Family Spirit Nurture (FSN) – A Randomized Controlled Trial to Prevent Early Childhood Obesity in American Indian Populations: Trial Rationale and Study Protocol




Allison Ingalls, Summer Rosenstock, Reese Foy Cuddy, Nicole Neault, Samantha Yessilth, Novalene Goklish, Leonela Nelson, Raymond Reid, and Allison Barlow

Brief Type

Journal Publication


  • Family Spirit


Background: Childhood overweight and obesity is a persistent public health issue in the US. Risk for obesity and obesity-related morbidity throughout the life course begins in utero. Native Americans suffer the greatest disparities in the US in childhood overweight and obesity status of any racial or ethnic group. Existing early childhood home visiting interventions provide an opportunity for addressing obesity during the first 1000 days. However, to date, no evidence-based model has been specifically designed to comprehensively target early childhood obesity prevention. Methods: This study is a randomized controlled trial to test the efficacy of home-visiting intervention, called Family Spirit Nurture, on reducing early childhood obesity in Native American children. Participants are expectant Native American mothers ages 14–24 and their child, enrolled from pregnancy to 24 months postpartum and randomized 1:1 to receive the Family Spirit Nurture intervention or a control condition. The intervention includes 36 lessons delivered one-on-one by locally-hired Native American Family Health Coaches to participating mothers from pregnancy until 18 months postpartum. A mixed methods assessment includes maternal self-reports, maternal and child observations, and physical and biological data collected at 11 time points from 32 weeks gestation to 2 years postpartum to measure the intervention’s primary impact on maternal feeding behaviors; children’s healthy diet and physical activity; children’s weight status. Secondary measures include maternal psychosocial factors; household food and water security; infant sleep and temperament; and maternal and child metabolic status. Discussion: None of the 20 current federally-endorsed home-visiting models have demonstrated impacts on preventing early childhood obesity. The original Family Spirit program, upon which Family Spirit Nurture is based, demonstrated effect on maternal and child behavioral health, not including obesity related risk factors. This trial has potential to inform the effectiveness of home-visiting intervention to reduce obesity risk for tribal communities and other vulnerable populations and expand public health solutions for the world’s obesity crisis. (author abstract)

Data Collection Methods

  • Interviews
  • Parent-child observations
  • Program administrative record reviews
  • Record and document reviews
  • Standardized assessment tools
  • Surveys or questionnaires



For More Information

Ingalls, A., Rosenstock, S., Cuddy, R. F., Neault, N., Yessilth, S., Goklish, N., . . . Barlow, A. (2019).  Family Spirit Nurture (FSN) – A randomized controlled trial to prevent early childhood obesity in American Indian populations: Trial rationale and study protocol. BMC Obesity. Advance online publication.  https://doi.org/10.1186/s40608-019-0233-9
Author Contact Information:
Allison Ingalls


  • Participant, Family, and Program Outcomes
  • Program Enhancements, Innovations, and Promising Approaches