Family dinner and diet quality among older children and adolescents

Family food environment and dietary behaviors likely to promote fatness in 5-6 year-old children

BACKGROUND

The family food environment (FFE) is likely to exert important influences on young children's eating. Examination of multiple aspects of the FFE may provide useful insights regarding which of these might most effectively be targeted to prevent childhood obesity.

OBJECTIVE

To assess the associations between the FFE and a range of obesity-promoting dietary behaviors in 5-6-year-old children.

DESIGN

Cross-sectional study.

SUBJECTS

Five hundred and sixty families sampled from three socio-economically distinct areas.

MEASUREMENTS

Predictors included parental perceptions of their child's diet, food availability, child feeding practices, parental modeling of eating and food preparation and television (TV) exposure. Dietary outcomes included energy intake, vegetable, sweet snack, savory snack and high-energy (non-dairy) fluid consumption.

RESULTS

Multiple linear regression analyses, adjusted for all other predictor variables and maternal education, showed that several aspects of the FFE were associated with dietary outcomes likely to promote fatness in 5-6-year-old children. For example, increased TV viewing time was associated with increased index of energy intake, increased sweet snack and high-energy drink consumption, and deceased vegetable intake. In addition, parent's increased confidence in the adequacy of their child's diet was associated with increased consumption of sweet and savory snacks and decreased vegetable consumption.

CONCLUSION

This study substantially extends previous research in the area, providing important insights with which to guide family-based obesity prevention strategies.

Food Preparation and Purchasing Roles among Adolescents: Associations with Sociodemographic Characteristics and Diet Quality

OBJECTIVE

To describe adolescent involvement in preparing and shopping for food and examine if extent of involvement is related to diet quality.

DESIGN

Cross-sectional study design. Past week frequency of involvement in preparing and shopping for food was self-reported on the Project EAT (Eating Among Teens) survey. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire.

SUBJECTS/SETTING

Middle school and high school students from Minneapolis/St Paul, MN, public schools.

STATISTICAL ANALYSES PERFORMED

Associations between involvement and sociodemographic characteristics were examined using cross tabulations. General linear modeling was used to compare dietary intakes of adolescents across different levels of involvement in preparing and shopping for food.

RESULTS

The majority of adolescents reported helping prepare dinner (68.6%) and nearly half reported shopping for groceries (49.8%) at least once during the past week. Greater involvement in these food tasks was related to sex (female), grade level (middle school), race (Asian American), socioeconomic status (low), family meal frequency (high), and weight status (overweight). Frequency of preparing food was related to lower intakes of fat (P<0.01) and higher intakes of fruits and vegetables, fiber, folate, and vitamin A. Preparing was related to lower intakes of carbonated beverages among female adolescents (P<0.01) and lower intakes of fried foods among male adolescents (P<0.01). In contrast, food shopping frequency was related to greater consumption of fried foods among female adolescents (P<0.01).

CONCLUSIONS

Adolescents should be encouraged to help with meal preparation and may benefit from interventions and programs that teach skills for cooking and making healthful purchasing decisions.

Household food insecurity and overweight status in young school children: results from the Early Childhood Longitudinal Study

OBJECTIVE

Recent work on the determinants of obesity has shown a positive association between household food insecurity and overweight status in adult women, yet research exploring this issue in children has been inconclusive. In this study we examine the association between food insecurity and overweight status in young school children by using a large, nationally representative sample.

METHODS

Data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K) were analyzed. Replicate heights and weights were measured on kindergarten children (N = 16889) in the spring of 1999. Children with a body mass index > or = 95th percentile of their gender-specific BMI-for-age chart were considered overweight. Food-insecurity status was assessed by using the full 18-question US Department of Agriculture Household Food Security Scale. Multivariate logistic regression was used to assess the relationship between overweight and food-insecurity status while controlling for potential demographic, socioeconomic, and behavioral confounders.

RESULTS

Overall, 11.2% of the girls and 11.8% of the boys were overweight. Children from food-insecure households were 20% less likely to be overweight than their food-secure counterparts. Similar results on the food-insecurity/overweight link were found across a range of different models and expressions for key variables. Positive predictors of overweight status included low physical activity, television watching for > 2 hours/day, high birth weight, black or Latino ethnicity, and low income.

CONCLUSIONS

There are strong arguments for reducing food insecurity among households with young children. This research suggests that these arguments would be based on reasons other than a potential link to obesity. Low activity levels and excessive television watching, however, were strongly related to overweight status, a finding that supports continued efforts to intervene in these areas.

Ethnicity and Nutrition of Adolescent Girls in Hawaii

OBJECTIVE

To describe the ethnicity and nutrition of adolescent girls in Hawaii.

DESIGN

This was a cross-sectional survey.

SUBJECTS

Girls, aged 9 to 14 years, were identified from the membership files of Kaiser Permanente Hawaii, a large Hawaii health maintenance organization.

MAIN OUTCOME MEASURES

Nutrient and food group intakes were compared against recommended intakes, physical activity levels, and anthropometric measurements of height, weight, body mass index (BMI), and subscapular and iliac skinfold thicknesses.

STATISTICAL ANALYSIS PERFORMED

Asian girls, girls of mixed ethnicity, and white girls were compared using analysis of variance.

RESULTS

Although Asian girls weighed the least and were the most sedentary, white girls had the lowest BMIs. Mixed ethnicity girls had the highest weights, BMIs, and subscapular and iliac skinfold thicknesses. No significant differences were found in major macronutrient intake. However, mixed ethnicity and Asian girls had lower fiber, iron, folate, and calcium intake than white girls. All groups met recommendations for iron intake, whereas none met fiber and calcium recommendations. All girls met folate recommendations. No differences were found in intakes for tofu, soy, grains, vegetables, or fruit and nuts food groups. Mixed ethnicity girls had the highest sweetened carbonated beverage intake although overall sugar intake was highest in white girls. Asian and mixed ethnicity girls' meat intakes were higher than white girls'. Intakes of mixed ethnicity girls more closely resembled those of Asians, although they exhibited the highest BMIs.

CONCLUSIONS

These data suggest grain, vegetable, fruit, and dairy intake should be encouraged as part of a balanced diet for adolescent girls in Hawaii.

Dietary recommendations for children and adolescents: a guide for practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Positive maternal attitude to the family eating together decreases the risk of adolescent overweight

OBJECTIVES

To determine whether maternal attitude towards the family regularly eating together and maternal report of how often the family eat together are associated with adolescent offspring overweight.

RESEARCH METHODS AND PROCEDURES

A cross-sectional mother-child-linked analysis was carried out using 14-year follow-up data from a population-based prospective birth cohort of 3795 children (52% males) who were participants in the Mater-University study of pregnancy, Brisbane, Australia. Maternal reports on family eating pattern reported at age 14 were used.

RESULTS

The prevalence of overweight at age 14 was 24.1% (95% confidence interval (CI), 22.3, 26.1) for males and 27.1% (CI, 25.1, 29.2) for females. The majority of mothers (78%) reported that the family ate together at least once a day, but only 43% reported that they felt that family eating together was important. The offspring of women who felt that the family eating together was not important had increased odds of being overweight at age 14 (odds ratio, 1.27; 95% CI, 1.05, 1.53) in age- and sex-adjusted models. Adjustment for potential confounding factors had no substantive effect on the association. There was no association between maternal reports of how often the family actually did eat together and overweight at age 14 in the offspring.

DISCUSSION

These findings suggest that maternal attitude towards family eating patterns, but not maternal report of how often the family do eat together, are associated with childhood overweight status. Maternal attitude towards family eating (as opposed to a report of actual frequency at one time-point) may reflect broader maternal influences (beyond family eating pattern) on their child's diet and eating patterns over a long time course.

Preventing the broad spectrum of weight-related problems: working with parents to help teens achieve a healthy weight and a positive body image

A spectrum of eating-, activity-, and weight-related concerns is presented that includes 5 dimensions (weight control practices, level of physical activity, body image, eating behaviors, and weight status) and different levels of severity within each of these dimensions. Multiple interacting factors contribute to the etiology of problems within each of these dimensions in adolescents at the individual, familial, peer, school, community, and societal levels. Families have an important role to play in reinforcing the positive influences at each of these levels and in filtering out the negative influences. Parents can help their children engage in more healthful eating and physical activity behavior and feel better about themselves through (1) role modeling healthful behaviors, (2) providing an environment that makes it easy for their children to make healthful choices, (3) focusing less on weight and more on behaviors and overall health, and (4) providing a supportive environment for their children to enhance communication. Families need to be proactive within our society, which works against the development of a healthy weight and a positive body image in children and adolescents. However, families cannot do it on their own and need support from the more distal environments within which they function.

Dietary Recommendations for Children and Adolescents

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children’s cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Prevalence of and risk factors for childhood overweight and obesity

BACKGROUND

Increases in childhood overweight and obesity have become an important public health problem in industrialized nations. Preventive public health action is required, but more research of risk factors is required before evidence-based initiatives can be developed and targeted effectively. We investigated the association between childhood overweight and obesity and risk factors relating to dietary habits, activities, parents and schools.

METHODS

In 2003 we surveyed grade 5 students and their parents and school principals in Nova Scotia. We measured height and weight and assessed dietary habits (using Harvard's Youth/Adolescent Food Frequency Questionnaire), physical and sedentary activities, and parental and school-based risk factors. We estimated neighbourhood income by averaging, per school, the postal-code level means of household income of residential addresses of children attending that school. We used multilevel logistic regression to evaluate the significance of these risk factors for overweight and obesity.

RESULTS

On the basis of measurements taken of 4298 grade 5 students, we estimated the provincial prevalence of overweight to be 32.9% and of obesity to be 9.9%. Children who bought lunch at school were at increased risk of overweight (fully adjusted odds ratio [OR] 1.39, 95% confidence interval [CI] 1.16-1.67), whereas those who ate supper together with their family 3 or more times a week were at decreased risk (OR 0.68, 95% CI 0.52-0.88). Physical education classes 2 or more times a week at school were associated with a decreased risk of overweight (OR 0.61, 95% CI 0.43-0.87) and obesity (OR 0.54, 95% CI 0.33-0.88). Children in high-income neighbourhoods were half as likely to be obese as their peers living in low-income neighbourhoods (OR 0.50, 95% CI 0.36-0.70).

INTERPRETATION

Parents and schools provide important opportunities for public health initiatives for reducing childhood overweight and obesity. Children and schools in low-income neighbourhoods should receive priority in public health initiatives to reduce future socioeconomic inequalities in health.

Family dinner and adolescent overweight

OBJECTIVE

The purpose of this study was to examine both cross-sectional and longitudinal associations between frequency of family dinner and overweight status in a large sample of 9- to 14-year-old children.

RESEARCH METHODS AND PROCEDURES

We studied a cohort of 7784 girls and 6647 boys, 9 to 14 years of age at baseline in 1996, participating in the Growing Up Today Study. From annual mailed surveys, we calculated BMI from self-reported height and weight and assessed frequency of family dinner over the previous year. We defined "overweight" as age- and sex-specific BMI >85th percentile. We performed multiple logistic regression analyses; the longitudinal analyses assessed the association of previous year family dinner consumption with 1-year incidence of becoming overweight, using prospective data from 1996 through 1999.

RESULTS

At baseline in 1996, 16% of participants had family dinner "never or some days," 40% on "most days," and 44% "every day." Across these categories, overweight prevalence for girls was 19.4%, 16.6%, and 16.7% and for boys was 24.6%, 23.3%, and 22.7%, respectively. In cross-sectional analyses, adjusting for potential confounders, the odds of being overweight was 0.85 [95% confidence interval (CI): 0.76, 0.96] among children who ate family dinner on "most days" or "every day" compared with those who ate family dinner "never or some days." In longitudinal multivariate models, the odds ratios between previous year frequency of eating family dinner and 1-year incidence of becoming overweight were 0.95 (95% CI: 0.78, 1.16) and 1.04 (95% CI: 0.85, 1.27) for children who ate family dinner on "most days" and "every day," respectively, compared with those who ate family dinner "never or some days."

DISCUSSION

The frequency of eating family dinner was inversely associated with overweight prevalence at baseline but not with likelihood of becoming overweight in longitudinal analyses.

Behavioural determinants of obesity

Obesity in children arises from a complex interplay between genetic susceptibility and behaviour, primarily relating to dietary habits and physical activity. Evidence for specific behavioural factors that promote or protect against excess weight gain in children is more limited than in adults, and the effects of growth and development are not clear. A number of behavioural risk factors has been postulated, including diets with a high energy density, high consumption of sugar-sweetened beverages, large portion sizes, eating patterns, high levels of sedentary behaviour and low levels of physical activity. However, most evidence is derived from cross-sectional studies which frequently yield conflicting results. More prospective studies with accurate measures of exposures and outcomes in terms of body composition are needed to provide more robust evidence on which to base interventions to achieve long-term behavioural change and prevent excess weight gains in children.

Prevention of childhood obesity

Childhood obesity is a complex disease with different genetic, metabolic, environmental and behavioural components that are interrelated and potentially confounding, thus making causal pathways difficult to define. Given the tracking of obesity and the associated risk factors, childhood is an important period for prevention. To date, evidence would support preventative interventions that encourage physical activity and a healthy diet, restrict sedentary activities and offer behavioural support. However, these interventions should involve not only the child but the whole family, school and community. If the current global obesity epidemic is to be halted, further large-scale, well-designed prevention studies are required, particularly within settings outside of the USA, in order to expand the currently limited evidence base upon which clinical recommendations and public health approaches can be formulated. This must be accompanied by enhanced monitoring of paediatric obesity prevalence and continued support from all stakeholders at global, national, regional and local levels.

Barriers that influence eating behaviors in adolescents

Adolescence is a time of rapid growth and development with biologic, psychological, and emotional changes occurring simultaneously. We conducted a critical review of the literature to analyze key topics in the study of adolescents' eating behaviors and to identify barriers to healthy eating experienced by adolescents. The literature documents that nutritional deficits and poor eating established during adolescence have long-term health, growth, and developmental consequences. Gaps in the literature are identified and recommendations for future studies are proposed.

Integration and individuality in healthy eating: meanings, values, and approaches of childless, dual earner couples

INTRODUCTION AND OBJECTIVES

Although considered to be an important component of food choice, perceptions and practices regarding healthy eating vary between people and change over the life-course. The purpose of this paper is to examine integration and individuality in healthy eating meanings, values, and approaches of individuals in childless, dual earner couples.

MATERIALS AND METHODS

Fourteen participants (from seven couples) were recruited using notices and snowball sampling. Food journals and individual interviews were used to explore the nature of and negotiations between partners' healthy eating values and approaches. Data were analysed through iterative procedures that included coding, thematic analysis and memo writing.

RESULTS

Participants presented individual healthy eating values and approaches based on their own experiences with food over time. Cohabitation resulted in a continuum of healthy eating negotiation outcomes, including congruent values and approaches, congruent values but divergent approaches, and divergent values and approaches. In combination with other salient factors, cohabitation provides an opportunity for improving healthy eating approaches.

DISCUSSION

Cohabitation has the potential to lead to positive changes in healthy eating approaches. Practitioners need to tailor messages for clients' specific needs and encourage change in the direction of the partner with the healthier eating approach.

Food Choice Motives and the Importance of Family Meals Among Immigrant Mothers

To determine the health and social benefits of the family mealtime, we examined the contribution of immigrant mothers’ food motives to the importance placed on family meals, and cultural differences in mothers’ food motives and the importance ascribed to family meals. Data were taken from a study on food choice factors among ten- to 12-year-old children from three cultural communities in Montreal. A 24-item, self-administered questionnaire was used to explore food choice motives. Each mother was also asked how important it was for her family to take the time to eat together, and if the child enjoyed sharing meals with his or her family. In all, 209 of the 653 questionnaires distributed were valid; 68 were from Haitian, 75 from Portuguese, and 66 from Vietnamese mothers. Five factors emerging from factor analyses explained 61.67% of the variance. Analysis of variance indicated significant differences between mothers’ countries of origin for the importance placed on health, pleasure, familiarity, and ingredient properties (p<0.005). Among Haitian and Portuguese mothers, health motivations emerged as the only significant predictor of the importance given to family meals, whereas for Vietnamese mothers, both health and eating familiar foods were predictors (p<0.05).

Dietary intake and risk factors for poor diet quality among children in Nova Scotia

OBJECTIVE

Public health policies promote healthy nutrition but evaluations of children's adherence to dietary recommendations and studies of risk factors of poor nutrition are scarce, despite the importance of diet for the temporal increase in the prevalence of childhood obesity. Here we examine dietary intake and risk factors for poor diet quality among children in Nova Scotia to provide direction for health policies and prevention initiatives.

METHODS

In 2003, we surveyed 5,200 grade five students from 282 public schools in Nova Scotia, as well as their parents. We assessed students' dietary intake (Harvard's Youth Adolescent Food Frequency Questionnaire) and compared this with Canadian food group and nutrient recommendations. We summarized diet quality using the Diet Quality Index International, and used multilevel regression methods to evaluate potential child, parental and school risk factors for poor diet quality.

RESULTS

In Nova Scotia, 42.3% of children did not meet recommendations for milk products nor did they meet recommendations for the food groups 'Vegetables and fruit' (49.9%), 'Grain products' (54.4%) and 'Meat and alternatives' (73.7%). Children adequately met nutrient requirements with the exception of calcium and fibre, of which intakes were low, and dietary fat and sodium, of which intakes were high. Skipping meals and purchasing meals at school or fast-food restaurants were statistically significant determinants of poor diet. Parents' assessment of their own eating habits was positively associated with the quality of their children's diets.

INTERPRETATION

Dietary intake among children in Nova Scotia is relatively poor. Explicit public health policies and prevention initiatives targeting children, their parents and schools may improve diet quality and prevent obesity.

Family Environment and Pediatric Overweight: What Is a Parent to Do?

Although the causes of pediatric overweight are many and the levels of intervention required to prevent overweight in children extend from the child's immediate environment to the larger societal level, one critical intervention target is the parent. Scientific evidence points to specific dietary and physical activity/inactivity behaviors that families can adopt to encourage healthful weight status. Dietary recommendations include providing children with ample access to nutrient-dense foods and beverages and high-fiber foods, both at meals and snack times, reducing children's access to high-calorie, nutrient-poor beverages and foods both when eating at home and at restaurants, avoiding excessive food restriction or use of food as a reward, and encouraging children to eat breakfast on a daily basis. Physical activity recommendations include providing opportunities and encouragement for children to be physically active while reducing children's television and video game time. Parental modeling of healthful eating and physical activity practices is recommended to reinforce these patterns in youth. Dietetics professionals, physicians, and other health care professionals can assist parents in their efforts to prevent pediatric overweight by providing information and supporting these key behaviors, while working to create environments that support healthful lifestyle changes.

Dietary habits and children's family lives

PURPOSE

To investigate associations between 'less healthy eating' and 'unhealthy snacking' at age 11, and family life (family structure, meals and maternal employment status) together with potential socio-economic confounders and gender.

METHODS

Children participated in a school-based survey, questionnaires also being completed by parents. Analyses were based on those with complete data, weighted to account for bias in return of parental questionnaires (N = 2146). Data from a dietary inventory, questions on food choice and snacks were used to classify 'less healthy eating' and 'unhealthy snacking'.

RESULTS

Less healthy eating' (57%) and 'unhealthy snacking' (32%) were associated with greater deprivation, fewer maternal qualifications and being male. Compared with children of full-time homemakers, the likelihood of 'less healthy eating' was reduced among those whose mothers worked part-time (this effect remaining after socio-economic adjustment), full-time (effect removed after adjustment), or were unemployed, sick or disabled (effect emerging after adjustment). 'Unhealthy snacking' was not related to maternal employment, and neither measure was associated with family structure or daily meals.

CONCLUSIONS

There was no evidence that family structure or meals were associated with children's diets, although maternal employment had a positive association. Contrasting with the size of these effects, relationships between diet and socio-economic status were strong.

Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods

OBJECTIVE

This study examines parental report of household food availability, parent dietary intake and associations with adolescent intakes of fruits, vegetables and dairy foods.

DESIGN

Cross-sectional study. Adolescents completed the Project EAT survey and the Youth Adolescent Food Frequency Questionnaire at school. Parents of adolescents were interviewed by telephone about the home food environment, eating habits and weight-related behaviours. General linear modelling was used to compare dietary intakes of adolescents across different levels of household food availability and parental intakes.

SUBJECTS/SETTING

The study sample included 902 adolescents and their parent or guardian.

RESULTS

Many parents were not consuming the minimum number of daily recommended fruit (44.5%), vegetable (69.9%) or dairy (46.9%) servings. While most parents reported that fruits and vegetables were available at home (90.3%) and vegetables were usually served at dinner (87.0%), fewer parents reported milk was served at meals (66.6%). Soft drinks were usually available at home (56.8%). Among girls, household availability was positively associated with fruit and vegetable intake (ttrend=2.70, P<0.01) and soft drink availability was inversely associated with dairy intake (ttrend=2.08, P=0.04). Among boys, serving milk at meals was positively associated with dairy intake (ttrend=3.65, P<0.01). Parental intakes were positively associated with dairy intake for boys (ttrend=2.04, P=0.04), and with dairy (ttrend=2.43, P=0.01), vegetable (ttrend=3.72, P<0.01) and fruit (ttrend=3.17, P<0.01) intakes for girls.

CONCLUSIONS/APPLICATIONS

Interventions designed to help adolescents improve consumption of fruits, vegetables and dairy foods may be enhanced by including a parental component aimed at increasing household availability and parents' intake of healthful food choices.

Barriers to and motivators for healthful eating as perceived by rural and urban Costa Rican adolescents

OBJECTIVE

To assess the perceptions of rural and urban Costa Rican adolescents about their diet and the factors they consider significant to healthful eating.

DESIGN

Data were collected in focus group discussions.

PARTICIPANTS

The study sample included 108 male and female adolescents aged 12 to 18 years. Adolescents were recruited among 7th to 11th grade students interested in taking part in the study.

SETTING

Two urban and one rural high school in San José, Costa Rica.

PHENOMENA OF INTEREST

Diet perceptions and barriers to and motivators for healthful eating.

ANALYSIS

Data were reviewed for emerging themes, and themes were coded applying content analysis procedures. The conceptual model for understanding adolescent eating behavior, proposed by Story and colleagues, served as the framework for this study.

RESULTS

Factors perceived as barriers to adopting healthful eating practices included unavailability of healthful food in the school environment, inadequate food choices within the family diet, and the peer-group notion among males and females that healthful eating by males is effeminate. Factors perceived as motivators included improving the nutritional quality of foods available at school, adoption of healthful eating practices by the entire family, and healthful eating becoming a peer-group social norm.

CONCLUSIONS AND IMPLICATIONS

This study suggests that the family, peer group, and school environment are potential targets for nutrition interventions for Costa Rican adolescents, but further studies are needed to confirm this conclusion. Future studies should explore in depth the factors associated with the family's eating pattern and the influence of adolescent socialization patterns (particularly male) in the establishment of a healthful diet.

Are family meal patterns associated with disordered eating behaviors among adolescents?

PURPOSE

To examine associations between family meal patterns (frequency, priority, atmosphere, and structure of family meals) and disordered eating (unhealthy weight control behaviors, binge eating, and chronic dieting) in adolescent girls and boys.

METHODS

Survey and anthropometric data were collected from 4746 ethnically diverse adolescents from public middle and senior high schools who participated in the Project EAT study (Eating Among Teens). Variables of interest included family meal patterns and disordered eating behaviors. Logistic regressions were performed to examine associations between family meal patterns and disordered eating behaviors adjusting for body mass index, sociodemographic characteristics, family connectedness, and weight pressures within the home.

RESULTS

In general, adolescents who reported more frequent family meals, high priority for family meals, a positive atmosphere at family meals, and a more structured family meal environment were less likely to engage in disordered eating. For example, 18.1% of girls who reported 1-2 family meals/week engaged in extreme weight control behaviors compared with 8.8% of girls who reported 3-4 family meals/week. Making family meals a priority, in spite of scheduling difficulties, emerged as the most consistent protective factor for disordered eating. Associations between family meal patterns and disordered eating behaviors tended to be stronger among girls than among boys. Family meal patterns were more consistently associated with unhealthy weight control behaviors than with chronic dieting and binge eating. Although associations between family meals and disordered eating were weakened after adjusting for more global familial factors, including family connectedness and weight-specific pressures within the home, a number of the associations remained statistically significant, suggesting an independent relationship between family meals and disordered eating.

CONCLUSION

Family meals have the potential to play an important role in the prevention of unhealthy weight control behaviors among youth. Findings suggest that attention needs to be directed toward increasing family meal frequency and creating a positive environment for family meals.

Food habits in 10-11-year-old children with functional gastrointestinal disorders

OBJECTIVE

To evaluate the role of food habits and nutrient intake in children with functional gastrointestinal disorders (FGIDs) considering their association with psychosocial factors.

DESIGN

Cross-sectional.

SETTING

A rural town in Mid-Western Finland.

SUBJECTS

After excluding organic gastrointestinal (GI) disorders, a total of 49 children with FGID and 78 control children without GI symptoms from a cohort of 422 children were studied.

METHODS

Food frequency questionnaire, GI-symptoms questionnaire and the Child Behaviour Check List (CBCL) filled in by parents together with their child, and 24-h dietary recall and anthropometric and haematological measurements.

RESULTS

Compared to control children, fewer children with FGID had daily family dinner (77 vs 91%, P = 0.030) and they used less often vegetables (P = 0.023), fruits (P = 0.027) and berries (P = 0.011), but more often ice cream (P = 0.018) and soft drinks (P = 0.027) and had a higher sucrose intake (9 vs 7E%, P = 0.032) and lower lactose intake (27 vs 36 g, P = 0.001). Reported food-related symptoms were more common among FGID group (69 vs 11%), as well as restricted milk use (31 vs 0%). Children with FGID had higher total problem scores in CBCL (P=0.002), and the behavioural/emotional problems associated with occurrence of FGID (OR 1.04, 95% CI 1.07-1.076) as did the sugar intake (OR 1.1, 95% CI 1.004-1.215).

CONCLUSIONS

This population-based study suggests that school-aged children with FGIDs have less-organized food habits and higher milk avoidance, and they display internalizing psychological characteristics.

SPONSORSHIP

Juho Vainio Foundation, Finland; the Alma and K.A. Snellman Foundation, Oulu, and the Pediatric Research Foundation, Finland.

Role of parents in the determination of the food preferences of children and the development of obesity

The role of parental behaviour in the development of food preferences is considered. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. Particularly towards the second year of life, there is a tendency to avoid novel foods (neophobia). Food aversions can be learnt in one trial if consumption is followed by discomfort. There is a predisposition to learn to like foods with high-energy density. However, from birth genetic predispositions are modified by experience and in this context during the early years parents play a particularly important role. Parental style is a critical factor in the development of food preferences. Children are more likely to eat in emotionally positive atmospheres. Siblings, peers and parents can act as role models to encourage the tasting of novel foods. Repeated exposure to initially disliked foods can breakdown resistance. The offering of low-energy-dense foods allows the child to balance energy intake. Restricting access to particular foods increases rather than decreases preference. Forcing a child to eat a food will decrease the liking for that food. Traditionally, educational strategies have typically involved attempts to impart basic nutritional information. Given the limited ability of information to induce changes in behaviour, an alternative strategy would be to teach parents about child development in the hope that an understanding of the characteristic innate tendencies and developmental stages can be used to teach healthy food preferences.

Modifying the healthy eating index to assess diet quality in children and adolescents

OBJECTIVE

The Healthy Eating Index (HEI) is a scoring system used by the US government to assess adherence to the Dietary Guidelines for Americans. We examined the ability of the HEI to monitor diet quality among youth.

DESIGN

We modified and simplified the HEI for use by older children and adolescents. The new Youth Healthy Eating Index (YHEI) focuses on food quality and assesses both healthful and unhealthful foods and eating behaviors. Both HEI and YHEI scores were calculated from a food frequency questionnaire that was mailed to participants in the Growing Up Today Study in 1996.

SUBJECTS/SETTING

Girls (n=8,807) and boys (n=7,645) 9 to 14 years of age who are children of participants in the Nurses Health Study II cohort and who reside across the United States.

STATISTICAL ANALYSIS

Mean HEI and YHEI scores were calculated by sex and age, and associations with age, body mass index, activity, inactivity, energy intake, and several nutrients were assessed with Pearson correlations. Linear regression was used to examine the contributions of the individual HEI and YHEI components toward the total scores.

RESULTS

The HEI score was highly correlated with total energy intake ( r =0.67), indicating a strong association with quantity of food consumption. In contrast, the YHEI was not strongly correlated with energy intake ( r =0.12) but was inversely associated with time spent in inactive pursuits ( r =-0.27). The HEI component for variety in food selection accounted for 60% of the variation in the total score and several HEI components were highly correlated with each other, particularly those for total and saturated fat ( r =0.78).

CONCLUSIONS

To successfully monitor diet in a population of children and adolescents, the HEI may benefit from modifications that focus on food quality and include assessments of unhealthful foods. Further research is needed to determine the dietary elements that are most related to health in diverse populations of youth.

Effect of ambience on food intake and food choice

Eating takes place in a context of environmental stimuli known as ambience. Various external factors such as social and physical surroundings, including the presence of other people and sound, temperature, smell, color, time, and distraction affect food intake and food choice. Food variables such as the temperature, smell, and color of the food also influence food intake and choice differently. However, the influence of ambience on nutritional health is not fully understood. This review summarizes the research on ambient influences on food intake and food choice. The literature suggests that there are major influences of ambience on eating behavior and that the magnitude of the effect of ambience may be underestimated. Changes in intake can be detected with different levels of the number of people present, food accessibility, eating locations, food color, ambient temperatures and lighting, and temperature of foods, smell of food, time of consumption, and ambient sounds. It is suggested that the manipulation of these ambient factors as a whole or individually may be used therapeutically to alter food intake and that more attention needs to be paid to ambience in nutrition-related research.

Factors of fruit and vegetable intake by race, gender, and age among young adolescents

OBJECTIVE

To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake.

DESIGN

Self-report questionnaires administered to a convenience sample of middle school students during regular classes.

PARTICIPANTS

Black and white adolescents, 11 to 15 years of age (N = 736).

VARIABLES MEASURED

Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics.

ANALYSIS

Chi-square, general linear models, and Poisson and linear regressions as appropriate.

RESULTS

Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice.

CONCLUSIONS AND IMPLICATIONS

Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children

OBJECTIVE

To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits.

DESIGN

Cross-sectional survey.

SETTING

Questionnaires were distributed to parents through 22 London nursery schools.

SUBJECTS

Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children.

RESULTS

Significant predictors of children's fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with child's vegetable consumption were mother's education and child's age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to child's gender and enjoyment of food.

CONCLUSIONS

These findings may be used to inform future interventions aimed at increasing children's consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years

It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.

Children's meal patterns have changed over a 21-year period: the Bogalusa Heart Study

OBJECTIVE

The objective of this study was to analyze children's meal patterns over 2 decades.

DESIGN

One 24-hour dietary recall was collected on each child who participated in one of seven cross-sectional surveys.

SUBJECTS/SETTING

Dietary intake data were collected on 1,584 10-year-old children (65% white, 35% African American), in Bogalusa, LA, from 1973 to 1994.

STATISTICAL ANALYSES

Descriptive statistics and one-way analysis of variance adjusting for gender and ethnicity.

RESULTS

From 1973 to 1978, there was a marked increase (P<.0001) in the percentage of children who skipped breakfast, from 8.2% to 29.6%. When school breakfast was introduced in 1981, the proportion of children skipping breakfast declined to 12.5% (P<.01). From 1973-1974 to 1993-1994, the percentage of children eating a school lunch declined from 89.7% (1973-1974) to 78.2% (1993-1994) (P<.001); eating lunch brought from home increased from 5.9% to 11.1% (P<.01); consuming a home dinner decreased from 89.2% to 75.9% (P<.01); eating a dinner prepared outside the home increased from 5.4% to 19.0% (P<.01); consuming a meal at a restaurant increased from 0.3% to 5.4% (P<.0001); consuming snacks decreased (P<.0001); total eating episodes decreased from 6.6 to 5.2 (P<.0001); and eating time span significantly decreased from 12.4 hours to 11.5 hours (P<.0001). Despite these changes in meal patterns, no associations were found between meal patterns and overweight status.

CONCLUSIONS

Striking alterations in the meal patterns of children occurred over the 2-decade period. These changes may have implications for the changes in the dietary intakes of children during the same time. However, data from this study do not support an association between meal patterns and children's overweight status. Further research with multiple days of assessment is needed to better understand the complexity of diet as it relates to childhood obesity.

Role of the physician in childhood obesity

OBJECTIVE

To suggest the role of the practicing physician in examining and treating childhood obesity. How should obesity be determined at clinical examination? Is there an obesity epidemic? What is the likely influence of obesity upon current and future health? What are the causes of obesity, and what does this imply for prevention and treatment?

DATA SOURCES

Relevant articles in Medline and personal files.

DATA SYNTHESIS

The 80th and 95th percentiles of body mass index and skinfold readings provide the most commonly accepted indices of overweight and obesity in the child. Over the last 20 years, the proportions of overweight and obese children have increased in both indigenous populations and most developed societies. Current methods of assessing physical activity and diet during childhood lack the precision to establish the primary cause of the obesity epidemic, but correlational analysis shows a close relationship between body fat content and a decline in daily energy expenditures. Immediate consequences of childhood obesity include an increased prevalence of atherosclerotic plaques, hypertension, and an adverse lipid profile, with a poor self-image that limits participation in physical activity. Tracking is such that many obese children become obese adults, and in consequence, the long-term risks of cardiovascular and all-cause deaths are increased. The prevention of obesity is easier than its cure. A combination of increased lifestyle activities, less sedentary behavior, and dietary modification seems the most effective approach. This should be supported by the use of behavioral modification techniques and changes in the urban environment that encourage an active lifestyle.

CONCLUSIONS

The pediatric physician can contribute to the control of obesity by monitoring body mass index and skinfold thicknesses in all patients. Children above the 50th percentile of body fat need dietary modification and a greater amount of moderate physical activity. Physicians should also advocate quality daily physical education and an environment that encourages adoption of an active lifestyle.

Calcium intake trends and health consequences from childhood through adulthood

Issues involving low calcium intake and dairy product consumption are currently the focus of much debate and discussion at both the scientific and lay community levels. In this review, we examine the following major areas of interest: (1). the role of calcium intake and dairy product consumption in chronic diseases, (2). nutritional qualities of milk and other dairy products, (3). trends in calcium intake and dairy product consumption, (4). current status of calcium intakes and dairy product consumption in children, (5). tracking of calcium intake and diary product consumption, (6). the impact of school meal participation on calcium intake and dairy product consumption, (7). concerns related to calcium-fortified foods and beverages and (8). factors influencing children's milk consumption. To date, the findings indicate that calcium intake and dairy product consumption have beneficial roles in a variety of chronic diseases; dairy products provide an abundant source of vitamins and minerals; calcium intakes of children have increased over time, yet intakes are not meeting the current adequate intake (AI) calcium recommendations; dairy consumption has decreased, and soft drink consumption and, possibly, consumption of calcium-fortified products have increased; consumption of dairy products have a positive nutritional impact on diets of children, particularly from school meals, and there are many factors which influence children's milk consumption, all of which need to be considered in our efforts to promote adequate calcium intakes by children. Based on this review, areas that need immediate attention and future research imperatives are summarized in an effort to further our understanding on what we already know and what we need to know to promote healthier eating habits early in life.

Parents are key players in the prevention and treatment of weight-related problems

There is growing agreement among experts that an obesogenic environment, which encourage excess food intake and idealizes thinness, plays a crucial role in the epidemic of childhood obesity and eating disorders. Because parents provide a child's contextual environment, they should be considered key players in interventions aimed at preventing or treating weight-related problems. Parenting style and feeding style are crucial factors in fostering healthy lifestyle and awareness of internal hunger and satiety cues and de-emphasizing thinness. Effective interventions for prevention and treatment of weight-related problems should be approached from a health-centered rather than a weight-centered perspective, with the parents as central agents of change. This paper reviews the environmental risk factors and parents' role in the prevention and treatment of children's weight-related problems.

The family context of an intervention to prevent type 2 diabetes in high-risk teens

PURPOSE

This research describes the family context of eating and mealtime patterns in young adolescents at high risk for type 2 diabetes and the implications for preventing this disease.

METHODS

Ten families, each consisting of a child and one parent, participated in individual, semistructured interviews that focused on family eating patterns. Topics included meal schedules, food preparation, family eating patterns, school eating patterns, and perception of the child's weight. Interviews were audiotaped, transcribed verbatim, and analyzed using focused summaries and thematic analysis methods.

RESULTS

Four main themes were identified: child and family eating patterns, perspectives on obesity, perspectives on weight control, and health concerns. Family eating patterns were often inconsistent, and few healthy eating models were available at home or school. Obesity was not always seen as a negative factor, particularly by the youth. Weight-control efforts were sporadic, typically unsuccessful, and consisted primarily of intermittent increases in physical activity. Parents did not actively participate in their child's weight-control efforts.

CONCLUSIONS

Effective interventions for obesity and prevention of type 2 diabetes in youth should include parents in both cognitive and behavioral strategies.

Meal and snack patterns of infants and toddlers

OBJECTIVE

To describe meal and snack patterns of infants and toddlers.

DESIGN

A cross-sectional telephone survey in which mothers reported their infants' and toddlers' food and beverage intakes for a 24-hour period.

SUBJECTS

Subjects included 3,022 infants and toddlers, ages 4 to 24 months, in the Feeding Infants and Toddlers Study.

STATISTICAL ANALYSES PERFORMED

Means+/-standard deviations, frequencies, percentages, energy and nutrient analyses, nutrient densities.

RESULTS

On average, infants and toddlers were fed seven times per day. The breakfast, lunch, and dinner pattern, plus snacks, emerged at 7 to 8 months and was well established by 9 to 11 months. Breakfasts were higher in nutrient density for iron, folate, and calcium than other meals. The percentage of children reported to be eating snacks increased with age. The afternoon snack was consumed by over 80% of toddlers (12 to 24 months), and snacks provided about 25% of toddlers' daily energy intakes. Typical snack foods for toddlers were milk, water, cookies, crackers, chips, and fruit drinks.

APPLICATIONS/CONCLUSIONS

Results of this study provide parents and professionals with specific information about meal and snack patterns, thereby allowing development of targeted messages and/or strategies to improve the dietary patterns of infants and toddlers. Although most foods provided to the Feeding Infants and Toddlers Study infants and toddlers were nutritionally and developmentally appropriate, snack choices could be improved by delaying introduction of and limiting exposures to foods low in nutrients and high in calories.

Effects of fast-food consumption on energy intake and diet quality among children in a national household survey

BACKGROUND

Fast food has become a prominent feature of the diet of children in the United States and, increasingly, throughout the world. However, few studies have examined the effects of fast-food consumption on any nutrition or health-related outcome. The aim of this study was to test the hypothesis that fast-food consumption adversely affects dietary factors linked to obesity risk.

METHODS

This study included 6212 children and adolescents 4 to 19 years old in the United States participating in the nationally representative Continuing Survey of Food Intake by Individuals conducted from 1994 to 1996 and the Supplemental Children's Survey conducted in 1998. We examined the associations between fast-food consumption and measures of dietary quality using between-subject comparisons involving the whole cohort and within-subject comparisons involving 2080 individuals who ate fast food on one but not both survey days.

RESULTS

On a typical day, 30.3% of the total sample reported consuming fast food. Fast-food consumption was highly prevalent in both genders, all racial/ethnic groups, and all regions of the country. Controlling for socioeconomic and demographic variables, increased fast-food consumption was independently associated with male gender, older age, higher household incomes, non-Hispanic black race/ethnicity, and residing in the South. Children who ate fast food, compared with those who did not, consumed more total energy (187 kcal; 95% confidence interval [CI]: 109-265), more energy per gram of food (0.29 kcal/g; 95% CI: 0.25-0.33), more total fat (9 g; 95% CI: 5.0-13.0), more total carbohydrate (24 g; 95% CI: 12.6-35.4), more added sugars (26 g; 95% CI: 18.2-34.6), more sugar-sweetened beverages (228 g; 95% CI: 184-272), less fiber (-1.1 g; 95% CI: -1.8 to -0.4), less milk (-65 g; 95% CI: -95 to -30), and fewer fruits and nonstarchy vegetables (-45 g; 95% CI: -58.6 to -31.4). Very similar results were observed by using within-subject analyses in which subjects served as their own controls: that is, children ate more total energy and had poorer diet quality on days with, compared with without, fast food.

CONCLUSION

Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.

Impact of television viewing patterns on fruit and vegetable consumption among adolescents

BACKGROUND

National data indicate that children and youth do not meet Healthy People 2010 objectives for fruit and vegetable intake. Television viewing is hypothesized as a contributing factor because of its documented role in encouraging consumption of highly advertised foods that may lead to the replacement of fruits and vegetables.

METHODS

A sample of 548 ethnically diverse students (average age: 11.7 +/- 0.8 years) from public schools in 4 Massachusetts communities were studied prospectively over a 19-month period from October 1995 to May 1997. We examined the associations between baseline and change in hours of television and video viewing per day (the predictor variables) and change in energy-adjusted intake of fruits and vegetables by using linear regression analyses to control for potentially confounding variables and the clustering of observations within schools.

FINDINGS

For each additional hour of television viewed per day, fruit and vegetable servings per day decreased (-0.14) after adjustment for anthropometric, demographic, dietary variables (including baseline percent energy from fat, sit-down dinner frequency, and baseline energy-adjusted fruit and vegetable intake), and physical activity. Baseline hours of television viewed per day was also independently associated with change in fruit and vegetable servings (-0.16).

CONCLUSIONS

Television viewing is inversely associated with intake of fruit and vegetables among adolescents. These associations may be a result of the replacement of fruits and vegetables in youths' diets by foods highly advertised on television.

Commensal eating patterns: a community study

Commensality is eating with other people, and commensal eating patterns reflect the social relationships of individuals. This study examined usual meal partners in commensal units and frequency of eating with others in commensal circles among 663 adults responding to a mailed questionnaire in one community. Meal partner data revealed that most respondents ate alone at breakfast, alone or with co-workers at lunch, and with family members at dinner. Commensal frequency data revealed some eating at the homes of other family members, little eating at friends' homes, and almost no eating at neighbors' homes. Few demographic variations existed in commensal eating, except that unmarried individuals more often ate breakfast and dinner alone and more often ate with friends. These finding suggest that contemporary work-oriented society may lead people to eat alone during the day but share evening meals with family, and that people maintain commensal relationships primarily with family members rather than friends or neighbors. Peoples' social worlds appear to be focused on the nuclear family, and family members are also the people they usually eat with.

Influences on adolescent eating patterns: the importance of family meals

PURPOSE

To provide national estimates of the frequency and determinants of adolescents' consumption of fruits, vegetables, and dairy foods.

METHODS

Analyses were based on 18,177 adolescents in the first interview of the National Longitudinal Study of Adolescent Health. Multivariate logistic regressions provide estimates of the unique contribution of sociodemographic characteristics, body weight perception, and parental influences on adolescent food consumption.

RESULTS

Almost one in five adolescents reported skipping breakfast the previous day. A large percentage of adolescents reported eating less than the recommended amount of vegetables (71%), fruits (55%), and dairy foods (47%). Adolescents with better-educated parents had better consumption patterns than those with less-educated parents. Consumption patterns differed significantly by race. Adolescents who perceived themselves to be overweight were significantly more likely to have poor consumption patterns. Parental presence at the evening meal was associated with a lower risk of poor consumption of fruits, vegetables, and diary foods as well as the likelihood of skipping breakfast.

CONCLUSION

Parental presence at the evening meal is positively associated with adolescents' higher consumption of fruits, vegetables, and dairy foods. Nutrition and health professionals should educate parents about the role of family mealtimes for healthy adolescent nutrition.

Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents

OBJECTIVE

To examine family meal patterns and associations with sociodemographic characteristics and dietary intake in adolescents.

DESIGN

A population-based cross-sectional study design was employed. Adolescents completed the Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire within their schools. Subjects/setting The study population included 4,746 middle and high school students from Minneapolis/St. Paul public schools with diverse racial and socioeconomic backgrounds. Statistical analyses Associations were examined using cross tabulations, log-linear modeling, and linear regressions.

RESULTS

There was a wide distribution in the frequency of family meals during the previous week: never (14.0%), 1 or 2 times (19.1%), 3 to 6 times (40.1%), and 7 or more times (24.8%). Sociodemographic characteristics associated with more frequent family meals included gender (boys), school level (middle school), race (Asian American), mother's employment status (not employed), and socioeconomic status (high). Frequency of family meals was positively associated with intake of fruits, vegetables, grains, and calcium-rich foods and negatively associated with soft drink consumption. Positive associations were also seen between frequency of family meals and energy; protein (percentage of total calories); calcium; iron; folate; fiber; and vitamins A, C, E, and B-6.

CONCLUSIONS

Family meals appear to play an important role in promoting positive dietary intake among adolescents. Feasible ways to increase the frequency of family meals should be explored with adolescents and their families.

Sandwiching it in: spillover of work onto food choices and family roles in low- and moderate-income urban households

Lower status jobs, high workloads and lack of control at work have been associated with less healthful diets, but the ways through which work is connected to food choices are not well understood. This analysis was an examination of workers' experience of the relationship of their jobs to their food choices. Fifty-one multi-ethnic, urban, low- and moderate-income adults living in Upstate New York in 1995 participated in a qualitative interview study of fruit and vegetable choices and discussed employment and food choices. The workers who participated in this study described a dynamic relationship between work and food choices that they experienced in the context of their other roles and values. These workers presented a relationship that was characterized by positive and negative spillover between their jobs and their ability to fulfill family roles and promote personal health, linked by a spectrum of food choice strategies. Participants' narratives fit into three different domains: characterizations of work and their resources for food choice, strategies used to manage food choices within the constraints of work, and affect related to the negative and positive spillover of these strategies on family roles and on personal food choices. Characterizations of work as demanding and limiting or demanding and manageable differentiated participants who experienced their food choice strategies as a source of guilt and dissatisfaction (negative spillover) from those who experienced food choices as a source of pride and satisfaction (positive spillover). Ideals and values related to food choice and health were balanced against other values for family closeness and nurturing and personal achievement. Some participants found work unproblematic. These findings direct attention to a broad conceptualization of the relationship of work to food choices in which the demands and resources of the work role are viewed as they spill over into the social and temporal context of other roles and values.

Parental weight status and girls' television viewing, snacking, and body mass indexes

OBJECTIVE

The purpose of this study was to examine whether television viewing (TVV) provides a context for patterns of snacking fostering overweight in young girls from overweight and non-overweight families.

RESEARCH METHODS AND PROCEDURES

Participants were 173 non-Hispanic white girls and their parents from central Pennsylvania, assessed longitudinally when girls were 5, 7, and 9 years old. Path analysis was used to test patterns of relationships among girls' TVV, snacking while watching television, snacking frequency, fat intake from energy-dense snack food, and girls' increase in body mass index (BMI) from age 5 to 9.

RESULTS

In both overweight and non-overweight families, girls who watched more television consumed more snacks in front of the television. In families where neither parent was overweight, television viewing was the only significant predictor of girls' increase in BMI. In families where one or both parents were overweight, girls who watched more television snacked more frequently, and girls who snacked more frequently had higher intakes of fat from energy-dense snacks, which predicted their increase in BMI from age 5 to 9. TVV did not directly predict girls' increase in BMI in girls from overweight families.

DISCUSSION

The results of this study support and extend previous findings that have shown that excessive television viewing and snacking patterns are risk factors for the development of overweight in children; however, patterns of relationships may differ based on parental weight status. For overweight families, TVV may provide a context for excessive snack consumption, in addition to inactivity.

Childhood obesity: public-health crisis, common sense cure

During the past two decades, the prevalence of obesity in children has risen greatly worldwide. Obesity in childhood causes a wide range of serious complications, and increases the risk of premature illness and death later in life, raising public-health concerns. Results of research have provided new insights into the physiological basis of bodyweight regulation. However, treatment for childhood obesity remains largely ineffective. In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors for which straightforward, if politically difficult, solutions exist.