The trust model: a different feeding paradigm for managing childhood obesity

Food Parenting Practices and Child Eating Behaviors in Australian Families: A Cross-Sectional Sibling Design

BACKGROUND

Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.

OBJECTIVE

Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviors.

DESIGN

A cross-sectional online survey was conducted between October and December 2022.

PARTICIPANTS/SETTING

Data were collected from parents (97.5% women) in Australia with 2 children aged 2 to 5 years (n = 336 parents and n = 672 children).

MAIN OUTCOME MEASURES

Survey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire and seven subscales of the Feeding Practices and Structure Questionnaire-28.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviors and food parenting practices, adjusting for differences in child body mass index z score, age, gender, and early feeding method.

RESULTS

Within-sibling pair differences in eating behaviors were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behavior, and less of the structure-based practice, family meal settings (P values < 0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (P values < 0.007); however, no significant differences in reward for behavior were observed in relation to sibling differences in these eating behaviors. For the more food responsive sibling, parents reported using more control-based practices, including reward for behavior and overt restriction (P values < 0.002).

CONCLUSIONS

Within families, parents may adapt certain practices in response to differences in their children's eating behaviors. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.

Isolation in a Sea of "Experts": Identifying the Parental Struggles Caring for Children With Early-Onset Obesity

Background: Severe early-onset childhood obesity is diagnosed by having a BMI >120% of the 95th percentile before age 5 years. Treatment for early-onset obesity is frequently unsuccessful. Prior studies have shown parents of children with obesity often face stigmatization and those who experience weight bias also experience poorer medical care. Home environment influences many risk factors, and parents are crucial for intervention. Research on the parental perspective of care is lacking and greater understanding could increase the effectiveness of treatment. We sought to understand the common stressors and obstacles parents encounter caring for a child with early-onset severe obesity. Methods: Parents of children with early-onset severe obesity participated in semistructured interviews. Interviews were digitally recorded, transcribed verbatim, coded, and analyzed using hybrid thematic analysis. Results: We identified a global theme of "Isolation in a sea of 'experts'," supported by three organizing themes: (i) Facing barriers at every turn; (ii) Carrying all the burdens; and (iii) Struggling to get their child seen as an individual. Within each organizing theme, subthemes emerged that highlighted the struggles that parents encountered. These included significant conflict with others when attempting to implement dietary changes (e.g., spouses, other children, and extended family), protecting their child's self-esteem, perceived weight bias from medical staff, lack of experienced obesity clinicians, lack of access to weight management services, and judgment from others (e.g., family, friends, and strangers). Conclusions: This study highlighted that many parents of children with early-onset severe obesity felt significant struggles, both internal and external. Understanding the barriers parents face when caring for their children is critical to improving relationships and medical care.

"I Wear a Mask. I Wear It All the Time. The Kids Don't Wear Masks": Early Childhood Education Mask-Wearing During COVID-19 in Florida

BACKGROUND

New federal health guidance was issued for early childhood education (ECE) programs to reduce the risk of COVID-19 in March 2020. The Centers for Disease Control and Prevention recommended mask-wearing for adults and children aged 2 years and older. Wearing masks was a new practice for teachers and children, and this study investigated when and how masks were worn in ECE centers in Florida.

METHODS

This study was part of a larger assessment of the impact of COVID-19 on mealtime routines in ECE centers. Two statewide surveys based on the Trust Model were sent to directors and teachers via Florida Department of Children and Families. Only teachers were interviewed. Data were collected from August to October 2020. The analysis included survey results and interview responses related to mask-wearing.

RESULTS

Surveys were completed by 759 directors and 431 teachers, and 29 teachers were interviewed. Survey results indicated that more teachers than children wore masks during pre- and postmeal activities. Interviews revealed three models that explain mask-wearing: (1) teachers only, in which teachers were required to wear a mask, but children were not; (2) teachers and children, in which teachers and children were required to wear a mask; and (3) masks optional, in which teachers and children could choose to wear a mask.

CONCLUSION

Understanding how decisions about mask-wearing were made at the center level can inform training and support health and safety in ECE. Use of personal protective equipment (such as masks) is effective for reducing risk of pathogen transmission for children and adults in ECE settings.

Perceived Role of Asian Indian Fathers in Florida During Mealtimes: Factors to Consider for Their Involvement in Childhood Obesity Prevention

Research has shown that fathers play an important role in children's mealtimes and dietary habits; yet, little is known about the factors that affect how fathers perceive this role, especially among Asian Indians. This study aimed to examine how Asian Indian fathers perceive their role during child mealtimes and the factors that are associated with fathers' mealtime perceptions. Eighty Asian Indian fathers of 6- to 11-year-old children completed an online survey including measures of demographics, acculturation, gender roles, nutrition knowledge, parental self-efficacy, perceived child weight, and the role of father at mealtime (ROFM). Data were analyzed using descriptive statistics and linear regression. Participants perceived a moderately high level of responsibility during child mealtimes. Regression analysis showed that fathers who had higher income, perceived child weight as being higher, and had higher self-efficacy in feeding children healthy food had higher ROFM. Higher father nutrition knowledge was correlated with lower perceived ROFM, indicating a lack of confidence in utilizing their nutrition knowledge during child mealtimes. The results indicate potential targets to improve Asian Indian fathers' involvement during child mealtimes. These results could be utilized to enhance their engagement in child mealtime healthy eating practices and for childhood obesity prevention.

Mixed-method assessment of caregiver feeding practices in early care and education centres during COVID-19

OBJECTIVE

The COVID-19 pandemic changed early care and education (ECE) mealtimes. Feeding practices that support children's emerging autonomy may support children's healthy eating, but it is unknown whether and how COVID-19 changed feeding practices. This paper describes caregiver feeding practices in ECE centres in Florida during COVID-19.

DESIGN

A mixed-methods design was used to understand mealtime feeding practices. Survey and interview questions were developed based on the Trust Model. More than 7000 surveys were sent to ECE centres. Analysis included descriptive statistics for survey data and thematic analysis for interview data.

SETTING

This statewide study included teachers in all licensed and license-exempt ECE centres.

PARTICIPANTS

Four hundred and thirty-one teachers completed a survey, and twenty-nine participated in follow-up interviews.

RESULTS

Surveys showed most teachers engaged in autonomy-supportive behaviours, such as letting children eat until they were finished (90 %). The most common controlling behaviour was praising children for cleaning their plates (70 %). The most common responses about changes to mealtimes were keeping physical distance and serving healthy food. Interview themes were Autonomy Support, Controlling Feeding Practices, Interactions are the Same, Interactions are Different, Physical Distancing and Healthy Eating.

CONCLUSIONS

Mealtimes are a central part of the day for young children and teachers in ECE environments. COVID-19 continues to influence ECE routines as behaviour change remains the primary method of reducing the risk of COVID-19 in the absence of a vaccine for young children. Understanding teachers' practices and perspectives is important for reducing the risk of COVID-19 and supporting children's autonomy and healthy eating.

Mealtime best practices and infection control in early care and education centres during COVID-19

BACKGROUND

Most young children in the United States attend early care and education (ECE) programmes, where they consume the majority of daily calories. Best practices to support children's healthy eating include teachers sitting together with children, eating the same food, and appropriately supporting children in serving and feeding themselves. To understand how the COVID-19 pandemic changed mealtime practices in ECE, this study (1) describes what adaptations ECE directors and teachers made to mealtimes to include best practices, and (2) identifies common adaptations made to comply with COVID-19 infection control guidelines.

METHODS

This cross-sectional, mixed-methods study utilized survey and interview questions based on the trust model and social cognitive theory. More than 7000 surveys were distributed to ECE directors and teachers in Florida. Surveys were completed by 759 directors and 431 teachers. Also, 29 follow-up interviews with teachers were completed. Participants were asked to describe their mealtimes before and during COVID-19. Descriptive statistics and frequencies were used to analyse survey data, and thematic analysis was applied to interview data.

RESULTS

Less than 5% of survey respondents reported children serving themselves, a pre-COVID best practice. Interviews identified three common adaptations: (1) modification-best practices were incorporated into new routines, such as eating together but sitting farther away, (2) elimination-routines changed so that best practices were no longer possible, such as teachers wearing masks and standing during meals, and (3) minimal change-minimal changes due to COVID-19 occurred and consequently mealtime practices did not change.

CONCLUSIONS

Current recommendations do not allow children to self-serve, which previously was a key best practice. ECE centres that have successfully integrated COVID-19 modifications and maintained mealtime best practices-perhaps in a new form-can serve as examples for others. These findings are generalizable to ECE centres in Florida and could be compared with other states.

Initial investigation of associations between feeding practices, eating behaviours, and weight status in Vietnamese children using modified questionnaires

AIMS

This cross-sectional study aims to extend the preliminary validation of the Feeding Practices and Structure Questionnaire (FPSQ) and Children's Eating Behaviour Questionnaire (CEBQ) in the Vietnamese context by examining associations between maternal feeding practices, child eating behaviours, and child weight status.

METHODS

Modified versions of the FPSQ and CEBQ were used to measure maternal feeding practices and child eating behaviours, respectively, in a sample of Vietnamese mothers of children within the age range of two to five years (n = 100). Children's weight-for-height z-scores (WHZs) were calculated using weight and height measurements obtained by clinicians. Pearson's correlation coefficients were used to examine bivariate associations between maternal feeding practices, child eating behaviours, and child WHZs. Significant variables were then entered into a multivariable regression model.

RESULTS

Child WHZs were associated with maternal persuasive feeding, and child slowness in eating, enjoyment of food/food responsiveness, and emotional undereating, but in multivariable regression analysis, only persuasive feeding (β = -0.44, p = 0.027) and slowness in eating (β = -0.39, p = 0.036) contributed significantly to the model.

CONCLUSIONS

The findings provide some evidence of construct validity for the modified questionnaires. Potential implications of dietary-related behaviours on weight status in preschool-aged children in Viet Nam are evident. However, further validation and analysis in larger datasets must be undertaken in order to examine these associations with increased certainty.

Daily variability in mothers' and fathers' feeding practices and associations with children's eating behaviors

The current study explores daily variability in maternal and paternal pressuring, restrictive, and structure-related feeding practices and their associations with child energy regulation and food refusal. Multilevel models were run separately for mothers and fathers to understand these associations, as well as within a dyadic framework to account for the interdependence of partners. One hundred families with at least one child between 3- to 5-years old participated by completing seven days of daily diaries. Results suggest there is daily variability in feeding practices for mothers and fathers and children's energy regulation and food refusal. Mothers' daily reports (within family variability) suggested that on days when mothers used more pressure and less structure than usual, children showed more food refusal. Fathers' daily reports suggested that on days when fathers used more pressure or less structure, children showed less energy regulation. On average across the week (between family variability), maternal pressure and restriction was related to child energy regulation. Dyadic multilevel models suggested that fathers' daily feeding behavior was associated with child eating behavior, while mothers' pressure and restrictive feeding on average across the week was a better predictor of between family variability in child eating behavior. For provision of support or structure during feeding, maternal structure was related to less father-reported energy regulation and paternal structure was related to more father-reported energy regulation. The results highlight the necessity of considering both mothers' and fathers' behaviors from day-to-day to get a more authentic picture of the family feeding relationship.

"Just sit and eat." Adult and Child Mealtime Responsibilities in Early Care and Education Centers During COVID-19 in Florida

Most young children in the United States attend early care and education (ECE) programs, in which they eat 3-4 times daily. 'Division of responsibility' between adult and child means the adults are responsible for what, when and where, and the child is responsible for whether, what and how much to eat. A balanced division of responsibility can support children's development of healthy eating competency. This paper aims to describe division of responsibility during mealtimes during COVID-19 in Florida using a cross-sectional, mixed methods design. Questions were developed based on Trust Model and Social Cognitive Theory. A survey was completed by 759 ECE directors and 431 teachers, and 29 teachers completed in-depth interviews. COVID-19 increased teacher mealtime responsibilities. Most (95%+) ECE teachers provided meals at the same time and place daily (when and where). Children determined what and how much they ate, but did not serve or handle food. Implications include modifying mealtime routines to minimize the risk of COVID-19 and support healthy eating with a balanced division of responsibility.

Responsive feeding values and practices among families across the Canadian Maritime provinces

Children benefit from responsive feeding practices where their internal signals of hunger and satiety are valued and met with prompt, emotionally supportive, and developmentally appropriate responses. Using an online survey, this study describes responsive feeding values and practices among parents of young children (0-5 years) (n = 1039) across 3 Canadian Maritime provinces. Independent-samples t-tests and 1-way ANOVA were performed to determine the differences in survey questions related to the responsive feeding practices and values. First-time parents and parents with younger children report implementing more consistently some of the challenging responsive feeding practices, such as avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices with food such as pressuring, rewarding, and restriction. These coercive practices may be ineffective and counterproductive as they reinforce reasons to eat unrelated to appetite and self-regulation. Preschool and early feeding interventions that support parents in understanding normal child development, including typical eating behaviours and self-regulation, could help to equip them for challenging feeding experiences and encourage long-term responsive feeding practices. Novelty: First-time parents and parents with younger children report more consistently avoiding pressuring their children to eat, compared with parents with multiple children and parents with children ages 3-5 years. Parents often have well-intended reasons to encourage their children to eat; however, these can coincide with non-responsive practices such as pressuring, rewarding, and restriction.

Factors Associated with Feeding Problems in Young Children with Gastrointestinal Diseases

Feeding problems are associated with the consumption of a limited amount or restricted variety of foods and often occur in children with gastrointestinal diseases. The majority of studies to date do not use valid and reliable measurements to detect feeding problems. The aim of this cross-sectional study was to assess behavioral and skill-based feeding problems in young children with gastrointestinal diseases by using a well-established parent-reported feeding measure and identify demographic, anthropometric, and environmental factors associated with maladaptive feeding behaviors in this pediatric population. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and self-reported questionnaires assessing mealtime environment and parental feeding practices. It was found that 18.6% of the sample had abnormal Total Frequency Score (TFS) (frequency of problematic feeding behaviors) and 39.5% had abnormal Total Problem Score (TPS) (number of behaviors perceived as problematic by parents). Younger children, with lower body mass index, lower birth weight, and only children were more likely to have feeding problems. The study showed that parent-reported feeding problems are increased in young children with gastrointestinal diseases and are associated with specific aspects of mealtime environment and parental feeding practices.

Caregivers' Perceived Emotional and Feeding Responsiveness toward Preschool Children: Associations and Paths of Influence

Although there is a large body of research connecting emotion to eating behaviors, little is known about the role of caregivers' responses to children's emotions in the context of child feeding. The purpose of this study was to analyze the relation between caregivers' emotional responsiveness and feeding responsiveness. The mothers of 137 children between 2 and 6 years of age reported on their responses to children's negative emotions using the Coping with Children's Negative Emotions Scale and on their feeding practices using the Comprehensive Feeding Practices Questionnaire. The results showed that mothers' supportive emotion responses (e.g., problem-focused, emotion-focused, and expressive encouragement reactions) tend to be positively associated with responsive feeding practices (e.g., encouraging, modelling, and teaching healthy food-related behaviors). Instead, mothers' unsupportive responses (e.g., distress, punitive and minimization reactions) tend to be positively associated with nonresponsive feeding practices (e.g., food as reward or to regulate emotions, and pressure to eat) and negatively associated with responsive feeding practices. Our results suggest that emotional and feeding responsiveness may be intertwined and that differences in parent's emotional responsiveness may translate into differences in their feeding styles, setting the stage for parents' use of positive vs. negative feeding practices.

Mealtime Environment and Control of Food Intake in Healthy Children and in Children with Gastrointestinal Diseases

Parental feeding practices and mealtime routine significantly influence a child’s eating behavior. The aim of this study was to investigate the mealtime environment in healthy children and children with gastrointestinal diseases. We conducted a cross-sectional case–control study among 787 healthy, typically developing children and 141 children with gastrointestinal diseases, aged two to seven years. Parents were asked to provide data on demographics and describe their mealtime environment by answering to 24 closed-ended questions. It was found that the majority of the children had the same number of meals every day and at the same hour. Parents of both groups exerted considerable control on the child’s food intake by deciding both when and what their child eats. Almost one third of the parents also decided how much their child eats. The two groups differed significantly in nine of the 24 questions. The study showed that both groups provided structured and consistent mealtime environments. However, a significant proportion of children did not control how much they eat which might impede their ability to self-regulate eating. The presence of a gastrointestinal disease was found to be associated with reduced child autonomy, hampered hunger cues and frequent use of distractions during meals.

Preventing Nutritional Disorders in Adolescents by Encouraging a Healthy Relationship With Food

Nutritional disorders, including overweight, underweight, and/or nutrient deficiency, are a significant cause of morbidity and mortality. These disorders are frequently related to abnormal patterns of eating and/or physical activity, which commonly begin in adolescence and persist into adulthood. Abnormal eating and exercise behaviors may stem from an unhealthy relationship with food, which often takes root in preadolescence or early adolescence. To prevent eating disorders, overweight, underweight, and nutritional deficiencies in adolescence and beyond, health care providers need to proactively support early adolescents and their caregivers to develop a healthy relationship with food and their bodies. Anticipatory guidance, nutrition and exercise counseling, and encouragement of body positivity and healthy self-image during the vulnerable period of early adolescence can prevent maladaptive behaviors from emerging later on. Advocacy beyond the health care setting is also needed to ensure that adolescents are exposed to consistent and positive nutritional messaging. In this position article, authors from both the Nutrition/Obesity Committee and the Eating Disorder Committee of the Society of Adolescent Health and Medicine provide practical recommendations for health care professionals to guide their young patients and caregivers toward a flexible, balanced, and satisfying approach to nutrition that will lead to physical and emotional wellness throughout their lifetimes.

Positive parenting approaches and their association with child eating and weight: A narrative review from infancy to adolescence

Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's risk for developing undesirable eating behaviours and unhealthy weight outcomes. Fewer reviews adopt a strengths-based perspective focusing on the ways that parents can actively support the development of healthy eating behaviours and weight trajectories. Emerging research on such positive parenting styles and practices offers solutions beyond the avoidance of coercive control, as well as opportunities to highlight parallels between research on food parenting and the broader, well-established developmental literature on positive parenting. The focus of this review is to summarize what is known regarding benefits of positive parenting styles and practices for child eating and weight outcomes and discuss recommendations for future research. Current evidence supports starting with responsive feeding and parenting during infancy and incorporating structure and limit setting in early childhood, with monitoring and mealtime structure remaining important during middle childhood and adolescence. Areas for future research include: (1) further examination of the implications of identified food parenting practices and styles among diverse groups and caregivers; (2) increased consideration of child factors (eg, temperament) as moderators or mediators; and (3) further clarification of the relationship between general parenting and food parenting.

Does the recall of caregiver eating messages exacerbate the pathogenic impact of shame on eating and weight-related difficulties?

PURPOSE

The central role of caregiver eating messages has been recognized on later individual's eating behaviour, body image and weight status. Additionally, shame is a painful emotion also associated with the development and maintenance of body image and eating-related difficulties. The main aim of the present study was to explore the moderator effect of the recall of caregiver eating messages on the associations between external shame, body weight and shape-related concerns, and the adoption of inflexible eating rules.

METHODS

The sample comprised 479 women from the general population, aged from 18 to 60 years, who completed self-report measures.

RESULTS

Results of the correlation analyses showed that early caregiver restrictive/critical eating messages were positively associated with external shame, inflexible eating and overvaluation of body weight and shape. Path analysis results demonstrated a moderator effect of early caregiver critical eating messages on the relationship between external shame and both weight and shape-related concerns and inflexible eating. These results revealed that caregiver restrictive/critical eating messages exacerbated the impact of shame on these psychopathological indices, with the tested model accounting for 19% and 38% of the variance of inflexible eating rules and body weight and shape concerns, respectively.

CONCLUSIONS

These findings seem to suggest important research and clinical implications, contributing to the understanding of disordered eating patterns, and appear to represent a new avenue for the development of prevention and intervention programs. Particularly, these findings support the relevance of targeting caregiver eating-related attitudes and messages in prevention interventions for eating psychopathology.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Fathers' Perceptions of Their Role in Family Mealtimes: A Grounded Theory Study

OBJECTIVE

This study examines how fathers negotiate the role of feeding with other family members, and how this both impacts and is shaped by the structure of mealtimes.

DESIGN

Six separate focus groups.

SETTING

South East Queensland, Australia.

PARTICIPANTS

Fathers (N = 27) of children aged ≤12 years employed in blue-collar occupations or service industries.

PHENOMENON OF INTEREST

Fathers' perceptions of their role in family feeding.

ANALYSIS

Grounded theory.

RESULTS

Two major themes were identified: (1) mealtime structure, reflecting various arrangements and management procedures that give ultimate shape to mealtimes; and (2) division of labor, reflecting the work required to bring about such arrangements and how this work is allocated. These themes were interrelated and harmonized to create family mealtimes. Fathers felt that labor was assigned pragmatically; designated roles around feeding within the family facilitated structured mealtimes.

CONCLUSIONS AND IMPLICATIONS

Fathers' roles in balancing the labor and structured mealtimes to feed the family require further research attention, particularly across different family structures, to enhance their engagement in and contribution to the family meal environment. Offering cooking programs and meal planning education to fathers may support them in their different roles and enhance efficiency.

Supporting healthy lifestyle behaviours in families attending community playgroups: parents' perceptions of facilitators and barriers

BACKGROUND

Establishing healthy nutrition, activity, and sleep behaviours early in life is a key strategy in childhood obesity prevention. Parents are the primary influence on the development and establishment of obesity-related behaviours in young children. There is evidence that autonomy supporting parenting practices are crucial for the development of self-regulation and the internalisation of healthy behaviours in children. It is therefore imperative that parenting practices are targeted as part of an obesity prevention intervention. However, there is limited understanding of barriers and facilitators to parents using autonomy supporting parenting practices with their children aged 0-5 years. Therefore, the aim of the study was to identify barriers and facilitators to using autonomy supporting parenting practices. A secondary aim was to determine parent preferences in respect to an intervention program to be delivered in community playgroups.

METHODS

Parents were recruited through Playgroup Queensland (PGQ), a not-for-profit organisation in Brisbane, Australia, to attend a focus group during their usual playgroup session. The focus group interview guide was designed to promote discussion among the participants in respect to their shared experiences as parents of young children. The focus group transcripts were coded and analysed using qualitative content analysis. Five focus groups with parents (n = 30) were conducted in May 2018. Most of the participants were mothers [1], and the majority (76%) had a child at playgroup aged between 2 and 4 years.

RESULTS

The support and guidance received from other parents at playgroup was a facilitator to autonomy supporting parenting practices. Barriers included beliefs around the need to use rewards to encourage child eating, beliefs around the need for screens as babysitters, and feeling disempowered to change sleep behaviours. Parents were enthusiastic about a potential program that would leverage off the existing playgroup support networks, but they did not want to be "educated", or to lose their "playgroup time" to an intervention. Rather they wanted strategies and support to deal with the frustrations of food, screen and sleep parenting.

CONCLUSION

These results will be used to inform the development of a childhood obesity prevention intervention to be delivered in a community playgroup setting.

Restrictive feeding and excessive hunger in young children with obesity: A case series

Treatment recommendations for childhood obesity include guidance to reduce portions and the consumption of high-energy-dense foods. These messages may unintentionally promote restrictive feeding among parents of children with obesity with excessive hunger. Clinical guidance may benefit from framing treatment messages to parents in the context of a nonrestrictive feeding style.

Feeding Practices and Parenting: A Pathway to Child Health and Family Happiness

Feeding and parenting are inextricably linked. The complex bidirectional interactions between parent feeding practices and child eating behaviour shape the early feeding environment which in turn interacts with genetic predispositions to lay the foundation for life-long eating habits and health outcomes. Parent feeding and child (and parent) eating are central to the fabric of family life and are strongly rooted in culture and tradition. Yet, many parents experience stress and anxiety related to this ubiquitous parenting task and perceive their child as a “fussy eater” or a “difficult feeder.” Parents commonly misinterpret heritable and developmentally “normal” child eating behaviour, such as food refusal, as cause for concern. In an effort to get their child to “eat well” they respond with coercive feeding practices, such as pressure, reward and restriction. Emotional feeding that uses food to comfort, distract, calm or shape behaviour is also common. Although well intentioned, these non-responsive, parent- rather than child-centred feeding practices are ineffective, even counterproductive. They teach children to eat for reasons unrelated to appetite and, hence, more than they need and fail to support development of healthy food preferences and appetite regulation. Early feeding interventions are needed that assist parents to understand normal child eating behaviour and promote responsive feeding practices and effective food parenting. The aim of this chapter is to review (1) “normal” eating behaviour of young children, (2) the range of feeding practices and strategies that parents use to respond to and try to shape these behaviours, (3) evidence for approaches to feeding young children that have potential to reduce conflict related to child feeding and promote life-long healthy eating patterns that are a key determinant of long-term health and well-being and (4) to provide an overview of an early feeding intervention, NOURISH, which demonstrated a positive impact on maternal feeding practices and potentially reduced parent anxiety and stress related to feeding.

Association Between Maternal Feeding Practices and Symptoms of Anxiety and Depression Among 6-Year-Old Children

Background:

Maternal feeding practices (MFPs) have been linked to childhood obesity and other eating disorders. However, population-based research examining the association between MFPs and children’s emotional well-being is currently lacking.

Methods:

We examined 1241 participants from Year 6 Follow-Up of the Infant Feeding Practices Study II, conducted from March to June 2012 in the United States.

Results:

Approximately 57.5% and 47.8% of participants reported at least one symptom of childhood anxiety and depression, respectively. After adjusting for potential confounders, mothers who responded “yes” to “If I did not guide or regulate my child’s eating, he or she would eat too much of his or her favorite food” had higher odds of having a child who has symptoms of depression and anxiety compared with mothers who responded “no” (odds ratio [OR], 95% confidence interval [CI]) (2.02; 1.47-2.78, P < .001) and (1.41, 1.05-1.91, P = .024), respectively. The odds of having a child who has symptoms of depression were lower among mothers who responded “yes” to “I make sure that my child does not eat too many sweets or junk foods” compared with mothers who responded “no” (0.49; 0.26-0.91, P = .020). Mothers who responded “yes” to “I encourage my 6 year-old to eat all of the food on his or her plate” had higher odds of having a child who has symptoms of anxiety compared with mothers who responded “no” (1.43; 1.01-2.05, P = .049).

Conclusions:

Controlling MFPs may influence a child’s emotional well-being. Further research is needed to address the complex relationships between MFPs and psychosocial well-being in children.

An examination of children's eating behaviours as mediators of the relationship between parents' feeding practices and early childhood body mass index z-scores

OBJECTIVE

Parent's use of restrictive feeding practices is associated with child weight. Similarly, the literature shows that children's eating behaviours are also associated with child weight. Given this interrelationship between children's eating behaviours, restrictive feeding practices and child weight, examination of possible mediator relationships is warranted. This study aimed to examine the relationships between overt restriction and covert restriction with child body mass index z-scores (BMIz) and determine if children's eating behaviours (satiety responsiveness and food responsiveness) act as mediators.

METHOD

Parents of Australian children (n = 977) 2.0-5.0 years of age (49.4% male) provided data in an online survey on child eating behaviours, parent's restrictive feeding practices and child anthropometrics (modified z-scores were created to screen for biologically implausible values). Correlation analysis was used to determine variables to include in mediation models. Hayes' PROCESS macros in spss was used to examine mediation, controlling for covariates of child BMIz.

RESULTS

Overt restriction was the only parent feeding practice related to child BMIz (B = 0.132, P = 0.04). Mediation analysis showed that the indirect effect of overt restriction on child BMIz (controlling for child age, gender, parent BMI and income) became non-significant when controlling for food responsiveness, thus suggesting full mediation, explaining 5.75% of the relation.

CONCLUSION

Overt restriction and covert restriction have distinctly different relationships with children's eating behaviours. Food responsiveness appears an important intermediary in the relationship between overt restriction and child BMIz.

The Relationship between Structure-Related Food Parenting Practices and Children's Heightened Levels of Self-Regulation in Eating

BACKGROUND

Food parenting practices influence children's eating behaviors and weight status. Food parenting practices also influence children's self-regulatory abilities around eating, which has important implications for children's eating behaviors. The purpose of the following study is to examine use of structure-related food parenting practices and the potential impact on children's ability to self-regulate energy intake.

METHODS

Parents (n = 379) of preschool age children (M = 4.10 years, SD = 0.92) were mostly mothers (68.6%), Non-White (54.5%), and overweight/obese (50.1%). Hierarchical Multiple Regression was conducted to predict child self-regulation in eating from structure-related food parenting practices (structured meal setting, structured meal timing, family meal setting), while accounting for child weight status, parent age, gender, BMI, race, and yearly income.

RESULTS

Hierarchical Multiple Regression results indicated that structure-related feeding practices (structured meal setting and family meal setting, but not structured meal timing) are associated with children's heightened levels of self-regulation in eating. Models examining the relationship within children who were normal weight and overweight/obese indicated the following: a relationship between structured meal setting and heightened self-regulation in eating for normal-weight children and a relationship between family meal setting and heightened self-regulation in eating for overweight/obese children.

CONCLUSIONS

Researchers should further investigate these potentially modifiable parent feeding behaviors as a protective parenting technique, which possibly contributes to a healthy weight development by enhancing self-regulation in eating.

[Current status of parental feeding behaviors in Urumqi, China, and its association with body mass index of children]

OBJECTIVE

To investigate the association between parental feeding behaviors and body mass index (BMI) of children, and to provide a scientific basis for the prevention and intervention of overweight and obesity in children.

METHODS

Stratified random cluster sampling was used to select 976 children from 7 kindergartens in Xinshi District of Urumqi, and a questionnaire survey and physical measurement were performed to obtain related data.

RESULTS

A total of 976 questionnaires were distributed and 924 (94.7%) usable questionnaires were collected. The overall detection rates of underweight, overweight, and obesity in children were 3.1% (29 children), 9.2% (85 children), and 6.7% (62 children), respectively. The highest level of parental feeding behavior was monitoring, followed by restriction and pressure to eat. The parents of the Han children had significantly higher levels of restriction and pressure to eat than those of the Uygur children (P<0.01). As for parental feeding behaviors, restriction to eat was positively correlated with BMI of the Han and Uygur boys (P<0.01); pressure to eat was negatively correlated with BMI of the Han boys and girls (P<0.01) and was positively correlated with BMI of the Uygur boys and girls (P<0.01); monitoring was negatively correlated with BMI of the Han and Uygur boys and girls (P<0.05). Among the parents of the Han and Uygur boys, the parents of the overweight/obese children had significantly higher scores of restriction to eat than those of the children with normal weight (P<0.05); among the parents of the Uygur boys and girls, the parents of the overweight/obese children had significantly higher scores of pressure to eat than those of the children with normal weight (P<0.01); among the parents of the Uygur and Han boys and girls, the parents of the overweight/obese children had significantly lower scores of monitoring than those of the children with normal weight (P<0.01).

CONCLUSIONS

The parental feeding behavior is good in Urumqi, and the parental feeding behavior of the Uygur children is a little better than that of the Han children. Parental feeding behavior is closely correlated with BMI of children, and such correlation differs across ethnic groups and sexes. A high level of monitoring and low levels of restriction and pressure to eat may help to prevent and control the development of overweight and obesity in children.

How Does Context Relate to Nutrition Promotion and Mealtime Practice in Early Care and Education Settings? A Qualitative Exploration

BACKGROUND

Early childhood educators have the potential to influence children's dietary outcomes through daily interactions. However, existing research suggests that educator practices are often suboptimal. Previous research has often focused on individual characteristics that affect practices. There is less study of contextual influences of practices of early childhood educators.

OBJECTIVE

The purpose of this study was to understand and describe contextual factors evident in narratives of early childhood educators influencing mealtime and nutrition promotion practices. We use the Promoting Action on Research Implementation in Health Services framework to consider how contextual factors related to practices of early childhood educators.

DESIGN

This cross-sectional, qualitative study collected data through in-depth interviews with early childhood educators. Analyses of the data reflected a factist perspective and semantic approach to complete thematic content analysis of in-depth interviews.

PARTICIPANTS

The study used a stratified purposive sampling approach to recruit 28 educators to balance across educator role, agency type (Head Start vs state-funded), and obesity prevalence in the community. Early childhood educators were mostly lead teachers (62%), between the ages of 30 and 49 (82.1%), and white (75%) or African American (14.3%).

RESULTS

The coders identified three primary themes: Mealtime Structures, Resources, and Classroom/Center Atmosphere. Mealtime Structures associated with detrimental practices included cafeteria meals with rigid schedules. Mealtime Structures associated with evidence-based practices (EBPs) included classroom meal service. Resources associated with detrimental practices included limited funding. Resources associated with EBPs included meals paid for early childhood educators and classroom food experiences. Classroom/Center Atmosphere factors associated with detrimental practices included poor food offerings and policies that conflicted (eg, allowing children to bring in outside foods). Classroom/Center Atmosphere factors associated with EBPs included clarity around meal service rules and healthy, appealing food offerings.

CONCLUSIONS

This study highlighted that it may be difficult for an early childhood educator to adopt and maintain EBPs in certain contexts.

Bidirectional associations between mothers' feeding practices and child eating behaviours

Background

This study examined bidirectional relationships between maternal feeding practices and child food responsiveness and satiety responsiveness from 2 to 5 years.

Methods

Mothers (N = 207) reported their own feeding practices and child eating behaviours using validated questionnaires at child ages 2, 3.7, and 5 years. Cross-lagged analyses were conducted to test for bidirectional effects, adjusting for child BMI z-score (based on measured weight and height) at 14 months.

Results

Eating behaviours and feeding practices showed strong continuity across the three time points. Maternal feeding practices (higher reward for behaviour [β = 0.12, p = 0.025] and lower covert restriction [β = −0.14, p = 0.008]) were prospectively associated with higher food responsiveness. Conversely, increased child satiety responsiveness was primarily prospectively associated with mothers’ feeding practices (increased structured meal timing [β = 0.11, p = 0.038], overt [β = 0.14, p = 0.010] and covert restriction [β = 0.11, p = 0.022]). The only exception was family meal setting, which was prospectively negatively associated with satiety responsiveness (β = −0.11, p = 0.035).

Conclusion

While maternal feeding practices and child satiety and food responsiveness show strong continuity between child age 2 and 5 years, maternal feeding practices appear to be associated with child food responsiveness over time. Conversely, child satiety responsiveness, but not food responsiveness, may also be associated with maternal feeding practices over time. These results are consistent with interventions that provide feeding advice to parents on how to respond appropriately to individual child eating behaviour phenotype.

Trial registration

ACTRN12608000056392. Registered 29 January 2008.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0644-x) contains supplementary material, which is available to authorized users.

Associations between body weight status, psychological well-being and disordered eating with intuitive eating among Malaysian undergraduate university students

Intuitive eating, which can be defined as reliance on physiological hunger and satiety cues to guide eating, has been proposed as a healthy weight management strategy. To date, there has not been a published study on intuitive eating in the context of Malaysia. Therefore, this cross-sectional study aims to determine associations between body weight status, psychological well-being and disordered eating behaviors with intuitive eating among undergraduate university students. A total of 333 undergraduate respondents (21.3% males and 78.7% females) from three randomly selected faculties in a public university in Malaysia participated in this study. Respondents completed a self-administered questionnaire which featured socio-demographic characteristics, intuitive eating, self-esteem, body appreciation, general unconditional acceptance, body acceptance by others, body function and disordered eating. Body weight, height, body fat percentage and waist circumference were measured. The results from this study revealed that there was no difference (t = 0.067, p = 0.947) in intuitive eating scores between males (75.69 ± 7.16) and females (75.62 ± 7.90). Multiple linear regression results have shown that body appreciation (β = 0.385, p < 0.001) and disordered eating (β = -0.168, p = 0.001) were significant predictors of intuitive eating, which accounted for 19.6% of the variance in intuitive eating. Health promotion programs should highlight the importance of enhancing body appreciation and preventing disordered eating behaviors among university students in order to promote intuitive eating as one of the healthy weight management approaches.

Mothers' Perspectives on the Development of Their Preschoolers' Dietary and Physical Activity Behaviors and Parent-Child Relationship: Implications for Pediatric Primary Care Physicians

The study explores female caregivers' reflections on their relationship with their child (2-5 years old) and the development of their child's dietary and physical activity behaviors. Five, 90-minute semistructured focus groups were conducted to inquire about children's growth, eating behaviors and routines, physical activity, personality, and the parent-child relationship. Nineteen female caregivers diverse in race/ethnicity, age, and educational attainment participated. Participants reported that they maintained a schedule, but needed to be flexible to accommodate daily responsibilities. Family, social factors, and day care routines were influences on their children's behaviors. The main physical activity barriers were safety and time constraints. Guidance from pediatric primary care providers aimed at supporting female caregivers to build a positive foundation in their parent-child relationship, and to adopt and model healthy diet and physical activity behaviors that are respectful of schedules and barriers should be a priority for childhood obesity prevention.

Learning to eat again: Intuitive eating practices among retired female collegiate athletes

The present study used an open-ended survey to collect information about current eating practices and coping strategies among 218 retired female athletes. An inductive and deductive thematic analysis revealed three themes relevant to the intuitive eating framework-permission to eat; recognizing internal hunger and satiety cues; and eating to meet physical and nutritional needs. Athletes described feeling liberated with regards to their eating following retirement from sport, and for some this included an alleviation of disordered eating practices. These changes, however, required an effortful process of recalibration, during which athletes had to relearn and reinterpret their body's physiological signals of hunger and satiety. Additional research is needed to understand just how this process unfolds and how retired athletes can be supported in developing a healthier and more adaptive approach to eating.

Mealtime Structure and Responsive Feeding Practices Are Associated With Less Food Fussiness and More Food Enjoyment in Children

OBJECTIVE

To identify associations between structure-related and non-responsive feeding practices and children's eating behaviors.

DESIGN

Cross-sectional online survey design.

PARTICIPANTS

Parents (n = 413) of 1- to 10-year-old children.

MAIN OUTCOME MEASURES

Parental feeding practices and child eating behaviors were measured via the validated Feeding Practices and Structure and Children's Eating Behaviour questionnaires.

ANALYSIS

Associations between parental feeding practices and children's eating behaviors were tested using hierarchical multivariable linear regression models, adjusted for covariates.

RESULTS

Feeding practices accounted for 28% and 21% of the variance in food fussiness and enjoyment of food, respectively (P < .001). For all other eating behaviors the amount of variance explained by feeding practices was < 10% (P < .001). Key findings were that more structure and less non-responsive practices were associated with lower food fussiness and higher enjoyment of food.

CONCLUSIONS AND IMPLICATIONS

Overall, the findings suggested that mealtime structure and responsive feeding are associated with more desirable eating behaviors. Contrary to predictions, there was no evidence to indicate that these practices are associated with better self-regulation of energy intake. Longitudinal research and intervention studies are needed to confirm the importance of these feeding practices for children's eating behaviors and weight outcomes.

Breastfeeding Duration and Authoritative Feeding Practices in First-Time Mothers

BACKGROUND

Longer breastfeeding duration appears to have a protective effect against childhood obesity. This effect may be partially mediated by maternal feeding practices during the first years of life. However, the few studies that have examined links between breastfeeding duration and subsequent feeding practices have yielded conflicting results.

OBJECTIVE

Using a large sample of first-time mothers and a newly validated, comprehensive measure of maternal feeding (the Feeding Practices and Structure Questionnaire), this study examined associations between breastfeeding duration and maternal feeding practices at child age 24 months.

METHODS

Mothers (n = 458) enrolled in the NOURISH trial provided data on breastfeeding at child age 4, 14, and 24 months, and on feeding practices at 24 months. Structural equation modeling was used to examine associations between breastfeeding duration and 5 nonresponsive and 4 structure-related "authoritative" feeding practices, adjusting for a range of maternal and child characteristics.

RESULTS

The model showed acceptable fit (χ(2)/df = 1.68; root mean square error of approximation = .04, comparative fit index = .91, and Tucker-Lewis index = .89) and longer breastfeeding duration was negatively associated with 4 out of 5 nonresponsive feeding practices and positively associated with 3 out of 4 structure-related feeding practices. Overall, these results suggest that mothers who breastfeed longer reported using more appropriate feeding practices.

CONCLUSION

These data demonstrate an association between longer breastfeeding duration and authoritative feeding practices characterized by responsiveness and structure, which may partly account for the apparent protective effect of breastfeeding on childhood obesity.

Maternal intuitive eating as a moderator of the association between concern about child weight and restrictive child feeding

Mothers who are concerned about their young child's weight are more likely to use restrictive feeding, which has been associated with increased food seeking behaviors, emotional eating, and overeating in young children across multiple prospective and experimental studies. In the present study, we examined whether mothers' intuitive eating behaviors would moderate the association between their concern about their child's weight and their use of restrictive feeding. In a sample of 180 mothers of young children, two maternal intuitive eating behaviors (i.e., eating for physical reasons, trust in hunger and satiety cues) moderated this association after controlling for maternal age, body mass index, years of education, race/ethnicity, awareness of hunger and satiety cues and perceptions of child weight. More specifically, concern about child weight was unrelated to restrictive feeding for mothers with higher levels of eating for physical reasons and trust in hunger and satiety cues. However, concern about child weight was positively related to restrictive feeding among mothers with lower or average levels of eating for physical reasons and trust in hunger and satiety cues. These findings indicate that it may be important address maternal intuitive eating within interventions designed to improve self-regulated eating in children, as mothers who attend these interventions tend to be highly concerned about their child's weight and, if also low in intuitive eating, may be at risk for using restrictive feeding behaviors that interfere with children's self-regulated eating.

Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention

Among early adolescents (10-14 years), poor diet quality along with physical inactivity can contribute to an increased risk of obesity and associated biomarkers for chronic disease. Approximately one-third of United States (USA) children in this age group are overweight or obese. Therefore, attention to factors affecting dietary intake as one of the primary contributors to obesity is important. Early adolescents consume foods and beverages during eating occasions that occur with and without parental supervision. Parents may influence eating behaviors of early adolescents during eating occasions when they are present or during independent eating occasions by engaging in practices that affect availability of foods and beverages, and through perceived normative beliefs and expectations for intake. Therefore, the purpose of this article was to describe the influence of parenting practices on eating behaviors in general and when specifically applied to independent eating occasions of early adolescents. This information may be helpful to inform parenting interventions targeting obesity prevention among early adolescents focusing on independent eating occasions.

Addressing Childhood Obesity: Opportunities for Prevention

The overweight and obesity epidemic among children and adolescents in the United States continues to worsen, with notable racial, ethnic, and socioeconomic disparities. Risk factors for pediatric obesity include genetics; environmental and neighborhood factors; increased intake of sugar-sweetened beverages (SSBs), fast-food, and processed snacks; decreased physical activity; shorter sleep duration; and increased personal, prenatal, or family stress. Pediatricians can help prevent obesity by measuring body mass index at least yearly and providing age- and development-appropriate anticipatory guidance to families. Public policies and environmental interventions aim to make it easier for children to make healthy nutrition and physical activity choices. Interventions focused on family habits and parenting strategies have also been successful at preventing or treating childhood obesity.

Participation as a leader in immersion weight loss treatment may benefit, not harm, young adult staff members

Despite the success of weight-management programmes, some researchers caution that participation in an aggressive approach to weight management could promote the development of eating pathology. The current study evaluated the risks and benefits for young adults of serving as staff members in an immersion treatment of adolescent obesity over the course of a summer. Participants included weight loss staff members (n = 108) along with a comparison group of young adults with similar demographic characteristics (n = 136). Participants completed assessments of eating disorder and obesity risk at three time points: the beginning of the summer, the end of the summer and a 6-week follow-up. Weight loss leadership participants who were initially overweight lost weight over the course of the summer, but those at healthy weights maintained their weight. Comparison participants also maintained their weight during the summer. Weight loss staff members also increased dietary restraint over the summer, and increases in dietary restraint appeared to facilitate appropriate weight reduction. Participation as a leader in an immersion weight loss programme seemed to benefit, not harm, young adults; this suggests potential advantages for using weight controlling interventions in a wide range of individuals, including as an obesity prevention strategy.

Maternal intuitive eating as a moderator of the association between concern about child weight and restrictive child feeding

Mothers who are concerned about their young child's weight are more likely to use restrictive feeding, which has been associated with increased food seeking behaviors, emotional eating, and overeating in young children across multiple prospective and experimental studies. In the present study, we examined whether mothers' intuitive eating behaviors would moderate the association between their concern about their child's weight and their use of restrictive feeding. In a sample of 180 mothers of young children, two maternal intuitive eating behaviors (i.e., eating for physical reasons, trust in hunger and satiety cues) moderated this association after controlling for maternal age, body mass index, years of education, race/ethnicity, awareness of hunger and satiety cues and perceptions of child weight. More specifically, concern about child weight was unrelated to restrictive feeding for mothers with higher levels of eating for physical reasons and trust in hunger and satiety cues. However, concern about child weight was positively related to restrictive feeding among mothers with lower or average levels of eating for physical reasons and trust in hunger and satiety cues. These findings indicate that it may be important address maternal intuitive eating within interventions designed to improve self-regulated eating in children, as mothers who attend these interventions tend to be highly concerned about their child's weight and, if also low in intuitive eating, may be at risk for using restrictive feeding behaviors that interfere with children's self-regulated eating.

An Early Feeding Practices Intervention for Obesity Prevention

OBJECTIVE

Report long-term outcomes of the NOURISH randomized controlled trial (RCT), which evaluated a universal intervention commencing in infancy to provide anticipatory guidance to first-time mothers on "protective" complementary feeding practices that were hypothesized to reduce childhood obesity risk.

METHODS

The NOURISH RCT enrolled 698 mothers (mean age 30.1 years, SD = 5.3) with healthy term infants (51% female). Mothers were randomly allocated to usual care or to attend two 6-session, 12-week group education modules. Outcomes were assessed 5 times: baseline (infants 4.3 months); 6 months after module 1 (infants 14 months); 6 months after module 2 (infants 2 years) and at 3.5 and 5 years of age. Maternal feeding practices were self-reported using validated questionnaires. BMI Z-score was calculated from measured child height and weight. Linear mixed models evaluated intervention (group) effect across time.

RESULTS

Retention at age 5 years was 61%. Across ages 2 to 5 years, intervention mothers reported less frequent use of nonresponsive feeding practices on 6 of 9 scales. At 5 years, they also reported more appropriate responses to food refusal on 7 of 12 items (Ps ≤ .05). No statistically significant group effect was noted for anthropometric outcomes (BMI Z-score: P = .06) or the prevalence of overweight/obesity (control 13.3% vs intervention 11.4%, P = .66).

CONCLUSIONS

Anticipatory guidance on complementary feeding resulted in first-time mothers reporting increased use of protective feeding practices. These intervention effects were sustained up to 5 years of age and were paralleled by a nonsignificant trend for lower child BMI Z-scores at all postintervention assessment points.

Extending the validity of the Feeding Practices and Structure Questionnaire

Background

Feeding practices are commonly examined as potentially modifiable determinants of children’s eating behaviours and weight status. Although a variety of questionnaires exist to assess different feeding aspects, many lack thorough reliability and validity testing. The Feeding Practices and Structure Questionnaire (FPSQ) is a tool designed to measure early feeding practices related to non-responsive feeding and structure of the meal environment. Face validity, factorial validity, internal reliability and cross-sectional correlations with children’s eating behaviours have been established in mothers with 2-year-old children. The aim of the present study was to further extend the validity of the FPSQ by examining factorial, construct and predictive validity, and stability.

Methods

Participants were from the NOURISH randomised controlled trial which evaluated an intervention with first-time mothers designed to promote protective feeding practices. Maternal feeding practices (FP) and child eating behaviours were assessed when children were aged 2 years and 3.7 years (n = 388). Confirmatory Factor analysis, group differences, predictive relationships, and stability were tested.

Results

The original 9-factor structure was confirmed when children were aged 3.7 ± 0.3 years. Cronbach’s alpha was above the recommended 0.70 cut-off for all factors except Structured Meal Timing, Over Restriction and Distrust in Appetite which were 0.58, 0.67 and 0.66 respectively. Allocated group differences reflected behaviour consistent with intervention content and all feeding practices were stable across both time points (range of r = 0.45-0.70). There was some evidence for the predictive validity of factors with 2 FP showing expected relationships, 2 FP showing expected and unexpected relationships and 5 FP showing no relationship.

Conclusions

Reliability and validity was demonstrated for most subscales of the FPSQ. Future validation is warranted with culturally diverse samples and with fathers and other caregivers. The use of additional outcomes to further explore predictive validity is recommended as well as testing test-retest reliability of the questionnaire.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Rationale and design of the Feeding Dynamic Intervention (FDI) study for self-regulation of energy intake in preschoolers

In 2011, the Institute of Medicine Early Childhood Prevention Policies Report identified feeding dynamics as an important focus area for childhood obesity prevention and treatment. Feeding dynamics includes two central components: (1) caregiver feeding practices (i.e., determining how, when, where, and what they feed their children) and (2) child eating behaviors (i.e., determining how much and what to eat from what food caregivers have provided). Although there has been great interest in overweight and obesity prevention and treatment in young children, they have not focused comprehensively on feeding dynamics. Interventions on feeding dynamics that reduce caregivers' excessive controlling and restrictive feeding practices and encourage the development of children's self-regulation of energy intake may hold promise for tackling childhood obesity especially in the young child but currently lack an evidence base. This manuscript describes the rationale and design for a randomized controlled trial designed to compare a group of mothers and their 3-to 5-year old children who received an intervention focused primarily on feeding dynamics called the Feeding Dynamic Intervention (FDI) with a Wait-list Control Group (WLC). The primary aim of the study will be to investigate the efficacy of the FDI for decreasing Eating in the Absence of Hunger (EAH) and improving energy compensation (COMPX). The secondary aim will be to examine the effect of the FDI in comparison to the WLC on maternal self-reported feeding practices and child satiety responsiveness.

Targeting Feeding and Eating Behaviors: Development of the Feeding Dynamic Intervention for Caregivers of 2- to 5-Year-Old Children

Targeting feeding dynamics, a concept centered on the roles and interaction of the caregiver and child in a feeding relationship, may have significant potential for obesity intervention. The aim of this paper is to describe the 3-phase development of the Feeding Dynamics Intervention (FDI), an acceptability and feasibility study on implementing the feeding dynamic roles (Study 1), development of the FDI content (Study 2), and a pilot study on use of the 6-lesson FDI to promote behaviors consistent with a feeding dynamic approach (Study 3). Sample population was mothers with young children, 2-5 years old. An effect size (Hedges' g) greater than 0.20 was seen in more than half (57%) of maternal feeding behaviors, with the largest effect sizes (Hedges' g ≥ 0.8) occurring with behaviors that represent the mother adopting her roles of determining what food is served, not using food as a reward, and not controlling her child's intake. There was a significant decline in Pressure to Eat behaviors (2.9 versus 2.2, p < 0.01) and Monitoring (4.1 versus 3.5, p < 0.001). The FDI emerged as an acceptable and implementable intervention. Future studies need to investigate effects of the FDI on the child's eating behaviors, self-regulation of energy intake, and anthropometrics.

Feeding practices and child weight: is the association bidirectional in preschool children?

BACKGROUND

Parental feeding practices are associated with children's body mass index (BMI). It has been generally assumed that parental feeding determines children's eating behaviors and weight gain, but feeding practices could equally be a parent's response to child weight.

OBJECTIVE

In longitudinal analyses, we assessed the directionality in the relation between selected controlling feeding practices and BMI in early childhood.

DESIGN

Participants were 4166 children from the population-based Generation R Study. BMI was measured at ages 2 and 6 y. With the use of the Child Feeding Questionnaire, parents reported on restriction, monitoring, and pressure to eat (child age: 4 y). BMI and feeding-behavior scales were transformed to SD scores.

RESULTS

With the use of linear regression analyses, there was an indication that a higher BMI at age 2 y predicted higher levels of parental restriction (adjusted β = 0.07; 95% CI: 0.04, 0.10) and lower levels of pressure to eat (adjusted β = -0.20; 95% CI: -0.23, -0.17) 2 y later. Restriction at age 4 y positively predicted child BMI at 6 y of age, although this association attenuated to statistical nonsignificance after accounting for BMI at age 4 y (β = 0.01; 95% CI: -0.01, 0.03). Pressure to eat predicted lower BMI independently of BMI at age 4 y (β = -0.02; 95% CI: -0.04, -0.01). For both restriction and pressure to eat, the relation from BMI to parenting was stronger than the reverse (Wald's test for comparison: P = 0.03 and < 0.001, respectively). Monitoring predicted a lower child BMI, but this relation was explained by confounding factors.

CONCLUSIONS

Although the feeding-BMI relation is bidirectional, the main direction of observed effects suggests that parents tend to adapt their controlling feeding practices in response to their child's BMI rather than the reverse. Therefore, some components of current programs aimed at preventing or treating unhealthy child weight may need to be carefully scrutinized, especially those targeting parental food-related restriction and pressure to eat.

Position of the Academy of Nutrition and Dietetics: nutrition guidance for healthy children ages 2 to 11 years

It is the position of the Academy of Nutrition and Dietetics that children ages 2 to 11 years should achieve optimal physical and cognitive development, maintain healthy weights, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. Rapid increases in the prevalence of childhood obesity during the 1980s and 1990s focused attention on young children's overconsumption of energy-dense, nutrient-poor foods and beverages and lack of physical activity. While recent data suggest a stabilization of obesity rates, several public health concerns remain. These include the most effective ways to promote healthy weights, the number of children living in food insecurity, the under-consumption of key nutrients, and the early development of diet-related risks for chronic diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This Position Paper reviews what children 2 to 11 years old in the United States are reportedly eating, explores trends in food and nutrient intakes, and examines the impact of federal nutrition programs on child nutrition. Current dietary recommendations and guidelines for physical activity are also discussed. The roles of parents and caregivers in influencing the development of life-long healthy eating behaviors are highlighted. The Academy of Nutrition and Dietetics works with other allied health and food industry professionals to translate dietary recommendations and guidelines into positive, practical health messages. Specific recommendations and sources of science-based nutrition messages to improve the nutritional well-being of children are provided for food and nutrition practitioners.

Qualité ou quantité : des parents québécois lèvent le voile sur leurs stratégies déployées pour favoriser le « bien manger » chez leurs enfants

Les attitudes et comportements alimentaires développés pendant la petite enfance influencent grandement la relation future du mangeur à l’égard des aliments. Le parent s’avère en ce sens des plus déterminants. Cette étude vise à connaître les pratiques observées et les attitudes adoptées par les parents québécois d’enfants d’âge préscolaire pour favoriser le « bien manger ». La collecte de données a été effectuée à l’aide de cartes postales distribuées dans les centres de la petite enfance du Québec pour ensuite être remises aux parents. L’analyse des réponses à la question ouverte figurant sur la carte postale a été réalisée sur la base du modèle des prises alimentaires de Jean-Pierre Poulain. 1257 cartes postales ont été retenues aux fins d’analyses. Les données recueillies permettent dans un premier temps de connaître la perception des parents quant à la notion de « manger bien ». Les notions de qualité et de quantité, diamétralement opposées, se démarquent. Cette étude permet de constater la variété des stratégies employées par les parents québécois au moment du repas. D’une grande pertinence pour la santé publique, ces données permettront de cibler les messages clés à promouvoir auprès de ces acteurs d’influence dans le développement des habitudes alimentaires des tout-petits.