Enhancing alternatives to eating in infancy

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ABSTRACT Obesity is a disorder of positive energy balance in which energy intake exceeds energy expenditure. The motivation to eat is a basic human need, which is present at birth. One factor that may lead to increased energy intake is the imbalance between the motivation to eat and the motivation to engage in other behaviors. The motivation to eat versus engaging in other behaviors can be operationalized as the relative reinforcing value of eating versus alternative behaviors. A strong motivation to eat instead of engaging in alternative behaviors has been related to increased energy intake in adults. The motivation to eat is cross-sectionally and prospectively related to obesity in children, adolescents, and adults, and cross-sectionally related to weight status in infants. Shifting the balance from high motivation to eat to increased motivation to engage in alternative behaviors can reduce energy intake, and may be protective against weight gain. We have recently shown that a structured program to enhance music engagement in infants who are strongly motivated to eat can shift their choice from food to music. The goal of this study is to expand on this preliminary research and examine long-term effects of this intervention in infants who are highly motivated to eat. We are proposing to randomize 92 healthy infants who are high in food reinforcement to a music enhancement program versus an attention placebo play date and assess changes in food/non-food reinforcement, infant energy intake, weight for length z-score, and enriched home environment, and follow the development of these infants over a 24 month period. We predict that the music program, in comparison to the control play date, will result in a shift in choice from a motivation to eat to a motivation to engage in alternatives to eating (Specific Aim 1) and thus reduce energy intake (Specific Aim 1a), lower weight for length z-score (zWFL) (Specific Aim 2), and create a more enriched home environment (Specific Aim 3) at each measurement interval. We propose that enhancing the motivation to engage in alternatives to eating represents a novel approach to obesity prevention, and these interventions are easily implemented and scalable.