Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity

Examining parents' experiences and challenges of feeding preschool children with avid eating behaviour

Avid eating behaviours, including greater responsiveness to food cues and emotional over-eating, have been linked to child overweight and obesity. Parental feeding practices are modifiable components of a child's food environment and may be key levers for behaviour change in tailored interventions to support parents of children with avid eating behaviour. However, there is a lack of research examining parents' experiences in this context. This study aimed to explore parents' experiences of feeding children with avid eating behaviour and to understand any challenges experienced in this context. Semi-structured interviews with parents (N = 15) of a preschool child (3-5 years) identified as having an avid eating behaviour profile explored how children's avid eating manifests, the parental feeding practices used to manage avid eating, and the perceived effectiveness of these strategies. Data were analysed using reflexive thematic analysis. Four core themes were generated. Theme one, 'Have they got worms? Children's insatiable hunger', captures parents' interpretation of the complex ways in which avid eating behaviour manifests. Theme two, 'Parenthood as a duty', illustrates how parents' perceived responsibilities shape their feeding practices. Theme three, 'Lifelong habits', captures parents' use of responsive feeding practices to support children's healthy relationship with food. Theme four, 'Picking battles', captures the structure- and coercive-based feeding strategies commonly used to manage children's avid eating. This novel study provides an in-depth understanding of the complex ways that children's avid eating behaviour manifests, and the strategic and creative parental feeding practices used to manage these behaviours. Such findings are valuable for informing the development of future support resources for parents/caregivers to help their children with avid eating behaviours to develop a healthy relationship with food.

A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

"A balancing act": parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment

Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.

Profiles of Cultural Adaptation and Parenting Approach for Childhood Obesity in Lifestyle Interventions for Families With Young Children: A Systematic Review

BACKGROUND AND OBJECTIVES

Various interventions aim to reduce obesity and promote healthy lifestyles among different cultural groups.

METHODS

We have conducted a systematic literature review, following PRISMA guidelines (registered at https://doi.org/10.17605/OSF.IO/HB9AX), to explore profiles of cultural adaptation and parenting approach of lifestyle interventions for families with young children (1-4 years).

RESULTS

Our search (in CINAHL, ERIC, PsycINFO, PubMed, Scopus, and SSCI) yielded 41 studies reporting 31 interventions. Drawing on Intervention Mapping, we applied a newly developed framework with various indicators of cultural adaptation and a parenting approach to analyze interventions. Our review shows clear differences in the level of cultural adaptation. A categorical principal component analysis revealed 6 different empirical profiles of cultural adaptation.

CONCLUSIONS

Based on our profiles, we discuss how cultural adaptation can be strengthened in the design of future early interventions aimed at promoting a healthy lifestyle.

Experiences of parents of children with corrosive esophageal ingestion: a qualitative study

PURPOSE

To describe the experiences of parents of children treated for corrosive esophageal ingestion.

METHODS

In-depth interviews were conducted with 17 parents (nine mothers and eight fathers) of children who had suffered a corrosive esophageal ingestion requiring hospitalization. Online interviews were also conducted with parents of children who were still undergoing treatment for corrosive esophageal ingestion. The interview guide explored the parents' overall experiences and included research questions that explored the participants' perceptions, thoughts, feelings and problems. The interviews were digitally recorded and transcribed verbatim. Inductive reflective thematic analysis was performed using MAXQDA.

RESULTS

Analysis of the interview transcripts generated three themes and nine sub-themes describing parents' experiences: emotional consequences, social consequences and facilitators. The results reveal that caregivers experienced anxiety and difficulties, prompting them to seek support from their family and social environment.

CONCLUSION

These findings highlight the importance of identifying and understanding parental experiences. This understanding will also enable healthcare professionals to optimize the parental experience in caring for children with corrosive esophageal ingestion within a holistic clinical service. Understanding the experiences of children with corrosive esophageal ingestion from the parents' perspective identifies opportunities for systematic treatment and care.

A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions

Danish children have a much larger intake of sugar-rich foods and drinks than recommended. This study aimed to (1) explore social aspects and practices of pre-school children's intake of sugar-rich foods and drinks and (2) evaluate barriers and parental strategies to reduce their children's intake of sugar-rich foods and drinks employed in connection with the 3.5-month family-centred intervention trial 'Are you too sweet?'. Intervention components included communication of the recommended maximum intake and reduction strategies, supported by resources encouraging and facilitating behavioural changes. A random sample of families (n = 24) from intervention schools participated in post-intervention semi-structured interviews. A thematic content analysis was conducted, revealing three main domains of social practices: (1) 'family treats', including the weekly Danish concept 'Friday sweets', (2) 'everyday treats', such as sweet snacks in lunch packs, between-meals snacks and soft drink habits and (3) 'socialized treats', including treats at special occasions. Parents employed several strategies, most often substitution and portion-size reduction, but also limiting home availability. Families most frequently made changes that were easily adoptable and close to existing routines at home. In conclusion, the intervention components provided families with knowledge and strategies that facilitated behavioural changes towards reducing the intake of sugar-rich foods and drinks.

Maternal-child overweight relationship, assessment of maternal perception of child weight status and feeding behaviours

BACKGROUND

Parents play a key role in constructing children' behaviours. We studies maternal-child overweight relationship and compared maternal perception of child weight status and feeding behaviours between groups of normal-weight and overweight children.

METHODS

The cross-sectional study was conducted on 192 girls aged 10-13 years and their mothers. They were divided to two groups of overweight (n = 94) and normal-weight (n = 98) children. Anthropometric characteristics were measured for children and mothers. Logistic regression analysis was used to examine the association between child overweight and tertiles of maternal body mass index (BMI). Maternal perception of child's weight status and her engagement in promoting child's healthy behaviours was assessed.

RESULTS

BMI and waist circumference was significantly higher in children (P < 0.001) and mothers (P < 0.01) of overweight compared to normal-weight group. There was a significant relationship between children's overweight and tertiles of maternal BMI, which remained significant after adjusting for potential confounders. Mothers of overweight children were more concerned for their child's overeating and overweight, and for compelling the child to diet to maintain a desirable weight (P < 0.001). In contrast, mothers of normal-weight children restricted sugar-sweetened drinks (P = 0.008), offered fruit and vegetables (P = 0.035), and helped their children to get enough physical activity (P = 0.022) and night sleep (P = 0.001) more than mothers in other group.

CONCLUSIONS

This study showed a strong relationship between children and mothers' overweight. Despite being more concerned about their child weight status, mothers of overweight children reported behaviours which were less encouraging the children for healthy eating and lifestyle than mothers of normal-weight children.

Parents' experiences following conversations about their young child's weight in the primary health care setting: a study within the STOP project

BACKGROUND

In primary healthcare, conversations between clinicians and parents about young children's overweight are key to providing support and initiating weight management. However, given the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents' experiences following conversations with primary care nurses about their child's overweight.

METHODS

Participants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (n = 12/17), had a university degree (n = 14/17) and were born in Sweden (n = 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (n = 7) or obesity (n = 10). The interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Two main themes were developed. Theme 1, 'Receiving the overweight/obesity diagnosis', explores parents' reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child's and the family's needs (subtheme Conversations that empower), or felt limited, uncomfortable, or belittling (subtheme Conversations that provoke resistance). Theme 2, 'Parenting a child with a formal diagnosis of obesity', explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme Fear of transferring weight anxiety), dealing with others' reactions (subtheme Involve family and manage surroundings) and asking for and receiving support from health care professionals (subtheme Obtain support from health care professionals).

CONCLUSIONS

While conversations with primary care nurses about children's weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03800823 ; 11 Jan 2019.

Children's experiences of meals after obesity treatment: a qualitative follow-up four years after a randomized controlled trial

Background

The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.

Method

The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.

Results

We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized.

Conclusions

While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.

How Do Interpersonal Relationships Affect Children's Weight Management? A Qualitative Analysis of Parents' Long-Term Perceptions after Obesity Treatment

Background: Childhood obesity interventions are particularly effective during the preschool age, but little is known about parents' long-term perceptions of weight management. This study explores how parents perceive the influence of interpersonal relationships on their children's eating and physical activity 4 years after participating in a randomized controlled trial. Bronfenbrenner's ecological systems theory frames this study, with the child's environment conceptualized as interlocking microsystems that affect weight management. Methods: Interviews were conducted with 33 parents (85% mothers, 48% with university degree) of 33 children [mean age 9.3 (standard deviation 0.7), 46% girls] from Stockholm, Sweden. Interviews were analyzed using thematic analysis, focusing on parents' perceptions of interpersonal relationships: family, relatives, other children, preschool/school staff, and health care practitioners. Results: Two main themes were developed: (1) Discouragement, with the subthemes Conflicting rules and Social comparison, and (2) Support and understanding, with the subthemes Teamwork and Shared responsibility and continuity of care. Parents perceived children's weight management as a continuous orchestration of different influences across social spheres. Years after obesity treatment, parents struggled to maintain the child's healthy routines outside the home. However, when siblings, grandparents, teachers, and friends' parents acted supportively, routines were easier to maintain. Conclusions: The findings suggest that each microsystem in a child's environment has important influence on weight management, such that, as children grow older, children's lifestyles cannot be managed by parents alone. To facilitate weight management, more people in the child's environment should be involved early in the treatment process, and continued professional support should be offered to parents.

Changing the Home Food Environment: Parents' Perspectives Four Years after Starting Obesity Treatment for Their Preschool Aged Child

Changing the home food environment is key to childhood obesity treatment. However, new challenges arise as the child grows older. This study investigates parents' views on the longer-term management of the home food environment, 4 years after starting obesity treatment for their preschool-aged child. Semi-structured interviews were conducted with 33 parents (85% mothers, 48% with a university degree) of 33 children (mean age 9.3 (SD 0.7), 46% girls) from Sweden. The interviews were analyzed using thematic analysis. Two main themes were developed. Making changes in the home food environment illustrates the types of changes families make over time in relation to child development. It consists of three subthemes: covert changes, overt changes and child-directed changes. The second theme, an ongoing negotiation, captures parents' experiences of managing the home food environment as a continuous process of balancing and recalibrating in relation to present challenges and concerns about the future. It includes three subthemes: concern and care, two steps forward one back and maintaining everyday balance. Managing the home food environment is a constant process affected by everyday life, parents' strategies and the child's development. Our findings can strengthen childhood obesity treatment and help prepare parents for challenges that lie ahead.

Overt restrictive feeding for weight management: a preliminary retrospective examination of childhood experiences

PURPOSE

Overt restrictive feeding practices (ORFP), aimed at promoting weight loss or preventing weight gain for children, are often implemented by parents with good intentions. Despite findings that indicate unintended weight and behavioral outcomes little is known about how parental ORFP are experienced by those who are subjected to them. Thus, we explored retrospective accounts of meaning making related to experiences of such practices during childhood.

METHODS

Six young adult females who experienced ORFP were interviewed. Data were analyzed using constructivist grounded theory.

RESULTS

Participants retrospectively associated experiencing ORFP with a meaning making process that involves: (a) perceiving parental motivation for ORFP and receiving messages about weight, (b) internalizing parental messages about weight, and (c) viewing self-worth as contingent on weight.

CONCLUSION

Preliminary findings suggest that parents may be reinforcing weight stigma in their children through ORFP. Results add evidence against the use of parental ORFP for childhood weight management.

LEVEL OF EVIDENCE

Level V, Descriptive study.