Overview

Food insecurity is associated with obesity in children, and childhood obesity leads to long term health consequences. While existing research shows that food benefit programs reduce food insecurity, little is known about the mediating factors between food benefit programs and child health. The purpose of this study is to understand if the resolution of food insecurity in young children with early onset obesity can improve body mass index (BMI) over one year, and if so, by what mechanisms. The investigators will conduct a randomized comparative effectiveness study among infants (n=228) aged 12 months at risk for food insecurity and deliver two different food security interventions. Both will provide families with $50/week for one year of study enrollment. The first group will receive this as an unrestricted cash benefit ("cash benefit group") and the second group will receive this as a benefit in the form of weekly grocery purchases with the support of a trained nutrition expert to guide healthy grocery purchasing ("grocery benefit group"). The investigators will also construct a contemporary comparison cohort of infants meeting the inclusion/exclusion criteria from the electronic health record, using propensity score matching to allow comparisons between both intervention groups and usual care. The primary endpoint is difference in BMI at 12 months post-enrollment (24 months of age). Secondary outcomes include measures of nutrition, food security, electronic health record data related to general child health, and other factors related to parental stress and unmet social needs. Patients will have the opportunity to participate in post-study interviews to report on intervention satisfaction, and facilitators and barriers of infant feeding. Data analysis will be conducted by a trained statistician (Duke Biostatistics, Epidemiology, and Research Design; BERD) and will employ a two-means test for a repeated-measures design. The benefits to participants outweigh the minimal risks of loss of privacy, and confidential information will be managed carefully to minimize this risk.

Eligibility

Inclusion

• Aged 9-12 months and their primary caregiver "parent".
• Medicaid and WIC-eligible (proxy for "at risk for food insecurity")
• World Health Organization BMI ≥ 95%ile at current or most recent encounter (early-onset obesity)
• Caregiver speaks either English or Spanish as their primary language.
• Infant was born as a singleton infant at ≥ 35 weeks gestational age with birth weight ≥ 3% per the sex-specific WHO growth standard (also could use our criteria for SGA, which is <10% for Olsen reference)

  Exclusion

• Diagnosed with monogenic obesity.
• Diagnosis affecting growth or feeding (e.g., congenital heart disease, cleft lip/palate, inborn errors of metabolism, malabsorption, Prader-Willi disease, etc.)
• Current enrollment of a household member in Healthy Lifestyles, adult obesity treatment program, or active enrollment in a nutrition or obesity-related intervention
• Plans to move from the area in the next 12 months.
• Parent is currently pregnant.