Appetitive Traits and Weight in Children: Evidence for Parents' Controlling Feeding Practices as Mediating Mechanisms

The effects of parent-child dysfunctional interactions on early childhood weight: A serial mediation model through emotional feeding and child appetite traits

Parent-child dysfunctional interactions (PCDI) are known to contribute to children's weight status. However, the underlying mechanisms in how dysfunctional interactions between parent and child influence child weight are not clear. This study investigates the impact of PCDI on toddlers' weight, focusing on the potential serial mediation by maternal emotional feeding and child appetite traits. We conducted a secondary analysis of longitudinal data from a larger intervention trial to prevent childhood obesity in low-income Hispanic families. A total of 241 mother-child dyads were included in these analyses. Measurements were taken at various stages: PCDI at child age 19 months, maternal emotional feeding at 28 months, and both child appetite traits and weight-for-age z-score (WFAz) at 36 months. Serial mediation analyses revealed a significant indirect effect of early PCDI on later child WFAz through maternal emotional feeding and two child food approach traits (food responsiveness, emotional overeating) out of the eight child appetite traits assessed. PCDI at 19 months was associated with increased use of emotional feeding in mothers at 28 months, which was associated with heightened food responsiveness and emotional overeating in children at 36 months, which in turn was linked to greater child WFAz at 36 months. The findings of this study expand the understanding of the mechanisms underlying PCDI and child weight, emphasizing the interplay between maternal feeding practices and child appetite in the context of adverse parent-child interactions during early childhood.

The associations between attentional bias to food cues, parent-report appetitive traits, and concurrent adiposity among adolescents

OBJECTIVE

To assess whether attentional bias to food cues and appetitive traits are independently and interactively associated with adiposity in adolescents.

METHOD

Eighty-five adolescents, 14-17-years had their attentional bias to food images measured in a sated state by computing eye tracking measures of attention (first fixation duration, cumulative fixation duration) to food and control distractor images that bordered a computer game. Parents reported adolescent appetitive traits including the food approach domains of enjoyment of food, food responsiveness, emotional overeating, and the food avoidance domains of satiety responsiveness and emotional overeating through the Children's Eating Behavior Questionnaire.

RESULTS

First fixation bias to food cues was positively associated with enjoyment of food, and negatively associated with satiety responsiveness. In a series of regression models adjusted for relevant covariates, first fixation bias to food cues (β = 0.83, p = 0.007), higher food responsiveness (β = 0.74, p < 0.001), higher emotional overeating (β = 0.51, p = 0.002), and a composite appetite score (β = 1.42, p < 0.001) were each significantly associated with greater BMI z-scores. In models assessing the interactive effects between attentional bias and appetitive traits, higher first fixation bias to food cues interacted synergistically with food responsiveness and emotional overeating in relation to BMI z-score. A synergistic interaction between first fixation bias to food cues and the composite appetite score in relation to BMI z-score was also observed.

CONCLUSION

Individuals with high attentional bias to food cues and obesogenic appetitive traits may be particularly susceptible to weight gain.

Do Appetite Traits Mediate the Link Between Birth Weight and Later Child Weight in Low-Income Hispanic Families?

Background: Birth weight and appetite traits (ATs) are important early life determinants of child weight and obesity. Objectives: The aim of this study is to examine whether (1) birth weight-for-gestational age z-scores (BWGAzs) were associated with ATs at child age 2 years and (2) ATs mediated the link between BWGAzs and weight-for-age z-scores (WFAzs) at child ages 3 and 4 years among Hispanic children. Methods: We conducted a secondary longitudinal analysis of data from the Starting Early Program of low-income, Hispanic mother-child pairs. ATs were assessed using the Child Eating Behavior Questionnaire at age 2 years. Child birth weight was obtained from medical records. Birth weight, sex, and gestational age were used to generate BWGAzs with Fenton growth curves. WFAz was calculated based on the CDC 2000 growth charts. Regression and mediation analyses were used to explore associations between BWGAzs, ATs, and WFAzs. Results: Infants with higher BWGAzs had significantly lower Satiety Responsiveness (B = -0.10) and Food Fussiness (B = -0.13) scores at age 2 years and higher WFAzs at ages 3 (B = 0.44) and 4 (B = 0.34) years. Lower Satiety Responsiveness at age 2 years was associated with higher WFAzs at ages 3 (B = -0.11) and 4 (B = -0.34; all p < 0.01) years. Lower Satiety Responsiveness partially mediated the positive relationship between birth weight and child WFAzs at ages 3 and 4 years. Conclusions: Children with higher birth weight and lower Satiety Responsiveness scores may be at higher risk of developing obesity in childhood. Further research is needed to understand the mechanisms through which birth weight influences child appetite. Clinical Trial Registration: ClinicalTrials.gov: NCT01541761.

The roles of child temperament, parent stress, and parenting style in family mealtimes

Family mealtimes are associated with benefits for children, including healthy eating, fewer behavior problems, and healthy psychological well-being. However, the interactions during family mealtimes, and the parent and child characteristics, which may affect both the family mealtime environment and the associated benefits in children are not fully understood. The goal of this study was to examine the role of child and parent characteristics on the family mealtime environment. We tested several mediation models to explain how child temperament (negative affectivity), parent stress, and the dimensions of parent feeding style (responsiveness and demandingness) interact and influence each other to impact the structure and quality of the mealtime environment. Parents (68 mothers; 82 fathers) of children between 2 and 6 years completed an online survey. Measures included the Children's Behavior Questionnaire, Perceived Stress Scale, Caregiver's Feeding Styles Questionnaire, and The Meals in Our Household Questionnaire. Child negative affectivity was associated with poorer mealtime quality and structure. These associations were mediated through parent responsiveness, but not demandingness. The role of demandingness in family mealtimes may depend on parent responsiveness. When examined together in a serial mediation model, child negative affectivity increased parent stress, which reduced responsiveness, and led to poorer mealtime quality and structure. These results emphasize the complex relationships between child temperament, parent stress, and the dimensions of parenting styles that occur within the mealtime context. This line of research is essential for understanding family mealtime dynamics and informing future studies aimed at creating positive interactions between parents and children during mealtimes.

Preschoolers BMI: Associations with Patterns of Caregivers' Feeding Practices Using Structural Equation Models

Background: Childhood obesity is a major health concern. Caregivers' feeding practices are modifiable targets of obesity prevention. The study tested two hypotheses: (1) autonomy-promoting feeding practices are associated with lower BMI; and (2) diet mediates the association. We also explored examined whether feeding practices and BMI z-score (BMIz) associations are moderated by child sex, caregiver race, education, family poverty level, and food insecurity. Methods: Cross-sectional study of 437 preschoolers (44.4% girls, 38.2% Black/Other, mean age 48.1 months) and caregivers (90.2% female) from 50 child care centers. Feeding Practices were measured by Comprehensive Feeding Practices Questionnaire, child-size perception by preschooler silhouettes, temperament by the Behavior Rating Inventory of Executive Function, child diet by Young Children Food and Drink Questionnaire, and BMIz by measured weight and height. Latent profile analysis delineated feeding practice patterns. Structure equation modeling assessed the patterns in relationship to BMIz. Mediation and multiple-group analyses were used to assess mechanisms of feeding practice patterns and BMIz association. Results: From the three feeding practice patterns, Controlling, Balancing, and Regulating, Regulating was associated with lower child BMIz (b = -0.09) compared to Controlling. Higher difficult temperament (b = 0.09), higher caregiver BMIz (b = 0.26), and caregiver desire for thinner (b = 0.23) were associated with BMIz (p < 0.05). Evaluations of moderators and mediators were not significant. Conclusions: Comprehensive feeding practices support family factors related to child BMIz. Longitudinal research is needed to examine temporal associations between feeding practices and BMIz, with attention to autonomy-supporting practices, promotion of young children's self-regulation, and caregivers' perceptions of child temperament and size. Trial Registration: NCT03111264.

Children's eating behaviours and related constructs: conceptual and theoretical foundations and their implications

BACKGROUND

There is a substantial body of research on children's eating behaviours (e.g., food responsiveness and fussiness) and related constructs (e.g., eating in the absence of hunger, appetite self-regulation). This research provides a foundation for understanding children's dietary intakes and healthy eating behaviours, as well as efforts at intervention, whether in relation to food avoidance, overeating and/or trajectories to excess weight gain. The success of these efforts and their associated outcomes is dependent on the theoretical foundation and conceptual clarity of the behaviours and constructs. This, in turn contributes to the coherence and precision of the definitions and measurement of these behaviours and constructs. Limited clarity in these areas ultimately creates uncertainty around the interpretation of findings from research studies and intervention programs. At present there does not appear to be an overarching theoretical framework of children's eating behaviours and associated constructs, or for separate domains of children's eating behaviours/constructs. The main purpose of the present review was to examine the possible theoretical foundations of some of the main current questionnaire and behavioural measures of children's eating behaviours and related constructs.

METHODS

We reviewed the literature on the most prominent measures of children's eating behaviours for use with children aged ~ 0-12 years. We focused on the explanations and justifications for the original design of the measures and whether these included theoretical perspectives, as well as current theoretical interpretations (and difficulties) of the behaviours and constructs.

RESULTS

We found that the most commonly used measures had their foundations in relatively applied or practical concerns rather than theoretical perspectives.

CONCLUSIONS

We concluded, consistent with Lumeng & Fisher (1), that although existing measures have served the field well, to advance the field as a science, and better contribute to knowledge development, increased attention should be directed to the conceptual and theoretical foundations of children's eating behaviours and related constructs. Suggestions for future directions are outlined.

The relationships between caregivers' self-reported and visual perception of child weight and their non-responsive feeding practices: A systematic review and meta-analysis

BACKGROUND

The impacts of caregivers' perception of child weight on their non-responsive feeding practices are inconclusive. This systematic review aimed to examine their relationships.

METHODS

A systematic search of five databases was conducted from inception to March 2022, following PRISMA guidelines. Data synthesis was performed using semi-quantitative approach and meta-analysis.

RESULTS

Twenty-two studies with 12005 respondents were included for semi-quantitative analyses. Eighteen studies examined 26 associations between caregivers' perception of child weight and food restriction with 12 statistically significant associations being observed. A total of 22 relationships between caregivers' perception of child weight and pressure to eat were investigated, with 13 being statistically significant. The statistically significant associations consistently reported that caregivers' visual and self-reported perception of child weight was positively associated with their restrictive feeding and negatively associated with pressure to eat. The pooled odds ratios (ORs) indicated that caregivers who perceived their child as overweight were found to apply pressure to eat less frequently (OR = 0.61; 95%CI: 0.44, 0.84) compared with those who did not. However, caregivers' perception of child weight was not statistically significantly associated with restrictive feeding (OR = 1.37; 95%CI: 0.74, 2.55).

CONCLUSION

Caregivers' self-reported and visual perception of child weight may be important risk factors for non-responsive feeding practices, particularly food restriction and pressure to eat. Thus, interventions need to consider the role of caregivers' perception of child weight, which may optimize feeding practices. Furthermore, longitudinal and intervention-based studies using validated measurements while controlling for potential covariates are needed to provide more evidence on their causal relationships.

Appetitive traits and body mass index in Chinese adolescents: An 18-month longitudinal study with latent growth curve analyses

A longitudinal approach with Latent Growth Curve Modeling (LGCM) was adopted to explore the trajectories of appetitive traits corresponding to BMI in Chinese adolescents. Within a large sample of adolescents (N = 2566, 45.9% boys) aged from 11 to 17 years (M = 13.80, SD = 1.56) at the baseline survey, our results indicated that appetitive traits of emotional overeating, food fussiness, and hunger increased significantly over time while enjoyment of food decreased over time. Slowness in eating and satiety responsiveness significantly increased in girls, while emotional undereating significantly decreased in boys. Moreover, the growth parameters of emotional undereating and satiety responsiveness were significantly and negatively related to BMI in girls. Our findings evidence that certain appetitive traits could change over time in adolescence and these changes relate to weight status. Gender differences are suggested in the design of future intervention and treatment of overweight/obesity in Chinese adolescents.

Associations between Emotion Regulation, Feeding Practices, and Preschoolers' Food Consumption

Previous research identified emotion dysregulation, non-responsive feeding practices, and unhealthy food consumption as risk factors for childhood obesity. However, little is known about the relationships between these factors. This study examined associations between children’s emotion regulation, parental feeding practices, and children’s food consumption. The sample consisted of 163 mothers of children aged 3–5 years. Mothers completed the Emotion Regulation Checklist, the Child Feeding Questionnaire, and the Child Health Section from the Parent Interview of the Early Childhood Longitudinal Study-B to assess model variables. Results showed that healthy food consumption was associated with higher emotion regulation abilities, higher monitoring, and lower pressure to eat. For unhealthy food consumption, the associations were in opposite directions. Higher emotion regulation abilities were also associated with higher monitoring, lower pressure to eat, and lower restriction. For lability, the associations were in opposite directions. Regression analyses revealed that children’s lability, pressure to eat, and monitoring were significant predictors of children’s food consumption. These findings suggest that children’s emotion regulation and feeding practices are important determinants of children’s food consumption. Future longitudinal studies that examine bidirectional associations between children’s emotion regulation, parental feeding practices, children’s food consumption, and potential mechanisms accounting for these associations are needed.

Parent-Child Interaction Therapy Supports Healthy Eating Behavior in Child Welfare-Involved Children

OBJECTIVE

We tested the efficacy of standard Parent-Child Interaction Therapy (PCIT), a live-coached, behavioral parent-training program, for modifying problematic eating behaviors in a larger effectiveness trial of PCIT for children involved in the child welfare system.

METHOD

Children ages 3-7 years and their parents were randomly assigned to PCIT intervention (n = 120) or services as the usual control (SAU; n = 84) groups in a randomized clinical trial. Children's eating behaviors were assessed pre- and post-intervention via the Child Eating Behaviors Questionnaire (CEBQ). Intention-to-treat analyses were conducted, followed by per-protocol analyses, on treatment-engaging families only.

RESULTS

PCIT led to reductions in child welfare-involved children's food responsiveness, speed of food consumption, and tendency to engage in emotional overeating relative to children in the services-as-usual control condition. Standard PCIT may be an effective intervention to promote healthy child eating behaviors in families involved with child welfare, even when food-related behaviors are not directly targeted by the intervention. Public Health Significance: This clinical trial provides evidence that child welfare-involved children who received PCIT experienced significant reductions in maladaptive eating-related behaviors, namely food responsiveness, emotional overeating, and speed of eating. These findings were observed in relation to children in a comparison control group who had access to child welfare services-as-usual.

Relationships between retrospective parental feeding practices and Chinese university students' current appetitive traits, weight status, and satisfaction with food-related life

Accumulating evidence suggests that parental feeding practices during childhood are related to adults' eating behaviors and weight status, but research exploring these relationships is largely conducted in Western contexts. However, China, a country that holds the largest world population, has distinct patterns of eating habits and food culture from Western countries. Therefore, the present study aimed to examine relationships between retrospective parental feeding practices (e.g., concern, monitoring, pressure to eat, and restriction) and current body mass index (BMI) and satisfaction with food-related life in a sample of 476 Chinese university students (195 men; Mage = 19.78 years, SD = 1.23). We also examined whether appetitive traits mediated these associations. Retrospective parental feeding practices were significantly related with participants' current BMI (concern: r = 0.26, p < .001; pressure to eat: r = -0.15, p < .001) and satisfaction with food-related life (concern: r = 0.15, p < .001; monitoring: r = 0.12, p = .009; pressure to eat: r = 0.13, p = .006; restriction: r = 0.16, p < .001). Relationships were partially mediated by young adults' current appetitive traits (e.g., enjoyment of food, emotional overeating, satiety responsiveness, slowness in eating). These findings suggest that retrospective parental feeding practices are important correlates of young adults' current weight status and satisfaction with food-related life, and that appetitive traits partially explain these relationships in the Chinese context.

A synthesis of early antecedents of eating behavior and weight status in girls: The legacy of girls' NEEDS project

Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the 'thin ideal' got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.

Parental Feeding Practices in Families Experiencing Food Insecurity: A Scoping Review

Parental feeding practices and styles influence child diet quality and growth. The extent to which these factors have been assessed in the context of disadvantage, particularly household food insecurity (HFI), is unknown. This is important, as interventions designed to increase responsive practices and styles may not consider the unique needs of families with HFI. To address this gap, a scoping review of studies published from 1990 to July 2021 in three electronic databases was conducted. A priori inclusion criteria were, population: families with children aged 0–5 years experiencing food insecurity and/or disadvantage; concept: parental feeding practices/behaviours/style; and context: high income countries. The search identified 12,950 unique papers, 504 full-text articles were screened and 131 met the inclusion criteria. Almost all the studies (91%) were conducted in the United States with recruitment via existing programs for families on low incomes. Only 27 papers assessed feeding practices or styles in the context of HFI. Of the eleven interventions identified, two assessed the proportion of participants who were food insecure. More research is required in families outside of the United States, with an emphasis on comprehensive and valid measures of HFI and feeding practices. Intervention design should be sensitive to factors associated with poverty, including food insecurity.

Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices

Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance (e.g., satiety responsiveness, slowness in eating) and food approach (e.g., enjoyment of food, food responsiveness). Children's body mass index z-score (BMIz) was calculated from measured height and weight. Parents' BMI and food parenting practices were also measured. Four profiles were identified that characterized children with dysregulated behavior, higher food approach and lower food avoidance (16%), dysregulated behavior but lower food approach and higher food avoidance (33%), regulated behavior but highest food approach and lowest food avoidance (16%), and highly-regulated behavior, lowest food approach and highest food avoidance (35%). Children's BMIz was highest in the profile consisting of children with dysregulated behavior, higher food approach and lower food avoidance. BMI was similar in the profile with children with regulated behavior but highest food approach and lowest food avoidance; children in this profile also had parents who reported the highest levels of controlling food parenting practices, and the lowest levels of parental modeling of healthy eating. Compared to all other profiles, children in the profile characterized by highly-regulated behavior, lowest food approach and highest food avoidance had the lowest BMIz and had parents who reported food parenting practices characterized by the highest levels of child control in feeding and the lowest levels of pressure to eat. These findings provide evidence of differing patterns of relations between self-regulation across behavioral and eating domains, and children's obesity risk may vary based on these different patterns.

Parental feeding practices and child eating behavior in different socioeconomic neighborhoods and their association with childhood weight. The STEPS study

Child obesity risk, child eating behavior and parental feeding practices show a graded association with individual level socioeconomic status. However, their associations with neighborhood socioeconomic disadvantage are largely unknown. In this study (n = 682), we investigated how parental feeding practices and child eating behaviors were associated with body mass index and risk of overweight at preschool age in affluent and disadvantaged neighborhoods. We found that high food approach tendency in disadvantaged neighborhoods predicted higher body mass index and increased the risk of overweight at the age of 6 years compared with affluent neighborhoods. Our results suggest that children's eating habits may have stronger impact on overweight risk in disadvantaged than in affluent neighborhoods.

Style of meal service and feeding practices among Mexican American fathers and mothers: An analysis of video-recorded children's evening mealtime at home

The aim of this study was to examine video-recorded observations of evening family mealtime at home among Mexican American children to help elucidate style of meal service, fathers' and mothers' feeding practices and child's eating behavior. Consistent with guidelines for coding behaviors, we analyzed observational data of evening mealtimes of 71 Mexican American children aged eight to 10 years. Regarding style of meal service, in almost all cases (96%), parents plated the child's food, with more available on the table or counter in 40% of the observations. Mothers almost always served the child (94%). Regarding parental feeding practices, parents used positive involvement in meals (80%), pressure to eat (42%) and restriction of food (9%). Using food as a reward to control behavior was never used by either parent. The majority (75%) of children requested or negotiated to eat less food, or only eat certain items. In Mexican American families, both mothers and fathers play a role in family mealtimes and both use positive involvement in child's meals, and to a lesser extent pressure to eat, with their children aged eight to 10 years. To help reduce the obesity epidemic, intervention strategies are needed, which integrate the family, a plating style of meal and parental feeding practices that promote healthy eating in the home. To reduce obesity among Mexican American children, interventions that focus on parental positive involvement in child's meal and maintenance of home cooked meals could have a positive impact on the entire family.

Eater profile and associated factors in pediatric patients of the PEDIANUT cohort

Appetite traits have multifactorial origins. In association with environmental and genetic factors, they could become problematic and lead to Feeding or Eating Disorders (FED). As the DSM-5 classification is not suitable for pediatric FED, another way to describe eating behavior is to distinguish the clinical profiles of "small eater" and "big eater". The aim of this study was to identify socio-demographic and medical factors associated with these profiles, and to compare problematic and non-problematic profiles. From the Pedianut study, we analyzed socio-demographic, medical and family history data among 401 children according to 4 age groups (<1 year n = 101, 1-6 years n = 99, 6-12 years n = 100, 12-18 years n = 101). The information collected on eating behavior made it possible to define small eater profile (SEP) and big eater profile (BEP) using predefined grids. BEP was more frequent in adolescents (35.6%), and SEP was more frequent in children aged 1-6 years (34.3%). BEP was associated with having separated parents, being male and the oldest sibling (p < 0.05). Problematic BEP was associated with eating while watching television, being a girl, and having sensory disorders (p < 0.05). SEP was associated, whatever age, with non-breastfeeding, chronic illness, psychological history, sensory disorders, language delays (in the 1-6 year age group), and family history of FED (in the adolescent group) (p < 0.05). This analysis of factors associated with eater profile opens new perspectives for research on risk factors associated with eating traits, which warrants further study in larger populations to delineate transition from healthy to problematic eating.

Associations between Children's Genetic Susceptibility to Obesity, Infant's Appetite and Parental Feeding Practices in Toddlerhood

Previous findings suggest that parental feeding practices may adapt to children's eating behavior and sex, but few studies assessed these associations in toddlerhood. We aimed to study the associations between infant's appetite or children's genetic susceptibility to obesity and parental feeding practices. We assessed infant's appetite (three-category indicator: low, normal or high appetite, labelled 4-to-24-month appetite) and calculated a combined obesity risk-allele score (genetic risk score of body mass index (BMI-GRS)) in a longitudinal study of respectively 1358 and 932 children from the EDEN cohort. Parental feeding practices were assessed at 2-year-follow-up by the CFPQ. Three of the five tested scores were used as continuous variables; others were considered as binary variables, according to the median. Associations between infant's appetite or child's BMI-GRS and parental feeding practices were assessed by linear and logistic regression models, stratified on child's sex if interactions were significant. 4-to-24-month appetite was positively associated with restrictive feeding practices among boys and girls. Among boys, high compared to normal 4-to-24-month appetite was associated with higher use of food to regulate child's emotions (OR [95% CI] = 2.24 [1.36; 3.68]). Child's BMI-GRS was not related to parental feeding practices. Parental feeding practices may adapt to parental perception of infant's appetite and child's sex.

Complementary feeding of infants and young children 6 to 23 months of age

Complementary feeding, when foods are introduced to complement a milk-based diet, generally occurs between 6 and 23 months of age. It is a critical period for both physical and cognitive development. During this period, the growth rate of the brain is one of the fastest during the life span and, consequently, the timing, dose, and duration of exposure to specific nutrients can result in both positive and negative effects. Complementary feeding is more than ensuring an adequate intake of nutrients; it also is about avoiding excess intakes of calories, salt, sugars, and unhealthy fats. Meals are cultural and social events where young children observe, imitate, learn about foods to like or dislike, and form lifelong eating habits and practices. Meals are also when a child learns to touch foods and connect food tastes to how foods look and feel. Ideally, complementary feeding is responsive and promotes child autonomy, but it can also be used to manage behavior problems or overly indulge a child, resulting in long-term consequences for nutrition and health. Therefore, in addition to what a child is fed, attention to how a child is fed is also important. In this review, 12 topics relevant for updating global guidance on complementary feeding were identified: age of introduction of complementary foods; continued breastfeeding; responsive feeding; safe preparation and storage of complementary foods; food textures, flavors, and acceptance; energy and meal and snack frequency; fats, protein, and carbohydrates; dietary diversity; milks other than breast milk; fluid needs; unhealthy foods and beverages; and use of vitamin and mineral supplements or supplementary foods.

Parental Child-feeding in the Context of Child Temperament and Appetitive Traits: Evidence for a Biopsychosocial Process Model of Appetite Self-Regulation and Weight Status

Pediatric obesity is a serious public health challenge and there is a need for research that synthesizes the various linkages among the child and parental factors that contribute to pediatric overweight and obesity. The main objective of this study was to examine potential mechanisms and pathways that might explain how child temperament is indirectly related to child body composition through appetitive traits and parental child-feeding practices. Participants consisted of 221 children between 4–6 years of age (51% males, mean age = 4.80 years, standard deviation = 0.85) and their parents (90.5% biological mothers, (Mage) = 32.02 years, (SDage) = 6.43) with 71% of the parents being married. Study variables included child temperament (negative affectivity and effortful control), child appetitive traits (food avoidance and food approach), controlling parental child-feeding practices (restrictive feeding and pressure to eat), and child body composition. Body composition were indexed by parent perceptions, body mass index (BMI), and percent body fat. Results showed that children with low levels of effortful control are more prone to exhibit food avoidance, which in turn is likely to elicit parental pressure to eat that in turn is linked to high child weight status. In addition, children with high levels of negative affectivity are prone to exhibit a food approach, which in turn is likely to elicit restrictive feeding from parents that in turn is linked to high child objective weight status. Findings situate controlling parental child-feeding practices in the context of child temperament and appetitive traits using a biopsychosocial framework of appetite self-regulation and weight. Results highlight that child appetite self-regulation processes and parental child-feeding practices could be essential components to target in childhood obesity preventive interventions.

Psychosociocultural Contributors to Maladaptive Eating Behaviors in African American Youth: Recommendations and Future Directions

Childhood overweight and obesity disproportionately affects African Americans, and these children benefit less from standard pediatric weight management treatment programs compared to other racial/ethnic groups. Maladaptive eating behavior has been identified as a behavioral contributor to obesity and is also associated with the development of nonrestrictive eating disorders over time. Unique psychosociocultural factors have been identified that may promote higher risk for maladaptive eating behaviors in African American children beyond the effects of economic disparity. To best treat this group, it is important for practitioners to have a thorough understanding of these factors. We review several of these considerations and describe ways they may interact to contribute to the subsequent development of maladaptive eating behaviors and increased weight. Recommendations are made regarding how attention to these factors could be incorporated into current pediatric weight management treatments to better serve this population via a patient-centered care approach. Future directions will also be discussed.