The COMET study: Examining the effects of COVID-19-related perceived stress on Los Angeles Mothers' dysregulated eating behaviors, child feeding practices, and body mass index

Examining child schooling/care location and child temperament as predictors of restaurant-related behaviors during the COVID-19 pandemic: findings from a nationally representative survey

Purpose

Emerging research highlights impacts of the COVID-19 pandemic on U.S. families, including changes in eating behavior and increased child body mass index. Aims of the present study were to examine whether child temperament and at-home vs. out-of-home childcare/school predicted families' restaurant-related behaviors during the pandemic. Examining energy balance-related behaviors, like restaurant patronage, during the pandemic can help better understand lasting impacts on child health behaviors and health outcomes.

Methods

An online survey was administered to U.S. parents with a 4-to-8-year-old child in October 2020 (n = 1,000). Linear and logistic regression examined whether child temperament and at home vs. out-of-home childcare/school predicted: (1) the frequency the child consumed restaurant meals (take-out, delivery, dine-in), (2) who chose the child's restaurant meal, and (3) parent-reported reasons for the child's meal choice. Income, education, employment, race/ethnicity, and regional COVID-19 restrictions were tested as covariates.

Results

Parents with children higher on negative affectivity reported more frequent restaurant use in-person (p < 0.05) and via delivery (p < 0.05) compared to parents of children lower on negativity. Child negativity was also linked with parent-reported reasons for children's restaurant meal choices. Parents of children receiving at-home childcare/schooling used delivery services less frequently than those receiving out-of-home care or schooling (p < 0.01).

Conclusion

These findings suggest that individual and family factors may impact restaurant use and the meal selection process for children using restaurants during and beyond the COVID-19 era. Continued examination of individual differences in the impacts of the COVID-19 pandemic can facilitate intervention and policy approaches that fit with different families' needs.

Independent associations of food addiction and binge eating measures with real-time eating behaviors and contextual factors: An exploratory ecological momentary assessment study

Food addiction (FA) is a concept centered around the addictive potential of highly palatable processed foods, though there is debate over the discriminative validity of FA as a distinct construct from binge-eating symptomatology. This study explored how trait measures of FA and binge-eating symptoms independently and interactively predicted eating behaviors and posited correlates of FA and binge eating measured via ecological momentary assessment (EMA). Adult participants (N = 49) who met the criteria for FA and/or binge-eating disorder completed baseline measures of FA (Yale Food Addiction Scale [YFAS 2.0]) and binge-eating symptoms (Eating Pathology Symptom Inventory [EPSI] binge eating scale) followed by a 10-day EMA protocol. Generalized linear mixed models examined the independent effects of YFAS 2.0, EPSI, and their interaction predicting EMA outcomes. Higher YFAS 2.0 symptom count scores were uniquely related to greater EMA-measured overeating, loss of control eating, negative and positive affect, and impulsivity when controlling for EPSI scores. Conversely, higher EPSI scores were uniquely related to greater EMA-measured eagerness and urge to eat, and expectancies that eating would improve mood. No interaction effects were significant. These results highlight potential distinctions between phenomena captured by FA and other measures of binge eating, in that FA symptoms may be a marker of heightened binge-eating severity, emotional arousal, and impulsivity.

Perceptions of Parental Support for Physical Activity and Healthy Eating among School-age Children During COVID-19 pandemic

Family routines play a key role in promoting child health behaviors. This study 1) describes changes in children's perceptions of physical activity (PA) and healthy eating family routines across three time points: pre-pandemic (2017-2020), early pandemic (2020), and mid-pandemic (2021); and 2) explores how sex, age, and pandemic-related economic stressors relate to changes. Children's perceptions of family routines were assessed using four subscales adapted from the Comprehensive Home Environment Survey: PA-policies, Diet-policies, Diet-rules, and PA-Diet-role-model. Linear mixed models assessed changes in perceptions and associated factors (child age and sex; caregiver(s) job loss during pandemic). Children (N=277) were aged 9.3-15.5y at pandemic onset (March 2020), dichotomized by median age (12.1y) as younger and older. Children's perceptions of PA-policies (pre-pandemic mean=15.4) and Diet-policies (pre-pandemic mean=26.3) increased significantly from pre- to early (b=1.2 and 2.3, respectively) and mid-pandemic (b=1.0 and 1.2, respectively). Diet-rules (pre-pandemic mean=10.8) decreased significantly from pre- to early (b=-1.1) and mid-pandemic (b=-2.0), with no PA-Diet-role-model changes. Younger children had a greater increase in perceived PA-policies and Diet-policies across the pandemic. Females (59.9%) had a greater decrease in perceived Diet-rules across the pandemic and less increase in Diet-policies and PA-Diet-role-model from pre- to early pandemic. Children whose caregiver(s) lost employment (51.8%) perceived a greater increase in PA-policies. Overall, children reported increased parental policies to support PA and healthy eating and decreased parental rules for diet during the pandemic. Future research is needed to understand how changes in family routines relate to PA and healthy eating behaviors.

Association of stress on eating competence in mothers during pregnancy and six months postpartum

BACKGROUND

Perceived stress is related to poor diet quality and unhealthy dietary patterns in women of reproductive age. Eating competence represents a variety of contextual skills reflecting a comfortable and flexible approach to eating and is associated with diet quality and health related behavior. In non-pregnant samples, perceived stress is negatively associated with eating competence. Given that pregnancy and the postpartum period can be periods of high stress, we hypothesized that higher stress in pregnancy would result in lower pregnancy eating competence.

METHODS

Women (n = 296, mean BMIbaseline pregnancy = 26.3 ± SD 6.0) in the Pregnancy Eating Attributes Study (PEAS) were recruited from the Chapel Hill, North Carolina area. Perceived stress was assessed using the Perceived Stress Scale and eating competence using the ecSatter Inventory at their first trimester and 6-month postpartum visits. We used a mixed effect model to assess the effect of stress by time on eating competence, controlling for baseline pregnancy BMI, race and ethnicity, poverty to income ratio, and WIC status.

RESULTS

Perceived stress was negatively associated with eating competence (b= -0.23, SE = 0.06, p < 0.001). The interaction of stress by time was negatively associated with eating competence (b = -0.15, SE = 0.08, p = 0.03), indicating that the association of stress with eating competence was stronger in postpartum than in pregnancy.

CONCLUSIONS

Perceived stress may adversely impact eating competence during both pregnancy and postpartum. Future studies intervening upon stress or eating competence during pregnancy and postpartum may inform potential causal relations.

The Impact of the First and Second Wave of the COVID-19 Pandemic on Eating Symptoms and Dysfunctional Eating Behaviours in the General Population: A Systematic Review and Meta-Analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to examine the prevalence of feeding and eating disorder (FED) symptoms or dysfunctional eating behaviours (DEB) in the general population during the COVID-19 outbreak.

METHOD

We searched eligible articles in biomedical databases from 1 January 2020 to 31 March 2022. Prevalence rates of FED or DEB changes between pre-pandemic and pandemic time and correlation with psychological distress were pooled with a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 186 studies with 406,076 participants met the inclusion criteria.

RESULTS

The more prevalent FED or DEB during the COVID-19 outbreak were: body image concerns (52%, 95% CI 0.38, 0.66), binge eating (40%, 95% CI 0.25, 0.55), and overeating (40%, 95% CI = 0.32-0.48). Pooled data of longitudinal studies (k = 8) only showed a significant difference in the prevalence of weight gain from pre-pandemic to the pandemic time. Finally, increased levels of psychological distress (k = 35) positively correlated with some ED symptoms.

CONCLUSION

This meta-analysis evidenced a negative impact of the pandemic on eating symptoms and DEB in the general population.

Maternal mood, body image, and eating habits predict changes in feeding practices during the COVID-19 pandemic

Maternal mood and eating habits are associated with food parenting practices, including non-responsive feeding practices, which in turn impact children's eating habits. The COVID-19 pandemic may have negatively impacted maternal mood due to the overall stress and challenges, contributing to changes in eating behaviors and food parenting practices. The present study examined how maternal mood, body image, and eating concerns were related to perceived changes in feeding practices during the pandemic. A total of 137 mothers participated in an online study. Participants retrospectively reported their mood, eating habits, body dissatisfaction, and non-responsive feeding practices, before and during the pandemic, and responded to open-ended questions regarding changes in eating and feeding patterns during the pandemic. Results suggested differences in non-responsive feeding practices, including higher use of food as a reward for behavior and lower use of standard meal settings during the pandemic. In addition, significant relationships were found between higher maternal stress and higher body dissatisfaction (r = 0.37; p < .01), restrained eating (r = 31; p < .01), emotional eating (r = 0.44; p < .01), and higher use of overt and covert restriction retrospectively and during the pandemic. Results revealed trends in the same direction for depression and anxiety. Finally, qualitative findings were consistent with the quantitative findings, suggesting relationships between maternal mood, eating habits, and feeding practices. These results provide support for previous findings suggesting that the pandemic negatively impacted maternal well-being, increasing the use of some non-responsive feeding practices. Further work exploring the impacts of the pandemic on well-being, child feeding, and eating patterns is warranted.

Food Insecurity, Federal Nutrition Support, and Parent Feeding Practices During COVID-19: A 1-Year Follow-up Study

OBJECTIVES

COVID-19 caused stark increases in food insecurity. To maintain food provision, policy changes to the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program (SNAP) were instated. This longitudinal study examined (1) food security patterns across the timeline of COVID-19; (2) the relationship among food security patterns, NSLP/SNAP use, and parent feeding practices; and (3) parent perceptions of NSLP/SNAP policy changes.

METHODS

A total of 333 US parents completed online surveys during the COVID-19 pandemic: May 2020 (T1), September 2020 (T2), and May 2021 (T3). Food security and parent feeding practices were reported at each time point; pre-COVID-19 behaviors were retrospectively reported at T1. Use and perceptions of NSLP/SNAP policy changes were reported at T3. We examined associations between food security and parent feeding practices using repeated-measures mixed models.

RESULTS

The percentage of parents with very low food security increased from pre-COVID-19 (9.6%) to T1 (29.1%) and remained elevated at T3 (16.8%). One-third (31.2%) of families fluctuated between food security and food insecurity, with 27.0% remaining food insecure at T3. Thirty percent of consistently food-insecure families reported not receiving school-provided meals, and 45% did not receive SNAP benefits. Most parents reported that pickup school meal sites (71.4%), Pandemic Electronic Benefit Transfer cards (51.4%), and increased SNAP benefits (79.6%) were beneficial. Initial changes in parent feeding practices reported at T1 returned to pre-COVID-19 levels by T3, yet concern for child overweight remained significantly elevated.

CONCLUSION

Continued policy efforts to support food-insecure families via expanded food access in NSLP/SNAP are critical.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

A longitudinal study on changes in food parenting practices during COVID-19 and the role of parental well-being

The COVID-19 pandemic may negatively influence food parenting practices, also among parents of adolescents. Parental well-being (stress and depressive symptoms) may explain these COVID-19 related changes in food parenting practices (snack structure, healthy structure, modeling, autonomy support, and coercive control). However, most previous studies performed before or during the COVID-19 pandemic have been limited by cross-sectional designs. The aim of the current study among parents of adolescent children was twofold. First, we aimed to examine prospective differences in food parenting practices comparing the situation before and during COVID-19. Second, we aimed to examine both cross-sectional and longitudinal associations between parental well-being and the dimensions of food parenting, while additionally examining whether these prospective associations were more pronounced in parents who had experienced more COVID-19 stressful life events. Parents (N = 290; 74.9% female; at baseline: M_age = 46.9; SD_age = 4.3) of adolescent children (at baseline: M_age = 14.3; SD_age = 0.6) completed online surveys about parental well-being and food parenting twice: One year before the COVID-19 pandemic (spring 2019) and during the COVID-19 pandemic, 1.5 years after the first measurement (autumn 2020). In general, we found consistent evidence for an average decrease in food autonomy support and an increase in coercive control during COVID-19. However, parental well-being did not seem to explain (changes in) food parenting practices during COVID-19, also not in combination with stressful life events. Our findings suggest that, regardless of parental well-being, the general COVID-19 situation had some small negative influences on autonomy support and coercive control among parents of adolescents. These findings might be explained by parents being more often confronted with unhealthy eating occasions in the COVID-19 home context, triggering these negative parental responses.

Relationship between Mental Health and Emotional Eating during the COVID-19 Pandemic: A Systematic Review

Obesity is one of the most dangerous epidemics of the 21st century. In 2019, the COVID-19 pandemic began and caused many deaths among patients with obesity with and without complications. Simultaneously, the lockdown related to the COVID-19 pandemic caused a host of emotional problems including anxiety, depression, and sleep disturbances. Many people began to cope with their emotions by increasing food (emotional eating) and alcohol consumption and in combination with decreased physical activity, promoted the development of overweight and obesity. Emotional eating, also known as stress eating, is defined as the propensity to eat in response to positive and negative emotions and not physical need. It should be noted that emotional eating may be the first step in the development of binge eating disorder and its extreme subtypes such as food addiction. Interestingly in some post-bariatric surgery patients, an increased frequency of addictive disorders has been observed, for example food addiction replaced by alcohol addiction called: “cross addiction” or “addiction transfer”. This data indicates that obesity should be treated as a psychosomatic disease, in the development of which external factors causing the formation of negative emotions may play a significant role. Currently, one of these factors is the COVID-19 pandemic. This manuscript discusses the relationships between the COVID-19 pandemic and development of emotional eating as well as potential implications of the viral pandemic on the obesity pandemic, and the need to change the approach to the treatment of obesity in the future.

Variation of parental feeding practices during the COVID-2019 pandemic: a systematic review

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is highly contagious and has resulted in a protracted pandemic. Infections caused by new coronavirus strains, primarily Delta and Omicron and currently highly prevalent globally. In response to the epidemic, countries, and cities implemented isolation and quarantine guidance, such as limiting social contact, which have affected the lifestyles and quality of life of the population. Parental feeding behaviors may vary as a result of factors such as prolonged home isolation of parents and children, lack of supplies during isolation, and stress. This study was designed to assess the available evidence and its implications for parental feeding practices in the context of COVID-19. We screened and reviewed research published in five electronic databases between 2020 and 2022, and eight studies met the selection criteria. Parents were observed to use a variety of feeding practices, including high levels of coercive control and reduction of rules and limits according to Vaughn’s food parenting constructs. The findings suggest that parental feeding practices are changing as a result of the pandemic and that more research is needed to further explore how to provide supportive feeding guidance to parents during emergencies in order to jointly promote child health.

Subjective socioeconomic disadvantage is indirectly associated with food portion selection through perceived disruption of personal resources during a nationwide COVID-19 stay-at-home order

In addition to its public health implications, the global COVID-19 pandemic has also produced significant disruptions to individuals' socioeconomic resources and opportunities. Prior research has suggested that low subjective socioeconomic status (SSES) may stimulate appetite and motivate increased energy intake. Here, we tested whether individuals experiencing lower levels of SSES (SSES disadvantage) during a nationwide stay-at-home order for COVID-19 exhibited preferences for larger food portion sizes through perceived disruptions to personal financial and material resources. Data was collected near the conclusion of a nationwide partial lockdown (Singapore's “Circuit-Breaker” from April to June 2020). Participants (N = 295) completed an online survey involving a measure of SSES, the Coronavirus Impacts Questionnaire, and a food portion selection task where participants estimated the portion size they prefer to consume for a range of common foods. SSES disadvantage was associated with selection of smaller average portion sizes. Yet, a significant indirect effect of coronavirus impact was observed in this relationship, such that participants experiencing greater SSES disadvantage selected larger portion sizes through the effect of greater perceived impacts of COVID-19 to one's financial/material resources (controlling for one's actual level of income). These findings further support the idea that perceived deprivation and insecurity of important resources (financial, social, material) may influence intentions to consume greater amounts of energy. Consequently, systematic societal disruptions to such resources may reinforce and perpetuate potentially obesogenic eating behaviors of populations that are especially vulnerable to such shocks (i.e., people experiencing SSES disadvantage).

Changes in Feeding Behavior and Feeding Stress Among Mothers of Preschoolers Before and During the Novel Coronavirus Pandemic

Objective

To examine changes in maternal feeding behaviors (MFB) and maternal feeding stress (MFS) among mothers of preschoolers in Saudi Arabia before and during the novel coronavirus pandemic.

Methods

This is a prospective cohort study including 64 mothers of preschoolers who were drawn from a sample of a 2019 study. Study questionnaire was completed during November–December 2020. MFB were assessed using the Child Feeding Questionnaire-Arabic (CFQ-A) and MFS was assessed using the MFS-mealtimes index and the MFS-maternal resentment/difficult child index. Paired samples t-tests were used to examine changes in MFB and MFS.

Results

Mothers have reported an increase in perceived responsibility (M = 4.09, SD = 0.87 vs. M = 4.33, SD = 0.59, P-value < 0.05) and monitoring (M = 4.23, SD = 0.73 vs. M = 4.48, SD = 0.66, P-value < 0.05) during the pandemic period compared to the period prior to the pandemic. Mothers have reported a decrease in use of food as a reward (M = 4.11, SD = 0.87 vs. M = 2.30, SD = 0.88, P-value < 0.001) and concern about child's diet (M = 3.34, SD = 1.12 vs. M = 2.55, SD = 1.04, P-value <0.001). There was an increase in MFS-maternal resentment/difficult child (M = 2.47, SD = 0.68 vs. M = 2.71, SD = 0.72, P-value < 0.01).

Conclusions

Findings can help inform future research aiming to measure the long-term effects of the pandemic on child outcomes.

Engaging New Parents in the Development of a Peer Nutrition Education Model Using Participatory Action Research

This study investigated the implementation model and research methods of a peer education program for new parents focused on infant feeding and nutrition. Two hundred and sixty-nine parents with an infant aged birth to two years old were invited to become co-researchers in a Participatory Action Research (PAR) study over three years. Data included focus group and online participant meeting transcripts, social media data, correspondence between the implementation team and peer educators, and field notes. All data were consolidated regularly and discussed by project participants and the research team. After each PAR cycle, structured content analysis was conducted, informing the next iteration of the implementation model and research methods. Participating parents were highly engaged in child feeding peer-to-peer education, but felt more effective and comfortable being considered as a child-feeding information resource sharer or 'champion' rather than a formal peer educator. Similarly, quantitative data collection was only effective when it was integrated seamlessly into the implementation model. PAR methodology suited the diversity and dynamic real-life study setting, facilitating substantial improvements to the peer nutrition intervention model and data collection methods. Our study demonstrated that a genuine collaboration between health professionals and participants to implement research in practice can achieve both intervention outcomes and research aims.

Life history strategy and overeating during COVID-19 pandemic: a moderated mediation model of sense of control and coronavirus stress

BACKGROUND

This study examined the mediating effect of sense of control and the moderating effect of coronavirus stress on the relationship between life history strategy and overeating among Chinese college students during the COVID-19 period.

METHODS

3310 Chinese students (Mage = 19.74, SD = 1.50; 47% males) completed self-reported questionnaires regarding life history strategy, sense of control, overeating, and coronavirus stress. The data were analyzed using Pearson's r correlations and moderated mediation analysis.

RESULTS

The results revealed that control sense mediated the link between life history strategy and college students' overeating. College students' coronavirus stress moderated the associations between life history strategy and college students' sense of control and between control sense and overeating. The association between life history strategy and sense of control was stronger for those with lower coronavirus stress, and the association between sense of control and overeating was stronger for those with lower coronavirus stress.

CONCLUSIONS

This study identified that the critical factors were associated with overeating. On the one hand, the research deepens the application and interpretation of life history theory in the field of eating; on the other hand, it provides evidence for the prevention of overeating, and provides theoretical basis for psychological assistance among Chinese college students.

COVID-19 and the Change in Lifestyle: Bodyweight, Time Allocation, and Food Choices

We analyze the dynamic changes in individuals' lifestyle during the COVID-19 outbreak and recovery period through a survey of 1061 Chinese households. Specifically, we are interested in individuals' bodyweight, time allocation and food choices. We find that COVID-19 is associated with weight gain, less time spent on exercise and more time on entertainment. The proportion of online food purchase and snack purchases also shows an upward trend. This study provides useful implications on the impact of COVID-19 and its associated lockdowns on individuals' lifestyle and offers foresights for countries in different stages of the pandemic. It explains how encouraging exercise, managing new food purchase venues, and reducing the intake of unhealthy food such as snacks may also need to be considered in dealing with the aftermath of COVID-19.

Quarantine During COVID-19 Outbreak: Eating Behavior, Perceived Stress, and Their Independently Associated Factors in a Brazilian Sample

The study aimed to assess the eating behavior [uncontrolled eating (UE), emotional eating (EE), and cognitive restraint (CR)], the perceived stress, and independently associated factors among Brazilians during the COVID-19 pandemic. An online survey was conducted and data about 1,368 participants were evaluated. Multivariate logistic regression models were performed to identify factors independently associated (socioeconomic, lifestyle, and eating habits data) with eating behaviors and perceived stress. Working in the COVID-19 frontline (OR = 2.19), increased food delivery (OR = 1.49), increased food intake (OR = 1.48), increased number of meals (OR = 1.13), and EE (OR = 1.05) were factors independently associated with UE. Variables that were independently associated with EE were: increased food intake (OR = 2.57), graduation in a non-health-related course (OR = 1.78), perceived stress (OR = 1.08), UE (OR = 1.07), and CR (OR = 1.02). Reduced snacking (OR = 2.08), female gender (OR = 1.47), having a higher degree (OR = 1.44), increased homemade meals (OR = 1.31), the higher difference in the frequency of instant meals and snacks intake (OR = 0.91), EE (OR = 1.01), not increased alcohol dose intake (OR = 0.57), and increased physical activity (OR = 0.54) were independently associated with CR. Perceived stress was independently associated with changes in the way of working or studying (OR = 2.48), worse sleep quality (OR = 2.22), younger age (OR = 1.06), and EE (OR = 1.02). This study indicates that socioeconomic variables, lifestyle, and eating habits were independently associated with the eating behaviors of Brazilians and perceived stress during the quarantine.