The few existing early-life obesity prevention initiatives have concentrated on nutrition and physical activity, with little examination of sleep.
This community-based, randomized controlled trial allocated 802 pregnant women (≥16 years, <34 weeks’ gestation) to: control, FAB (food, activity, and breastfeeding), sleep, or combination (both interventions) groups. All groups received standard well-child care. FAB participants received additional support (8 contacts) promoting breastfeeding, healthy eating, and physical activity (antenatal–18 months). Sleep participants received 2 sessions (antenatal, 3 weeks) targeting prevention of sleep problems, as well as a sleep treatment program if requested (6–24 months). Combination participants received both interventions (9 contacts). BMI was measured at 24 months by researchers blinded to group allocation, and secondary outcomes (diet, physical activity, sleep) were assessed by using a questionnaire or accelerometry at multiple time points.
At 2 years, 686 women remained in the study (86%). No significant intervention effect was observed for BMI at 24 months (P = .086), but there was an overall group effect for the prevalence of obesity (P = .027). Exploratory analyses found a protective effect for obesity among those receiving the “sleep intervention” (sleep and combination compared with FAB and control: odds ratio, 0.54 [95% confidence interval, 0.35–0.82]). No effect was observed for the “FAB intervention” (FAB and combination compared with sleep and control: odds ratio, 1.20 [95% confidence interval, 0.80–1.81]).
A well-developed food and activity intervention did not seem to affect children’s weight status. However, further research on more intensive or longer running sleep interventions is warranted.
Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT
Keri Berkowitz
Affiliations: Utica College, Utica, New York
Address correspondence to: 1600 Burrstone Rd, Utica, NY 13502
Short title:
Funding Source: No Funding was secured for this study.
Financial Disclosure: Keri Berkowitz has no financial relationships relevant to this article to disclose.
Potential Conflict of Interest: Keri Berkowitz has no conflicts of interest to disclose.
Abbreviations: FAB: food, activity, and breastfeeding
The Article “Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT” By Taylor et al in the February 2017 issue, was intriguing to me. I was aware that a regular sleep cycle was important for mental processing, but not aware that it could be a factor in weight gain or loss.
Being overweight or obese can have a negative impact on a child’s health. This negative impact does not disappear after adolescence. Side effects can carry on throughout ones entire life.2 There has been an abundance of studies conducted in regards to childhood obesity prevention by means of diet and exercise. However, monitoring sleep cycles has been a novel idea that only a handful of studies have explored.
In particular, an infant should sleep more than eleven hours when five years old or younger and about nine hours when they are ten years of age or older.3 This is an important concept to grasp because the longer an infant is awake the more likely they are going to get hungry or get fed to put an infant back to sleep.3 This creates a peculiar sleep schedule and can cause a variance in appetite.
The adverse side effects of sleep deprivation would be intriguing to include within the article due to the wide range of physiological effects. Sleep deprivation has proven to show a difference in hormonal levels. The hormones linked to growth, development, and energy balance are most commonly affected.3 Imbalanced hormone levels are linked to weight gain because sleep and appetite controls are positioned in the hypothalamus.3 Thus, the physiological relationship between the two is quite relevant.
Poor sleep patterns not only lead to psychological imbalances, but physical changes as well. “Fatigue, daytime sleepiness, hyperactivity, learning problems, and attention difficulties”3 are often symptoms of sleep deprivation. When an infant suffers from fatigue or daytime sleepiness the infant is less likely to engage in physical activity or play. An infant is more likely to engage in sedentary behavior thus increasing the propensity for obesity.
The question that arises from the previous data is “do obese children tend to sleep less, or do children who sleep less tend to develop obesity?”3 A study performed in the United Kingdom concluded that children that slept less than 10.5 hours a day at the age of three are more likely to be obese by the age of seven.3 As such, partaking in appropriate sleep cycles assists with decreasing one’s likelihood for being obese.
Parents need to be well educated on proper infant sleeping patterns, eating habits, and the effects of sleep deprivation both physiologically and physically because an infant cannot rationally be educated on the concept. If a parent is not properly informed or educated, their child could potentially suffer from obesity, which has many adverse physical and psychological effects. Parental educational classes need to be frequent and consistent before and after birth in order to insure that the parents fully understand the importance of obesity prevention.
Keri Berkowitz
Health Studies
Utica College
Utica, NY
References
1. Taylor BJ, Gray AR, Galland BC, et al. Targeting Sleep, Food, and Activity in Infants for Obesity Prevention: An RCT. Pediatrics. 2017;139(3). 1-11.
2. Sobko T, Svensson V, Ek A, et al. A randomized controlled trial for overweight and obese parents to prevent childhood obesity – Early STOPP (Stockholm Obseity Prevention Proram). BMC Public Health. http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-336. Published August 11, 2016. Accessed March 30, 2017.
3. Rudolf M. Tackling Obesity Through the Healthy Child Programme A Framework for Action. National Obesity Observatory. http://www.noo.org.uk/uploads/doc/vid_4865_rudolf_TacklingObesity1_21011.... Accessed March 30, 2017.