many challenges, which can contribute to poor caregiver mental health. In the UK, 1 in 5 women who are pregnant or recently gave birth experience mental health problems, which is also true for many fathers and other caregivers. Caregiver mental health problems in this period contribute both to increased caregiver mortality and poorer health outcomes for the child. Furthermore, the associated economic costs exceed £8.1 billion for every one-year cohort of births in the UK. Therefore, it is important to investigate what factors contribute to poor caregiver mental health and the related child health outcomes in the early years after birth. A key part of infant care is feeding, which has been the focus of many public health campaigns in the UK and worldwide. The World Health Organisation recommends six months of exclusive breastfeeding. Yet exclusive breastfeeding rates are very low in the UK. Based on the last UK-wide infant feeding survey in 2010, only 1% of mothers were exclusively breastfeeding at six months after birth. Given the breastfeeding-focused recommendations, caregivers who cannot or do not breastfeed may have negative experiences with infant feeding. But even caregivers who breastfeed may have negative infant feeding experiences, for example when breastfeeding in public. Quantitative research into how such infant feeding experiences are associated with caregiver mental health outcomes or infant health outcomes is scarce. One likely reason for this scarcity is the absence of a psychologically rigorous questionnaire of caregiver experiences with infant feeding. This project thus aims to: (i) develop a new measure of caregiver infant feeding experiences, and (ii) explore the relationships between caregiver infant feeding experiences, and caregiver mental health outcomes and infant feeding and health outcomes during the first year of life. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2024 |
| Provided To Others? | No |
| Impact | A carefully developed measure of caregiver infant feeding experiences will enable researchers to map how experiences differ based on types of milk-feeding (formula, mixed, or breastfeeding) as well as other categories of interest. This project would therefore contribute to the evidence base needed to inform specific policies and interventions aimed at supporting caregivers. Specifically, the project could help map the impact of different public health messaging surrounding breastfeeding. Furthermore, this project aims to conduct 1-to-1 interviews with caregivers to ensure the questionnaire is comprehensive, relevant, sensitive, and acceptable to caregivers. This participatory approach will likely increase engagement with the project. |
| Title | Toddler appetite screening tool |
| Description | We developed a screening tool for high toddler appetite (1-3 years of age). The parent-reported appetite questionnaire used was the Child Eating Behaviour Questionnaire - Toddler Version. The mean, median and variation of a large population-base sample of twins was used to derive the cut-off scores for parent-reported high and low scores. This screening tool can be used to give parents tailored advice on optimal feeding practices, that is specific to toddler appetite and eating styles. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | This tool will be made available online for parents to use, and will be tested out in a future randomised controlled trial as part of the intervention develoepd by the MRC-PHIND project |
| Title | Toddler fussy eating screening tool |
| Description | We developed a screening tool for toddler fussy eating (1-3 years of age). The parent-reported fussy eating questionnaire used was the 'Food Fussiness' scale from the Child Eating Behaviour Questionnaire - Toddler Version. The mean, median and variation of a large population-base sample of twins was used to derive the cut-off score for parents. |
| Type Of Material | Physiological assessment or outcome measure |
| Year Produced | 2023 |
| Provided To Others? | No |
| Impact | This tool will be made available online for parents to use, and will be tested out in a future randomised controlled trial as part of the intervention develoepd by the MRC-PHIND project |
| Title | Behaviour Change Technique Mapping Table |
| Description | Previous interventions focusing on infant feeding behaviours were analysed. Key target behaviours and messaging used in these interventions were identified and collated in a table. Behaviour change techniques used in these interventions were also coded. |
| Type Of Material | Data handling & control |
| Year Produced | 2021 |
| Provided To Others? | No |
| Impact | This overview of behaviour change techniques was used as a framework for the development of a new intervention. |
| URL | https://liveuclac.sharepoint.com/:w:/r/sites/MRCPHINDInfantFeedingProject/_layouts/15/Doc.aspx?sourc... |
| Title | COM-B mapping excercise for Infant Feeding Behaviours |
| Description | A systematic map which links barriers and facilitators to responsive bottle-feeding as identified in the Redsell review (2021) on 'Barriers and enablers to caregivers' responsive feeding behaviour: A systematic review to inform childhood obesity prevention' to BCT's using the behavior change technique taxonomy (v1) , and directly translates the findings into actionable recommendations to inform the approach taken forward in BRIGHT |
| Type Of Material | Database/Collection of data |
| Year Produced | 2022 |
| Provided To Others? | No |
| Impact | This work has allowed us to systematically identify opportunities where barriers/facilitators to responsive feeding can be addressed by means of effective behaviour change techniques. This dataset strengthens the theoretical underpinning of the BRIGHT intervention. |
| URL | https://liveuclac.sharepoint.com/:x:/s/MRCPHINDInfantFeedingProject/EYUdtBR9w5lIkMeQdQy72o0BO9_ylfUV... |
| Description | Collaboration with Dr Abigail Page (2024 - Still Active) |
| Organisation | Brunel University London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | TBC |
| Collaborator Contribution | TBC |
| Impact | TBC |
| Start Year | 2024 |
| Description | Collaboration with Dr Brittany Johnson |
| Organisation | Flinders University |
| Country | Australia |
| Sector | Academic/University |
| PI Contribution | Dr Brittany Johnson is a Postdoctoral Research Fellow in the Caring Futures Institute, at Flinders University.She has expertise in applying behaviour change theory and creating supportive environments where children and families live, work and play. She leads the deconstructing interventions component of the TOPCHILD Collaboration funded by an NHMRC Ideas Grant (2020-23). The TOPCHILD Collaboration is an international project that brings together researchers from over 20 countries to transform early childhood obesity prevention, by exploring past, ongoing and planned interventions to understand how they work, and for whom. Brittany has provided expertise on BCT coding and how to apply this specifically to the NOURISH intervention. |
| Collaborator Contribution | We have onboarded Brittany to the BRIGHT project, introduced her to the wider team and have engaged in ideas exchange about digital intervention design. |
| Impact | N/A |
| Start Year | 2022 |
| Description | Collaboration with Dr Brittany Markides |
| Organisation | Deakin University |
| Country | Australia |
| Sector | Academic/University |
| PI Contribution | Dr Brittany Markides is a researcher with expertise in how to maximise access and use technology for health behaviour change interventions. She combines this with a background in dietetics. We reached out to Brittany after noticing her work at the ISBNPA 2022 conference. We have organised online meetings to ask questions and exchange knowledge on how to optimise the design of the BRIGHT intervention and have offered to meet up and host a seminar on her own research in London/Cambridge/Uppsala in 2023. |
| Collaborator Contribution | Dr Markides has provided time (responding to e-mails/online meetings) and has guided us towards relevant resources on digital intervention design to optimise the design of BRIGHT |
| Impact | N/A |
| Start Year | 2022 |
| Description | Collaboration with Dr Rebecca Byrne |
| Organisation | Queensland University of Technology (QUT) |
| Country | Australia |
| Sector | Academic/University |
| PI Contribution | We have invited Rebecca Byrne to teams meetings and seminars to onboard her to the overall project. We have attended online coding meetings between Dr Rebecca Byrne and Dr Brittany Johnson to support efforts to code the BCTs applied in the original NOURISH interventions. |
| Collaborator Contribution | Dr Rebecca Byrne is an ARC DECRA Fellow (2023-2025) and Accredited Practising Dietitian who is passionate about supporting parents of young children and educators in the early childhood education and care setting to create calm and enjoyable mealtimes. Her research focuses on what and how young children are fed. She has a focus on improving the measurement of dietary intake and other health behaviours in early childhood, and the promotion of responsive feeding practices which support children's autonomy, development of healthy food preferences and optimal growth. Rebacca has taken over leadership of the NOURISH intervention and potential spin-offs. She has been advising the BRIOGHT project on way to opimise the digitisation of the NOURISH materials and the choice of measures to include in the future feasibility trial |
| Impact | n/A |
| Start Year | 2022 |
| Description | Collaboration with new research study - AppeTypes |
| Organisation | University of Cambridge |
| Department | MRC Epidemiology Unit |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Participation by main PI (CL) and team member (AS) as a result of the award in a new research study - Appetypes |
| Collaborator Contribution | This study will collect height, weight and appetite data in 10,000 children to establish threshold cut-offs to possibly determine clinical thresholds |
| Impact | N/a |
| Start Year | 2022 |
| Title | Baby Responsive Intervention for Growth and Health Tracking (BRIGHT) |
| Description | BRIGHT is a novel digital intervention to prevent rapid weight gain in infancy and promote responsive feeding among formula-fed infants, delivered via the Baby Buddy app. It comprises 6 modules that support caregivers to manage specific weight-related behaviours during the first 2 years of life: formula-feeding; complementary feeding; child appetite; sleep; crying; growth monitoring. Content includes written articles, videos and interactive features that tailor content to infant behaviour and weight, and draws on a range of behaviour change techniques (e.g. tailored feedback on behaviour, demonstration of behaviours, framing/reframing). The efficacy of BRIGHT will be evaluated in future work, for which we are currently seeking funding. |
| Type | Preventative Intervention - Behavioural risk modification |
| Current Stage Of Development | Refinement. Non-clinical |
| Year Development Stage Completed | 2023 |
| Development Status | Under active development/distribution |
| Impact | The development of BRIGHT was conducted in 3 phases. Phase 1 included evidence synthesis on responsive feeding, and identification of intervention components. Phase 2 involved co-development of the intervention guiding principles and co-creation of the intervention prototype with a panel of the target population (n=15), Best Beginnings' Content, Digital and Engagement teams, and key stakeholders. Phase 3 involved optimisation of the prototype using 'think aloud' interviews (n=25), and evaluation of the intervention against the APEASE criteria (affordability, practicability, effectiveness, acceptability, safety, equity) using in-depth 'in the wild' qualitative interviews (n=7) - conducted online with target users. User-testing confirmed that BRIGHT fulfils the APEASE criteria, and that target users valued the app format and tailored approach. Best Beginnings, the UK charity that hosts Baby Buddy, is supportive of us testing out its effacy in a randomised controlled trial and we are seeking funding for this next stage, in partnership. |
| Description | A talk or presentation - Invited talk for the British Feeding and Drinking annual meeting (BFDG) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Invited talk as part of ECR satellite event for BFDG on applying and managing funding in academia (in collaboration with Professor Martin Yeomans). Includes discussion of MRC PPHIND and ESRC NIG awards |
| Year(s) Of Engagement Activity | 2024 |
| URL | https://www.aru.ac.uk/science-and-engineering/conferences-and-events/the-british-feeding-and-drinkin... |
| Description | Hosting of research workshop |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Study participants or study members |
| Results and Impact | 7 researchers gathered in-person and online to discuss content development of the intervention prototype |
| Year(s) Of Engagement Activity | 2022 |
| Description | Interview for BBC podcast 'A Thorough Examination' with Drs Chris and Xand van Tulleken |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | I was interviewed by Dr Chris van Tulleken about the value of twin studies for research into individual differences in characteristics such as weight and food preferences. This was as part of a Podcast series about differences (Series 2: 'Can I change?'; Episode 1: 'The twin effect'). The podcast series is very popular and was broadcast on BBC Radio 4 during prime time. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://www.bbc.co.uk/programmes/m0017tcz/episodes/downloads |
| Description | Invitation to talk at MRC Epidemiology Unit Research Event (University of Cambridge) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | A live presentation on the MRC PHIND 'Development of a responsive-feeding intervention for the first 2 years of life at the MRC Epidemiology Unit Research Away day (in-person and on Zoom) |
| Year(s) Of Engagement Activity | 2022 |
| Description | Invited key note talk for the British Feeding and Drinking Group annual meeting |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Invited to give the opening key note talk for the British Feeding and Drinking Group's annual meeting. My talk 'An appetite for life: genetic influence on the development of eating behaviour', focused on twin and molecular genetic studies of weight, appetite and eating disorder symptoms. I summarised my fellowship work into links between appetite and eating disorders, and summarised the work we are doing as part of the MRC-funded intervention development to optimise infant and child appetite through responsive feeding during the first two years of life. The British Feeding and Drinking Group is a non-profit organisation committed to advancing scientific research on food and fluid intake and associated biological, psychological and social processes. The Group provides a multidisciplinary environment for the free exchange of ideas and information, and serves as a resource for scientific expertise and education on topics related to the study of feeding and drinking behaviour. The 2-day annual meeting each year is attended by around 200-300 researchers, academics, students and industry workers in food, drink, nutrition, eating behaviour and weight. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://eu.eventscloud.com/ehome/bfdg2022/speakers/ |
| Description | Invited talk at the Royal Society |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | I was one of only 34 scientists invited to give a talk at the Royal Society, at their first ever large meeting dedicated to the causes of obesity ('Causes of obesity: theories, conjectures and evidence'). The talk 'Behavioural Susceptibility Theory: the role of appetite in rapid infant weight gain, obesity and eating disorders' focused on the work we have done to establish: the strong genetic influence on both early weight gain, obesity risk and appetite in infancy and childhood; the epidemiological work implicating appetite in weight gain and obesity risk; appetite as a behavioural mediator of genetic susceptibility; and the new findings linking early appetite to predisposition to eating disorder symptoms in early adolescence. The talk also summarised the intervention we are developing with MRC-funding to support responsive feeding in infancy and early childhood, as a potential pathway to modifying genetic susceptibility to obesity and eating disorders. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://royalsociety.org/science-events-and-lectures/2022/10/causes-obesity/ |
| Description | Invited talk for the Society for the Study of Ingestive Behaviour's annual meeting |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | Invited talk for the Society for the Study of Ingestive Behaviour's annual meeting. Talk was part of a symposium: 'Too Much Too Soon? Influence of Early Life Feeding'. My talk 'Behavioural Susceptibility to rapid infant weight gain' focused on genetic influence on early weight gain, later obesity risk, and the role of appetite in genetic susceptibility to early weight gain and later obesity. The talk also summarised the work we are undertaking to examine the links between early appetite and the onset of eating disorder symptoms as they start to emerge in early adolescence. The Society for the Study of Ingestive Behavior is a non-profit organizstion committed to advancing scientific research on food and fluid intake and its associated biological, psychological and social processes. The Society provides a multidisciplinary environment for the free exchange of ideas and information, and serves as a resource for scientific expertise and education on topics related to the study of ingestive behaviour. the 3-day annual meeting each year is attended by around 200-300 researchers, academics, students and industry workers in the field of ingestive behaviour and obesity. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://www.ssib.org/2022/program.php?dayshow=&displayday=&hide_details=yes |
| Description | Invited talk for the UK Association for the Study of Obesity's annual meeting (UK Congress on Obesity) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | I gave an invited talk for the UK Association for the Study of Obesity's annual meeting (the UK Congress on Obesity). The talk 'Nature and nurture in children's food preferences' was part of a symposium focused on influences on obesity in the 'home', and focused on the relative influence of genetic and environmental influences on preferences for a range of different foods in toddlerhood and childhood, and the possible links with disordered eating later. The talk also summarised the new MRC-funded intervention that we are developing to optimise parental feeding practices during the first two years of life, for which we are measuring food preferences as an outcome. The UK Association for the Study of Obesity is the UK's foremost charitable organisation dedicated to the understanding, prevention and treatment of obesity. The ASO aims to develop an understanding of obesity through the pursuit of excellence in research and education, the facilitation of contact between individuals and organisations, and the promotion of action to prevent and treat obesity. Its annual meeting is the UK Congress on Obesity. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://aso.org.uk/ukco/2022/programme |
| Description | Invited talk on genetic and environmental influences on eating behaviour |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | This was an invited talk for a conference on childhood obesity, hosted by the University of Cambridge in collaboration with the Danish Diabetes Academy. My talk focused on the work my group has undertaken into Behavioural Susceptibility Theory (including links between appetite and weight gain, twin studies of genetic and environmental influences on eating behaviour, links between appetite and eating disorders, and interventions to modify child eating behaviours). The symposium was attended by about 150 early career postdoctoral researchers, academics and students from the University of Cambridge and Denmark. After the talk, there were questions from the audience. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Lecture on genetic susceptibility to obesity and eating disorders and the role of appetite for the Young People's Eating Disorders Whole Team Training |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | I prepared and recorded a lecture on 'Genetic susceptibility to obesity and eating disorders and the role of appetite; for the Young People's Eating Disorders Whole Team Training, commissioned by Health Education England. This is for healthcare professionals involved in the care of children and young people with eating disorders. The talk summarised the strong link between obesity and eating disorders, with genetic risk and appetite as common risk factors for both. ti also talked about potential for interventions supporting responsive parental feeding practices in early life to nurture the development of healthy eating behaviours and a good relationship with food, highlighting the MRC-PHIND intervention we have developed. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Lecture on genetic susceptibility, appetite and eating behaviour, and obesity risk (MSc Clinical and Public Health Nutrition) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | 2-hour lecture on the role of eating behaviour in obesity, to students on UCL's MSc Clinical and Public Health Nutrition. The lecture covers: genetic susceptibility to obesity; the role of appetite and early eating behaviour in susceptibility to obesity; the role of parental feeding practices and the home family and wider environment in relation to obesity; the links between obesity, appetite and susceptibility to eating disorders. |
| Year(s) Of Engagement Activity | 2018,2019,2020,2021,2022,2023 |
| Description | Lecture on obesity (MSc Health Psychology) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | 2-hour lecture on obesity, delivered to students on UCL's MSc in Health Psychology. The lecture covered the links between obesity and eating disorder, including: genetic susceptibility to obesity; the role of appetite and early eating behaviour in susceptibility to obesity; and the links between appetite and susceptibility to eating disorders, incorporating findings from our research examining early appetite and the onset of eating disorder symptoms in two large prospective cohorts - Gemini and Generation R. The lecture also talked about opportunities for early life prevention and highlighted the MRC-PHIND intervention, which focuses on supporting responsive parental feeding practices in early life. Following this lecture students asked questions about the research and for opportunities to undertake research dissertations on the topics discussed within the lecture. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Lecture on the links between genetic susceptibility to obesity, appetite, environment and eating disorders for MSc Health Psychology |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | 2-hour lecture to students on 'Obesity' for UCL's MSc Health Psychology. The lecture covered: the epidemiology of obesity; difficulty identifying obesity in early childhood; genetic susceptibility to obesity; the role of appetite and early eating behaviour in susceptibility to obesity; the role of parental feeding practices and the home family and wider environment in relation to obesity; the links between obesity, appetite and susceptibility to eating disorders. Following this lecture I frequently have students contacting me for research opportunities on the topics of child eating behaviour, parental feeding practices, obesity prevention intervention development and eating disorders. |
| Year(s) Of Engagement Activity | 2018,2019,2020,2021,2022,2023 |
| Description | Lecture on the role of appetite in genetic susceptibility to obesity and eating disorders (MSc Clinical and Public Health Nutrition) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | 2-hour lecture on the role of appetite in genetic susceptibility to obesity and eating disorders, delivered to students on UCL's MSc Clinical and Public Health Nutrition. The lecture covered: genetic susceptibility to obesity; the role of appetite and early eating behaviour in susceptibility to obesity; and the links between appetite and susceptibility to eating disorders, incorporating findings from our research examining early appetite and the onset of eating disorder symptoms in two large prospective cohorts - Gemini and Generation R. The lecture also talked about opportunities for early life prevention and highlighted the MRC-PHIND intervention, which focuses on supporting responsive parental feeding practices in early life. Following this lecture students asked questions about the research and for opportunities to undertake research dissertations on the topics discussed within the lecture. |
| Year(s) Of Engagement Activity | 2024 |
| Description | Poster Presentation at International Society for Behavioural Nutrition and Physical Activity Annual Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Postgraduate students |
| Results and Impact | In May 2022, Kristiane Tommerup will be presenting findings from her project 'Associations Between Infant Feeding Modality and Rapid Infant Weight Gain Across the First Year of Life' as a poster presentation at the International Society for Behavioural Nutrition and Physical Activity Annual Conference. This epidemiological work was undertaken to inform the direction of the intervention protocol at it's early stages. Abstract: Associations Between Infant Feeding Modality and Rapid Infant Weight Gain Across the First Year of Life Purpose: Rapid infant weight gain (RIWG; upward crossing of >1 major centile space on the WHO growth reference chart) is associated with greater risk of childhood obesity. Formula-fed infants are at higher risk of RIWG than breastfed infants. Two possible mechanisms have been hypothesised to explain this association: the formula milk itself and/or bottle-feeding behaviour. The present study used the most detailed data on infant feeding methods collected to date to disentangle whether 'what' (formula milk vs. breast milk) or 'how' an infant is fed (bottle vs. breast) places them at greater risk of RIWG. Methods: Data were from Gemini, a population-based sample of n=4800 British twins born in 2007. Parent-reported infant milk-feeding methods from birth to 3-months of age were categorised into; i) exclusive breastfeeding, ii) breastfeeding and expression of breastmilk, iii) exclusive expression, iv) breast and formula feeding, v) breastfeeding expression and formula feeding, vi) expression and formula, and vii) exclusive formula feeding. The outcome measure was change in weight-SDS from birth to 3- and 12- months. Two General Linear Models examined associations between feeding methods and weight-SDS change, adjusting for infant health and socioeconomic characteristics, excluding infants born <36 weeks' gestation. Results/findings: At 3-months (n=2,655) and 12-months of age (n=1,360), infants fed through either exclusive formula feeding (3-months; n=971, ß = 0.37, 95% CI: 0.24, 0.52 , 12-months; n=428, ß = 0.19, 95% CI: 0.00, 0.40), breastfeeding and formula feeding (3-months; n=896, ß = 0.22, 95% CI: 0.08, 0.36 , 12-months; ß = 0.24, 95% CI: 0.05, 0.43), and breastfeeding, formula feeding, and expression (3-months; n=148, ß = 0.32, 95% CI: 0.10, 0.52, 12-months; n= 85; ß = 0.35, 95% CI: 0.05, 0.63) showed significantly higher increases in weight-SDS than exclusively breastfed infants; infants fed expressed breastmilk did not differ from exclusively breastfed infants (3-months; n=52, ß = 0.23, 95% CI: -0.11, 0.57 , 12-months; n= 33, ß = 0.00, 95% CI: -0.39, 0.40). Conclusions: Formula-fed infants, but not expressed milk-fed infants, showed greater RIWG. Hence, 'what' (i.e. formula milk) rather than only 'how' (i.e. through a bottle) might place infants at greater risk of RIWG. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Talk to International Society for Behavioural Nutrition and Physical Activity on 'The development of BRIGHT - an app-based intervention to support healthy growth amongst formula fed infants through co-design with caregivers and digital resources tailored to infant appetite' |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Kristiane Tommerup gave a talk titled 'The development of BRIGHT - an app-based intervention to support healthy growth amongst formula-fed infants through co-design with caregivers and digital resources tailored to infant appetite.' within the symposium ' Opportunities and Challenges for Developing Digital Health Interventions for the First 1,000 days' at the ISBNPA annual meeting in Sweden on the 16th of June 2023. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Talk to Soc-B Doctoral Training Programme Students |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | As part of Kristiane Tommerup's (PhD Student) involvement in the project she has given two presentations discussing the progress and outputs on the project to date. These presentations have been given to current Soc-B Doctoral Training Programme students and academic staff involved with the programme, from UCL, The University of Machester, and The University of Essex (30-50 participants). |
| Year(s) Of Engagement Activity | 2020,2021 |
| Description | Talk to UCL Department of Behavioural Science and Health Energy Balance Group |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Postgraduate students |
| Results and Impact | Kristiane gave a 45-minute talk on BRIGHT, updating UCL's Department of Behavioural Science and Health's Energy Balance Group, who meet on a weekly basis, on the progress and initial findings from the PPIE interviews with parents. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Talk to give an overview of the project for the Early Years Digital Partnership update meeting |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Third sector organisations |
| Results and Impact | I gave a talk about this project as part of the Early Years Digital Partnership update meeting. It was one of several talks to showcase the research that Best Beginnings is undertaking to provide evidence-based content for their website and app (Baby Buddy). The meeting was attended by other partners in the network. |
| Year(s) Of Engagement Activity | 2021 |