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Larsen JK, Sleddens EFC, Vink JM, Fisher JO, Kremers SPJ. General Parenting Styles and Children's Obesity Risk: Changing Focus. Front Psychol 2018; 9:2119. [PMID: 30459686 PMCID: PMC6232304 DOI: 10.3389/fpsyg.2018.02119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/15/2018] [Indexed: 12/15/2022] Open
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Kral TVE, Moore RH, Chittams J, Jones E, O'Malley L, Fisher JO. Identifying behavioral phenotypes for childhood obesity. Appetite 2018; 127:87-96. [PMID: 29709528 PMCID: PMC5994376 DOI: 10.1016/j.appet.2018.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/30/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022]
Abstract
Existing programs which aim to prevent and treat childhood obesity often do not take into account individual variation and the underlying mechanisms that impact child eating behavior. Individual differences in children's appetitive traits have been shown to appear as early as during infancy and become more pronounced as children grow older and become more exposed to the obesogenic food environment. Differences in genetic predispositions interacting with factors in children's early environment account in part for individual differences in appetitive traits. It is very likely that obesogenic eating phenotypes manifest themselves before the onset of childhood obesity. If so, identifying these phenotypes early is expected to move primary prevention strategies in a new direction and holds great potential to significantly enhance our ability to prevent childhood obesity. The aim of this narrative review is to discuss the role of behavioral phenotyping as an innovative approach for the development of more personalized obesity prevention and treatment interventions that are tailored to children's individual predispositions. We describe several examples of appetitive traits which have been linked to overeating and excess weight gain in children and thus may represent modifiable risk factors for future interventions. The review concludes with a comprehensive synthesis of opportunities for future human ingestive behavior research on identifying behavioral phenotypes for childhood obesity.
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Kachurak A, Davey A, Bailey RL, Fisher JO. Daily Snacking Occasions and Weight Status Among US Children Aged 1 to 5 Years. Obesity (Silver Spring) 2018; 26:1034-1042. [PMID: 29656571 PMCID: PMC6001698 DOI: 10.1002/oby.22172] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To characterize associations of snacking frequency with weight status among US children aged 1 to 5 years. METHODS Participants were children (n = 4,669) aged 1 to 5 years in the 2005 to 2014 National Health and Nutrition Examination Survey (NHANES). Snacking was assessed by two 24-hour dietary recalls using definitions that considered "snack" occasions as well as other foods/beverages consumed between meals. Overweight/obesity (OW/OB) was defined using percentile cutoffs: ≥ 97.7th weight-for-length (< 2 years) cutoff and the ≥ 85th BMI-for-age (≥ 2 years) cutoff. Linear/logistic regressions evaluated snacking based on daily occasions and relative to current recommendations (two to three snacks per day). RESULTS During 2005 to 2014, US children aged 1 to 5 years consumed, on average, two to three snacks daily. Children with normal weight in both age groups tended to snack less frequently than children with OW/OB when considering all foods/beverages eaten between meals (P < 0.01-0.12). Across most snacking definitions, children < 2 years who snacked more frequently than recommended had greater odds of having OW/OB (P < 0.01-0.12) and consumed greater daily snack energy than those who snacked within recommendations (all P < 0.01). Recommendations did not clearly delineate weight status among children aged 2 to 5 years. CONCLUSIONS Snacking frequency and weight are positively associated among US children 1 to 5 years old, with most consistent associations seen among children < 2 years old and when considering all foods/beverages consumed between meals.
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Davison KK, Blake CE, Kachurak A, Lumeng JC, Coffman DL, Miller AL, Hughes SO, Power TG, Vaughn AF, Blaine RE, Younginer N, Fisher JO. Development and preliminary validation of the Parenting around SNAcking Questionnaire (P-SNAQ). Appetite 2018; 125:323-332. [PMID: 29475073 DOI: 10.1016/j.appet.2018.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/22/2017] [Accepted: 01/28/2018] [Indexed: 01/03/2023]
Abstract
Snacking makes significant contributions to children's dietary intake but is poorly understood from a parenting perspective. This research was designed to develop and evaluate the psychometrics of a theoretically grounded, empirically-informed measure of snack parenting. The Parenting around SNAcking Questionnaire (P-SNAQ) was developed using a conceptual model derived from current theory and mixed-methods research to include 20 hypothesized snack parenting practices along 4 parenting dimensions (autonomy support, structure, coercive control and permissiveness). Expert panel evaluation and cognitive interviews were used to refine items and construct definitions. The initial instrument of 105 items was administered to an ethnically diverse, low-income sample of 305 parents (92% mothers) of children aged 1-6 y participating in three existing cohort studies. The sample was randomly split into two equal samples. Exploratory factor analysis was conducted with the first sample to identify snack parenting practices within each parenting dimension, followed by confirmatory factor analysis with the second sample to test the hypothesized factor structure. Internal consistency of sub-scales and associations with existing measures of food parenting practices and styles and child weight status were evaluated. The final P-SNAQ scale included 51 items reflecting 14 snack parenting practices across four parenting dimensions. The factor structure of the P-SNAQ was consistent with prior theoretical frameworks. Internal consistency coefficients were good to very good for 12 out of 14 scales and subscale scores were moderately correlated with previously validated measures. In conclusion, initial evidence suggests that P-SNAQ is a psychometrically sound measure for evaluating a wide range of snack parenting practices in young children.
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Keller KL, English LK, Fearnbach SN, Lasschuijt M, Anderson K, Bermudez M, Fisher JO, Rolls BJ, Wilson SJ. Brain response to food cues varying in portion size is associated with individual differences in the portion size effect in children. Appetite 2018; 125:139-151. [PMID: 29408590 DOI: 10.1016/j.appet.2018.01.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
Abstract
Large portions promote intake of energy dense foods (i.e., the portion size effect--PSE), but the neurobiological drivers of this effect are not known. We tested the association between blood oxygen level dependent (BOLD) brain response to food images varied by portion size (PS) and energy density (ED) and children's intake at test-meals of high- and low-ED foods served at varying portions. Children (N = 47; age 7-10 years) participated in a within-subjects, crossover study consisting of 4 meals of increasing PS of high- and low-ED foods and 1 fMRI to evaluate food images at 2 levels of PS (Large, Small) and 2 levels of ED (High, Low). Contrast values between PS conditions (e.g., Large PS - Small PS) were calculated from BOLD signal in brain regions implicated in cognitive control and reward and input as covariates in mixed models to determine if they moderated the PSE curve. Results showed a significant effect of PS on intake. Responses to Large relative to Small PS in brain regions implicated in salience (e.g., ventromedial prefrontal cortex and orbitofrontal cortex) were positively associated with the linear slope (i.e., increase in intake from baseline) of the PSE curve, but negatively associated with the quadratic coefficient for the total meal. Responses to Large PS High ED relative to Small PS High ED cues in regions associated with cognitive control (e.g., dorsolateral prefrontal cortex) were negatively associated with the linear slope of the PSE curve for high-ED foods. Brain responses to PS cues were associated with individual differences in children's susceptibility to overeating from large portions. Responses in food salience regions positively associated with PSE susceptibility while activation in control regions negatively associated with PSE susceptibility.
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Polonsky HM, Davey A, Bauer KW, Foster GD, Sherman S, Abel ML, Dale LC, Fisher JO. Breakfast Quality Varies by Location among Low-Income Ethnically Diverse Children in Public Urban Schools. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:190-197.e1. [PMID: 29107474 PMCID: PMC7340127 DOI: 10.1016/j.jneb.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate breakfast location and children's food choices. METHODS Cross-sectional analysis of 1,371 fourth- through sixth-grade students in 2013. Foods and beverages in 17 categories characterized breakfast choices: (1) ≥ 1 fruits or vegetables, (2) ≥ 1 foods high in saturated fats and added sugars (SFAS), and (3) meeting School Breakfast Program (SBP) requirements. RESULTS Among breakfast eaters (n = 1,133; 82.6%), 46.0% ate at home, 13.1% ate at school, 41.0% ate at multiple locations; and 21.8% ate at a corner store. Those eating at school were more likely to consume ≥1 fruit or vegetable (odds ratio [OR] = 1.90; 95% confidence interval [CI], 1.26-2.87), less likely to eat ≥1 SFAS food (OR = 0.46; 95% CI, 0.22-0.94), and more likely to meet SBP requirements (OR = 2.47; 95% CI, 1.42-4.29). Those eating at corner stores (n = 247) were more likely to consume high-SFAS foods (63.9% vs 9.2%; P < .001). CONCLUSIONS AND IMPLICATIONS Eating school breakfast increased the odds of consuming fruit, choosing lower SFAS, and meeting nutritional requirements of the SBP relative to other locations.
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Larsen JK, Hermans RCJ, Sleddens EFC, Vink JM, Kremers SPJ, Ruiter ELM, Fisher JO. How to bridge the intention-behavior gap in food parenting: Automatic constructs and underlying techniques. Appetite 2017; 123:191-200. [PMID: 29277519 DOI: 10.1016/j.appet.2017.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 01/12/2023]
Abstract
Although parents often report positive intentions to promote and create a healthy food environment for their children (e.g., setting limits to snacks offered), they also experience difficulties in translating these intentions into actual behaviors. In this position paper, we argue that automatic processes explain an important part of the gap between parents' intentions and their actual food parenting behaviors. We provide a conceptual framework in which we hypothesize that automatic effects on food parenting occur through two key interrelated constructs: habits (key outcome construct) and volitional regulation behaviors (key mediating construct). Moreover, we discuss potentially important impulse-focused techniques that may directly change habits (e.g., nudging; inhibitory control training) or indirectly through volitional regulation behaviors (e.g., implementation intentions; mental contrasting). We make use of the literature on the role of intention-behavior discordance in general health behaviors and discuss implications for food parenting practices. Our framework provides a dual process view towards food parenting and may help to explain when and why parents are likely to engage in (un)healthy food parenting behaviors. In addition, this framework may hopefully stimulate research on (combinations of old and) new techniques to promote good food parenting behaviors.
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English LK, Fearnbach SN, Wilson SJ, Fisher JO, Savage JS, Rolls BJ, Keller KL. Food portion size and energy density evoke different patterns of brain activation in children. Am J Clin Nutr 2017; 105:295-305. [PMID: 27881393 PMCID: PMC5267299 DOI: 10.3945/ajcn.116.136903] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/27/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Large portions of food promote intake, but the mechanisms that drive this effect are unclear. Previous neuroimaging studies have identified the brain-reward and decision-making systems that are involved in the response to the energy density (ED) (kilocalories per gram) of foods, but few studies have examined the brain response to the food portion size (PS). OBJECTIVE We used functional MRI (fMRI) to determine the brain response to food images that differed in PSs (large and small) and ED (high and low). DESIGN Block-design fMRI was used to assess the blood oxygen level-dependent (BOLD) response to images in 36 children (7-10 y old; girls: 50%), which was tested after a 2-h fast. Pre-fMRI fullness and liking were rated on visual analog scales. A whole-brain cluster-corrected analysis was used to compare BOLD activation for main effects of the PS, ED, and their interaction. Secondary analyses were used to associate BOLD contrast values with appetitive traits and laboratory intake from meals for which the portions of all foods were increased. RESULTS Compared with small-PS cues, large-PS cues were associated with decreased activation in the inferior frontal gyrus (P < 0.01). Compared with low-ED cues, high-ED cues were associated with increased activation in multiple regions (e.g., in the caudate, cingulate, and precentral gyrus) and decreased activation in the insula and superior temporal gyrus (P < 0.01 for all). A PS × ED interaction was shown in the superior temporal gyrus (P < 0.01). BOLD contrast values for high-ED cues compared with low-ED cues in the insula, declive, and precentral gyrus were negatively related to appetitive traits (P < 0.05). There were no associations between the brain response to the PS and either appetitive traits or intake. CONCLUSIONS Cues regarding food PS may be processed in the lateral prefrontal cortex, which is a region that is implicated in cognitive control, whereas ED activates multiple areas involved in sensory and reward processing. Possible implications include the development of interventions that target decision-making and reward systems differently to moderate overeating.
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Rollins BY, Savage JS, Fisher JO, Birch LL. Alternatives to restrictive feeding practices to promote self-regulation in childhood: a developmental perspective. Pediatr Obes 2016; 11:326-32. [PMID: 26403816 DOI: 10.1111/ijpo.12071] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
Intake of energy-dense snack foods is high among US children. Although the use of restrictive feeding practices has been shown to be counterproductive, there is very limited evidence for effective alternatives to restriction that help children moderate their intake of these foods and that facilitate the development of self-regulation in childhood. The developmental literature on parenting and child outcomes may provide insights into alternatives to restrictive feeding practices. This review paper uses a model of parental control from the child development and parenting literatures to (i) operationally define restrictive feeding practices; (ii) summarize current evidence for antecedents and effects of parental restriction use on children's eating behaviours and weight status, and (iii) highlight alternative feeding practices that may facilitate the development of children's self-regulation and moderate children's intake of palatable snack foods. We also discuss recent empirical evidence highlighting the role of child temperament and food motivation related behaviours as factors that prompt parents to use restrictive feeding practices and, yet, may increase children's dysregulated intake of forbidden foods.
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Dykstra H, Davey A, Fisher JO, Polonsky H, Sherman S, Abel ML, Dale LC, Foster GD, Bauer KW. Breakfast-Skipping and Selecting Low-Nutritional-Quality Foods for Breakfast Are Common among Low-Income Urban Children, Regardless of Food Security Status. J Nutr 2016; 146:630-6. [PMID: 26865650 DOI: 10.3945/jn.115.225516] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Universal access to the School Breakfast Program (SBP) is intended to help low-income and food-insecure students overcome barriers to eating breakfast. However, SBP participation is often still low despite universal access. Further information is needed with regard to these children's breakfast behaviors, and in particular breakfast behaviors among youth from food-insecure families, to inform effective breakfast interventions. OBJECTIVES The objective of this study was to examine breakfast behaviors among a large sample of urban students with universal access to the SBP and to identify differences in breakfast behaviors among children from food-secure compared with food-insecure households. METHODS A cross-sectional study of 821 fourth- through sixth-grade students and their parents from 16 schools was conducted. Students reported the foods/drinks selected and location of obtaining food/drink on the morning of data collection, parents reported household food security status using the 6-item Food Security Survey Module, and the school district provided SBP participation data during the fall semester of 2013. Multivariable linear regression models accounting for school-level clustering were used to examine differences in breakfast behaviors across 3 levels of household food security: food secure, low food secure, and very low food secure. RESULTS Students participated in the SBP 31.2% of possible days, with 13% never participating in the SBP. One-fifth (19.4%) of students purchased something from a corner store for breakfast, and 16.9% skipped breakfast. Forty-six percent of students were food insecure; few differences in breakfast behaviors were observed across levels of food security. CONCLUSIONS Despite universal access to the SBP, participation in the SBP is low. Breakfast skipping and selection of foods of low nutritional quality in the morning are common, regardless of household food security status. Additional novel implementation of the SBP and addressing students' breakfast preferences may be necessary to further reduce barriers to students obtaining a free, healthful breakfast. This trial was registered at clinicaltrials.gov as NCT01924130.
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Vaughn AE, Ward DS, Fisher JO, Faith MS, Hughes SO, Kremers SPJ, Musher-Eizenman DR, O'Connor TM, Patrick H, Power TG. Fundamental constructs in food parenting practices: a content map to guide future research. Nutr Rev 2016; 74:98-117. [PMID: 26724487 DOI: 10.1093/nutrit/nuv061] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.
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Fisher JO, Dwyer JT. Next Steps for Science and Policy on Promoting Vegetable Consumption among US Infants and Young Children. Adv Nutr 2016; 7:261S-271S. [PMID: 26773035 PMCID: PMC4717881 DOI: 10.3945/an.115.009332] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Vegetables are an important part of a healthy diet for infants and young children, but they are poorly accepted and underconsumed. This paper highlights major themes and research needs for understanding how to raise children to consume and enjoy vegetables as part of a healthful diet. A range of factors impedes US infants and young children from eating as many vegetables as experts consider optimal for child nutrition, health, and development. Barriers include biological and behavioral issues relating to infant and child development, household- and family-related barriers, obstacles in the larger community, economic limitations, and some government policies and programs. These barriers must be removed to encourage children to eat more vegetables. Research gaps also must be filled. We summarize the basic and applied research that is needed to craft more effective messages, devise strategies for parents and other child caretakers to take within households, develop action in the larger community, and modify some government policies and programs.
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Gardner KR, Sapienza C, Fisher JO. Genetic and epigenetic associations to obesity-related appetite phenotypes among African-American children. Pediatr Obes 2015; 10:476-82. [PMID: 25779370 DOI: 10.1111/ijpo.12010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 11/02/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Genetic and epigenetic variations may be an important contributer to altered eating behaviors in childhood which may lead to weight gain and obesity later in life. OBJECTIVE This study aimed to evaluate epigenetic as well as genetic associations with appetite in young children. SUBJECTS AND METHODS Participants were 32 non-obese and 32 obese African-American children aged 5-6 years. Saliva was collected from each child, and RNA and DNA were extracted for analysis. Individuals were genotyped for eating- and obesity-associated single nucleotide polymorphisms in seven candidate genes (FTO, MAOA, SH2B1, LEPR, DNMT3B, BDNF and CCKAR), and DNA methylation levels were measured in the upstream promoter region of each. Transcript levels of MAOA and FTO were also assessed. The Children's Eating Behavior Questionnaire (CEBQ) was used to assess the aspects of appetite. Child obesity was assessed using measured height and weight, and percent body fat was measured by dual-energy X-ray absorptiometry. RESULTS Food responsiveness was higher and satiety responsiveness was lower among obese than non-obese female children (P = 0.001 and P = 0.031), but did not differ among male children. Epigenetic analysis of the BDNF promoter revealed associations with altered satiety responsiveness among female children (P < 0.01). CONCLUSION The findings provide new evidence of epigenetic associations with altered appetite among young African-American girls.
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Davison KK, Blake CE, Blaine RE, Younginer NA, Orloski A, Hamtil HA, Ganter C, Bruton YP, Vaughn AE, Fisher JO. Parenting around child snacking: development of a theoretically-guided, empirically informed conceptual model. Int J Behav Nutr Phys Act 2015; 12:109. [PMID: 26377320 PMCID: PMC4573676 DOI: 10.1186/s12966-015-0268-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 08/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Snacking contributes to excessive energy intakes in children. Yet factors shaping child snacking are virtually unstudied. This study examines food parenting practices specific to child snacking among low-income caregivers. METHODS Semi-structured interviews were conducted in English or Spanish with 60 low-income caregivers of preschool-aged children (18 non-Hispanic white, 22 African American/Black, 20 Hispanic; 92% mothers). A structured interview guide was used to solicit caregivers' definitions of snacking and strategies they use to decide what, when and how much snack their child eats. Interviews were audio-recorded, transcribed verbatim and analyzed using an iterative theory-based and grounded approach. A conceptual model of food parenting specific to child snacking was developed to summarize the findings and inform future research. RESULTS Caregivers' descriptions of food parenting practices specific to child snacking were consistent with previous models of food parenting developed based on expert opinion [1, 2]. A few noteworthy differences however emerged. More than half of participants mentioned permissive feeding approaches (e.g., my child is the boss when it comes to snacks). As a result, permissive feeding was included as a higher order feeding dimension in the resulting model. In addition, a number of novel feeding approaches specific to child snacking emerged including child-centered provision of snacks (i.e., responding to a child's hunger cues when making decisions about snacks), parent unilateral decision making (i.e., making decisions about a child's snacks without any input from the child), and excessive monitoring of snacks (i.e., monitoring all snacks provided to and consumed by the child). The resulting conceptual model includes four higher order feeding dimensions including autonomy support, coercive control, structure and permissiveness and 20 sub-dimensions. CONCLUSIONS This study formulates a language around food parenting practices specific to child snacking, identifies dominant constructs, and proposes a conceptual framework to guide future research.
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Mooreville M, Davey A, Orloski A, Hannah EL, Mathias KC, Birch LL, Kral TVE, Zakeri IF, Fisher JO. Individual differences in susceptibility to large portion sizes among obese and normal-weight children. Obesity (Silver Spring) 2015; 23:808-14. [PMID: 25683105 DOI: 10.1002/oby.21014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Determine the association of children's susceptibility to large food portion sizes with appetite regulation and obesity. METHODS Normal-weight and obese non-Hispanic black children (n = 100) aged 5-6 years were observed in four dinner conditions of varying portion size; portions of all foods (except milk) offered were: 100% (677 kcal), 150% (1015 kcal), 200% (1353 kcal), or 250% (1691 kcal) of those in the reference condition (100%). Condition order was randomly assigned to 2-4 children who ate together at each meal. Child height and weight were measured and caregiver reports of child appetite were obtained. Hierarchical growth curve models were used to estimate associations of meal energy intake with portion size condition, child weight status, and appetite regulation traits, controlling for demographics. RESULTS Total energy intake increased across conditions of increasing food portion size (P < 0.001). The effect of portion size condition on total energy intake varied with food responsiveness (P = 0.05) and satiety responsiveness (P < 0.05), but not weight status (P = 0.682). Children with lower satiety responsiveness and greater food responsiveness showed greater increases in meal energy across conditions. CONCLUSIONS Children with poorer appetite regulation may be more vulnerable to obesogenic dietary environments offering large food portions than other children.
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Bauer KW, MacLehose R, Loth KA, Fisher JO, Larson NI, Neumark-Sztainer D. Eating- and weight-related parenting of adolescents in the context of food insecurity. J Acad Nutr Diet 2015; 115:1408-16. [PMID: 25824114 DOI: 10.1016/j.jand.2015.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/23/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food insecurity is hypothesized to influence mothers' use of parenting strategies to regulate children's eating. Little is known about the parenting practices directed toward adolescents in food-insecure households. OBJECTIVE Our aim was to examine the differences in use of eating- and weight-related parenting practices among mothers of adolescents by household food-security status. DESIGN This was a cross-sectional study. PARTICIPANTS/SETTING A sociodemographically diverse sample of mothers and adolescents from the Minneapolis/St Paul, MN, metropolitan area who participated in the Eating and Activity Among Teens 2010 and Project Families and Eating and Activity Among Teens studies in 2009 to 2010 (dyad n=2,087). Seventy percent of mothers identified as nonwhite. MAIN OUTCOME MEASURES We examined mother-reported use of parenting practices, including pressuring children to eat, restricting high-calorie foods, and encouraging dieting. STATISTICAL ANALYSES PERFORMED Logistic regression models were used to determine the predicted probabilities of parenting practices among food-secure, low food-secure, and very-low food-secure households. Sociodemographic characteristics, mothers' body mass index, and adolescents' body mass index-for-age percentile were examined as confounders. RESULTS In unadjusted models, food-insecure mothers were more likely than food-secure mothers to frequently encourage their children to diet, comment on their child's weight, be concerned about their child's weight, use restrictive feeding practices, and use pressured feeding practices. After adjustment for sociodemographic characteristics and mothers' and children's body mass index, compared to food-secure mothers, mothers with low food security were more likely to frequently comment on their sons' weight (41.5% vs 32.9%, prevalence difference=8.6; 95% CI 0.9 to 16.3) and mothers with very low food security were more likely to be concerned about their sons' weight (48.8% vs 35.1%; prevalence difference=13.7; 95% CI 3.5 to 23.9). Mothers with very low food security were more likely to frequently use restrictive feeding practices with their daughters compared to food-secure mothers (33.0% vs 20.5%; prevalence difference=12.4; 95% CI 4.2 to 20.7). CONCLUSIONS Interventions to improve food-insecure adolescents' eating behaviors may benefit from supporting mothers' use of health-promoting parenting practices.
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Larsen JK, Kleinjan M, Engels RCME, Fisher JO, Hermans RCJ. Higher weight, lower education: a longitudinal association between adolescents' body mass index and their subsequent educational achievement level? THE JOURNAL OF SCHOOL HEALTH 2014; 84:769-776. [PMID: 25388593 DOI: 10.1111/josh.12212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/10/2014] [Accepted: 07/11/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The purpose of this study was to examine the association between adolescents' body mass index (BMI) z-scores and their subsequent level of schooling, extending previous longitudinal research by using objectively measured weight and height data. METHODS A longitudinal study with 3 study waves (1-year intervals) involving 1248 Dutch adolescents (49% girls; mean age = 13.7 years) at schools providing different educational levels was used to determine adolescents who moved and did not move to a lower educational level in the first year, or in the second year, and to examine whether this movement could be predicted by BMI z-scores (zBMI), after controlling for a large range of potential confounding factors. RESULTS A total of 1164 Dutch adolescents continued in the same level of education, whereas 84 adolescents moved to a lower educational level (43 moved in the first and 41 in the second year). A higher zBMI significantly increased the risk of a general transition to a lower educational level, and of a transition in the first year, but not in the second year, after controlling for potential demographic, behavioral, and psychological confounds. CONCLUSIONS Findings suggest that a higher zBMI during adolescence immediately lowers educational achievement level during general secondary education.
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Fisher JO, Goran MI, Rowe S, Hetherington MM. Forefronts in portion size. An overview and synthesis of a roundtable discussion. Appetite 2014; 88:1-4. [PMID: 25463048 DOI: 10.1016/j.appet.2014.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Establishing eating habits in early life that include appropriate portion sizes of foods which are nutrient dense and low in energy density is considered important in the prevention of obesity in children. This special supplement presents the proceedings of a symposium focusing on advances in scientific understanding of the development of healthy food portion sizes in children and their families. Recent basic research highlights individual differences in children's responsiveness to portion size as well as potential mechanisms of portion size effects. Quantitative approaches highlight the influence of maternal serving in determining intake, while qualitative approaches seek to elaborate caregiver decisions around child portion sizes at meals and snacks. Family-based environmental interventions for child weight control involving food portion size are outlined. An overview of the overarching issues and roundtable discussion on the forefronts of portion size research are presented as well as policy considerations to promote healthy portion control.
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Fisher JO, Wright G, Herman AN, Malhotra K, Serrano EL, Foster GD, Whitaker RC. "Snacks are not food". Low-income, urban mothers' perceptions of feeding snacks to their preschool-aged children. Appetite 2014; 84:61-7. [PMID: 25240637 DOI: 10.1016/j.appet.2014.09.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/12/2014] [Accepted: 09/13/2014] [Indexed: 11/19/2022]
Abstract
Snacking has become more frequent among US preschool-aged children in recent decades and represents a significant proportion of daily energy intake. Social influences on snacking among children, however, are not well understood. This qualitative research described low-income, urban mothers' perceptions of feeding snacks to their preschool-aged children using data from 7 focus groups with 32 participants. Focus group transcripts were analyzed using a constant comparative method to identify themes. Mothers described snacks as involving less preparation, balance, and sustenance than meals (Theme 1). Mothers also made reference to some snacks as not being "real food" (Theme 2). At the same time, snacks had significant hedonic value as reflected in mothers' enjoyment of those foods (Theme 3), the effectiveness of snacks to manage children's behavior (Theme 4), and the variety of restrictions that mothers placed on children's access to snacks, such as locking cabinets, offering small servings, and reducing the number of snacks in sight (Theme 5). Two overarching themes highlighted distinctions mothers made in feeding children snacks vs. meals as well as the powerful hedonic appeal of snacks for both mother and child. These observations suggest that low-income, urban mothers of preschool-aged children may perceive snacks as serving a more important role in managing children's behavior than in providing nutrition. Child feeding interventions should address non-food related ways of managing children's behavior as well as encouraging caregivers to see snacks as structured opportunities for nutrition and connecting with their children.
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Lawman HG, Polonsky HM, Vander Veur SS, Abel ML, Sherman S, Bauer KW, Sanders T, Fisher JO, Bailey-Davis L, Ng J, Van Wye G, Foster GD. Breakfast patterns among low-income, ethnically-diverse 4th-6th grade children in an urban area. BMC Public Health 2014; 14:604. [PMID: 24928474 PMCID: PMC4070352 DOI: 10.1186/1471-2458-14-604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increasing school breakfast participation has been advocated as a method to prevent childhood obesity. However, little is known about children's breakfast patterns outside of school (e.g., home, corner store). Policies that increase school breakfast participation without an understanding of children's breakfast habits outside of school may result in children consuming multiple breakfasts and may undermine efforts to prevent obesity. The aim of the current study was to describe morning food and drink consumption patterns among low-income, urban children and their associations with relative weight. METHODS A cross-sectional analysis was conducted of data obtained from 651 4th-6th graders (51.7% female, 61.2% African American, 10.7 years) in 2012. Students completed surveys at school that included all foods eaten and their locations that morning. Height and weight were measured by trained research staff. RESULTS On the day surveyed, 12.4% of youth reported not eating breakfast, 49.8% reported eating one breakfast, 25.5% reported eating two breakfasts, and 12.3% reported eating three or more breakfasts. The number of breakfasts consumed and BMI percentile showed a significant curvilinear relationship, with higher mean BMI percentiles observed among children who did not consume any breakfast and those who consumed ≥ 3 breakfasts. Sixth graders were significantly less likely to have consumed breakfast compared to younger children. A greater proportion of obese youth had no breakfast (18.0%) compared to healthy weight (10.1%) and overweight youth (10.7%, p = .01). CONCLUSIONS When promoting school breakfast, policies will need to be mindful of both over- and under-consumption to effectively address childhood obesity and food insecurity. CLINICAL TRIAL REGISTRATION NCT01924130 from http://clinicaltrials.gov/.
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Larsen JK, Otten R, Fisher JO, Engels RCME. Depressive symptoms in adolescence: a poor indicator of increases in body mass index. J Adolesc Health 2014; 54:94-9. [PMID: 24045096 DOI: 10.1016/j.jadohealth.2013.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the association between depressive symptoms and subsequent body mass index (BMI) z scores among early-to-mid adolescents, extending previous research by using objectively measured weight and height data. METHODS Latent growth curve analysis was used to examine whether growth parameters of zBMI could be predicted by depressive symptoms (n = 2,051 adolescents, 48.5% female, at baseline; 1,465 with data at all three time points). Specifically, we tested whether depressive symptoms were associated with the initial assessment of BMI (intercept) as well as with changes in BMI over time (slope). Analyses were performed for the total group, and separately for boys and girls. RESULTS Depressive symptoms were not associated with the slope of zBMI. In girls, but not boys, depressive symptoms were positively associated with the intercept of zBMI. CONCLUSIONS Findings suggest that although depressive symptoms among females are associated with a higher zBMI, they do not predict excessive weight gain during early-to-mid adolescence.
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Hodges EA, Johnson SL, Hughes SO, Hopkinson JM, Butte NF, Fisher JO. Development of the responsiveness to child feeding cues scale. Appetite 2013; 65:210-9. [PMID: 23419965 PMCID: PMC3995412 DOI: 10.1016/j.appet.2013.02.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/04/2013] [Accepted: 02/08/2013] [Indexed: 11/24/2022]
Abstract
Parent-child feeding interactions during the first 2 years of life are thought to shape child appetite and obesity risk, but remain poorly studied. This research was designed to develop and assess the Responsiveness to Child Feeding Cues Scale (RCFCS), an observational measure of caregiver responsiveness to child feeding cues relevant to obesity. General responsiveness during feeding as well as maternal responsiveness to child hunger and fullness were rated during mid-morning feeding occasions by three trained coders using digital-recordings. Initial inter-rater reliability and criterion validity were evaluated in a sample of 144 ethnically-diverse mothers of healthy 7- to 24-month-old children. Maternal self-report of demographics and measurements of maternal/child anthropometrics were obtained. Inter-rater agreement for most variables was excellent (ICC>0.80). Mothers tended to be more responsive to child hunger than fullness cues (p<0.001). Feeding responsiveness dimensions were associated with demographics, including maternal education, maternal body mass index, child age, and aspects of child feeding, including breastfeeding duration, and self-feeding. The RCFCS is a reliable observational measure of responsive feeding for children <2 years of age that is relevant to obesity.
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DiSantis KI, Birch LL, Davey A, Serrano EL, Zhang J, Bruton Y, Fisher JO. Plate size and children's appetite: effects of larger dishware on self-served portions and intake. Pediatrics 2013; 131:e1451-8. [PMID: 23569096 DOI: 10.1542/peds.2012-2330] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Dishware size is thought to influence eating behaviors, but effects on children's self-served portion sizes and intakes have not been studied. We aimed to evaluate whether larger dishware increased children's self-served portion sizes and intake during meals. METHODS A within-subjects experimental design was used to test the effects of dishware size (ie, plates and bowls) on children's self-served portion sizes and intakes in a naturalistic setting. Subjects were predominantly African American elementary school-aged children (n = 42) observed on repeated occasions during school lunch. Children served themselves an entree and side dishes using either child- or adult-size dishware, which represented a 100% increase in the surface area of plates and volume of bowls across conditions. Condition order was randomly assigned and counterbalanced across 2 first-grade classrooms. Entrées of amorphous and unit form were evaluated on separate days. Fruit and vegetable side dishes were evaluated at each meal. Fixed portions of milk and bread were provided at each meal. RESULTS Children served more energy (mean = 90.1 kcal, SE = 29.4 kcal) when using adult-size dishware. Adult-size dishware promoted energy intake indirectly, where every additional calorie served resulted in a 0.43-kcal increase in total energy intakes at lunch (t = 7.72, P = .001). CONCLUSIONS Children served themselves more with larger plates and bowls and consumed nearly 50% of the calories that they served. This provides new evidence that children's self-served portion sizes are influenced by size-related facets of their eating environments, which, in turn, may influence children's energy intake.
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Fisher JO, Birch LL, Zhang J, Grusak MA, Hughes SO. External influences on children's self-served portions at meals. Int J Obes (Lond) 2013; 37:954-60. [PMID: 23295501 DOI: 10.1038/ijo.2012.216] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/25/2012] [Accepted: 11/09/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Large portions promote intake among children, but little is known about the external influences of the eating environment on children's self-selected portion sizes. This research experimentally tested effects of the amount of entree available and serving spoon size on children's self-served entree portions and intakes at dinner meals. A secondary objective was to identify child and family predictors of self-served entree portion sizes. DESIGN A 2 × 2 within-subjects design was used, in which the amount of a pasta entree available for self-serving (275 vs 550 g) and the serving spoon size (teaspoon vs tablespoon) were systematically varied. The serving bowl size and portion sizes of all other foods offered were held constant across conditions. Conditions were spaced 1 week apart and randomly assigned. Weighed self-served entree portions and food intakes as well as demographics, maternal feeding styles and child/maternal anthropometrics were measured. SUBJECTS Participants were 60 ethnically diverse children aged 4-6 years and their mothers. RESULTS Mixed models revealed that children served themselves 40% more entree when the amount available was doubled (P<0.0001) and 13% more when the serving spoon size was tripled (P<0.05). Serving spoon size and the amount of entree available indirectly influenced children's intake, with larger self-served portion sizes related to greater entree intakes (P<0.0001). Greater self-served portions and energy intakes at the meal were seen among those children whose mothers reported indulgent or authoritarian feeding styles (P<0.001). CONCLUSION Children's self-served portion sizes at meals are influenced by size-related facets of the eating environment and reflect maternal feeding styles.
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Herman AN, Malhotra K, Wright G, Fisher JO, Whitaker RC. A qualitative study of the aspirations and challenges of low-income mothers in feeding their preschool-aged children. Int J Behav Nutr Phys Act 2012; 9:132. [PMID: 23157723 PMCID: PMC3541152 DOI: 10.1186/1479-5868-9-132] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 11/07/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The prevalence of obesity among preschool-aged children has increased, especially among those in low-income households. Two promising behavioral targets for preventing obesity include limiting children's portion sizes and their intake of foods high in solid fats and/or added sugars, but these approaches have not been studied in low-income preschoolers in the home setting. The purpose of this study was to understand the contextual factors that might influence how low-income mothers felt about addressing these behavioral targets and mothers' aspirations in feeding their children. METHODS We recruited 32 English-speaking women in Philadelphia, Pennsylvania who were eligible for the Supplemental Nutrition Assistance Program and who were the biologic mothers of children 36 to 66 months of age. Each mother participated in 1 of 7 focus groups and completed a brief socio-demographic questionnaire. Focus group questions centered on eating occasions, foods and drinks consumed in the home, and portion sizes. Each focus group lasted 90 minutes and was digitally recorded and transcribed verbatim. Three authors independently identified key themes and supporting quotations. Themes were condensed and modified through discussion among all authors. RESULTS Thirty-one mothers identified themselves as black, 15 had a high school education or less, and 22 lived with another adult. Six themes emerged, with three about aspirations mothers held in feeding their children and three about challenges to achieving these aspirations. Mothers' aspirations were to: 1) prevent hyperactivity and tooth decay by limiting children's sugar intake, 2) use feeding to teach their children life lessons about limit setting and structure, and 3) be responsive to children during mealtimes to guide decisions about portions. Especially around setting limits with sweets and snacks, mothers faced the challenges of: 1) being nagged by children's food requests, 2) being undermined by other adults in the family, and 3) having bad memories from childhood that made it hard to deny children's food requests. CONCLUSIONS Although the primary aspirations of low-income mothers in feeding their preschool-aged children were not focused on children's weight, these aspirations were compatible with obesity prevention strategies to limit children's portion sizes and their intake of solid fats and/or added sugars.
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