Development and Feasibility of a Childhood Obesity Prevention Program for Rural Families: Application of the Social Cognitive Theory

Feeding Stressors and Resources Used by Caregivers of Children With Down Syndrome: A Qualitative Analysis

BACKGROUND

Challenging eating behaviors or feeding difficulties, commonly displayed in children with Down syndrome (DS), may amplify perceived stress in caregivers. If caregivers lack resources on how to accommodate the needs of the child with DS, they may find feeding the child stressful and resort to negative coping strategies.

OBJECTIVE

The aim of this study was to understand the feeding stressors, resources, and coping strategies used by caregivers of children with DS.

DESIGN

A qualitative analysis of interview transcripts was undertaken, framed around the Transactional Model of Stress and Coping.

PARTICIPANTS/SETTING

Between September to November 2021, 15 caregivers of children (aged 2 through 6 years) with DS, were recruited from 5 states located in the Southeast, Southwest, and West regions of the United States.

ANALYSIS

Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis and content analysis approaches.

RESULTS

Thirteen caregivers reported increased stress around feeding the child with DS. Stressors identified included concern about adequacy of intake and challenges associated with feeding difficulties. Stress related to feeding was higher among caregivers whose child was learning a new feeding skill or in a transitional phase of feeding. Caregivers used both professional and interpersonal resources in addition to problem- and emotion-based coping strategies.

CONCLUSIONS

Caregivers identified feeding as a stressful event with higher stress reported during transitional phases of feeding. Caregivers reported that speech, occupational, and physical therapists were beneficial resources to provide support for optimizing nutrition and skill development. These findings suggest that caregiver access to therapists and registered dietitian nutritionists is warranted.

Systems map of interventions to improve dietary intake of pre-school aged children: A scoping review

Implementation and sustaining impact of early childhood nutrition interventions in practice remains a challenge. An understanding of the extent to which determinants across multiple levels of the food system are being addressed may improve success. This literature review aimed to synthesise the evidence on interventions targeting dietary intake and eating behaviours in preschool children using a systems approach. Eligible studies included intervention studies targeting the dietary intake of preschool children aged 2-5 years in high income countries, published in English after January 2000. Interventions were categorised to the Determinants of Nutrition and Eating (DONE) framework for children developed and evaluated by experts across multiple fields. The framework maps and ranks 411 factors driving eating behaviours and nutrition and can be used to systematically summarise determinants. DONE ranks each determinant for its perceived research priority. A total of 160 eligible studies were identified. Most interventions targeted interpersonal (n = 101, 63.1%) and individual (n = 85, 53.1%) level determinants, with fewer targeting environmental (n = 55, 34.4%) and policy level (n = 17, 10.6%) determinants. The most frequently addressed determinants were Parental Resources and Risk Factors (n = 85) and Children's Food Knowledge, Skills and Abilities (n = 67). These determinants had a Moderate research priority rating. Home Food Availability and Accessibility at the environmental level is classified as the highest research priority, however, only 15 of 160 interventions addressed this determinant. This review highlights home food availability and accessibility as potential leverage points for future interventions to improve children's dietary intake and eating behaviours.

Parental mindful eating practices and mindful eating interventions are associated with child emotional eating

The family environment, which involves parent eating behaviors and feeding practices, influences child intake and eating behaviors. Specifically, parental emotional eating or emotional feeding practices may lead to emotional eating in the child. Mindful eating practices may decrease emotional eating behaviors. The purpose of this narrative review was to investigate the influence of parental mindful eating on emotional eating behaviors of their children or adolescents. A secondary purpose of this review was to determine whether a family-based or child mindful eating intervention improves child emotional eating directly or through the improvements of the parent and parental role modeling. EBSCOhost was used to simultaneously search 5 databases. The search was limited to full-text, peer-reviewed articles in the English language. Seven studies, 4 cross-sectional studies and 3 intervention studies, were identified. Across studies, measures of mindful and emotional eating differed. Among the cross-sectional studies, parental mindful eating/feeding or mindful parenting were either directly or indirectly related to decreased emotional eating in the child or adolescent. The effect was unclear among the intervention studies; however, these were pilot feasibility studies. Overall, parental mindful eating is associated with emotional eating behaviors among children and adolescents. Additional studies with a randomized controlled design are needed to evaluate parent mindful eating interventions on child and adolescent eating behaviors. Additionally, future trials need to use similar validated measures to ensure consistent quality data collection and allow for comparison of findings across studies.

The Implementation of Evidence-Based Obesity Education Curricula to Prevent Cancer in a Predominantly Mexican-American Community on the U.S.-Mexico Border

Although cancer is the leading cause of death among Mexican-Americans, few community-based programs target obesity reduction as a way to reduce the prevalence of obesity-related cancer in underserved populations. Evidence suggests that obesity correlates with 13 types of cancer. The objective is to provide an overview of evaluation and selection of evidence-based content; details of the implementation process; modifications needed to tailor education programs to specific needs of different target audiences; and demonstrate challenges of implementing a community-based prevention program intended to reduce cancer incidence and mortality in Mexican-Americans. We used the Social Cognitive Theory (SCT) to develop a 10-topic menu of educational classes using elements of multiple evidence-based curricula. Outcome measures for physical activity and nutrition were determined using the International Physical Activity Questionnaire (IPAQ) and the Dietary Screener Questionnaire (DSQ). Weight status was determined using weight, body fat, and body mass index (BMI). To date, 2845 adults received wellness education from our program. Multiple delivery models were used to reach a larger audience; they included a 4-week model, 5-week model, employer model, low-income housing, 1- and 2-h sessions, and clinic encounters. Individuals were given education at multiple community locations including senior centers (14%), churches (0.6%), employers (17.6%), low-income housing (8.2%), community centers (16.6%), clinics (11.5%), and schools (32.5%). Our study indicates that our delivery model is feasible and can disseminate evidence-based obesity education. Further investigation is necessary to assess long-term behavioral change and to assess the most effective model for delivery.

Testing the Feasibility and Potential Impact of a Mindfulness-Based Pilot Program in Urban School Youth

Mindfulness-based interventions (MBIs) could be effective in engaging children and reducing childhood obesity risk. The purpose of this study was to test feasibility, fidelity, and potential impact of a pilot MBI in urban school youth. A two-group quasi-experimental study was conducted in a Harlem, New York school. Participants comprised 51 students (ages 9–12, 54% female, 85% African American/Black). The experimental (E) group (n = 26) participated in a nine-session pilot MBI. Sessions were 90 min and offered weekly as part of afterschool programming. Children only attending during the school day comprised the control (C) group (n = 25). Process evaluation (e.g., fidelity, reach) was performed. Interviews with the E group were conducted to determine program acceptability. Mindful eating and resilience measures were collected at baseline and post-intervention. Intervention feasibility was high as the retention rate was 100% and fidelity was good as nine out of ten sessions were implemented. Relative to baseline, significant improvements were observed in the C group compared to the E group in the resilience composite score (p = 0.01) and its confidence domain (p = 0.01). A MBI may provide a unique opportunity to engage youth. However, further research is warranted to determine if a MBI could promote health in urban, school-age children.

Increasing Parental Knowledge About Child Feeding: Evaluation of the Effect of Public Health Policy Communication Media in France

Background

Unhealthy eating behaviors are risk factors for non-communicable diseases. Parents largely influence the development of eating behaviors during childhood through their feeding practices. Parental feeding practices in line with recommendations are more likely to turn into healthier outcomes in children. From a public health perspective, it should be first ascertained whether providing parents with recommendations about child feeding is a useful approach for increase parental knowledge. Recently, the French health authorities developed a brochure covering updated child feeding recommendations. The present study aims to evaluate the short-term effects of reading this brochure on parental knowledge about child feeding, distinguishing knowledge accuracy and certainty.

Methods

A brochure containing updated child feeding recommendations for 0-3 years old was developed by the French public health agency. A representative sample of French parents (n = 400) was targeted to complete an online questionnaire (T0) comprising 30 statements regarding child feeding. For each statement, parents indicated whether it was true/false and how certain they were of their answer (4-point scale). After receiving and reading the brochure, the same parents completed the same questionnaire 3 weeks later (T1). Accuracy (number of correct answers) and certainty (number of mastered answers: correct answers given with the maximal degree of certainty) were compared at T1 vs. T0 using paired t-tests. Knowledge evolution based on parental age, parity and education level was tested with linear models.

Results

A total of 452 parents responded at T0 and T1 and were considered for analysis. Between T0 and T1, the number of correct answers [median 22-25, t(451) = 17.2, p ≤ 0.001] and mastered answers [median 11-17, t(451) = 18.8, p ≤ 0.001] significantly increased. The median of the difference between T1 and T0 was larger for mastered than for correct answers. The observed evolution in knowledge was independent of parental age, parity or education level.

Conclusions

A brochure containing child feeding recommendations has the potential to increase the accuracy and, to an even greater degree, the certainty of parental knowledge. This increase was observed even for younger or less educated parents.

Trends in the Number of Behavioural Theory-Based Healthy Eating Interventions Inclusive of Dietitians/Nutritionists in 2000-2020

Nutrition interventions developed using behaviour theory may be more effective than those without theoretical underpinnings. This study aimed to document the number of theory-based healthy eating interventions, the involvement of dietitians/nutritionists and the behaviour theories employed from 2000 to 2020. We conducted a review of publications related to healthy eating interventions that used behaviour change theories. Interventional studies published in English between 2000 and 2020 were retrieved from searching Medline, Cinahl, Embase, Psycinfo and Cochrane Central. Citation, country of origin, presence or absence of dietitian/nutritionist authors, participants, dietary behaviours, outcomes, theories and any behaviour change techniques (BCTs) stated were extracted. The publication trends on a yearly basis were recorded. A total of 266 articles were included. The number of theory-based interventions increased over the two decades. The number of studies conducted by dietitians/nutritionists increased, but since 2012, increases have been driven by other researchers. Social cognitive theory was the most used behaviour theory. Dietitians/nutritionists contributed to growth in publication of theory-based healthy eating interventions, but the proportion of researchers from other professions engaged in this field increased markedly. The reasons for this growth in publications from other professions is unknown but conjectured to result from greater prominence of dietary behaviours within the context of an obesity epidemic.

Mindfulness-based programs for the prevention of childhood obesity: A systematic review

INTRODUCTION

The prevalence of overweight and obesity has increased worldwide at an alarming rate in recent decades and has become a serious public health problem. The purpose of this study is to carry out a systematic review of scientific research on mindfulness-based programs for the prevention of childhood obesity carried out in the last 10 years.

METHOD

A search of studies that used mindfulness to promote good eating behavior in minors was conducted. After applying the inclusion and exclusion criteria, a total of 16 studies were found.

RESULTS

Statistically significant improvements were found in most of the cases where changes in eating habits, food portions, reduction of stress, or reduction of cravings in minors were evaluated.

CONCLUSIONS

Mindfulness programs applied to improve eating behaviors appear to be an effective alternative to prevent childhood obesity, but further studies are needed to draw conclusions.

The Family Function and Exercise Behavior of Chinese College Students: A Moderated Mediation Model of Exercise Value Cognition and Only-Child Status

The purpose of this study is to investigate the mediating role of exercise value cognition between family function (FF) and exercise behavior and the moderating role of an only-child status. A questionnaire survey was conducted on 504 Chinese college students using the FF scale, the exercise value cognition scale, and the exercise behavior scale. The analysis yielded four main findings. (1) There are significant differences between an only-child and a non-only-child for negative exercise behavior and FF. The only-child group has a higher average FF score and a lower average negative exercise score. (2) Exercise behavior and four of its dimensions-exercise autonomy, attention control, exercise planning, and situational induction-are each significantly positively correlated with FF and exercise value cognition. (3) FF is a significantly positive predictor of exercise behavior, both directly and through exercise value cognition, which plays a partial mediating role. (4) Only-child status significantly moderates the mediating effect of exercise value cognition in the link between FF and exercise behavior. The intergroup differences mainly manifest in the influence of FF on exercise behavior and the influence of exercise value cognition on exercise behavior. In the only-child subsample, exercise value cognition plays a complete mediating role. The results of the current study demonstrated the important role that FF and exercise value cognition played in promoting the exercise behavior of college students. These findings have important implications for exercise behavior in adolescents by maintaining sound communication between family members and developing a healthy lifestyle or value cognition.

Development of a Family-Based Nutrition Program Rooted in Food Parenting Literature

Family-based nutrition programs have been used to support healthy eating; however, few programs emphasize parental roles in regard to food. The purpose of this study was to develop and test a family-based curriculum with a parenting focus aimed at influencing child obesity risk. Qualitative data in the pilot implementation (cohort 1, n = 6 families with elementary-aged children) suggested parent value for: positive messages, hands-on learning, and group sharing. However, Family Nutrition and Physical Activity (FNPA) scores for cohorts 2-6 (n = 18 families) did not change significantly from pre- to post-program. Future implementations will consider more robust ways of assessing change and recruiting participants at various stages of change.

Eat Like a Chef: A Mindful Eating Intervention for Health Care Providers

OBJECTIVE

To compare changes in mindful eating habits between students receiving a mindful eating intervention (MEI) vs those who were engaged in usual course work.

METHODS

From 2017 to 2019, 109 nutrition and medical students completed a quasi-experimental study, including usual course work either with or without the addition of a 5-week MEI. The Mindful Eating Questionnaire (MEQ) was completed before and after the MEI. Repeated measures MANOVA was used to detect differences in changes in the overall MEQ score and its 5 subscales between groups.

RESULTS

Within the MEI group (n = 64), overall MEQ, disinhibition, and eating with awareness scores increased significantly (P < .001, P < .001, and P = .004, respectively). No significant changes were noted within the comparison group (n = 45). Significant between-group differences were noted for the changes in the overall MEQ (P = .03) and disinhibition scores (P = .01).

CONCLUSIONS AND IMPLICATIONS

MEI participation may improve students' overall mindful eating scores. Future research could assess a larger cohort of participants, including health care professionals from other disciplines, assess additional mindfulness measures, and follow students for a longer period to determine the long-term effects on participants' mindful eating.

Examining Whether the Social Cognitive Theory Concepts Predict Childhood Obesity Prevention Outcome Expectations

The social cognitive theory (SCT) has been used to explain and promote childhood obesity prevention behaviors. We examined whether the SCT concepts predicted outcome expectations of childhood obesity among the children of African American caregivers. Caregivers (n  = 128) completed the childhood obesity perceptions paper-based survey. A multiple linear regression was conducted to determine the direct effects of moral disengagement, environment, self-efficacy, and behavioral capability on outcome expectations (p < .05). A mediation analysis using a bootstrapping bias correction method was used to test whether self-efficacy and behavioral capability mediated the effect of moral disengagement and environment on outcome expectations. Caregivers reported high levels of moral disengagement (M = 4.13; standard deviation [SD] = 0.70) and self-efficacy (M = 4.26; SD = 0.64) and moderate levels of behavioral capability (M = 2.83; SD = 0.75) and environment (M = 2.92; SD = 0.74). Findings indicated the hypothesized relationships in the SCT were not fully supported. In addition, the indirect effects of environment on outcome expectations were not statistically significantly mediated by behavioral capability. This research warrants more attention in testing the SCT concepts for the development of childhood obesity prevention efforts that prioritize African American families in rural communities.

Setting Kids Up for Success (SKUFS): Outcomes of an Innovation Project for Promoting Healthy Lifestyles in a Pediatric Patient-Centered Medical Home

INTRODUCTION

The greatest increase in childhood obesity prevalence occurs from preschool to school-age (SA). Evidence supports a family-centered approach to promote healthy lifestyle behaviors and weight management among SA children. The purpose of this study was to establish a healthy weight management support group in a pediatric patient-centered medical home.

METHODS

Overweight or obese SA children and their parent participated in four biweekly support meetings consisting of an educational presentation, group exercise, and a healthy snack. Sessions included education about nutrition, exercise, emotions, and health. Anthropometrics, the Healthy Habits screening tool, and Daily Logs, including step counts, were utilized to track outcomes.

RESULTS

There was a significant improvement in fruit and vegetable intake and dining out (p = <.05), and a clinical improvement in physical activity and sugar sweetened beverage intake.

DISCUSSION

Setting Kids Up For Success provides a framework for patient-centered medical home's to provide a healthy lifestyle support group for SA children and their families.

Pathways between maternal depression, the family environment, and child BMI z scores

PURPOSE

Modifiable aspects of the family environment that contribute to overweight in younger children have been identified, including parental feeding practices, child eating behaviors, and parenting practices related to eating and household routines. Maternal depression influences many of these factors, yet research examining pathways that may link maternal depression through the family environment to child weight is lacking. The current study examined parental feeding practices, child eating behaviors, and eating and household routines as potential mediators between maternal depressive symptoms and child weight at age six. The study also tested for differential effects of early versus concurrent maternal depressive symptoms.

METHODS

Longitudinal data on 1130 mothers and their children who participated in the Infant Feeding Practices Study II (IFSP II) and its Year 6 Follow-Up study were analyzed. A multi-step, multiple mediator model assessed direct and indirect relationships between early depressive symptoms (two months post-partum) and concurrent depressive symptoms with child Body Mass Index (BMI) z scores at age six. Potential mediators included parental feeding practices, child eating behaviors, and eating and household routines.

RESULTS

Higher early depressive symptoms directly explained lower child BMI z scores. Early depression also worked through concurrent depression, the child's food responsiveness, and the hours the child slept on week nights to explain higher child BMI z scores. Parental efforts to make sure the child eats enough directly predicted lower child weight but did not mediate the effects of early or concurrent maternal depressive symptoms.

CONCLUSIONS

The findings suggest the need for greater attention to the relationships between maternal depression and child weight as a critical step toward developing effective obesity prevention strategies.