What Are the Barriers at Home and School to Healthy Eating?: Overweight/Obese Child and Parent Perspectives

Barriers to Care for Pediatric Patients with Obesity

This review article emphasizes the challenges pediatric patients face during obesity treatment. Prior research has been compartmentalized, acknowledging that stigma, the ability to implement lifestyle changes, social health determinants, and healthcare accessibility are considerable impediments for obese children. These issues emerge at various levels, including the individual or family, the community and school, and even national policy. This suggests the need for a more comprehensive, team-based approach to tackle pediatric obesity. Understanding these barriers is the first step toward creating effective strategies and solutions to overcome these challenges.

Latinx Grandparents' Child Feeding Practices and Interaction with Parents

Despite Latinx grandparents' substantial involvement in child rearing, there is limited understanding of their child feeding practices. A survey examined 80 Latinx mothers' perception of Latinx grandparents' feeding practices and interaction with parents. Results showed grandparents engaged in positive feeding somewhat frequently and negative feeding somewhat infrequently. Mother-grandparent disagreement and grandparent-parent(s) communication on child feeding occurred at a moderate level of frequency. Mother-grandparent disagreement was associated with higher frequency of grandparents' negative feeding, while grandparent-parent(s) communication was associated with higher frequency of positive feeding by grandparents. Finally, grandparents' behaviors and practices varied depending on characteristics of grandparents, mothers, and children.

The social and environmental factors impacting the motivation of adolescents for weight control, why and how? A qualitative study

INTRODUCTION

Overweight and obesity are common problems among teenagers regardless of ethnicity, race, and socio-economic status. Therefore, this study aims to explore the social and environmental factors impacting adolescents motivation for weight control in Gilan province, Iran.

METHODOLOGY

Following a qualitative design, a content analysis approach was used to analyze the data. A total of 79 interviews were conducted with Adolescents (n = 23), Friends and Peers (n = 15), Parents (n = 12), Managers (n = 16), and Health care providers (n = 13), regarding adolescents obesity during 2019. MAXQDA V.10 software was used for our analysis.

FINDINGS

The main categories of environmental and social factors affecting adolescents motivation for weight control were external factors (the relative success of weight control intervention programs, the lack of environmental and social support, and the lack of family support for teenagers) that each one had some subcategories, and internal factors (competence, relatedness, and autonomy).

CONCLUSION

This study demonstrated the necessity of identifying environmental and social factors that are effective in reducing adolescents' motivation for weight loss. These factors are so influential that teenagers can't overcome them without receiving support from their environment and the government health-related policies. So, it seems that we need integrated multisectoral approaches and we suggest that health policymakers develop practical policies to control adolescents obesity by focusing on factors that have been mentioned in this study.

The Connection between Knowledge and the Nutritional Behaviour of Parents and the Occurrence of Overweight and Obesity among Preschool Children-A Pilot Study

The phenomenon of overweight and obesity constitutes a threat for health and children's lives at preschool age. Eating habits formed during this period seriously affect not only future dietary preferences but also the development of diet-related diseases. The purpose of the present study was the assessment of the relationship between the state of knowledge of children's nutrition and parents' eating behaviour and the prevalence of overweight and obesity in children aged 4-6 years. The study was conducted using 200 parent-child pairs. The behaviour and nutritional knowledge of parents was assessed using a questionnaire method. In contrast, anthropometric measurements were taken among the children. Nutritional disorders were noted in 46.5% of children of whom 39.0% struggled with overweight and 7.5% with obesity. The study showed that the children of parents with higher levels of nutritional knowledge were more likely to develop overweight and obesity. It also proved that irregularity of parental food intake predisposed the development of excessive body weight in children (p = 0.0049). Therefore, it is reasonable to undertake further investigation into factors implying the development of nutritional disorders among those youngest. Early recognition of dietary mistakes can contribute to their elimination at an early age.

The Influence of Grandparents on Children's Dietary Health: A Narrative Review

PURPOSE OF REVIEW

To examine and synthesise recent evidence on the role of grandparents in shaping children's dietary health.

RECENT FINDINGS

The influence of grandparents on children's dietary health was evident across studies. Grandparents frequently provide their grandchildren with meals and snacks, and engage in many of the same feeding practices used by parents. Although grandparents report providing their grandchildren with healthy foods, the provision of treat foods high in sugar or fat was a common finding. This provision led to family conflict, with the indulgent behaviours of grandparents seen by parents as a barrier to healthy eating. Grandparents are exerting significant influence on child dietary health. Efforts are needed to ensure these care providers are considered key stakeholders in the promotion of healthy eating and are targeted in policies and programs addressing children's diets. Research that determines how to best support grandparents to foster healthy behaviours in children is critical.

Impact of Parental Food Choices on Nutritional and Metabolic Status of Children with Type 1 Diabetes

Parents play a key role in what their children eat. The Food Choice Questionnaire (FCQ) has been used elsewhere to assess the dietary motivations of parents of healthy children, but not for parents of children with chronic diseases such as type 1 diabetes (T1D). The aim of our research was to evaluate the associations between parental food choice motivations and the nutritional status and glycemic control of children with T1D. A cross-sectional observational study of children aged 5 to 16 years with T1D attending the Pediatric Endocrinology Unit of Puerta del Mar University Hospital in Cádiz (Spain) was performed. Demographic, anthropometric and clinical data, including glycated hemoglobin, were collected. The FCQ in Spanish was conducted to assess the eating behaviors of the main caregivers of children with T1D. Significance was established at the level of p-value < 0.05. In total, 85 children with T1D (female 56.5%, age 12.07 ± 2.93 years, HbA1c 7.29 ± 0.77%) were recruited. Of these children, 31.3% showed HbA1c levels of <7.0% and 44.9% had a TIR >70%. A significant positive correlation was found between Hb1Ac and "familiarity" (R: +0.233). Anthropometric measures (weight, BMI, skinfolds and body circumferences) showed significant positive correlations with "sensory appeal" and "price". Parents' eating behaviors influence the nutritional status of their children with T1D and their glycemic control of the disease.

Diet quality scores associated with improved cardiometabolic measures among African American adolescents

BACKGROUND

The Reversing the Negative cardiovascular Effects on Weight (ReNEW) Clinic is a prospective cohort study in children and adolescents (≤21 years) at the Johns Hopkins Children's Center.

METHODS

Cross-sectional analysis between diet quality using the Alternative Healthy Eating Index (AHEI-2010), pro-inflammatory potential using the Children's Dietary Inflammatory Index (C-DII), and cardiometabolic outcomes. AHEI-2010 and C-DII scores were assessed by median intake determined from the sample distribution and associated with cardiometabolic measures using linear regression models. Changes in measures were evaluated in a sub-sample of participants invited to attend follow-up visits due to the presence of hypertensive blood pressure (n = 33).

RESULTS

Participants (n = 90) reported an average energy intake of 1790 kcal/day (SD ± 734), AHEI-2010 score of 55.04 (SD ± 9.86) (range: 0 to 110) and C-DII score of -0.12 (±0.86) (range -5 to 5). Participants with higher quality/anti-inflammatory diets trended towards more favorable cardiometabolic measures at baseline. Among the sub-sample (n = 33), there was a significant reduction in total energy (m = -302 kcal/day; p-value= 0.03) but no change in AHEI-2010 (p-value = 0.73) or C-DII score (p-value = 0.85) over follow-up.

CONCLUSIONS

Despite stable diet quality scores, outpatient dietary and behavioral counseling may be an effective tool to reduce energy intake in youth with overweight/obesity and elevated blood pressure.

IMPACT

Diet quality scores among obese, hypertensive, African American adolescents were low and reflect a pro-inflammatory diet. Reported intake was negligible for fruits, whole grains, nuts, and legumes, and well above the daily limit for sodium and saturated fat. Participants with high quality/anti-inflammatory diet quality scores trended toward improved cardiometabolic measures. Outpatient dietary counseling resulted in reduced total energy intake.

Children's Perceived Barriers to a Healthy Diet: The Influence of Child and Community-Related Factors

A healthy diet influences the promotion and maintenance of health throughout an individual’s life. Many individuals struggle to have a healthy diet, despite it being mainly under their control. The current study aims to explore children’s perceived barriers to a healthy diet. A qualitative study with the open-ended question, “Please identify the top 5 barriers to a healthy diet”, was undertaken between January–June 2019 in which 274 students from the 5–6th grades wrote down their answers to the open-ended question. Content analysis was used to analyze responses with a codebook based on the Six C’s Model. Five categories were identified: Child, Clan, Community, Country, and Culture-related barriers. Findings showed that the barriers most highlighted were in the Child sphere (e.g., dietary intake) and the Community sphere (e.g., peer food choices). Children seldom referred to barriers from the Clan sphere, i.e., related to family (e.g., food available at home). Additionally, it seems that girls emphasize more barriers from the Child sphere, while boys emphasize more barriers from the Community sphere. Due to the qualitative nature of this study, interpretation of the data should take into account the specific characteristics and context of the sample. Nevertheless, the current data are helpful in identifying implications for practice, for example, the need to empower children with tools (e.g., self-regulation-based interventions) likely to help them overcome perceived barriers. Finally, advocacy groups may help set environmental and structural changes in the community likely to facilitate children’s healthy choices.

Effectiveness of a combined obesity prevention program in South Korea for children from low-income families that included primary caregiver participation

Purpose

Obesity among children from low-income families is becoming a social problem. The aim of this study was to evaluate the effectiveness of an obesity prevention program that included physical activity, nutrition education, behavioral modification, and primary caregiver participation components among children from low-income families.

Methods

The study analyzed a nonequivalent control group using a pretest-posttest design. A total of 77 children were recruited from six community childcare centers using purposive sampling. For the intervention group (n=40), the pretest was administered before the combined intervention program involving the participants' primary caregivers was conducted for 8 weeks. The posttest was conducted immediately after the program and again four weeks after the program.

Results

Flexibility (F=4.64, p=.020), muscular endurance (F=11.22, p<.001), nutritional knowledge scores (F=4.79, p=.010), body image satisfaction scores (F=4.74, p=.012), and self-esteem scores (F=3.81, p=.029) showed significant differences and interactions between group and time for the intervention and control groups.

Conclusion

Strategies to actively engage the primary caregivers of low-income families in children's obesity programs are needed. Obesity prevention programs for children based on the program in this study should be routinely developed, and continuing attention should be given to children from low-income families.

Promoting healthy foods among urban school children in Bangladesh: a qualitative inquiry of the challenges and opportunities

BACKGROUND

In Bangladesh overweight and obesity among urban school children are on the rise. Urban school children tend to consume foods dense in calories and few fruits and vegetables which is associated with overweight and obesity. The current study explored the barriers and opportunities for promoting healthy diets among school children from the perspective of teachers and parents in Dhaka, Bangladesh.

METHODS

We conducted 14 key informant interviews with teachers and principals, six focus group discussions with 31 mothers of school children (5 to 15 year old) and 14 structured observations of the school food environment. Inductive thematic analysis was performed manually.

RESULTS

Schools were important for development of food preferences of children, however, most school cafeterias provided foods based on profit rather than health considerations. A shift in food culture resulted in making eating out acquire many meanings beyond convenience. Mothers, especially those who were employed, struggled to prepare healthy foods due to time pressure. Mothers were generally concerned about chemicals added to raw foods in markets which led to limited fruit and vegetable consumption.

CONCLUSIONS

There were many challenges to promoting healthy foods to school children within and outside the school. It is important to formulate policies and guidance to create a supportive environment for healthy foods in and in the proximity of schools. It is also important to educate consumers about identifying and choosing healthy foods. Laws related to food safety should be adequately implemented to boost the population's confidence in safety of available healthy foods in the food system.

Application of Multi-Objective Evolutionary Algorithms for Planning Healthy and Balanced School Lunches

A multi-objective formulation of the Menu Planning Problem, which is termed the Multi-objective Menu Planning Problem, is presented herein. Menu planning is of great interest in the health field due to the importance of proper nutrition in today’s society, and particularly, in school canteens. In addition to considering the cost of the meal plan as the classic objective to be minimized, we also introduce a second objective aimed at minimizing the degree of repetition of courses and food groups that a particular meal plan consists of. The motivation behind this particular multi-objective formulation is to offer a meal plan that is not only affordable but also varied and balanced from a nutritional standpoint. The plan is designed for a given number of days and ensures that the specific nutritional requirements of school-age children are satisfied. The main goal of the current work is to demonstrate the multi-objective nature of the said formulation, through a comprehensive experimental assessment carried out over a set of multi-objective evolutionary algorithms applied to different instances. At the same time, we are also interested in validating the multi-objective formulation by performing quantitative and qualitative analyses of the solutions attained when solving it. Computational results show the multi-objective nature of the said formulation, as well as that it allows suitable meal plans to be obtained.

Influences of psychosocial factors and home food availability on healthy meal preparation

The involvement of children in healthy meal preparation activities has emerged as a potential strategy to promote healthy eating behaviour among children. However, there is a lack of understanding of children's internal (psychosocial factors) and external factors (home food availability) that may support the practice of preparing healthy meals. This study aimed to determine children's psychosocial factors of healthy meal preparation within themselves and their external environment of home food availability as predictors for the practice of healthy meal preparation. Public schools (n = 8) from all three zones (Bangsar-Pudu, Keramat and Sentul) in Kuala Lumpur, Malaysia, were selected through stratified random sampling. Two hundred children aged 9-11 and their parents participated. Children's psychosocial factors towards healthy meal preparation and their home food availability were assessed through children and parents, respectively, using validated questionnaires. Majority of the schoolchildren (86.5%) had poor practice of healthy meal preparation. Increased attitude (r = 0.344, P < 0.001) and self-efficacy (r = 0.501, P < 0.001) of healthy meal preparation and the availability of fruits (r = 0.304, P < 0.001), vegetables (r = 0.243, P < 0.001) and healthful ready-to-eat foods (r = 0.227, P = 0.001) at home were positively correlated with the practice of preparing healthy meals. After adjusting for age, sex and monthly household income, increased self-efficacy (P < 0.001), availability of fruits (P = 0.01) and lower availability of less healthful ready-to-eat food (P = 0.01) were associated with better healthy meal preparation practices. Outcomes revealed that positive self-efficacy of healthy meal preparation, home food availability of fruits and less healthful alternatives were associated with the practice of healthy meal preparation and thus should be targeted in future health-promotion strategy.

Grandparents' perceptions of the barriers and strategies to providing their grandchildren with a healthy diet: A qualitative study

Grandparents are playing an increasingly important role in shaping their grandchildren's nutritional environment. Evidence-based interventions tailored to grandparents thus constitute a potential means of promoting healthy eating among children. For such interventions to be effective, they must account for the unique issues encountered by grandparents. However, research examining the potential needs of grandparents is limited. The present study thus explored (i) grandparents' perceptions of the barriers to providing their grandchildren with healthy food and minimizing consumption of unhealthy food and (ii) the strategies grandparents believe help increase their grandchildren's consumption of healthy food and reduce intake of unhealthy food. Seventy-nine grandparents, each of whom provided care to at least one grandchild aged 3-12 years, participated in one of ten focus groups. Transcripts from each of the groups were imported into NVivo for qualitative coding and semantic thematic analysis. The food preferences of their grandchildren, the promotion of unhealthy food consumption by their grandchildren's parents, advertising of unhealthy food, and peer pressure were the most frequently cited barriers to healthy food consumption. Grandparents reported using multiple strategies to increase their grandchildren's fruit and vegetable consumption and minimize unhealthy food intake. The most common were disguising vegetables, making fruit and vegetables appealing, managing child eating (e.g., limiting access to unhealthy food), saying no to requests for unhealthy food, involving grandchildren in meal planning and cooking, and using rewards. Findings suggest that grandparents may need support with managing food preferences and navigating and negotiating complex relations with parents regarding child feeding.

Service Providers' Perspectives on Barriers of Healthy Eating to Prevent Obesity among Low-income Children Attending Community Childcare Centers in South Korea: A Qualitative Study

This study aimed to identify individual and socio-ecological barriers in managing healthy eating among low-income children from the perspective of community childcare (CCC) center workers (n = 18) through focus group interviews. They perceived the increase in obesity among low-income children. The interviews revealed that the child's eating habits are affected by not only individual determinants including self-regulation and risk awareness but also environmental factors such as family, CCC centers, policy and social structure. To enhance children's health and behavior, it is necessary to consider the interactions among systems at a variety of levels, for example, local community and health care policies.