Development of a digital intervention to promote healthy growth during the first 2 years of life

根据国家儿童测量计划，英国超过1/5的儿童在上小学时就超重或肥胖。生活在最贫困地区的儿童受肥胖影响的可能性是生活在最贫困地区的儿童的两倍多。肥胖儿童成年后患肥胖症的可能性是常人的五倍多，而且患哮喘、2型糖尿病、癌症、心脏病和肝病以及相关心理健康问题的风险也在增加——甚至从童年开始就是如此。英国国家医疗服务体系（NHS）的肥胖支出超过51亿英镑，雇主的肥胖支出约为70亿英镑。肥胖一旦形成，就很难逆转，大量证据表明，婴儿体重的快速增加（从出生到两岁）与未来的肥胖有因果关系。因此，婴儿期是预防肥胖的关键时机。在高收入国家，婴儿体重迅速增加很常见，尤其是配方奶粉喂养的婴儿，大型研究估计多达40%的健康足月婴儿出现这种情况。对父母来说，控制婴儿体重迅速增加是一项挑战：许多婴儿食欲旺盛，偏爱甜味食物，容易导致他们摄入过多的牛奶和食物；许多父母用喂养来安抚不安的婴儿或延长睡眠时间；父母和医疗保健专业人士通常认为体重迅速增加是健康的或有利的。三种行为喂养干预措施已经成功地改变了纯母乳喂养和/或断奶（开始固体食物）期间婴儿的目标行为：婴儿牛奶（英国），滋养（澳大利亚）和洞察（美国）。然而，所有课程都是面对面的，还有额外的书面材料和电话支持。由于医疗保健提供者的工作量压力不断增加，需要一种不需要面对面交付的行为干预，这种干预具有成本效益和可持续性。数字干预将支持那些越来越多地看到自助材料的父母，并将允许干预扩展到人口水平。“Baby Buddy”是英国慈善机构Best Beginnings推出的免费、屡获殊荣的应用程序，它为父母提供婴儿护理方面的信息和工具。它已经被下载了20万次（每周约1200次下载），得到了DHSC（以及大量其他组织）的认可，可以在NHS应用程序库中下载，并且在年轻和贫困的母亲中具有非常广泛的影响力，这使得它成为这种干预的理想平台。我们将与Best Beginnings合作，通过BABY Buddy在英国推出BABY MILK、滋养和INSIGHT等品牌的数字化产品。目前，Baby Buddy在管理与婴儿体重增加相关的关键行为（母乳喂养、断奶、睡眠、哭泣、活动和理解健康的体重增加）方面的信息非常有限。我们将开发有关这些主题的新的互动信息，重点关注婴儿的头两年，根据现有的最佳证据证明有效的方法。我们将与“最佳开端”的家长和卫生专业人员网络合作，对干预发展的各个阶段进行审查并提出建议，以确保内容对用户友好、吸引人、有说服力和突出。这种数字干预将为父母提供急需的支持，帮助他们管理与婴儿体重增加有关的关键行为，也将为医疗保健专业人员提供信息来源，以便为家庭提供指引，从而腾出时间。优化婴儿生长和营养的有效和可扩展的干预措施有可能在人口层面上推广，并减轻儿童和成年期肥胖造成的健康和经济负担。

ContextAccording 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 objectivesIn 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 benefitsThis 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.