Weight Control Practices in Children of Parents Participating in Weight Management Programs

Parent childhood experiences, parenting strategies, and youth health-related outcomes in Hispanic families with unhealthy weight: An intergenerational study

We aimed to examine whether (a) parents' childhood family mealtime experiences (CFM) (e.g., mealtime communication-based stress) and parents' socio-demographic characteristics (e.g., education level) predict parents' health-related parenting strategies (e.g., discipline), (b) health-related parenting strategies for eating and physical activity predict youth's health-related outcomes (e.g., dietary intake), (c) parenting strategies mediate the relationship between CFM and youth outcomes. A path model was used to examine the above-mentioned relationships. Data were obtained from the baseline assessment of a randomized clinical trial evaluating the efficacy of a family-based intervention to promote quality diet and increase physical activity. Participants were 280 Hispanic youth (52.1 % female, Mage = 13.01 ± 0.83) with unhealthy weight (MBody Mass Index %tile = 94.55 ± 4.15) and their parents (88.2 % female, Mage = 41.87 ± 6.49). Results indicated that childhood mealtime communication-based stress and mealtime structure were positively associated with control. Appearance weight control was positively associated with monitoring, discipline, limit-setting, and reinforcement. Parental mealtime control had positive associations with discipline, control, and limit-setting. Emphasis on mother's weight was positively associated with reinforcement. We also found positive associations between parental monitoring and youth's physical QOL and between parental discipline and fruits and vegetables intake. No mediating effect was found. Findings demonstrated significant effects of parents' childhood experience on parenting strategies, which in turn was associated with the youths' health-related outcomes. These results suggest the intergenerational effects of parent's childhood experience on their youth's health-related outcomes.

The effect of parental diabetes prevention program participation on weight loss in dependent children: a prospective cohort study

INTRODUCTION

Obesity has reached epidemic proportions in children and adolescents in the United States. Children's behaviors are strongly influenced by parental behaviors, and weight loss in parents is positively associated with weight changes in their overweight/obese children. Research is limited on how parents' National Diabetes Prevention Program (DPP) participation affects the health outcomes of their dependent children. Analyzing the impact of parental DPP participation on weight loss in their dependent children may provide valuable insight into an important secondary benefit of DPP participation.

METHODS

In this study, we identified 128 adults with prediabetes who were offered the opportunity to participate in a DPP (n = 54 DPP participants and n = 74 DPP non-participants) and who had at least one child 3 to 17 years of age living with them. Age and BMI percentile for dependent children were collected from insurance claims data for 203 children (n = 90 children of DPP participants and n = 113 children of DPP non-participants). Parental practices related to diet and physical activity were assessed by surveys.

RESULTS

There were no significant changes in BMI percentiles of overweight or obese children (i.e. BMI percentile ≥ 50%) of DPP participants vs DPP non-participants with prediabetes over one-year. Parents who enrolled and did not enroll in the DPP did not report differences in their parenting practices related to diet and physical activity.

DISCUSSION

These results are not consistent with the literature that suggests parent-based interventions may influence their children's weight trajectories. Limitations include small sample size, short time span of intervention, and limited availability of additional health/biographic data on dependent children. Future studies should collect primary outcome data on children, investigate whether there is a minimum duration of parental involvement and level of parental adherence, and assess the effect of parent-child dynamics on child weight trajectories.

Examining the effect of parent participation in an adult weight management program on changes in children's weight

Children of parents participating in weight management programs (WMPs) are more likely to adopt their parents' weight control practices. Little is known about the weight outcomes of children who have a parent participating in a WMP. This study aimed to assess this relationship. Children 2-17 years of age with a parent who participated in a WMP were included in the study. Multilevel linear mixed-effects regression models were used, stratified by child weight status at the time of parental WMP participation (healthy weight, overweight/obesity) to determine change in children's BMIz from before to after parents WMP participation, including covariates of parent BMI and parental feeding practices. Parents (N = 77) were mostly white (76%) and female (84%). Children (N = 114) had a mean age of 10.5 ± 4.6; 47% had overweight or obesity. Children with overweight or obesity prior to their parent's WMP had a decrease in BMIz (-0.68) after the WMP while children with a healthy weight had no significant change. Children with overweight or obesity had a decrease in BMIz from before to after parent's participation in a WMP. Further research is needed to understand changes in family eating practices that occur during and after parent WMP participation.

Changes in Child Weight, Behaviors, and Family Dynamics during Parental Participation in a Medical Weight Management Program: A Longitudinal Uncontrolled Pilot Study

Background: There is limited evidence of the effects of parental participation in outpatient medical weight management (MWM) programs on children. The aims of the project were to (1) identify time effects from parental participation in the MWM program on changes in child weight trajectories, healthy and unhealthy weight control practices, physical and sedentary activity, parental restrictive feeding and pressure to eat, and family functioning and communication and (2) determine differences based on child factors. Methods: A longitudinal uncontrolled pilot study was conducted, in which parent-child (ages 7-19) dyads completed assessments at parents' MWM program initiation, 3 months (mid-program), 6 months (end of program), and 12 months to determine sustained effects. Repeated measures analysis of variance (ANOVA) was completed using a mixed multilevel modeling approach using Restricted Maximum Likelihood estimation method; each outcome was additionally analyzed with child baseline weight status, age group, and sex as between-subjects factors. Results: Fifty three dyads met inclusion criteria, 23 completed the initial assessment (enrollment: 43.3%), and 13 completed the 12-month assessment (retention: 56.5%). Significant effects over time were observed for decreased parental restrictive feeding (p < 0.038) over 12 months, and group by time effects were observed for increased restrictive feeding for female compared to male children (p = 0.025) over 12 months. Marginally significant group by time effects were found for increased impaired family functioning (p = 0.054) and communication (p = 0.054) for children with overweight/obesity compared to healthy weight children over 12 months. Conclusions: Female children and children with overweight/obesity may experience increased negative family dynamics (restriction of food, family functioning, and communication) through parental MWM programs.

Changes in Parent and Child Skin Carotenoids, Weight, and Dietary Behaviors over Parental Weight Management

(1) The objective was to determine changes in parent-child (ages 7-18) dyad skin carotenoids spanning parental participation in a medical weight management program (WMP), and associations with parent BMI, child BMIz, fruit/vegetable intake, and family meals and patterns. (2) The study design was a longitudinal dyadic observational study with assessment at WMP initiation, mid-point (3-months), and conclusion (6-months). Twenty-three dyads initiated the study, 16 provided assessments at 3 months, and 11 at program conclusion. Associations between parent and child carotenoids (dependent variables) and parent BMI, child BMIz, increases in fruit/vegetable intake, and family meals and patterns were analyzed using Pearson's correlations and independent samples t-tests. Repeated measures ANOVA assessed changes in weight status and carotenoids. (3) Parents experienced significant declines in BMI and skin carotenoid levels over 6 months. Parent and child carotenoids were correlated at each assessment. At initiation, parent BMI and carotenoids were inversely correlated, child carotenoids were associated with increased family meals, and never consuming an evening fast food or restaurant meal were associated with increased parent and child carotenoids. (4) Results demonstrate skin carotenoids are strongly correlated within dyads and may be associated with lower parental BMI and positive family meal practices.

High Prevalence of Food Insecurity in Participants Attending Weight Management and Bariatric Surgery Programs

We evaluated the prevalence and correlates of household food insecurity (HFI) in participants attending weight management and bariatric surgery programs (WMP). We surveyed participants (N = 298) residing with a child and romantic partner from two WMP offering bariatric surgery and medical weight management. We assessed HFI using the Hunger Vital Sign and conducted multivariate logistic regression to assess correlates of HFI. HFI was present in 29.2% of participants. There were increased odds of HFI in participants with lower income and those with three or more children living at home. There was no association with sex, race, program type, education, or BMI. HFI is highly prevalent among participants of WMP. WMP should screen all participants for food insecurity to address this potential barrier to a healthy lifestyle.

Dyadic reports of weight control practices, sedentary behaviors, and family functioning and communication between adult weight management patients and their children

Background

Parents are increasingly pursuing weight loss in medical weight management programs, yet little is known about the presenting behaviors and practices of children who have parents initiating these programs.

Objective

To describe congruence in weight control practices, sedentary and screen time behaviors, and family functioning and communication between parents initiating a medical weight management program and their children (ages 7-18).

Methods

Twenty-three dyads were enrolled and had measured height/weight and research packets completed including perceived weight status, weight control practices, sedentary and screen-time behaviors, and family functioning and communication. Paired t-tests and intraclass correlations assessed congruence; independent t-tests determined differences based on child demographics (age, sex, and weight status).

Results

Parents underestimated children's use of weight control practices compared to child reports. Children with overweight, males, and older in age had increased weight control practices and sedentary and screen-time behaviors. Children who perceived themselves to have overweight reported more impaired family communication than children perceived to be a healthy weight.

Conclusions

This study highlights the discrepancy between dyads' reports of children's behaviors, and identifies that specific child populations with overweight, older in age, and males are at-risk of experiencing less healthy behaviors and impaired family communication. Future research should monitor changes over time in parental weight management programs to determine effects based on parental weight loss.

Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment

PURPOSE OF REVIEW

The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity.

RECENT FINDINGS

Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.

Family Meal Practices and Weight Talk Between Adult Weight Management and Weight Loss Surgery Patients and Their Children

OBJECTIVE

To identify predictors associated with specific family meal practices and weight talk among patients participating in weight management programs (WMPs) and weight loss surgery (WLS) and their children.

DESIGN

Cross-sectional survey.

SETTING

Two US weight management centers.

PARTICIPANTS

259 patients (aged ≥ 18 years) in either WMP (n = 101) or WLS (n = 158) and residing with a child (aged 2-18 years) MAIN OUTCOME MEASURE(S): Dependent variables: family meal practices (Project EAT) and weight talk (investigator-created). Covariates: family communication (Family Communication Scale), family discouragement for making eating habit change (Social Support for Eating Habits Survey), child age, sex, and perceived weight status, and WMP or WLS participation.

ANALYSIS

Binomial and ordinal regression models determined the odds of engaging in specific family meal practices and weight talk, including covariates.

RESULTS

Patients had increased odds of engaging in family dinners if they reported lower family discouragement (P = .003) and had younger children (P < .001), and increased odds of engaging in family breakfast if they had higher family communication (P = .002) and younger children (P = .020). Patients had increased odds of talking about their child's weight if their child was perceived to have an overweight/obese weight status (P < .001). Patients with older children had increased odds of talking about their weight with their child (P = .021).

CONCLUSIONS AND IMPLICATIONS

Additional research assessing the family meal practices and weight talk in the families of adults pursuing weight loss could yield important evidence that could lead to improved patient outcomes, and safely promote healthy behaviors and prevention of obesity in children.