Biocultural construction of obesogenic ecologies of childhood: Parent-feeding versus child-eating strategies

The now and future of human biology at the extremes: An introduction to the special issue

OBJECTIVES

A hallmark of the human species is our adaptability to a wide range of different ecologies and ecosystems, including some of the most extreme settings. Human biologists have long studied how humans have successfully (and sometimes unsuccessfully) adapted to such extremes, particularly ecological extremes like environments at lower limits of temperature and high altitude. In this special issue, we revisit traditional definitions and explore new conceptions of work in extreme environments. We argue that our definitions of extremes should change with our changing world, and account for extremes unique to the Anthropocene, including environments of inequality and precarity, pandemic landscapes, climate-impacted settings, obesogenic environments, and the environments of human spaceflight. We also explore the future of work at the extremes and provide some suggested guidelines on how human biologists can continue to build and expand on foundational work in this area.

CONCLUSION

While human biologists have done critical work on groups living in extreme environments, our definitions of humans at the limits continue to change as the world around us also changes. Scholars in this area have a responsibility to re-examine the parameters of extremes to stay at the forefront of scientific exploration and collaboration so human biology, as a discipline, can continue to shape our understanding of adaptability, and thus contribute to the continued thriving of all humans as we endure new climatic, environmental, and societal extremes.

Associations between socioeconomic status, home food availability, parental role-modeling, and children's fruit and vegetable consumption: a mediation analysis

BACKGROUND

Recent literature has suggested that associations and interactions between family socioeconomic status (SES) and home food environment influence children's diet, but little is known about the mediation roles of parental role-modeling and food availability in the socioeconomic inequalities of children's diet. This study aimed to determine the associations between family SES and children's fruit and vegetable (FV) consumption and to assess the mediation roles of parental role-modeling and food availability in the above associations.

METHODS

Cross-sectional data of 574 Finnish children (aged 3 to 6) were analyzed. Parents completed an FFQ assessing their children's FV consumption frequency and a questionnaire assessing SES and home food environment. Two exposure variables: parental educational level ("low", "middle", and "high") and the relative family income tertiles of the family were used. The frequencies of parental role-modeling of FV and sugary food and drink (SFD) consumption, and the availability of FV and SFD at home were calculated. Single- and multiple-mediator models were created using IBM SPSS 27.0.

RESULTS

The positive association between high parental educational level and children's FV consumption (direct effect coefficient: 2.76, 95% CI: 0.51-4.86) was partially mediated by more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.89, 95% CI: 0.10-1.76), higher availability of FV (indirect effect coefficient: 1.00, 95% CI: 0.35-1.77), and lower availability of SFD (indirect effect coefficient: -0.30, 95% CI: -0.72 - -0.01). The relative family income was not directly associated with the outcome. However, the higher relative family income level indirectly predicted the Children's FV consumption (full mediation) through more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.91, 95% CI: 0.06-1.83) and higher availability of FV (indirect effect coefficient: 0.98, 95% CI: 0.40-1.67). Parental role-modeling on SFD consumption did not mediate any of the above associations.

CONCLUSIONS

Parental educational level showed more associations with children's FV consumption than relative family income. Our findings suggest that reducing the availability of SFD is as important as increasing the availability of FV to enhance children's FV consumption. Future interventions to improve children's dietary behaviors should pay greater attention to the lower SES segments of society. Longitudinal studies and intervention studies supporting these findings are needed for making meaningful recommendations for health promotion.

Fat Is All My Fault: Globalized Metathemes of Body Self-blame

Norms valorizing not-fat bodies appear to have spread around the world, combined with a globalizing belief that thinness is the result of individual management of self and hard work. We examine themes of blame and felt responsibility for weight and "fat" in four distinct geographic and cultural locations: peri-urban Georgia, United States; suburban Osaka, Japan; urban Encarnación, Paraguay; and urban Apia, Samoa. Use of a novel metatheme approach that compares and contrasts these four distinct places characterized by different population-level prevalences of obesity and by specific cultural histories relevant to body norms and ideals provides a flexible toolkit for comparative cross-cultural/multi-sited ethnographic research. We show that self-blame, marked by an articulated sense of individual responsibility for weight and a sense of failing in this responsibility, is present in every field site, but to varying degrees and expressed in different ways. [fat, obesity, metatheme, stigma, self-blame].

Young adult nutrition and weight correlates of picky eating during childhood

OBJECTIVE

To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood.

DESIGN

A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008-2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height.

SETTING

Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998-1999.

PARTICIPANTS

The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years).

RESULTS

Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults' weight status, use of weight-control strategies or report of binge eating.

CONCLUSIONS

While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.

An exploration of the longitudinal relation between parental feeding practices and child anthropometric adiposity measures from the West Midlands Active Lifestyle and Healthy Eating in Schoolchildren (WAVES) Study

Background

Some research suggests that parent or carer feeding practices may influence children's weight patterns, but longitudinal evidence is limited and inconsistent.

Objective

The aim of this study was to investigate the relation between various parent or carer feeding practices when a child is aged 7-8 y and proxy measurements of child adiposity at age 8-9 y (weight status, waist-to-height ratio, and body fat percentage).

Design

The study was a secondary analysis of data from the West Midlands Active Lifestyle and Healthy Eating in Schoolchildren (WAVES) Study comprising a diverse sample of parents and carers and their children from 54 primary schools in the West Midlands, England [n = 774 parent-child dyads (53% of the WAVES study sample)]. Information on feeding practices was collected with the use of subscales from the Comprehensive Feeding Practices Questionnaire, completed by the child's main parent or carer (self-defined). Child height, weight, bioelectrical impedance, and waist circumference were measured and converted into 3 proxy measurements of adiposity (weight status, waist-to-height ratio, and body fat percentage). Associations between these measurements and parent or carer feeding practices were examined with the use of mixed-effects logistic regression models.

Results

Of the questionnaire respondents, 80% were mothers, 16% were fathers, and 4% were other carers. Median standardized subscale scores ranged from 1.7 (emotion regulation: IQR = 1.0) to 4.0 (monitoring and modeling: IQR = 1.5), and significantly different subscale scores were present between child weight statuses for emotion regulation, pressure to eat, and restriction for weight control. Logistic regression modeling showed that when baseline adiposity measures were included as covariates, all associations between parental feeding practices at age 7-8 y and measures of adiposity at age 8-9 y were attenuated.

Conclusions

Observed relations between various parental feeding practices and later adiposity are mitigated by inclusion of the baseline adiposity measure. This finding lends support to the theory of reverse causation, whereby the child's size may influence parental choice of specific feeding practices rather than the child's subsequent weight status being a consequence of these feeding practices.

Cultural consensus modeling to measure transactional sex in Swaziland: Scale building and validation

Transactional sex is associated with increased risk of HIV and gender based violence in southern Africa and around the world. However the typical quantitative operationalization, "the exchange of gifts or money for sex," can be at odds with a wide array of relationship types and motivations described in qualitative explorations. To build on the strengths of both qualitative and quantitative research streams, we used cultural consensus models to identify distinct models of transactional sex in Swaziland. The process allowed us to build and validate emic scales of transactional sex, while identifying key informants for qualitative interviews within each model to contextualize women's experiences and risk perceptions. We used logistic and multinomial logistic regression models to measure associations with condom use and social status outcomes. Fieldwork was conducted between November 2013 and December 2014 in the Hhohho and Manzini regions. We identified three distinct models of transactional sex in Swaziland based on 124 Swazi women's emic valuation of what they hoped to receive in exchange for sex with their partners. In a clinic-based survey (n = 406), consensus model scales were more sensitive to condom use than the etic definition. Model consonance had distinct effects on social status for the three different models. Transactional sex is better measured as an emic spectrum of expectations within a relationship, rather than an etic binary relationship type. Cultural consensus models allowed us to blend qualitative and quantitative approaches to create an emicly valid quantitative scale grounded in qualitative context.

Parental feeding behaviour and motivations regarding pre-school age children: A thematic synthesis of qualitative studies

Poor childhood diet is a major risk factor for disease and obesity, and parents of pre-school children are in a powerful position to influence diet for life. The technique of thematic synthesis (Thomas & Harden, 2008) was used to synthesise recent qualitative research on parental feeding of pre-school age children (18 months-6 years). The aim was to inform development of nutrition advice by gaining a comprehensive picture of parental feeding behaviours and motivations. Six key parental feeding behaviours were identified: modelling, rewards, pressure and encouragement, repeated exposure, creativity, and limiting intake. Four overarching themes regarding motivations were identified: promoting good health (balance and variety, and weight control); building positive relationships (child involvement, and parental engagement and responsiveness); practicalities and constraints (time, cost, and lack of culinary skill, and pressure and flexibility); and emotional motivations (problem avoidance, and emotional investment). Practicalities and constraints, and emotional motivations impacted more significantly on low income parents. In order to be effective, nutrition advice ought to tap into parents' strong desire to build positive relationships and promote good health while remaining sensitive to the significant constraints and practicalities faced.

How parents process child health and nutrition information: A grounded theory model

The aim of the present study was to investigate low-income parents' experiences receiving, making meaning of, and applying sociocultural messages about childhood health and nutrition. Semi-structured interviews were conducted with parents from 16 low-income Early Head Start families. Verbatim interview transcripts, observations, field notes, documentary evidence, and follow-up participant checks were used during grounded theory analysis of the data. Data yielded a potential theoretical model of parental movement toward action involving (a) the culture and context influencing parents, (b) parents' sources of social and cultural messages, (c) parental values and engagement, (d) parental motivation for action, (e) intervening conditions impacting motivation and application, and (f) parent action taken on the individual and social levels. Parent characteristics greatly impacted the ways in which parents understood and applied health and nutrition information. Among other implications, it is recommended that educators and providers focus on a parent's beliefs, values, and cultural preferences regarding food and health behaviors as well as his/her personal/family definition of "health" when framing recommendations and developing interventions.

Persistent optimizing: how mothers make food choices for their preschool children

Mothers' ability to provide healthy food choices for their children has become more complex in our current obesogenic environment. We conducted a total of 35 interviews with 18 mothers of preschool children. Using constructivist grounded theory methods, we developed a substantive theory of how mothers make food choices for their preschoolers. Our substantive theory, persistent optimizing, consists of three main integrated conceptual categories: (a) acknowledging contextual constraints, (b) stretching boundaries, and (c) strategic positioning. Implications to improve mothers' ability to make healthy food choices that reduce their children's risk of becoming overweight or obese are discussed.

Evaluating the effect of energy-dense foods consumption on preschool children's body mass index: a prospective analysis from 2 to 4 years of age

PURPOSE

The aim of this study was to study the association between the consumption of energy-dense foods at 2 years and body mass index (BMI) at 4 years, using a cross-lagged panel design.

METHODS

The present study included 589 children evaluated at 2 and 4 years of age, as part of the birth cohort generation XXI. Information was obtained by face-to-face interviews. Consumption of energy-dense foods (salty snacks, soft drinks, cakes, and sweets) was measured using a food frequency questionnaire. Children's weight and height were measured by standard procedures, and BMI standard deviation scores (BMI z-scores) were calculated according to the World Health Organization. Linear regression and cross-lagged panel design models were fitted to estimate the associations between the consumption of energy-dense foods and BMI z-scores (controlled for maternal age, education and prepregnancy BMI, and children's exact age at 2 years).

RESULTS

The consumption of energy-dense foods at 2 years was significantly associated with their consumption at 4 years (β = 0.522, 95% CI 0.432-0.612). Children's BMI z-scores at 2 years were associated with posterior BMI z-scores (β = 0.747, 95% CI 0.688-0.806). In the cross-lagged analysis, consumption of energy-dense foods at 2 years had no effect on subsequent BMI z-scores (β = -0.030, 95% CI -0.095 to 0.035) and BMI z-scores at 2 years were not significantly associated with the consumption of energy-dense foods at 4 years (β = -0.012, 95% CI -0.086 to 0.062).

CONCLUSIONS

Consumption of energy-dense foods and BMI tracked over time, but the consumption of energy-dense foods at 2 years was not associated with BMI z-scores at 4 years.

Anxiety and depression levels in prepubertal obese children: a case-control study

INTRODUCTION

Childhood obesity has become a worldwide epidemic in Western and in developing countries and has been accompanied by many serious and severe comorbidities, such as diabetes, hypertension, sleep apnea syndrome, depression, dyslipidemia, impaired glucose homeostasis, steatohepatitis, and intracranial hypertension, as well as medical concerns unique to youth, such as accelerated pubertal and skeletal development and orthopedic disorders. To date, no specific studies about the psychological assessment in pediatric obesity are present. Therefore, the aim of this study was to evaluate the putative relationship between psychological troubles and obesity in a sample of school-aged children.

MATERIALS AND METHODS

The study population consists of 148 obese subjects (body mass index [BMI] >95th percentile) (69 males, mean age 8.9±1.23 years) consecutively referred from clinical pediatricians to the Child and Adolescent Neuropsychiatry department at the Second University of Naples. In all subjects, weight, height, and BMI z-score were evaluated. In order to assess the anxiety levels and the presence of depressive symptoms, the Children Depression Inventory (CDI) and the Italian Self-Administered Psychiatric Scales for Children and Adolescents (SAFA) were administered. The control group consisted of 273 healthy children (129 males and 144 females) (mean age 9.1±1.8 years), enrolled in schools within the Campania region of Italy.

RESULTS

No significant differences between the two study groups were found for age (8.9±1.23 years in the obese sample and 9.1±1.8 years in the control group) (P=0.228) or sex (ratio male/female: 69/79 in the obese group versus 129/144 in the control group) (P=0.983). Obviously, significant difference was found for the BMI z-score (2.46±0.31 in the obese group vs 0.73±0.51 in the control group) (P<0.001). The obese subjects showed significant higher level of depressive symptoms (CDI total score) (16.82±7.73 vs 8.2±2.9) (P<0.001) and anxiety (SAFA - Anxiety [SAFA-A]) scale score (58.71±11.84 vs 27.75±11.5) (P<0.001) compared with the control group. Moreover, the Pearson's correlation analysis showed a significantly positive relationship between the BMI z-score and both the CDI (r=0.677; P<0.001) and SAFA-A scores (r=0.591; P<0.001).

CONCLUSION

Our findings highlighted the importance of assessing the presence of internalizing problems, such as anxiety and depression, in the common management of childhood obesity.

The family meal panacea: exploring how different aspects of family meal occurrence, meal habits and meal enjoyment relate to young children's diets

The general consensus in the research to date is that family meals are linked to healthier eating habits in children, compared to not eating with the family. Yet, few studies explore what it is about commensality which leads to better food choices among children. Using a representative Scottish sample of five-year-old children, this research explores the extent to which family meal occurrence, meal patterns regarding where, when and with whom children eat and perceived meal enjoyment predict the quality of children's diets after controlling for indicators of maternal capital that influence both meal rituals and taste preferences. Eating the same food as parents is the aspect of family meals most strongly linked to better diets in children, highlighting the detrimental effect in the rise of 'children's food'. Although theoretical and empirical work pointed to the important health advantage in children eating together with parents, the results suggested that eating together was a far less important aspect of family meals. In evaluating the importance of the family meal, this article redirects attention away from issues of form and function towards issues of food choice. Policy implications and the importance for public health to recognise the way eating habits are defined by and reproduce social and cultural capital are discussed.

Beyond the reproduction of official accounts: parental accounts concerning health and the daily life of a California family

Considering the purported bias of interviews to elicit "official accounts"--conveying conventional teachings from health promotion--and limited insights individuals may have into their own health behaviors, the challenges of relating health as talk (directed at researchers) to health as enacted are examined. Focusing on one family from a study of dual-earner middle-class Los Angeles families, I propose and apply four analytic lenses to a conjoint analysis of ethnographic interviews and videorecordings of family life to examine the parental claim that their family is a "healthy family." Findings indicate that parental accounts enable deeper insights into health as entrenched in everyday life, here revealing the centrality of a relational view of health as "family well-being" (vs. individual health) extending into the social world. Discussion considers debates over the extent to which "discursive consciousness" in interview settings illuminates health-relevant practices in everyday life contexts.

The "childhood obesity epidemic": health crisis or social construction?

There has been a meteoric rise over the past two decades in the medical research and media coverage of the so-called global childhood obesity epidemic. Recently, in response to this phenomenon, there has been a spate of books and articles in the fields of critical sociology and cultural studies that have argued that this "epidemic" is socially constructed, what Natalie Boero (2007) dubs a "postmodern epidemic." As an anthropologist who has studied child nutrition and obesity in relation to poverty and the school environment, I am concerned about both the lack of reflexivity among medical researchers as well as critical scholars' treatment of the problem as entirely socially constructed. In this article I present both sides of this debate and then discuss how wee can attempt to navigate a middle course that recognizes this health issue but also offers alternative approaches to those set by the biomedical agenda.

Nonprescription antibiotic therapy: cultural models on both sides of the counter and both sides of the border

Antibiotic resistance is a global public health threat exacerbated by medically unwarranted or improper antibiotic use. Pharmacy counters at the U.S.-Mexico border provide an example of where lay decisions to use antibiotics in ways considered "risky" may be initiated and negotiated. We test how cultural and public health knowledge of antibiotics is distributed among pharmacy staff, local Mexican clients, and U.S. medical tourists in the bordertown of Nogales using a cultural consensus tool. We find that shared cultural models across these groups include public health statements; however, other shared statements are likely to reinforce antibiotic sales at pharmacy counters by those on both sides of the purchase as economic, rather than therapeutic, encounters. From a public health perspective, border pharmacy counters are not a location where increased "safe" knowledge about antibiotic use is being transmitted. However, we do find a positive relationship between "safe" knowledge and reductions in risky behavior.

Unpacking dietary acculturation among new Americans: results from formative research with African refugees

Epidemiological studies focusing on Latino immigrant health have found links between acculturation (time and language competency), weight gain, and disease risk. Since time and language competency are not mechanisms by which diets and activities change, associations between acculturation and weight change offer little to public health professionals who aim to develop nutrition and health interventions. We present a conceptual model and use a mixed-methods biocultural approach to address the fine-grained details of diet and activity choice for new arrivals to the USA. The results of our anthropological work with Liberian and Somali Bantu refugees indicate that, in addition to standard surveys (individual-level characteristics, socioeconomic status, employment, and acculturation), epidemiological research would benefit from the data generated from ethnography and more nuanced behavioral studies. A focus on the lived experiences of new Americans and the explicit examination of institutional support, peer support, and interactions between children and caretakers might offer points of intervention for immigrant health which is a growing public health concern.

Reliability of the Nursing Child Assessment Feeding Scale during toddlerhood

The quality of the maternal-child feeding interaction has been proposed to be an important contributor to a child's being overweight, yet assessment of this proposition has been hindered by a lack of age-appropriate instrumentation. The primary aim of this study was to examine the reliability of the Nursing Child Assessment of Feeding Scale (NCAFS) if extended to use during toddlerhood. A longitudinal design was used to assess NCAFS reliability at 12, 24, and 36 months. The NCAFS was used to code videotaped feeding observations of 116 mother-toddler dyads collected as part of a larger study examining mother-child interactions and adaptations of toddlers. Reliability was explored through the assessment of interrater reliability, internal consistency of the various subscales and the scale as a whole, and stability of the scale measurements over time. At each age, interrater reliability was generally quite good whereas the NCAFS' internal consistency was low. Maternal contributions to feeding interaction quality were stable over time but dyadic and child contributions were not. The lower internal consistency estimates were likely due to relatively low levels of variance among the dyads within each age. Another probable contributor to diminished internal consistency was the attrition of several behavior items due to zero variance. Possible explanations for this restriction of variance and several approaches for improving the NCAFS internal consistency during toddlerhood are considered. With revision, the NCAFS could be useful in assessment of feeding interaction quality during the transition to toddlerhood when issues of control and autonomy become increasingly prominent.