Manuscript Details

Paul, I. M., Barton, J. M., Anzman-Frasca, S., Hohman, E. E., Buxton, O. M., Hess, L. B., & Savage, J. S. (2025). Long-term effects of a responsive parenting intervention on child weight outcomes through age 9 years: the INSIGHT randomized clinical trial. JAMA pediatrics, 179(8), 827–835. https://doi.org/10.1001/jamapediatrics.2024.6897

Peer Reviewed

Model(s): Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT)
Study Registration: ClinicalTrials.gov
High rating
This manuscript received a rating of high because it is a randomized-controlled trial with low-attrition.

Study reviewed under: Handbook of Procedures and Standards, Version 2.3
Child Health
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Statistical Significance Sample Size Sample Description
Body Mass Index (BMI; standardized z-score) 3 years old High
0.28 Statistically significant, p ≤.05 232 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI; standardized z-score) 5 years old High
0.03 Not statistically significant, p >.05 222 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI; standardized z-score) 6 years old High
0.06 Not statistically significant, p >.05 203 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI; standardized z-score) 9 years old High
0.12 Not statistically significant, p >.05 177 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI) 3 years old High
0.29 Statistically significant, p ≤.05 232 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI) 5 years old High
0.01 Not statistically significant, p >.05 222 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI) 6 years old High
0.02 Not statistically significant, p >.05 203 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Body Mass Index (BMI) 9 years old High
0.10 Not statistically significant, p >.05 177 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Obese 3 years old High
0.70 Not statistically significant, p >.05 232 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Obese 5 years old High
0.13 Not statistically significant, p >.05 222 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Obese 6 years old High
0.10 Not statistically significant, p >.05 203 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Obese 9 years old High
0.07 Not statistically significant, p >.05 177 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Overweight 3 years old High
0.23 Not statistically significant, p >.05 232 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Overweight 5 years old High
0.22 Not statistically significant, p >.05 222 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Overweight 6 years old High
0.06 Not statistically significant, p >.05 203 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Overweight 9 years old High
0.08 Not statistically significant, p >.05 177 children INSIGHT vs. comparison, Pennsylvania 2012-2014, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

Note: Tables do not include findings that HomVEE rated low or indeterminate, or found to be ineligible for review.

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Asian
3%
Black or African American
5%
Hispanic or Latino
6%
Native Hawaiian or Pacific Islander
<1%
White
89%
Some other race
3%

Maternal Education

Some college or Associate's degree
23%
Bachelor's degree or higher
71%
Unknown
6%

Other Characteristics

Data not available

This study included participants from the following locations:

  • Pennsylvania
Study Participants
  • Study participants were first-time mothers and their infants, recruited from a maternity ward. 
  • At enrollment, the average age of mothers was 29.
  • A total of 291 pairs were randomly assigned to the intervention group (145 pairs) or the comparison group (146 pairs). Random assignment took place 10 to 14 days after birth.
  • Outcomes were measured when children were ages 3, 6, and 9.
Setting

The study took place in Hershey, Pennsylvania.

Intervention condition
Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT)

Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.

Comparison Conditions
  • The comparison group received a child safety intervention with age-appropriate safety guidance including information on preventing sudden infant death syndrome; storing breast milk and preparing formula; and safe bathing practices. 
  • The comparison intervention was delivered through a similar number of home visits, and at similar times, as the INSIGHT intervention.
Subgroups examined

• Boys • Girls

Author Affiliation

The authors were affiliated with Binghamton University; the University at Buffalo (Jacobs School of Medicine and Biomedical Sciences; Center for Ingestive Behavior Research); The Pennsylvania State University (Center for Childhood Obesity Research; Department of Nutritional Sciences); and Penn State College of Medicine (Departments of Pediatrics and Public Health Sciences). Several authors were part of the research team that designed the INSIGHT model.

Funding Sources

This research was supported by Award Number R01DK088244 from the National Institute of Diabetes and Digestive and Kidney Diseases; Award Numbers UL1TR002014 and KL2TR002015 from the National Institutes of Health’s National Center for Advancing Translational Sciences; and the Children’s Miracle Network at Penn State Health Children’s Hospital. Award Number 2011-67001-30117 from the U.S. Department of Agriculture supported graduate students involved in the study.

Study design characteristics contributing to rating
Design Random assignment compromised? Attrition Baseline equivalence Confounding factors? Valid, reliable measures?
Randomized controlled trial No Low

Not assessed for randomized controlled trials with low attrition

No

Yes
Notes from the review of this manuscript

Several findings in this manuscript received a low rating because they had high attrition and did not meet the baseline equivalence requirement. These findings were: blood pressure in the elevated or hypertensive range, waist circumference, and fat mass percentage at the six- and nine-year follow-ups, along with nine-year metabolic health indicators based on laboratory tests of glucose, hemoglobin, alanine aminotransferase, cholesterol, and triglycerides. Information on baseline equivalence was obtained through correspondence with one of the manuscript’s authors. This manuscript reports findings from the INSIGHT Study. HomVEE reports additional findings from this study under Adams et al., (2019), Anzman-Frasca et al. (2018), Hernandez Acton et al. (2025), Paul et al. (2018), Paul et al. (2016), and Tauriello et al. (2023).