Using food as reinforcer to shape children's non-food behavior: The adverse nutritional effect doubly moderated by reward sensitivity and gender

The Associations between Caregivers' Emotional and Instrumental Feeding, Children's Emotional Eating, and Children's Consumption of Ultra-Processed Foods in China

High consumption of ultra-processed foods (UPF) increases the risks of non-communicable diseases and all-cause mortality in adulthood, and the risk of early childhood caries. Limited evidence about factors influencing children's consumption of UPF exists. This study was conducted to assess the prevalence of UPF consumption among children less than three years of age, and identify its associations with caregivers' emotional and instrumental feeding, and children's emotional eating. A cross-sectional study was conducted in Shijiazhuang, Hebei Province, China. Caregivers caring for children aged 6-36 months (n = 408) were recruited. Caregivers' emotional and instrumental feeding practices and children's emotional eating were assessed by the Parents' Feeding Practices Scale for Infant and Young Child and Children's Eating Behaviour Questionnaire, respectively. Children's UPF consumption was assessed by a validated Food Frequency Questionnaire. Of the children, 86.8% consumed UPF. The highest percentage of UPF consumed was pastries (63.5%), followed by solid or semi-solid dairy products (58.8%), and reconstituted meat products (56.4%). Caregivers' emotional and instrumental feeding was positively associated with children's consumption of UPF (OR = 1.59, 95%CI: 1.01, 2.49), a higher frequency of UPF consumption weekly (OR = 1.80, 95%CI: 1.35, 2.39), and a larger amount of UPF consumption weekly (OR = 1.85, 95% CI: 1.38, 2.49). Children's higher frequency of emotional undereating was associated with their UPF consumption (OR = 1.61, 95%CI: 1.07, 2.42) and a higher frequency of UPF consumption weekly (OR = 1.33, 95%CI: 1.03, 1.73). Children's emotional undereating significantly mediated the associations between caregivers' emotional and instrumental feeding and children's consumption of reconstituted meat products. Caregivers should be educated to avoid emotional and instrumental feeding practices, and cultivate children's good eating habits to improve children's diet quality.

Choice is relative: Reinforcing value of food and activity in obesity treatment

Persons with obesity find high-energy-dense food and sedentary behaviors highly reinforcing. Diets and exercise programs deprive individuals of many favorite foods and activities, which can counterproductively heighten their value and lead to relapse. Since the value of reinforcers depend on the alternatives available, one approach to reducing food and sedentary activity reinforcement is to build healthy alternative reinforcers. Current behavioral treatment programs for children and adults do not attempt to build alternative reinforcers as substitutes for unhealthy behaviors to reduce the impact of food or activity deprivation on the motivation to eat or be inactive. A goal of the next generation of obesity treatment programs should focus on development of healthy behaviors as reinforcers so that people will be motivated to engage in them. This article provides an overview of relationships among reinforcers, how understanding substitutes and complements can influence eating and activity, and how enriching a person's environment and providing choice architecture can enhance weight control. Ideas for translation of these basic behavioral economic principles to obesity treatment programs are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The influence of social media on child feeding practices and beliefs among Hispanic mothers: A mixed methods study

OBJECTIVES

(1) To identify factors that influence child feeding practices and beliefs among Hispanic mothers in a low-income community; (2) to describe the use of social media, other internet websites, and text messaging among Hispanic mothers; and (3) to explore mothers' perceptions of social media and/or text messaging interventions to prevent childhood obesity.

METHODS

Mixed methods descriptive study with a sequential explanatory design. Hispanic mothers (N = 66) from Detroit, Michigan with children between 6 and 36 months of age completed surveys regarding their child feeding practices, the source (s) influencing these practices, and their use of social media, internet, and text messaging. During qualitative interviews (N = 19), we explored mothers' use of social media and internet websites to find child health information as well as mothers' perspectives on social media/internet/text messaging interventions to promote child health.

RESULTS

Most survey respondents were between the ages of 20 and 39 years. One-third of mothers breastfed their child for >6 months; 68% did not introduce solids until their child was older than 6 months. The majority (96%) owned a cellphone; 75% used social media at least once daily. Few mothers indicated that social media and other internet websites influenced their child feeding decisions. During qualitative interviews (N = 19), almost all mothers expressed interest in social media and/or text messaging as a tool to communicate information regarding child health and feeding.

CONCLUSIONS

Hispanic mothers had high rates of social media use and most desired social media/internet/text messaging interventions to promote child health.

The reinforcing value of food and non-food alternative: Associations with BMI z-score and percent fat mass

There is growing evidence of an association between the relative reinforcing value of food (RRVF; how hard a child is willing to work for a food versus a non-food reinforcer) and weight across many life stages, but few studies have examined this association among preschool age children. This study investigated the association between the RRVF (measured as the food reinforcing ratio (FRR)) and body mass index (BMI) z-score and percent fat mass (%FM), in 3 year-old children. The sample was comprised of 33 children who were 3 years of age (36-47 months). Children selected their favourite food reinforcer (cookie) and non-food (audiobook) reinforcer to be used in the FRR task, which was delivered using a sequential progressive fixed ratio reward schedule. Child height, weight and percent body fat using bioelectrical impedance analysis were assessed by trained research staff. Linear regression analyses showed that FRR was significantly and positively associated with BMI z-scores. FRR was not significantly associated with %FM. Findings from this study support the RRVF as a potential risk factor in the development of childhood obesity. Longitudinal research involving larger sample sizes would strengthen future research exploring associations between RRVF and body composition in preschool age children.

Donuts on our daughters: Gender differences in food categories on children's apparel

OBJECTIVE

Recent trends in children's fashion have featured food-graphics on children's apparel. Little attention has been paid to the food-graphic content of children's apparel. The objectives of this study were to describe and quantify food-graphics appearing on children's apparel, to examine characteristics of children's apparel items associated with the presence versus absence of food-graphics, and to examine gender differences in food-graphics.

METHODS

A content analysis of food-graphics on children's apparel from major apparel retailer websites was performed. Images of food-graphic apparel were reliably coded for food-graphic categories. Multivariable analyses examined the association of apparel item characteristics with food-graphic presence. Bivariate analyses tested the association of presence or absence of each food category with gender of apparel item.

RESULTS

Of the 3870 apparel items coded, 8.2% (318) had food-graphics. In multivariable analysis, food-graphics were more likely to be present on girls' (versus boys') apparel (RR = 1.73, 95% CI 1.34-2.12). Content analysis of food-graphic items revealed categories including "pastries", "frozen desserts", "pizza", "fast food", "fruit", and "love of food". Girls' (versus boys') food-graphic apparel was more likely to have categories of "pastries" (33% versus 12%), "frozen desserts" (20% versus 9%), and "fruit" (30% versus 11%) and less likely to have categories of "pizza" (9% versus 30%), and "fast food" (3% versus 23%). The "love of food" category did not differ by gender. All p-values ≤.01.

CONCLUSIONS

Food-graphics on children's apparel are fairly common, especially on apparel marketed for girls. Children's apparel may represent a novel cultural influence on children's eating and food perceptions.

Mothers' and fathers' media parenting practices associated with young children's screen-time: a cross-sectional study

Background

A major contributor to the growing obesity crisis is screen based sedentary behaviour among young children. Media parenting practices may be an important determinant of children’s screen time, however published research exploring the influence of parenting practices on children’s screen time has mainly focused on children’s television use and the parenting practices of the mother. This study examined children’s use of mobile media devices (as well as television use) and included the role of fathers in media parenting, allowing a fuller understanding of the role mothers’ and fathers’ media parenting practices play on children’s screen time in the current media environment.

Methods

Secondary data analysis was conducted using data from 62 children between 1.5 and 5 years of age and their parents (39 mothers, 25 fathers), who were part of the Guelph Family Health Study - phase 2 pilot. Linear regression using generalized estimating equations was used to examine associations between media parenting practices and children’s weekday and weekend screen-time.

Results

Mothers’ screen-time modeling, mealtime screen use, and use of screens to control behaviour were positively associated with children’s weekday screen-time. Mothers’ practices of monitoring screen-time and limiting screen-time were inversely associated with children’s weekday screen-time. Fathers’ mealtime screen use was positively associated with children’s weekday screen-time; whereas fathers’ monitoring screen-time and limiting setting were inversely associated with children’s weekday screen-time. Fathers’ modeling and use of screens to control behaviour was not significantly associated with children’s weekday screen time. While most associations were similar for weekend day screen time there were a few differences: Fathers’ use of screens to control behaviour was positively associated with children’s weekend screen-time. Mothers’ and fathers’ modeling and mealtime screen use were not significantly associated with children’s weekend screen time.

Conclusion

Mothers’ and fathers’ media parenting practices were associated with children’s screen-time. Interventions aimed at reducing children’s screen-time should address both mothers’ and fathers’ media parenting practices.

Providing healthy diets for young children: the experience of parents in a UK inner city

OBJECTIVES

There is a consistent body of evidence to demonstrate that obesity in very early childhood tends to continue into adolescence and through to adulthood. Parental practices in relation to food can have an effect on this trajectory, however existing studies reporting on interventions for treating obesity suggest there is a need to involve populations from demographically diverse backgrounds childhood obesity research.

DESIGN/METHODS

A qualitative study was carried out using semi-structured interviews with parents in a deprived inner city area.

RESULTS

Although parents had good intentions towards providing a health diet for their chidren, a number of barriers emerged. Findings were reported in relation to the following themes: information and education; barriers (having a child with special needs, children's food preferences and using food to promote desirable behaviour) and techniques (household rules & routines, setting limits and parameters, modelling and food preparation).

CONCLUSION

Parents and carers would benefit from targeted interventions based on improving techniques around food parenting practices, with a focus on equipping parents with the skills to overcome barriers encountered not only in early childhood, but as children progress to school age and through to adolescence.

Using food as a reward: An examination of parental reward practices

Eating patterns and taste preferences are often established early in life. Many studies have examined how parental feeding practices may affect children's outcomes, including food intake and preference. The current study focused on a common food parenting practice, using food as a reward, and used Latent Profile Analysis (LPA) to examine whether mothers (n = 376) and fathers (n = 117) of children ages 2.8 to 7.5 (M = 4.7; SD = 1.1) grouped into profiles (i.e., subgroups) based on how they use of food as a reward. The 4-class model was the best-fitting LPA model, with resulting classes based on both the frequency and type of reward used. Classes were: infrequent reward (33%), tangible reward (21%), food reward (27%), and frequent reward (19%). The current study also explored whether children's eating styles (emotional overeating, rood fussiness, food responsiveness, and satiety responsiveness) and parenting style (Authoritative, Authoritarian, and Permissive) varied by reward profile. Analyses of Variance (ANOVA) revealed that the four profiles differed significantly for all outcome variables except satiety responsiveness. It appears that the use of tangible and food-based rewards have important implications in food parenting. More research is needed to better understand how the different rewarding practices affect additional child outcomes.

Food culture of faith communities and potential impact on childhood obesity

OBJECTIVE

To explore the food culture within faith communities (FC) in order to examine the consumption of away-from-home foods, and to provide an evidence base for the future development of healthy away-from-home meal initiatives though FCs.

DESIGN AND SAMPLE

A qualitative descriptive design informed by an ethnographic method of free listing was utilized. A purposive sample of 34 FC leaders from seven distinct FCs participated in this study.

RESULTS

The top five salience scores for five research questions are considered in detail. Of note, food is provided at multiple FC events including at worship time and Bible or group study, but also as part of school, youth programming, and special events. The purposes of serving food were reported to be not only for modes of entertainment and fellowship but also for promoting attendance and providing basic nutrition needs.

CONCLUSIONS

Professionals practicing in public health, faith community nursing, or in community health nursing are apt to engage in focused dialogues regarding the multidimensional health problem of childhood obesity. This research study directs nurses to consider food culture as a dimension of importance, especially within FCs. Appreciating FC food culture is important because many families engage in the settings for years, decades, and possibly a life span.

When Are Caregivers More Likely to Offer Sugary Drinks and Snacks to Infants? A Qualitative Thematic Synthesis

Many children consume more sugar than is recommended, and caregivers often find it difficult to change this habit once established. This thematic synthesis aims to identify the "critical situations" where caregivers may be more likely to offer infants sugary drinks and snacks. This thematic synthesis is reported in accordance with the statement for enhancing transparency in reporting the synthesis of qualitative research (ENTREQ). Our confidence in the findings of our synthesis was assessed using the CERQual (Confidence in the Evidence From Reviews of Qualitative Research Approach). We included 16 studies from the United States, the United Kingdom, Australia, and Denmark. We identified eight "critical situations" when caregivers may be more likely to offer sugary drinks and snacks to infants. Interventions that seek to reduce sugar intake for caries prevention in infants and young children may be more successful if they provide caregivers with practical parenting strategies to replace the nonnutritive functions of sugary foods and drinks, as opposed to taking an information-giving approach.

Gene and environment interaction: Is the differential susceptibility hypothesis relevant for obesity?

The differential susceptibility model states that a given genetic variant is associated with an increased risk of pathology in negative environments but greater than average resilience in enriched ones. While this theory was first implemented in psychiatric-genetic research, it may also help us to unravel the complex ways that genes and environments interact to influence feeding behavior and obesity. We reviewed evidence on gene vs. environment interactions that influence obesity development, aiming to support the applicability of the differential susceptibility model for this condition, and propose that various environmental "layers" relevant for human development should be considered when bearing the differential susceptibility model in mind. Mother-child relationship, socioeconomic status and individual's response are important modifiers of BMI and food intake when interacting with gene variants, "for better and for worse". While only a few studies to date have investigated obesity outcomes using this approach, we propose that the differential susceptibility hypothesis is in fact highly applicable to the study of genetic and environmental influences on feeding behavior and obesity risk.

Effectiveness of different memory training programs on improving hyperphagic behaviors of residents with dementia: a longitudinal single-blind study

BACKGROUND

Hyperphagia increases eating-associated risks for people with dementia and distress for caregivers. The purpose of this study was to compare the long-term effectiveness of spaced retrieval (SR) training and SR training combined with Montessori activities (SR + M) for improving hyperphagic behaviors of special care unit residents with dementia.

METHODS

The study enrolled patients with dementia suffering from hyperphagia resident in eight institutions and used a cluster-randomized single-blind design, with 46 participants in the SR group, 49 in the SR + M group, and 45 participants in the control group. For these three groups, trained research assistants collected baseline data on hyperphagic behavior, pica, changes in eating habits, short meal frequency, and distress to caregivers. The SR and SR + M groups underwent memory training over a 6-week training period (30 sessions), and a generalized estimating equation was used to compare data of all the three groups of subjects obtained immediately after the training period and at follow-ups 1 month, 3 months, and 6 months later.

RESULTS

Results showed that the hyperphagic and pica behaviors of both the SR and SR + M groups were significantly improved (P<0.001) and that the effect lasted for 3 months after training. The improvement of fast eating was significantly superior in the SR + M group than in the SR group. The improvement in distress to caregivers in both intervention groups lasted only until the posttest. Improvement in changes in eating habits of the two groups was not significantly different from that of the control group.

CONCLUSION

SR and SR + M training programs can improve hyperphagic behavior of patients with dementia. The SR + M training program is particularly beneficial for the improvement of rapid eating. Caregivers can choose a suitable memory training program according to the eating problems of their residents.