Following the Government’s recent announcement to tackle childhood obesity through support in schools, it is important to recognise that prevention can begin much earlier. In this blog, ARC East of England researcher Dr Cara Ruggiero introduces the SPROUT study, which explores parents’ and professionals’ experiences of feeding during the first year of life to help inform healthier childhoods.
Image above: Dr Cara Ruggiero, Principal Investigator in the SPROUT study
The first 1,000 days of life are critical for shaping a child’s future health. It is a time of rapid physical, metabolic and neurodevelopmental change, including the development of appetite and metabolism, the ability to recognise hunger and fullness (responsive feeding), and early exposure to flavours and textures that influence later food preferences. Even though these early days are so important, many families face social and environmental inequalities, such as food insecurity, poverty, and difficulties accessing relevant services and support, that increase the risk of health disparities and contribute to childhood obesity. It is important that health and care services intervene and support families before unhealthy patterns become established, making the first 1,000 days a crucial opportunity to offer meaningful support.
The cost‑of‑living crisis has further increased the number of families experiencing food inequalities. New parents are particularly affected, often managing on reduced incomes during parental leave, and those who formula‑feed face rising costs that add additional pressure. With most research on responsive feeding conducted in controlled or higher-income settings, there remains a clear gap in understanding how responsive feeding is understood, practised and constrained in real-world, low-income contexts and whether these patterns are linked to obesity.
Understanding how the first 1,000 days shape a child’s obesity risk
To understand how the first 1,000 can influence obesity, we have developed the Supporting Parental Responsive feeding for Optimal Thriving and child development (SPROUT) study. SPROUT explores parents' and professionals' experiences of infant feeding, the challenges they face in practising responsive feeding, and the changes in services and policies that could help give every child the healthiest possible start.
“Childhood obesity is a major public health concern. The Government has recognised this by announcing new interventions in schools and at home, and restrictions across media. However, meaningful progress also depends on supporting families much earlier, when prevention has the greatest impact and is most cost-effective.
Dr Cara Ruggiero, Principal Investigator in the SPROUT study
“To design support that truly works, we need to understand how the first 1,000 days shape a child’s risk of obesity. Without this knowledge, policies and interventions risk being unrealistic, inequitable, or ineffective for the families who need them most. SPROUT combines national guidance, local public health priorities, and lived experiences that is both locally and nationally relevant.”
Dr Cara Ruggiero, Principal Investigator in the SPROUT study
We have co-produced this study with Cambridgeshire County Council, who have supported us in developing appropriate interview questions and in bringing together the voices of health visiting services, early-years practitioners, parents and local public health teams. So far, we have conducted focus groups with 39 parents of babies aged up to one year living in low‑income settings. Parents shared their lived experiences and the challenges that shaped their decision‑making around infant feeding. We have also held focus groups with 22 healthcare professionals to explore how services are delivered, how guidance is interpreted in practice, and what barriers they face when supporting responsive feeding.
“I would like to say to add that, you know, being part of this discussion like this really matters to me as a parent, you know, we often carry the stress of making sure our babies are healthy and well fed, but we don't always get the chance to talk about it.”
Anonymous, Parent involved in the study
Our preliminary findings have found that parents’ infant feeding practices are heavily influenced by a wide range of structural and social factors. Rising food costs limit the affordability of nutritious formula and food, while advertising often conflicts with responsive feeding practices. Parents also described confusion caused by food labels, making it difficult for them to understand what is healthy and appropriate for their child. In addition, advice from family members can encourage non‑responsive feeding, where feeding is driven by adult cues rather than the infant’s hunger and fullness signals, highlighting the importance of whole-family engagement. We have also found that food insecurity affects parental mental health, contributing to emotional or stress-related feeding practices.
Our discussions with healthcare professionals have revealed resource constraints limit their capacity to provide timely and detailed guidance on infant feeding, including the critical transition from milk to solids, which can affect infants’ nutrition and development. Professionals also described tensions around breastfeeding promotion, with some feeling restricted in how openly they can discuss formula feeding. This can leave parents feeling confused or insufficiently supported. Together, these challenges highlight the need for additional training, clearer resources, and practical guidance to enable staff to deliver balanced, evidence‑informed support to parents.
“I will also encourage that more awareness should be created for more parents to get to understand what it [nutrition] means and even those are yet to be to have babies also.”
Anonymous, Parent involved in the study
“[In regard to nutrition] having the right support and resources makes a huge difference and I hope more awareness is created about that family also, so no parents feels like they are struggling alone.”
Anonymous, Parent involved in the study
By bringing together these varied perspectives, SPROUT is generating evidence to strengthen local early‑years services by identifying practical and realistic ways to support responsive feeding in families experiencing food insecurity. As our findings have been co‑produced with parents and healthcare professionals, they can be translated directly into recommendations, resources, and training that help practitioners offer clearer and more consistent support. By addressing both structural barriers and everyday feeding behaviours, SPROUT will support more equitable early‑years provision and contributes to reducing inequalities in infant nutrition and future obesity risk.
“From our engagement with parents and practitioners through the SPROUT study, it is clear that infant feeding decisions do not occur in isolation but are shaped by financial pressures, service access, and the wider food environment. Supporting responsive feeding in the first 1,000 days therefore requires practical, equitable support that reflects families’ real-world circumstances.
Dr Marie Spreckley, Co-Investigator in the SPROUT Study
“By centering lived experiences alongside clinical and public health perspectives, this work aims to inform early-years services and policies that are both evidence-based and feasible for families facing food insecurity.”
Dr Marie Spreckley, Co-Investigator in the SPROUT Study
Last year, we presented this project to the Cross‑Party Group on a Fit and Healthy Childhood, which serves as a key forum for policymakers, academics, healthcare professionals, and advocacy groups to discuss and shape policies that support children’s health and well-being. By engaging directly with this group, we hope our findings will contribute to shaping future Government policy and strengthening early‑years support.
Next steps
The thematic analysis is now nearing completion, and the next phase of SPROUT will focus on turning these insights into action. We will work with parents, health visitors, and early‑years practitioners to co‑produce practical recommendations, training materials, and service guidance tailored to families experiencing food insecurity. Findings will be shared through local workshops, reports, webinars, and presentations to early‑years services, commissioners, and policymakers. We will also explore opportunities to pilot elements of the work or integrate them into existing local programmes aimed at supporting responsive feeding and reducing early childhood obesity.
To learn more about the SPROUT study, contact Dr Cara Ruggiero cara.ruggiero@mrc-epid.cam.ac.uk.
