1
|
Feng J, Huang WY, Zheng C, Jiao J, Khan A, Nisar M, Wong SHS. The Overflow Effects of Movement Behaviour Change Interventions for Children and Adolescents: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sports Med 2024:10.1007/s40279-024-02113-1. [PMID: 39292361 DOI: 10.1007/s40279-024-02113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Considering the finite time within a 24-h day, the distribution of time spent on movement behaviours has been found to be associated with health outcomes. OBJECTIVES This systematic review and meta-analysis aimed to summarise and evaluate the overflow effects of interventions targeting a single behaviour (physical activity, sedentary behaviour/screen time, or sleep) on other non-targeted behaviours among children and adolescents. METHODS Six databases (MEDLINE [Ovid], PsycINFO [ProQuest], EMBASE [Ovid], PubMed, Web of Science and SPORTDiscus [EBSCO]) were searched for relevant studies published before 13 May, 2024. Randomised controlled trials and clustered randomised controlled trials that targeted a single behaviour and also assessed the effects on non-targeted behaviours, comprised of healthy children under the age of 18 years, were included. Movement behaviours can be measured either objectively or subjectively. The revised Cochrane risk-of-bias tool for randomised trials was adopted to evaluate the risk of bias. RESULTS A total of 102 studies with 45,998 participants from 21 countries were identified, and 60 of them with 26,183 participants were incorporated into the meta-analysis. The meta-analysis demonstrated that physical activity interventions led to a reduction in the proportion of each day spent in sedentary behaviour (mean difference = - 0.95% of wear time, 95% confidence interval - 1.44, - 0.45, I2 = 39%). Sedentary behaviour interventions resulted in increased standing time (mean difference = 3.87%, 95% confidence interval 1.99, 5.75, I2 = 0%). Interventions targeting screen time did not yield changes in physical activity or sleep. The findings on the effectiveness of sleep interventions on non-targeted behaviours and of physical activity interventions on sleep were inconclusive. CONCLUSIONS Overall, the findings suggested that interventions aimed at increasing physical activity or reducing sedentary behaviour had overflow effects on non-targeted behaviours, but the effect sizes were small. Additional evidence is needed to reach definitive conclusions regarding the impact of behaviour change interventions on sleep and of the overflow effects of sleep interventions.
Collapse
Affiliation(s)
- Jie Feng
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Wendy Yajun Huang
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China.
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China.
| | - Chen Zheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Mehwish Nisar
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
2
|
Chan J, Conroy P, Phongsavan P, Raubenheimer D, Allman-Farinelli M. Systems map of interventions to improve dietary intake of pre-school aged children: A scoping review. Prev Med 2023; 177:107727. [PMID: 37848165 DOI: 10.1016/j.ypmed.2023.107727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
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.
Collapse
Affiliation(s)
- Jacqueline Chan
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
| | - Patrick Conroy
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Philayrath Phongsavan
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Allman-Farinelli
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
Grady A, Jackson J, Wolfenden L, Lum M, Yoong SL. Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review. Public Health Nutr 2023; 26:3211-3229. [PMID: 37990443 PMCID: PMC10755435 DOI: 10.1017/s1368980023002550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Early childhood education and care (ECEC) is a recommended setting for the delivery of health eating interventions 'at scale' (i.e. to large numbers of childcare services) to improve child public health nutrition. Appraisal of the 'scalability' (suitability for delivery at scale) of interventions is recommended to guide public health decision-making. This study describes the extent to which factors required to assess scalability are reported among ECEC-based healthy eating interventions. DESIGN Studies from a recent Cochrane systematic review assessing the effectiveness of healthy eating interventions delivered in ECEC for improving child dietary intake were included. The reporting of factors of scalability was assessed against domains outlined within the Intervention Scalability Assessment Tool (ISAT). The tool recommends decision makers consider the problem, the intervention, strategic and political context, effectiveness, costs, fidelity and adaptation, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability. Data were extracted by one reviewer and checked by a second reviewer. SETTING ECEC. PARTICIPANTS Children 6 months to 6 years. RESULTS Of thirty-eight included studies, none reported all factors within the ISAT. All studies reported the problem, the intervention, effectiveness and the delivery workforce and setting. The lowest reported domains were intervention costs (13 % of studies) and sustainability (16 % of studies). CONCLUSIONS Findings indicate there is a lack of reporting of some key factors of scalability for ECEC-based healthy eating interventions. Future studies should measure and report such factors to support policy and practice decision makers when selecting interventions to be scaled-up.
Collapse
Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Melanie Lum
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Victoria, Australia
| |
Collapse
|
4
|
Yoong SL, Lum M, Wolfenden L, Jackson J, Barnes C, Hall AE, McCrabb S, Pearson N, Lane C, Jones JZ, Nolan E, Dinour L, McDonnell T, Booth D, Grady A. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years. Cochrane Database Syst Rev 2023; 8:CD013862. [PMID: 37606067 PMCID: PMC10443896 DOI: 10.1002/14651858.cd013862.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health. OBJECTIVES To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions. SEARCH METHODS We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3). AUTHORS' CONCLUSIONS ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Melanie Lum
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Alix E Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jannah Z Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Lauren Dinour
- College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Therese McDonnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Debbie Booth
- Auchmuty Library, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| |
Collapse
|
5
|
Francis LA, Nix RL, BeLue R, Keller KL, Kugler KC, Rollins BY, Savage JS. Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project. Clin Trials 2023; 20:434-446. [PMID: 37077032 PMCID: PMC10338696 DOI: 10.1177/17407745231167115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND/AIMS Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.
Collapse
Affiliation(s)
- Lori A Francis
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Robert L Nix
- Department of Human Development and Family Studies, School of Human Ecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Rhonda BeLue
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Kathleen L Keller
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Kari C Kugler
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Brandi Y Rollins
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
6
|
Keller KL, Pearce AL, Fuchs B, Hallisky K, Rolls BJ, Wilson SJ, Geier C, Rose EJ. Children with lower ratings of executive functions have a greater response to the portion size effect. Appetite 2023; 186:106569. [PMID: 37059397 PMCID: PMC10213140 DOI: 10.1016/j.appet.2023.106569] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/21/2023] [Accepted: 04/12/2023] [Indexed: 04/16/2023]
Abstract
Deficits in executive functions (EFs), a set of cognitive processes related to self-regulation, are associated with the development of obesity. Prior studies from our group showed that lower food-cue related activation in brain regions implicated in self-regulation was related to a larger portion size effect. We tested the hypothesis that lower EFs in children would be positively related to the portion size effect. Healthy weight children aged 7-8 y (n = 88), who varied by maternal obesity status, participated in a prospective study. At baseline, the parent primarily in charge of feeding completed the Behavior Rating Inventory of Executive Function (BRIEF2) to assess child EFs, including Behavioral (BRI), Emotional (ERI), and Cognitive (CRI) indices. At 4 baseline sessions, children consumed meals in which the portion sizes of foods (pasta, chicken nuggets, broccoli, and grapes) varied by visit (total meal weight of 769, 1011, 1256, or 1492g). Intake increased with increasing portions in a linear trajectory (p < 0.001). EFs moderated the portion size effect such that lower BRI (p = 0.003) and ERI (p = 0.006) were associated with steeper increases in intake as portions increased. As amount of food increased, children in the lowest functioning tertiles for BRI and ERI increased intake by 35% and 36%, respectively, compared to children in the higher tertiles. Increases in intake among children with lower EFs were for higher- but not lower-energy-dense foods. Thus, in healthy weight children who varied by obesity risk, lower parentally reported EFs were associated with a larger portion size effect, and these results were independent of child and parent weight status. Therefore, EFs may be target behaviors that could be strengthened to help children moderate excess intake in response to large portions of energy-dense foods.
Collapse
Affiliation(s)
- Kathleen L Keller
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA; Social Science Research Institute, University Park, PA, USA; Department of Food Science, The Pennsylvania State University, University Park, PA, USA.
| | - Alaina L Pearce
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA; Social Science Research Institute, University Park, PA, USA
| | - Bari Fuchs
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA
| | - Kyle Hallisky
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA
| | - Barbara J Rolls
- Department of Nutritional Science, The Pennsylvania State University, University Park, PA, USA
| | - Stephen J Wilson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Charles Geier
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Emma J Rose
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
7
|
Yoong SL, Lum M, Wolfenden L, Jackson J, Barnes C, Hall AE, McCrabb S, Pearson N, Lane C, Jones JZ, Dinour L, McDonnell T, Booth D, Grady A. Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years. Cochrane Database Syst Rev 2023; 6:CD013862. [PMID: 37306513 PMCID: PMC10259732 DOI: 10.1002/14651858.cd013862.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health. OBJECTIVES To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions. SEARCH METHODS We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers. SELECTION CRITERIA We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both. DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes. MAIN RESULTS: We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3). AUTHORS' CONCLUSIONS ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.
Collapse
Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Victoria, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Melanie Lum
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Alix E Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Jannah Z Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Lauren Dinour
- College of Education and Human Services, Montclair State University, Montclair, New Jersey, USA
| | - Therese McDonnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Debbie Booth
- Auchmuty Library, University of Newcastle, Callaghan, Australia
| | - Alice Grady
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| |
Collapse
|
8
|
Rahmaty Z, Johantgen ME, Storr CL, Wang Y, Black MM. Preschoolers BMI: Associations with Patterns of Caregivers' Feeding Practices Using Structural Equation Models. Child Obes 2023; 19:169-178. [PMID: 35649202 PMCID: PMC10122251 DOI: 10.1089/chi.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- Zahra Rahmaty
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Institute of Higher Education and Research in Healthcare (IUFRS), Department of Biology and Medicine, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Mary E. Johantgen
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Carla L. Storr
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
- RTI International, Research Triangle Park, NC, USA
| |
Collapse
|
9
|
Larouche R, Kleinfeld M, Charles Rodriguez U, Hatten C, Hecker V, Scott DR, Brown LM, Onyeso OK, Sadia F, Shimamura H. Determinants of Outdoor Time in Children and Youth: A Systematic Review of Longitudinal and Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1328. [PMID: 36674085 PMCID: PMC9859594 DOI: 10.3390/ijerph20021328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Spending more time outdoors can improve children's social and cognitive development, physical activity, and vision. Our systematic review summarized the determinants of outdoor time (OT) based on the social-ecological model. We searched nine databases: MEDLINE, APA PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, SPORTDiscus, ERIC, SocINDEX, and ProQuest Dissertations and Theses. To be included, studies needed to be quantitative and longitudinal, include ≥1 potential determinant of OT among 0- to 17-year-olds, and be published in English, French, Japanese, or Spanish. We extracted the authors, publication year, country, design, sample size, OT measures, follow-up period, potential determinants, main results, and potential moderators or mediators. Fifty-five studies examining 119 potential determinants met the inclusion criteria. OT was consistently higher in warmer seasons and among participants reporting more OT at baseline. All three interventions that included both parent sessions and additional resources to promote OT (e.g., specific advice and community guides) were effective. COVID-19 restrictions and sun safety interventions discouraging midday outdoor activities led to less OT. The quality of evidence was rated as weak for 46 studies. Most potential determinants were examined in ≤3 studies; thus, more longitudinal studies are needed to enable stronger conclusions about the consistency of evidence and meta-analyses.
Collapse
Affiliation(s)
- Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Madeline Kleinfeld
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | | | - Cheryl Hatten
- School of Human Services, Lethbridge College, Lethbridge, AB T1K 1L6, Canada
| | - Victoria Hecker
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - David R. Scott
- Library, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Leanna Marie Brown
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Ogochukwu K. Onyeso
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Farzana Sadia
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Hanako Shimamura
- Faculty of Applied Community Studies, Douglas College, Coquitlam, BC V3B 7X3, Canada
| |
Collapse
|
10
|
Yin Z, Liang Y, Howard JT, Errisuriz V, Estrada VM, Martinez C, Li S, Ullevig S, Sosa E, Olmstead T, Small S, Ward DS, Parra-Medina D. ¡Míranos! a Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: One-year Results of a Clustered Randomized Controlled Trial. Public Health Nutr 2022; 26:1-26. [PMID: 36357340 PMCID: PMC10172390 DOI: 10.1017/s1368980022002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children. DESIGN A three-group clustered randomized controlled trial. SETTING Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home. STUDY OUTCOMES The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl). PARTICIPANTS Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29). RESULTS Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group. CONCLUSIONS There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.
Collapse
Affiliation(s)
- Zenong Yin
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Yuanyuan Liang
- The University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, USA
| | - Jeffrey T. Howard
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Vanessa Errisuriz
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
| | - Vanessa Marie Estrada
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Cristina Martinez
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Shiyu Li
- UT Health San Antonio, School of Nursing, San Antonio, Texas, USA
| | - Sarah Ullevig
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Erica Sosa
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Todd Olmstead
- The University of Texas at Austin, LBJ School of Public Affairs, Texas, USA
| | - Sharon Small
- Parent/Child Incorporated of San Antonio and Bexar County, San Antonio, Texas, USA
| | - Dianne Stanton Ward
- Department of Nutrition Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Deborah Parra-Medina
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
| |
Collapse
|
11
|
Beverage behaviors and correlates among Head Start preschooler-parent dyads. Matern Child Health J 2022; 26:2271-2282. [PMID: 36125670 DOI: 10.1007/s10995-022-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To describe beverage behaviors among preschooler-parent dyads and explore correlates with preschooler's beverage behaviors. METHODS This exploratory, cross-sectional study includes a convenience sample of 202 parents of preschoolers surveyed from four Head Start programs in Virginia and Ohio. Measurements included parent-child beverage behaviors, parent beverage perceptions, parent beverage rules, home beverage availability, and demographics. Analyses included descriptive statistics, correlations, Kruskal-Wallis test, and Quade's non-parametric ANCOVA tests. RESULTS Mean sugar-sweetened beverage (SSB; i.e., regular soda, sweetened fruit drinks, sports/energy drinks, and coffee/tea with sugar) intake was 1.3 (SD = 1.4) and 2.3 (SD = 2.0) times/day for preschoolers and parents, respectively. When considering all sugary drink sources [i.e., summing SSB with flavored milk and 100% fruit juice (FJ)], the mean frequency increased to 3.2 (SD = 2.1) and 3.6 (SD = 2.4) times/day, respectively, for preschoolers and parents. A significant positive correlation was observed between preschooler-parent dyads for SSB (r = 0.406, p < 0.001) and for all sugary drinks (r = 0.572, p < 0.001). Parents who were younger, single, less educated, and with lower income had preschoolers with significantly higher SSB and all sugary drink intake (all p < 0.05). Significant correlates with preschoolers' beverage behaviors also included parent perceived behavioral control (SSB: p = 0.003, 100% FJ: p = 0.008, water: p < 0.0001), parenting practices (SSB: p = 0.022), and home availability (SSB: p = 0.011, 100% FJ: p < 0.001, water: p < 0.001). CONCLUSIONS This study highlights excessive SSB and all sugary drink consumption among Head Start preschooler-parent dyads. Also, intervention targets to improve preschooler's beverage behaviors are identified, including efforts to improve parent's beverage behaviors, perceived behavioral control, parenting practices, and the home environment.
Collapse
|
12
|
Fisher JO, Hughes SO, Miller AL, Horodynski MA, Brophy-Herb HE, Contreras DA, Kaciroti N, Peterson KE, Rosenblum KL, Appugliese D, Lumeng JC. Characteristics of eating behavior profiles among preschoolers with low-income backgrounds: a person-centered analysis. Int J Behav Nutr Phys Act 2022; 19:91. [PMID: 35870976 PMCID: PMC9308918 DOI: 10.1186/s12966-022-01323-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight. METHODS A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status. RESULTS LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles. CONCLUSIONS Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.
Collapse
Affiliation(s)
- Jennifer Orlet Fisher
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Sheryl O Hughes
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Alison L Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Holly E Brophy-Herb
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Dawn A Contreras
- Health and Nutrition Institute, Michigan State University Extension, East Lansing, MI, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karen E Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
13
|
Flynn AC, Suleiman F, Windsor‐Aubrey H, Wolfe I, O'Keeffe M, Poston L, Dalrymple KV. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. MATERNAL & CHILD NUTRITION 2022; 18:e13354. [PMID: 35333450 PMCID: PMC9218326 DOI: 10.1111/mcn.13354] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 01/01/2023]
Abstract
The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.
Collapse
Affiliation(s)
- Angela C. Flynn
- Department of Women and Children's HealthKing's College LondonLondonUK
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Fatma Suleiman
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Hazel Windsor‐Aubrey
- Department of Nutritional Sciences, School of Life Course SciencesKing's College LondonLondonUK
| | - Ingrid Wolfe
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Majella O'Keeffe
- School of Food and Nutritional SciencesUniversity College CorkCorkIreland
| | - Lucilla Poston
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| | - Kathryn V. Dalrymple
- Department of Women and Children's HealthKing's College LondonLondonUK
- Institute for Women and Children's HealthKing's Health Partners'LondonUK
| |
Collapse
|
14
|
Bjørklund O, Wichstrøm L, Llewellyn C, Steinsbekk S. The prospective relation between eating behaviors and BMI from middle childhood to adolescence: A 5-wave community study. Prev Med Rep 2022; 27:101795. [PMID: 35656230 PMCID: PMC9152788 DOI: 10.1016/j.pmedr.2022.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/31/2022] [Accepted: 04/17/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oda Bjørklund
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll 7491 Trondheim, Norway
- St Olav University Hospital, 7030 Trondheim, Norway
- Corresponding author at: Department of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll 7491 Trondheim, Norway.
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll 7491 Trondheim, Norway
- St Olav University Hospital, 7030 Trondheim, Norway
| | - Clare Llewellyn
- Department of Behavioural Science & Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Silje Steinsbekk
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Dragvoll 7491 Trondheim, Norway
| |
Collapse
|
15
|
Francis LA, Rollins BY, Keller KL, Nix RL, Savage JS. Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices. Front Nutr 2022; 9:796580. [PMID: 35308281 PMCID: PMC8931462 DOI: 10.3389/fnut.2022.796580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Lori A. Francis
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
- *Correspondence: Lori A. Francis
| | - Brandi Y. Rollins
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Kathleen L. Keller
- Department of Nutrition Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Robert L. Nix
- Department of Human Development and Family Studies, University of Wisconsin-Madison, Madison, WI, United States
| | - Jennifer S. Savage
- Department of Nutrition Sciences, The Pennsylvania State University, University Park, PA, United States
| |
Collapse
|
16
|
Rollins BY, Francis LA, Riggs NR. Family Psychosocial Assets, Child Behavioral Regulation, and Obesity. Pediatrics 2022; 149:184741. [PMID: 35128559 DOI: 10.1542/peds.2021-052918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little attention has been given to the study of early childhood factors that protect against the development of obesity and severe obesity. We investigated whether exposure to familial psychosocial assets and risks in infancy (1-15 months) and early childhood (24-54 months) and child behavioral regulation in early childhood predict longitudinal change in BMI (2 to 15 years). METHODS Participants included 1077 predominantly non-Hispanic, White, English-speaking mother-child dyads from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development dataset. Cumulative familial asset and risk indices were created using measures (eg, maternal parenting sensitivity, poverty) from 2 developmental periods (1-15 months, 24-54 months). A child behavioral regulation index was created on the basis of behavioral tasks and parent reports. Previously published BMI trajectories (nonoverweight [40th percentile], nonoverweight [70th percentile], overweight/obese, severely obese) were used as the outcome. RESULTS All indices predicted membership in the overweight/obese trajectory; however, when entered into the same model, only familial assets continued to reduce the odds of membership in this trajectory. Familial assets and child behavioral regulation independently reduced the odds of membership in the severely obese trajectory. Furthermore, child behavioral regulation and familial assets buffered the negative effects of familial risk on BMI trajectory membership. CONCLUSIONS Early exposure to familial assets and child behavioral regulation may have long-term protective effects on weight gain over early exposure to some familial risk factors (eg, poverty); thus, these indices may help foster obesity resilience.
Collapse
Affiliation(s)
- Brandi Y Rollins
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania
| | - Lori A Francis
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania
| | - Nathaniel R Riggs
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado
| |
Collapse
|
17
|
Philippe K, Chabanet C, Issanchou S, Monnery-Patris S. Young Children's Eating in the Absence of Hunger: Links With Child Inhibitory Control, Child BMI, and Maternal Controlling Feeding Practices. Front Psychol 2021; 12:653408. [PMID: 34867571 PMCID: PMC8635239 DOI: 10.3389/fpsyg.2021.653408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/19/2021] [Indexed: 12/05/2022] Open
Abstract
This study aimed to gain a better understanding of the associations between young children’s eating in the absence of hunger (EAH), inhibitory control, body mass index (BMI) and several maternal controlling feeding practices (food as reward, restriction for health, restriction for weight control). In addition, to more properly assess the relationship between children’s and maternal variables, the link between EAH and restriction was explored separately in two directionalities: “child to parent” or “parent to child.” To do this, mothers of 621 children aged 2.00–6.97years (51% boys, M=4.11years, SD=1.34) filled in a questionnaire with items from validated questionnaires. Structural equation modeling (SEM) was used to analyze the data. The results showed, whatever the directionality considered, a positive association between children’s eating in the absence of hunger and their BMI z-scores. Restriction for health and restriction for weight control were differently linked to EAH and to children’s BMI z-scores. Namely, low child inhibitory control, food as reward and restriction for health were identified as risk factors for EAH. Restriction for weight control was not linked to EAH, but was predicted by child BMI z-scores. Interventions aiming to improve children’s abilities to self-regulate food intake could consider training children’s general self-regulation, their self-regulation of intake, and/or promoting adaptive parental feeding practices.
Collapse
Affiliation(s)
- Kaat Philippe
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Claire Chabanet
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Sylvie Issanchou
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Sandrine Monnery-Patris
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| |
Collapse
|
18
|
Jones A, Armstrong B, Weaver RG, Parker H, von Klinggraeff L, Beets MW. Identifying effective intervention strategies to reduce children's screen time: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:126. [PMID: 34530867 PMCID: PMC8447784 DOI: 10.1186/s12966-021-01189-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive screen time ([Formula: see text] 2 h per day) is associated with childhood overweight and obesity, physical inactivity, increased sedentary time, unfavorable dietary behaviors, and disrupted sleep. Previous reviews suggest intervening on screen time is associated with reductions in screen time and improvements in other obesogenic behaviors. However, it is unclear what study characteristics and behavior change techniques are potential mechanisms underlying the effectiveness of behavioral interventions. The purpose of this meta-analysis was to identify the behavior change techniques and study characteristics associated with effectiveness in behavioral interventions to reduce children's (0-18 years) screen time. METHODS A literature search of four databases (Ebscohost, Web of Science, EMBASE, and PubMed) was executed between January and February 2020 and updated during July 2021. Behavioral interventions targeting reductions in children's (0-18 years) screen time were included. Information on study characteristics (e.g., sample size, duration) and behavior change techniques (e.g., information, goal-setting) were extracted. Data on randomization, allocation concealment, and blinding was extracted and used to assess risk of bias. Meta-regressions were used to explore whether intervention effectiveness was associated with the presence of behavior change techniques and study characteristics. RESULTS The search identified 15,529 articles, of which 10,714 were screened for relevancy and 680 were retained for full-text screening. Of these, 204 studies provided quantitative data in the meta-analysis. The overall summary of random effects showed a small, beneficial impact of screen time interventions compared to controls (SDM = 0.116, 95CI 0.08 to 0.15). Inclusion of the Goals, Feedback, and Planning behavioral techniques were associated with a positive impact on intervention effectiveness (SDM = 0.145, 95CI 0.11 to 0.18). Interventions with smaller sample sizes (n < 95) delivered over short durations (< 52 weeks) were associated with larger effects compared to studies with larger sample sizes delivered over longer durations. In the presence of the Goals, Feedback, and Planning behavioral techniques, intervention effectiveness diminished as sample size increased. CONCLUSIONS Both intervention content and context are important to consider when designing interventions to reduce children's screen time. As interventions are scaled, determining the active ingredients to optimize interventions along the translational continuum will be crucial to maximize reductions in children's screen time.
Collapse
Affiliation(s)
- Alexis Jones
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - R. Glenn Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Hannah Parker
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Lauren von Klinggraeff
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - M. W. Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| |
Collapse
|
19
|
Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
Collapse
Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| |
Collapse
|
20
|
Olsen NJ, Ängquist L, Frederiksen P, Lykke Mortensen E, Heitmann BL. Primary prevention of fat and weight gain among obesity susceptible healthy weight preschool children. Main results from the "Healthy Start" randomized controlled intervention. Pediatr Obes 2021; 16:e12736. [PMID: 33021348 DOI: 10.1111/ijpo.12736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND A vital public health challenge lies in understanding the primary drivers behind excessive weight gain among healthy weight individuals. OBJECTIVES To examine if excessive weight and fat gain can be prevented among healthy weight, obesity susceptible children aged 2 to 6 years. METHODS Eligible children were identified based on information on either a high birth weight, maternal pre-pregnancy obesity or maternal low educational level from national registries, and randomized into an intervention group, a control group and a shadow control group. All children with overweight at baseline were excluded from subsequent analysis (n = 196), while healthy weight children were included (n = 926). The intervention was designed to deliver improvements in diet and physical activity habits, optimization of sleep quantity and quality, and reduction of family stress. The average intervention period was 1.3 years. RESULTS Intention-to-treat analyses indicated a lower gain in percentage fat mass and a higher gain in fat-free mass in the intervention group compared with the control group. However, the results should be interpreted with caution, as they were clinically small and borderline significant, only. CONCLUSION This primary prevention intervention among young healthy weight children with susceptibility to future obesity had clinically small effects on growth and body composition. More interventions, conducting primary obesity prevention, are urgently needed.
Collapse
Affiliation(s)
- Nanna Julie Olsen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark
| | - Lars Ängquist
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Peder Frederiksen
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, the Capital Region, Frederiksberg, Denmark.,The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Sydney, New South Wales, Australia.,Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
21
|
Martoccio TL, Senehi N, Brophy-Herb HE, Miller AL, Contreras D, Horodynski MA, Peterson KE, Lumeng JC. Temperament, socioeconomic adversity, and perinatal risk as related to preschoolers' BMI. Health Psychol 2021; 40:135-144. [PMID: 33315417 PMCID: PMC8363046 DOI: 10.1037/hea0001052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Disparities in childhood obesity necessitate identification of risk-protective and risk- augmenting factors for young children experiencing socioeconomic adversity born with perinatal risk. Temperamental reactivity is a biological marker of susceptibility to environmental characteristics. This study tested whether temperamental reactivity moderated the relation between socioeconomic risk and children's body mass index (BMI). METHOD This study examined 100 Head Start preschoolers (Mage = 4.07 years, SD = 0.56) with perinatal risk, defined as preterm birth (PT, <37 weeks gestation) or low birth weight (LBW, <2500g). Anthropometric measurements were collected from children and parents. Parents completed questionnaires on family level demographics and household food insecurity to create a cumulative socioeconomic risk variable. Parents also completed the Children's Behavior Questionnaire to assess preschoolers' temperamental reactivity. RESULTS Results supported a differential susceptibility hypothesis such that preschoolers' temperamental reactivity significantly moderated the relation between socioeconomic risk and child BMI z-score (BMIz). Higher BMIz was observed in highly reactive children exposed to higher socioeconomic risk. Alternatively, lower exposure to socioeconomic risk was related to lower BMIz for highly reactive children. CONCLUSIONS Findings suggest that highly reactive PT/LBW preschoolers are differentially susceptible to early socioeconomic adversity in a for better or for worse manner regarding BMIz. Thus, consideration of temperament as a marker of biological sensitivity to context may be necessary to inform obesity prevention for PT/LBW preschoolers from low-income families. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Tiffany L. Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland College Park
| | - Neda Senehi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | | | - Alison L. Miller
- Center for Human Growth and Development, University of Michigan
- Department of Health Behavior and Health Education, University of Michigan School of Public Health
| | | | | | - Karen E. Peterson
- Center for Human Growth and Development, University of Michigan
- Department of Nutritional Sciences, University of Michigan School of Public Health
| | - Julie C. Lumeng
- Center for Human Growth and Development, University of Michigan
- Department of Nutritional Sciences, University of Michigan School of Public Health
- Department of Pediatrics, University of Michigan Medical School
| |
Collapse
|
22
|
Child eating behaviors, parental feeding practices and food shopping motivations during the COVID-19 lockdown in France: (How) did they change? Appetite 2021; 161:105132. [PMID: 33493611 PMCID: PMC7825985 DOI: 10.1016/j.appet.2021.105132] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 02/03/2023]
Abstract
The COVID-19 pandemic caused France to impose a strict lockdown, affecting families' habits in many domains. This study evaluated possible changes in child eating behaviors, parental feeding practices, and parental motivations when buying food during the lockdown, compared to the period before the lockdown. Parents of 498 children aged 3–12 years (238 boys; M = 7.32; SD = 2.27) completed an online survey with items from validated questionnaires (e.g., CEDQ, CEBQ, HomeSTEAD). They reported on their (child's) current situation during the lockdown, and retrospectively on the period before the lockdown. Many parents reported changes in child eating behaviors, feeding practices, and food shopping motivations. When changes occurred, child appetite, food enjoyment, food responsiveness and emotional overeating significantly increased during the lockdown. Increased child boredom significantly predicted increased food responsiveness, emotional overeating and snack frequency in between meals. When parents changed their practices, they generally became more permissive: less rules, more soothing with food, more child autonomy. They bought pleasurable and sustainable foods more frequently, prepared more home-cooked meals and cooked more with the child. Level of education and increased stress level predicted changes in parental practices and motivations. This study provides insights in factors that can induce positive and negative changes in families' eating, feeding and cooking behaviors. This can stimulate future studies and interventions.
Collapse
|
23
|
Torres C, Brophy-Herb HE, McCaffery H, Struza J, Williams JM, Choi HH, Horodynski MA, Contreras D, Kerver J, Kaciroti N, Lumeng JC. Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score. Acad Pediatr 2021; 21:70-75. [PMID: 32590057 PMCID: PMC7755689 DOI: 10.1016/j.acap.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Parental mindfulness may be a novel intervention target for child obesity prevention. OBJECTIVE To examine associations between maternal mindfulness and child body mass index z-score (BMIz). METHODS In a secondary data analysis of preintervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n = 105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. RESULTS Children were M = 53.7 (standard deviation [SD] 7.5) months old, and mothers were M = 31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β = -.02 (SE 0.01), P = .027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (P = .016) and BMI at the trend level (P = .0595) at the trend level. CONCLUSIONS Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.
Collapse
Affiliation(s)
- Chioma Torres
- Department of Pediatrics, University of Michigan Medical School (C Torres, J Struza, and JC Lumeng), Ann Arbor, Mich.
| | - Holly E Brophy-Herb
- Department of Human Development and Family Studies, Michigan State University (HE Brophy-Herb, JM Williams, and HH Choi), East Lansing, Mich
| | - Harlan McCaffery
- Center for Human Growth and Development, University of Michigan (H McCaffery, N Kaciroti, and JC Lumeng), Ann Arbor, Mich
| | - Julie Struza
- Department of Pediatrics, University of Michigan Medical School (C Torres, J Struza, and JC Lumeng), Ann Arbor, Mich
| | - Jessica M Williams
- Department of Human Development and Family Studies, Michigan State University (HE Brophy-Herb, JM Williams, and HH Choi), East Lansing, Mich
| | - Hailey Hyunjin Choi
- Department of Human Development and Family Studies, Michigan State University (HE Brophy-Herb, JM Williams, and HH Choi), East Lansing, Mich
| | - Mildred A Horodynski
- College of Nursing, Michigan State University (MA Horodynski), East Lansing, Mich
| | - Dawn Contreras
- Michigan State University Extension, Michigan State University (D Contreras), East Lansing, Mich
| | - Jean Kerver
- Department of Epidemiology and Biostatistics, Michigan State University (J Kerver), East Lansing, Mich
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan (H McCaffery, N Kaciroti, and JC Lumeng), Ann Arbor, Mich
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School (C Torres, J Struza, and JC Lumeng), Ann Arbor, Mich; Center for Human Growth and Development, University of Michigan (H McCaffery, N Kaciroti, and JC Lumeng), Ann Arbor, Mich; Department of Nutritional Sciences, University of Michigan School of Public Health (JC Lumeng), Ann Arbor, Mich
| |
Collapse
|
24
|
Black MM, Hager ER, Wang Y, Hurley KM, Latta LW, Candelaria M, Caulfield LE. Toddler obesity prevention: A two-generation randomized attention-controlled trial. MATERNAL & CHILD NUTRITION 2021; 17:e13075. [PMID: 32885909 PMCID: PMC7729807 DOI: 10.1111/mcn.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/19/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022]
Abstract
Rapid weight gain increases risks of obesity and associated co-morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler-mother physical activity, mealtime interactions and fruit/vegetable intake. The randomized three-arm, eight-session, 4-month trial, conducted 2009-2013, included two intervention arms (responsive parenting and maternal lifestyle) and an attention control (home safety). Baseline and 6- and 12-month follow-up evaluations included weight and length/height, ankle accelerometry, video-recorded mealtime interactions (Emotional Availability Scales) and 24-h diet recalls (Healthy Eating Index-2015 [HEI-2015]). Analyses used linear mixed-effects models with repeated measures comparing intervention versus control changes in BMI z score. We recruited 277 racially mixed (70% African American) toddler-mother dyads (mean ages 20.1 months and 27.3 years) from US WIC and primary care clinics and randomized them into intervention versus control; 31% toddlers and 73% mothers were overweight/obese. At follow-up, changes in the rate of toddler BMI z score and maternal BMI were non-significant. Maternal lifestyle group toddlers and mothers spent 24.43 and 11.01 more minutes in physical activity (95% confidence interval [CI]: 2.55, 46.32, and 95% CI: 1.48, 20.54, respectively). Fruit intake increased in both intervention groups. Hostile mealtime interactions increased in the maternal lifestyle group, and in supplementary analyses, mealtime interactions were significantly higher in the responsive parenting group than in the maternal lifestyles group, suggesting that toddler dietary interventions include responsive parenting. Intervention effects were stronger among older versus younger toddlers. Despite no impact on weight gain, additional research should examine integrated two-generation responsive parenting and maternal lifestyle interventions among toddler-mother dyads.
Collapse
Affiliation(s)
- Maureen M. Black
- Department of Pediatrics and Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- RTI InternationalResearch Triangle ParkNorth CarolinaUSA
| | - Erin R. Hager
- Department of Pediatrics and Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Yan Wang
- Department of Pediatrics and Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Kristen M. Hurley
- Center for Human NutritionThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Laura W. Latta
- Institute for Innovation and ImplementationUniversity of Maryland School of Social WorkBaltimoreMarylandUSA
| | - Margo Candelaria
- Institute for Innovation and ImplementationUniversity of Maryland School of Social WorkBaltimoreMarylandUSA
| | - Laura E. Caulfield
- Center for Human NutritionThe Johns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| |
Collapse
|
25
|
Reigh NA, Rolls BJ, Savage JS, Johnson SL, Keller KL. Development and preliminary testing of a technology-enhanced intervention to improve energy intake regulation in children. Appetite 2020; 155:104830. [PMID: 32814120 PMCID: PMC10690740 DOI: 10.1016/j.appet.2020.104830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/08/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
Interventions designed to improve children's self-regulation of energy intake have yielded mixed results. We tested the efficacy of a technology-enhanced intervention designed to teach children to eat in response to internal hunger and fullness cues. Thirty-two children (mean age 4.9 ± 0.8 y) completed this within-subjects, pre-post design study that took place across 10 laboratory sessions, each scheduled approximately 1 week apart. The intervention was conducted across weeks 4-7 in small groups focused on teaching children how food travels through the body and how to respond to hunger and fullness signals. Children's short-term energy compensation, a measure of intake regulation, was collected at baseline and follow-up using a preloading protocol. Twenty-five minutes prior to receiving a standardized test meal, children consumed a low-energy (3 kcal) or high-energy (150 kcal) preload beverage, presented in random order at baseline and follow-up. Knowledge of intervention concepts was also assessed at baseline and follow-up. Linear mixed models were used to examine changes in short-term energy compensation and knowledge from baseline to follow-up. Knowledge related to the intervention improved from baseline to follow-up (3.5 ± 0.3 to 7.0 ± 0.3 correct responses out of a possible 10; P < 0.001). Children's energy compensation also improved from baseline to follow-up, as evidenced by a time-by-preload condition interaction (P = 0.02). However, this improvement was driven by boys who increased the adjustment for beverage energy content from baseline to follow-up (P = 0.04). Girls showed no change in energy compensation with the intervention (P = 0.58). The overall increase in knowledge, paired with the improvement in energy compensation in boys, suggests that this technology-enhanced intervention may be efficacious for some children. Further research is needed to determine whether boys and girls will benefit from different, personalized intervention strategies for obesity prevention.
Collapse
Affiliation(s)
- Nicole A Reigh
- The Pennsylvania State University, Department of Nutritional Sciences. 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Barbara J Rolls
- The Pennsylvania State University, Department of Nutritional Sciences. 226 Henderson Building, University Park, PA, 16802, USA
| | - Jennifer S Savage
- The Pennsylvania State University, Center for Childhood Obesity Research and Department of Nutritional Sciences. 129 Noll Laboratory, University Park, PA, 16802, USA
| | - Susan L Johnson
- University of Colorado Denver Anschutz Medical Campus, Department of Pediatrics. 12631 East 17th Avenue, Mail Stop F-561, Academic Office Building, Room 2609; Aurora, CO, 80045, USA
| | - Kathleen L Keller
- The Pennsylvania State University, Departments of Nutritional Sciences and Food Science. 321 Chandlee Laboratory, University Park, PA, 16802, USA.
| |
Collapse
|
26
|
Schmitt SA, Snyder F, Korucu I, Bryant LM, Finders JK. Pilot Intervention Enhances Preschoolers' Self-Regulation and Food Liking. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1035-1042. [PMID: 33168204 DOI: 10.1016/j.jneb.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The goal of this study was to develop and evaluate a 5-week intervention that targeted self-regulation and healthy food liking through mindfulness and classroom-based games with exposure to fruits and vegetables. METHODS Children (mean age, 3.6 ± 0.05 years) in 1 Head Start center received the classroom-based intervention (n = 24) and children in a second did not (n = 15). Assessments of self-regulation and liking of fruits and vegetables were administered pre- and postintervention. RESULTS Children in the intervention, but not the comparison group, experienced significant improvements in behavioral regulation (P = 0.003) and liking of fruits and vegetables (P = 0.02). CONCLUSIONS AND IMPLICATIONS This study lays a foundation for future research that replicates findings with a larger sample using a randomized controlled design, incorporates more typical mindful eating practices, and includes additional, broader measures of food liking.
Collapse
Affiliation(s)
- Sara A Schmitt
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN.
| | - Frank Snyder
- School of Health Sciences, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mt Pleasant, MI
| | - Irem Korucu
- Yale Center for Emotional Intelligence, Yale Child Study Center, Yale School of Medicine, Yale University, New Haven, CT
| | - Lindsey M Bryant
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN
| | - Jennifer K Finders
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN
| |
Collapse
|
27
|
Sanchez-Flack JC, Herman A, Buscemi J, Kong A, Bains A, Fitzgibbon ML. A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework. Transl Behav Med 2020; 10:1168-1176. [PMID: 33044537 PMCID: PMC7549410 DOI: 10.1093/tbm/ibz179] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.
Collapse
Affiliation(s)
| | - Annie Herman
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexis Bains
- Department of Kinesiology and Nutrition, College of Applied Health, Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian L Fitzgibbon
- Department of Pediatrics and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
28
|
Balantekin KN, Anzman-Frasca S, Francis LA, Ventura AK, Fisher JO, Johnson SL. Positive parenting approaches and their association with child eating and weight: A narrative review from infancy to adolescence. Pediatr Obes 2020; 15:e12722. [PMID: 32881344 PMCID: PMC8018716 DOI: 10.1111/ijpo.12722] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's risk for developing undesirable eating behaviours and unhealthy weight outcomes. Fewer reviews adopt a strengths-based perspective focusing on the ways that parents can actively support the development of healthy eating behaviours and weight trajectories. Emerging research on such positive parenting styles and practices offers solutions beyond the avoidance of coercive control, as well as opportunities to highlight parallels between research on food parenting and the broader, well-established developmental literature on positive parenting. The focus of this review is to summarize what is known regarding benefits of positive parenting styles and practices for child eating and weight outcomes and discuss recommendations for future research. Current evidence supports starting with responsive feeding and parenting during infancy and incorporating structure and limit setting in early childhood, with monitoring and mealtime structure remaining important during middle childhood and adolescence. Areas for future research include: (1) further examination of the implications of identified food parenting practices and styles among diverse groups and caregivers; (2) increased consideration of child factors (eg, temperament) as moderators or mediators; and (3) further clarification of the relationship between general parenting and food parenting.
Collapse
Affiliation(s)
- Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
| | - Stephanie Anzman-Frasca
- Center for Ingestive Behavior Research, University at Buffalo, Buffalo, New York, USA
- Department of Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, New York, USA
| | - Lori A Francis
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Alison K Ventura
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Jennifer O Fisher
- Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
| | - Susan L Johnson
- Department of Pediatrics, University at Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
29
|
Contreras DA, Martoccio TL, Brophy-Herb HE, Horodynski M, Peterson KE, Miller AL, Senehi N, Sturza J, Kaciroti N, Lumeng JC. Rural-urban differences in body mass index and obesity-related behaviors among low-income preschoolers. J Public Health (Oxf) 2020; 43:e637-e644. [PMID: 32964933 DOI: 10.1093/pubmed/fdaa162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With one in eight preschoolers classified as obese in the USA, childhood obesity remains a significant public health issue. This study examined rural-urban differences in low-income preschoolers' body mass index z-scores (BMIz), eating behaviors, dietary quality, physical activity (PA) and screen time. METHODS Pre-intervention data from 572 preschooler-parent dyads participating in a randomized, controlled obesity prevention trial in the Midwest USA were analyzed. We examined the associations among living in rural versus urban areas, child BMIz and child obesity-related behaviors, including eating behaviors, dietary quality, PA and screen time. RESULTS Rural children had higher BMIz, more emotional overeating behaviors and more time spent playing outdoors compared with urban children. We found no associations between children living in rural versus urban areas and dietary quality and screen time. CONCLUSIONS The study found that rural-urban differences in BMIz may start as early as 3-4 years of age, if not earlier. To reverse the weight-related health disparities between rural and urban low-income preschoolers, structural changes in rural locations and family supports around coping skills may be needed.
Collapse
Affiliation(s)
- Dawn A Contreras
- Michigan State University Extension, Michigan State University, East Lansing, MI 48824, USA
| | - Tiffany L Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, MD 20742, USA
| | - Holly E Brophy-Herb
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI 48824, USA
| | - Mildred Horodynski
- College of Nursing, Michigan State University, East Lansing, MI 48824, USA
| | - Karen E Peterson
- Department of the Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Neda Senehi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Niko Kaciroti
- Department of Pediatrics and Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Julie C Lumeng
- Department of Pediatrics and Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| |
Collapse
|
30
|
Javaras KN, Armstrong JM, Klein MH, Essex MJ, Davidson RJ, Goldsmith HH. Sex Differences in the Relationship Between Childhood Self-Regulation and Adolescent Adiposity. Obesity (Silver Spring) 2020; 28:1761-1769. [PMID: 32767554 PMCID: PMC7483948 DOI: 10.1002/oby.22926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Research suggests that higher childhood self-regulation (CSR) predicts lower adiposity in adolescence. However, it is unclear whether this relationship differs by sex or by baseline weight status. Thus, this study investigated these questions in a longitudinal, community-based cohort. METHODS The cohort included 221 girls and 214 boys. At age 9, CSR was assessed via parent/teacher reports of effortful control, and childhood BMI z scores (BMIz) were calculated from staff measurements. Late-adolescent waist-to-height ratio was based on staff measurements at age 18. RESULTS CSR has a small inverse correlation with concurrent childhood BMIz in girls, but not in boys. Prospectively, however, CSR has a small inverse association with late-adolescent weight-to-height ratio in both sexes, after adjusting for childhood BMIz and other childhood predictors. This prospective association is marginally stronger for girls with higher (vs. lower) childhood BMIz. CONCLUSIONS CSR inversely predicts changes in adiposity across adolescence in both sexes, with some evidence that this association is stronger for girls with higher (vs. lower) childhood adiposity. However, this inverse association between CSR and adiposity may emerge earlier in girls. Future research should examine the causal status of CSR and its relationship to behaviors (e.g., diet).
Collapse
Affiliation(s)
- K. N. Javaras
- University of Wisconsin - Madison, Department of
Psychology, 1202 E. Johnson St., Madison, WI 53706, United States
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United
States
- Harvard Medical School, 25 Shattuck Street, Boston, MA
02115, United States
- Corresponding author
()
| | - Jeffrey M. Armstrong
- University of Wisconsin - Madison, Department of
Psychiatry, 6001 Research Park Boulevard, Madison, WI 53719, United States
| | - Marjorie H. Klein
- University of Wisconsin - Madison, Department of
Psychiatry, 6001 Research Park Boulevard, Madison, WI 53719, United States
| | - Marilyn J. Essex
- University of Wisconsin - Madison, Department of
Psychiatry, 6001 Research Park Boulevard, Madison, WI 53719, United States
| | - Richard J. Davidson
- University of Wisconsin - Madison, Department of
Psychology, 1202 E. Johnson St., Madison, WI 53706, United States
| | - H. Hill Goldsmith
- University of Wisconsin - Madison, Department of
Psychology, 1202 E. Johnson St., Madison, WI 53706, United States
| |
Collapse
|
31
|
Scott-Sheldon LAJ, Hedges LV, Cyr C, Young-Hyman D, Khan LK, Magnus M, King H, Arteaga S, Cawley J, Economos CD, Haire-Joshu D, Hunter CM, Lee BY, Kumanyika SK, Ritchie LD, Robinson TN, Schwartz MB. Childhood Obesity Evidence Base Project: A Systematic Review and Meta-Analysis of a New Taxonomy of Intervention Components to Improve Weight Status in Children 2-5 Years of Age, 2005-2019. Child Obes 2020; 16:S221-S248. [PMID: 32936038 PMCID: PMC7482126 DOI: 10.1089/chi.2020.0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To evaluate the efficacy of childhood obesity interventions and conduct a taxonomy of intervention components that are most effective in changing obesity-related health outcomes in children 2-5 years of age. Methods: Comprehensive searches located 51 studies from 18,335 unique records. Eligible studies: (1) assessed children aged 2-5, living in the United States; (2) evaluated an intervention to improve weight status; (3) identified a same-aged comparison group; (4) measured BMI; and (5) were available between January 2005 and August 2019. Coders extracted study, sample, and intervention characteristics. Effect sizes [ESs; and 95% confidence intervals (CIs)] were calculated by using random-effects models. Meta-regression was used to determine which intervention components explain variability in ESs. Results: Included were 51 studies evaluating 58 interventions (N = 29,085; mean age = 4 years; 50% girls). Relative to controls, children receiving an intervention had a lower BMI at the end of the intervention (g = 0.10, 95% CI = 0.02-0.18; k = 55) and at the last follow-up (g = 0.17, 95% CI = 0.04-0.30; k = 14; range = 18-143 weeks). Three intervention components moderated efficacy: engage caregivers in praise/encouragement for positive health-related behavior; provide education about the importance of screen time reduction to caregivers; and engage pediatricians/health care providers. Conclusions: Early childhood obesity interventions are effective in reducing BMI in preschool children. Our findings suggest that facilitating caregiver education about the importance of screen time reduction may be an important strategy in reducing early childhood obesity.
Collapse
Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Larry V Hedges
- Department of Statistics, Northwestern University, Evanston, IL, USA
| | - Chris Cyr
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Deborah Young-Hyman
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Laura Kettel Khan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Heather King
- Impact Genome Project, Mission Measurement, Chicago, IL, USA
| | - Sonia Arteaga
- Office of the Director, National Institutes of Health, National Institutes of Health, Bethesda, MD, USA
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
- Department of Economics, Cornell University, Ithaca, NY, USA
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Debra Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University, Saint Louis, MO, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Bruce Y Lee
- CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Berkeley, CA, USA
| | - Thomas N Robinson
- Departments of Pediatrics and Medicine, Stanford Solutions Science Lab, Stanford University, Stanford, CA, USA
| | - Marlene B Schwartz
- Department of Human Development and Family Studies, University of Connecticut, Hartford, CT, USA
| |
Collapse
|
32
|
Effects of the Preschool-Based Family-Involving DAGIS Intervention Program on Children's Energy Balance-Related Behaviors and Self-Regulation Skills: A Clustered Randomized Controlled Trial. Nutrients 2020; 12:nu12092599. [PMID: 32859118 PMCID: PMC7551940 DOI: 10.3390/nu12092599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 01/11/2023] Open
Abstract
The study examines the effects of a preschool-based family-involving multicomponent intervention on children’s energy balance-related behaviors (EBRBs) such as food consumption, screen time and physical activity (PA), and self-regulation (SR) skills, and whether the intervention effects differed among children with low or high parental educational level (PEL) backgrounds. The Increased Health and Wellbeing in Preschools (DAGIS) intervention was conducted as a clustered randomized controlled trial, clustered at preschool level, over five months in 2017–2018. Altogether, 802 children aged 3–6 years in age participated. Parents reported children’s consumption of sugary everyday foods and beverages, sugary treats, fruits, and vegetables by a food frequency questionnaire, and screen time by a 7-day diary. Physical activity was assessed by a hip-worn accelerometer. Cognitive and emotional SR was reported in a questionnaire by parents. General linear mixed models with and without repeated measures were used as statistical methods. At follow-up, no differences were detected in EBRBs or SR skills between the intervention and control group, nor did differences emerge in children’s EBRBs between the intervention and the control groups when stratified by PEL. The improvement in cognitive SR skills among low PEL intervention children differed from low PEL control children, the significance being borderline. The DAGIS multicomponent intervention did not significantly affect children’s EBRBs or SR. Further sub-analyses and a comprehensive process evaluation may shed light on the non-significant findings.
Collapse
|
33
|
Lipsanen J, Elovainio M, Hakulinen C, Tremblay MS, Rovio S, Lagström H, Jaakkola JM, Jula A, Rönnemaa T, Viikari J, Niinikoski H, Simell O, Raitakari OT, Pahkala K, Pulkki-Råback L. Temperament profiles are associated with dietary behavior from childhood to adulthood. Appetite 2020; 151:104681. [PMID: 32251766 DOI: 10.1016/j.appet.2020.104681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/01/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Temperament may be associated with eating behaviors over the lifespan. This study examined the association of toddlerhood temperament with dietary behavior and dietary intervention outcomes across 18 years. METHODS The study comprised 660 children (52% boys) from The Special Turku Intervention Project (STRIP), which is a longitudinal randomized controlled trial from the age of 7 months until the age of 20 years (1990-2010). Temperament was assessed using Carey temperament scales when the participants were 2 years of age. Latent profile analysis yielded three temperament groups, which were called negative/low regulation (19% of the children), neutral/average regulation (52%) and positive/high regulation (28%). Dietary behavior was examined from 2 to 20 years of age using food records, which were converted into a diet score (mean = 15.7, SD 4.6). Mixed random-intercept growth curve analysis was the main analytic method. RESULTS Dietary behavior showed a significant quadratic U-shaped curve over time (B for quadratic association = 0.39, P<.001; B for linear association = 0.09, P = 0.58). Children in the negative/low regulation temperament group had a lower diet score (less healthy diet) across the 18 years compared to children in the neutral/average or in the positive/high regulation group. Temperament was not associated with the rate of change in diet over time. Temperament did not have any interactive effects with the intervention (F [2, 627], P = 0.72). CONCLUSION Children with a temperament profile characterized by high negative mood, high irregularity and high intensity in emotion expression constitute a risk group for less healthy eating over the lifespan.
Collapse
Affiliation(s)
- Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; National Institute for Health and Welfare, Finland
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Canada
| | - Suvi Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland
| | - Johanna M Jaakkola
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Finland
| | - Tapani Rönnemaa
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Harri Niinikoski
- Institute of Biomedicine, University of Turku, Department of Pediatrics and AdolescentMedicine, Turku University Hospital, Turku, Finland
| | - Olli Simell
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Paavo Nurmi Centre, Sports & Exercise Medicine Unit, Department of Health and Physical Activity, University of Turku, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Research Centre for Child Psychiatry, Faculty of Medicine, University of Turku, Finland.
| |
Collapse
|
34
|
Martoccio TL, Senehi N, Brophy-Herb HE, Miller AL, Horodynski MA, Kaciroti N, Contreras D, Peterson KE, Lumeng JC. Cross-lagged associations between behaviour problems and obesity in head start preschoolers. Pediatr Obes 2020; 15:e12627. [PMID: 32103623 DOI: 10.1111/ijpo.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/05/2019] [Accepted: 01/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behaviour problems and obesity are related but research findings have been inconclusive regarding the direction of effects. OBJECTIVES This study examined the cross-lagged associations between behaviour problems, body mass index (BMI) and obesity in preschoolers, and whether sex modified these associations. METHODS Repeated measures of teacher-reported externalizing (EXT) and internalizing behaviour problems (clinically significant T scores were >90th percentile), BMI z-scores (BMI-Z) and obesity status (BMI ≥95th for age and sex) were assessed in the fall (T1) and spring (T2) of the school year in Head Start preschoolers (N = 423). Associations were examined with cross-lagged modelling. RESULTS Prospective paths from T1 clinically significant EXT to both T2 BMI-Z (β = .05) and obesity (β = .18) were significant. There was no evidence that T1 BMI-Z or obesity preceded T2 behaviour problems. However, sex-specific models indicated that T1 BMI-Z was prospectively associated with higher T2 EXT for boys (β = .13), but not girls. T1 EXT was predictive of subsequent BMI-Z (β = .09) and obesity (β = .33) at T2 for girls only. CONCLUSION Findings suggest that behaviour problems, particularly externalizing behaviours, are prospectively related to childhood obesity, and early prevention methods should reflect sex-specific modifications.
Collapse
Affiliation(s)
- Tiffany L Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland College Park, College Park, Maryland
| | - Neda Senehi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Holly E Brophy-Herb
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan.,Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Mildred A Horodynski
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan.,Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Dawn Contreras
- Michigan State University Extension, East Lansing, Michigan
| | - Karen E Peterson
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan.,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan.,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.,Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
35
|
Hails KA, Zhou Y, Shaw DS. The Mediating Effect of Self-Regulation in the Association Between Poverty and Child Weight: A Systematic Review. Clin Child Fam Psychol Rev 2020; 22:290-315. [PMID: 30725306 DOI: 10.1007/s10567-019-00279-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Deficits in self-regulation (SR) have been proposed as a potential contributor to child overweight/obesity, a public health concern that disproportionately affects children living in poverty. Although poverty is known to influence SR, SR has not been considered as a potential mechanism in the association between poverty and child obesity. The aim of the current paper was to systematically review the current literature to determine whether SR is a viable mechanism in the relationship between child exposure to poverty and later risk of overweight/obesity. We systematically review and summarize literature in three related areas with the aim of generating a developmentally informed model that accounts for the consistent association between poverty and child weight, specifically how: (1) poverty relates to child weight, (2) poverty relates to child SR, and (3) SR is associated with weight. To quantify the strength of associations for each pathway, effect sizes were collected and aggregated. Findings from the studies included suggest small but potentially meaningful associations between poverty and child SR and between SR and child weight. The conceptualization and measurement of SR, however, varied across literature studies and made it difficult to determine whether SR can feasibly connect poverty to child obesity. Although SR may be a promising potential target for obesity intervention for low-income children, additional research on how SR affects risk of obesity is crucial, especially based on the lack of success of the limited number of SR-promoting interventions for improving children's weight outcomes.
Collapse
Affiliation(s)
- Katherine A Hails
- University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, USA
| | - Yiyao Zhou
- University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, USA
| | - Daniel S Shaw
- University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, USA.
| |
Collapse
|
36
|
Protzko J. Kids These Days! Increasing delay of gratification ability over the past 50 years in children. INTELLIGENCE 2020. [DOI: 10.1016/j.intell.2020.101451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Miller AL, Lo SL, Bauer KW, Fredericks EM. Developmentally informed behaviour change techniques to enhance self-regulation in a health promotion context: a conceptual review. Health Psychol Rev 2020; 14:116-131. [PMID: 31957556 PMCID: PMC7254982 DOI: 10.1080/17437199.2020.1718530] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Self-regulation (SR), or the ability to manage thoughts, emotions, and behaviours in order to achieve a desired goal, is seen as underlying positive health behaviours. In adults, behaviour change techniques (BCTs) are recommended to promote SR across health domains; although establishing healthy habits early in life is important, studies of SR and health in children are rare. This conceptual review provides guidance on developmental considerations for applying BCTs to enhance SR capacity in children and youth with the goal of fostering positive behavioural health trajectories early in the lifespan. Key considerations include the nature of developmental changes in SR and interaction among SR processes; temporal associations between SR and health behaviours; and relevance of health goals for children and youth. Building on a meta-review of BCT's used to promote SR in adults and youth, this conceptual review highlights key SR milestones to consider in behaviour change-focused interventions from early childhood through adolescence and provides an overview of social-ecologic influences on SR development and associations between SR and health behaviours across these age periods. Implications for and examples of using developmentally-informed BCTs in interventions to enhance SR in children and youth are noted and suggestions for future research are discussed.
Collapse
Affiliation(s)
- Alison L Miller
- Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sharon L Lo
- Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA
| |
Collapse
|
38
|
Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Grady A, Hodder RK, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2020; 2:CD011779. [PMID: 32036618 PMCID: PMC7008062 DOI: 10.1002/14651858.cd011779.pub3] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement evidence-based policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. Examine the cost or cost-effectiveness of such strategies; 2. Examine any adverse effects of such strategies on childcare services, service staff or children; 3. Examine the effect of such strategies on child diet, physical activity or weight status. 4. Describe the acceptability, adoption, penetration, sustainability and appropriateness of such implementation strategies. SEARCH METHODS We searched the following electronic databases on February 22 2019: Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, Embase, PsycINFO, ERIC, CINAHL and SCOPUS for relevant studies. We searched reference lists of included studies, handsearched two international implementation science journals, the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or nonrandomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. Centre-based childcare services included preschools, nurseries, long daycare services and kindergartens catering for children prior to compulsory schooling (typically up to the age of five to six years). DATA COLLECTION AND ANALYSIS Two review authors independently screened study titles and abstracts, extracted study data and assessed risk of bias; we resolved discrepancies via consensus. We performed meta-analysis using a random-effects model where studies with suitable data and homogeneity were identified; otherwise, findings were described narratively. MAIN RESULTS Twenty-one studies, including 16 randomised and five nonrandomised, were included in the review. The studies sought to improve the implementation of policies, practices or programmes targeting healthy eating (six studies), physical activity (three studies) or both healthy eating and physical activity (12 studies). Studies were conducted in the United States (n = 12), Australia (n = 8) and Ireland (n = 1). Collectively, the 21 studies included a total of 1945 childcare services examining a range of implementation strategies including educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing, reminders and tailored interventions. Most studies (n = 19) examined implementation strategies versus usual practice or minimal support control, and two compared alternative implementation strategies. For implementation outcomes, six studies (one RCT) were judged to be at high risk of bias overall. The review findings suggest that implementation strategies probably improve the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention in childcare services. Of the 19 studies that compared a strategy to usual practice or minimal support control, 11 studies (nine RCTs) used score-based measures of implementation (e.g. childcare service nutrition environment score). Nine of these studies were included in pooled analysis, which found an improvement in implementation outcomes (SMD 0.49; 95% CI 0.19 to 0.79; participants = 495; moderate-certainty evidence). Ten studies (seven RCTs) used dichotomous measures of implementation (e.g. proportion of childcare services implementing a policy or specific practice), with seven of these included in pooled analysis (OR 1.83; 95% CI 0.81 to 4.11; participants = 391; low-certainty evidence). Findings suggest that such interventions probably lead to little or no difference in child physical activity (four RCTs; moderate-certainty evidence) or weight status (three RCTs; moderate-certainty evidence), and may lead to little or no difference in child diet (two RCTs; low-certainty evidence). None of the studies reported the cost or cost-effectiveness of the intervention. Three studies assessed the adverse effects of the intervention on childcare service staff, children and parents, with all studies suggesting they have little to no difference in adverse effects (e.g. child injury) between groups (three RCTs; low-certainty evidence). Inconsistent quality of the evidence was identified across review outcomes and study designs, ranging from very low to moderate. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used. AUTHORS' CONCLUSIONS Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status.
Collapse
Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Meghan Finch
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | | |
Collapse
|
39
|
Mehdizadeh A, Nematy M, Vatanparast H, Khadem-Rezaiyan M, Emadzadeh M. Impact of Parent Engagement in Childhood Obesity Prevention Interventions on Anthropometric Indices among Preschool Children: A Systematic Review. Child Obes 2020; 16:3-19. [PMID: 31479311 DOI: 10.1089/chi.2019.0103] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Home environment, modeling of weight-related behaviors, and general parenting style are very important predictors of obesity in children. The effect of parent engagement in prevention of obesity in children is not clear. The main objective of this systematic review was to address the effects of parent engagement in obesity prevention interventions on anthropometric changes among preschool children. Methods: PubMed/Medline, Cochrane Library, ISI Web of Knowledge, Scopus, Science Direct, and Google Scholar were searched. Eligible studies were randomized controlled trials in last 10 years (from 2008 until February 14, 2018), which had a parent engagement in obesity prevention interventions (as an intervention) and children's anthropometric indices (as an outcome). Results: Twenty-six studies were included. Half of studies targeted both parents and children, and the rest targeted only parents. Types of interventions ranged from a simple motivational interviewing to professional skill training approaches. Studies that targeted overweight or obese children in their intervention containing training sessions followed by maintenance for parents and those that focused on individual support for overweight children and their parents, resulted in higher improvement in BMI and other outcomes. Conclusions: Anthropometric indices and BMI are not appropriate for reflecting the effectiveness of parent engagement in obesity prevention interventions. Having an individual component in the intervention and focusing more on parents vs. children in the intervention may result in improvement in anthropometric outcomes. Focusing on weight-related behaviors as the main outcome in both, children and parents, rather than anthropometric indices, is highly recommended for future reviews.
Collapse
Affiliation(s)
- Atieh Mehdizadeh
- Department of Clinical Nutrition, Qaem Educational, Research, and Treatment Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Mohsen Nematy
- Metabolic Syndrome Research Centers, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Majid Khadem-Rezaiyan
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
40
|
Miccoli A, Toussaint LL, Hansen CK, Smith LM, Lynch BA. Monitoring BMI Trends in a Midwest Regional Head Start Population: The Results of a Healthy Lifestyle Intervention. J Prim Care Community Health 2020; 11:2150132720962866. [PMID: 32996367 PMCID: PMC7533932 DOI: 10.1177/2150132720962866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Childhood obesity represents a public health crisis in the United States. Thus, focusing on early childhood is crucial to modify the consequences associated with obesity. The Food and Fitness Initiative (FFI) is a community-based wellness program implemented in Northeast Iowa since 2009. FFI focuses on healthy eating and physical activity. Our aim is to describe the impact on body mass index (BMI) after implementing FFI in a Northeast Iowa Community Action Head Start (HS) population. METHODS Retrospective BMI data was collected from all children attending 14 HS sites from 2012 to 2018. Children with BMI measurements during July to December of the first year in HS were included in the study. Follow-up data the second year in HS was obtained. Overweight and obesity prevalence, as well as, BMI changes between year 1 and 2 in HS were analyzed. RESULTS Data from 1013 children were collected, 850 (84%) had qualifying BMI measurements during their first year in HS and 352 of those children (41%) had follow-up data in their second year. There was a decrease in BMI between years 1 and 2 in HS that approached statistical significance (t = 1.83, P = .07, d = .10). There were no statistically significant changes in the percent of overweight (Wald χ2 = .50, P = .48) or obese (Wald χ2 = 1.71, P = .19) children between the first and second year. CONCLUSION The FFI wellness program can be feasibly integrated into the HS curriculum and shows promising short-term results in improving BMI, but not to a statistically significant level when evaluated over 1 year.
Collapse
|
41
|
Ray C, Kaukonen R, Lehto E, Vepsäläinen H, Sajaniemi N, Erkkola M, Roos E. Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers' energy balance-related behaviours and self-regulation skills. BMC Public Health 2019; 19:1670. [PMID: 31830926 PMCID: PMC6909522 DOI: 10.1186/s12889-019-7864-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Preschoolers’ energy balance-related behaviours (EBRBs) and self-regulation skills are important for their later health. Few preschool-based interventions aiming to promote preschoolers’ EBRBs and self-regulation skills, simultaneously reducing differences in EBRBs, due to children’s socio-economic status (SES) background, have been conducted. This study will present the Increased Health and Wellbeing in Preschools (DAGIS) intervention development process applying the Intervention Mapping (IM) framework. Methods The development of the DAGIS intervention study, a preschool level clustered randomized controlled trial (RCT), was based on the IM framework. The protocol in IM guides the development process of an intervention through six steps: needs assessment and logic model of the problem, programme outcomes and objectives, design of the programme, production, implementation plan, and evaluation plan. Results The needs assessment, part of the step 1 in IM, yielded the base for the DAGIS logic model of change. The model includes objectives related to changes in children’s EBRBs, self-regulation skills, and in psychosocial and physical environment that is determined by parents and early educators. A 22-week programme was developed, and materials for preschools and families were produced. A feasibility study of the recruitment processes, acceptability of the materials and methods, and implementation was conducted. The DAGIS intervention study was conducted September 2017–May 2018 as a clustered RCT including a comprehensive effectiveness and process evaluation. The process evaluation was run throughout the intervention targeting preschools and families. Conclusion A preschool-based family-involving programme was developed in the DAGIS intervention study by applying the IM protocol. It was a time- and resource-consuming process. However, the systematic planning, development, and running of the programme have reinforced a comprehensive evaluation, which is a strength in the intervention. The results from the evaluation will enhance the knowledge of how to promote EBRBs and self-regulation skills among preschoolers, and diminish SES differences in them. Trial registration ISRCTN57165350 (Prospectively registered January the 8th, 2015).
Collapse
Affiliation(s)
- Carola Ray
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland. .,Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014, Helsinki, Finland.
| | - Riikka Kaukonen
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland.,Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014, Helsinki, Finland
| | - Elviira Lehto
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland.,Department of Teacher Education, University of Helsinki, P.O. Box 9, 00014, Helsinki, Finland
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014, Helsinki, Finland
| | - Nina Sajaniemi
- Department of Teacher Education, University of Helsinki, P.O. Box 9, 00014, Helsinki, Finland.,Philosophical Faculty, School of Applied Educational Science and Teacher Education, University of Eastern Finland, P.O. Box 111, 80101 Joensuu, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014, Helsinki, Finland
| | - Eva Roos
- Folkhälsan Research Center, Topeliuksenkatu 20, 00250 Helsinki, Finland.,Department of Food and Nutrition, University of Helsinki, P.O. Box 66, 00014, Helsinki, Finland.,Department of Public Health, Clinicum, University of Helsinki, P.O. Box 63, 00014, Helsinki, Finland
| |
Collapse
|
42
|
van de Kolk I, Verjans-Janssen SRB, Gubbels JS, Kremers SPJ, Gerards SMPL. Systematic review of interventions in the childcare setting with direct parental involvement: effectiveness on child weight status and energy balance-related behaviours. Int J Behav Nutr Phys Act 2019; 16:110. [PMID: 31752917 PMCID: PMC6873502 DOI: 10.1186/s12966-019-0874-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The early years are a crucial period to promote healthy energy balance-related behaviours in children and prevent overweight and obesity. The childcare setting is important for health-promoting interventions. Increasingly, attention has been paid to parental involvement in childcare-based interventions. The aim of this systematic review is to evaluate the effectiveness of these interventions with direct parental involvement on the children's weight status and behavioural outcomes. METHODS A systematic search was conducted in four electronic databases to include studies up until January 2019. Studies written in English, describing results on relevant outcomes (weight status, physical activity, sedentary behaviour and/or nutrition-related behaviour) of childcare-based interventions with direct parental involvement were included. Studies not adopting a pre-post-test design or reporting on pilot studies were excluded. To improve comparability, effect sizes (Cohen's d) were calculated. Information on different types of environment targeted (e.g., social, physical, political and economic) was extracted in order to narratively examine potential working principles of effective interventions. RESULTS A total of 22 studies, describing 17 different interventions, were included. With regard to the intervention group, 61.1% found some favourable results on weight status, 73.3% on physical activity, 88.9% on sedentary behaviour, and all on nutrition-related behaviour. There were studies that also showed unfavourable results. Only a small number of studies was able to show significant differences between the intervention and control group (22.2% weight status, 60.0% physical activity, 66.6% sedentary behaviour, 76.9% nutrition behaviour). Effect sizes, if available, were predominantly small to moderate, with some exceptions with large effect sizes. The interventions predominantly targeted the socio-cultural and physical environments in both the childcare and home settings. Including changes in the political environment in the intervention and a higher level of intensity of parental involvement appeared to positively impact intervention effectiveness. CONCLUSION Childcare-based interventions with direct parental involvement show promising effects on the children's energy balance-related behaviours. However, evidence on effectiveness is limited, particularly for weight-related outcomes. Better understanding of how to reach and involve parents may be essential for strengthening intervention effectiveness.
Collapse
Affiliation(s)
- I. van de Kolk
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - S. R. B. Verjans-Janssen
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - J. S. Gubbels
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - S. P. J. Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - S. M. P. L. Gerards
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| |
Collapse
|
43
|
Zahry NR, Ling J. Parental Perceived Facilitators for and Barriers to Participating in a Lifestyle Intervention to Reduce Early Childhood Obesity: A Qualitative Evaluation. West J Nurs Res 2019; 42:405-414. [PMID: 31387464 DOI: 10.1177/0193945919866691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to examine low-income mothers' perceived facilitators for and barriers to participating in a lifestyle intervention. A phenomenography approach was used to individually interview 14 mothers from Midwestern U.S. The data were analyzed using content analysis. Drawing on the socio-ecological model, mothers' perceived facilitators included (a) intrapersonal factors including providing helpful information, being accommodating, motivating, and novel; (b) interpersonal factors, including two-way communication between mothers and preschoolers, social connectedness among mothers, and a positive relationship between mothers and researchers; and (c) environmental factors, including kid-friendly, and pleasant and comfortable intervention sites. Mothers' reported barriers were intrapersonal factors including (a) use of technology due to unreliable Wi-Fi access and unfamiliarity of electronic device, (b) being "busy moms" due to busy schedules and stressful daily lives, and (c) lack of reliable transportation. Future interventions to reduce early childhood obesity among low-income families should consider these identified facilitators and barriers.
Collapse
Affiliation(s)
- Nagwan R Zahry
- Department of Communication, University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Jiying Ling
- Michigan State University College of Nursing, East Lansing, MI, USA
| |
Collapse
|
44
|
Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
Collapse
Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
Collapse
Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | | |
Collapse
|
46
|
Derks IPM, Bolhuis K, Yalcin Z, Gaillard R, Hillegers MHJ, Larsson H, Lundström S, Lichtenstein P, van Beijsterveldt CEM, Bartels M, Boomsma DI, Tiemeier H, Jansen PW. Testing Bidirectional Associations Between Childhood Aggression and BMI: Results from Three Cohorts. Obesity (Silver Spring) 2019; 27:822-829. [PMID: 30957987 PMCID: PMC6594099 DOI: 10.1002/oby.22419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study examined the prospective, potentially bidirectional association of aggressive behavior with BMI and body composition across childhood in three population-based cohorts. METHODS Repeated measures of aggression and BMI were available from the Generation R Study between ages 6 and 10 years (N = 3,974), the Netherlands Twin Register (NTR) between ages 7 and 10 years (N = 10,328), and the Swedish Twin Study of Child and Adolescent Development (TCHAD) between ages 9 and 14 years (N = 1,462). In all samples, aggression was assessed with the Child Behavior Checklist. Fat mass and fat-free mass were available in the Generation R Study. Associations were examined with cross-lagged modeling. RESULTS Aggressive behavior at baseline was associated with higher BMI at follow-up in the Generation R Study (β = 0.02, 95% CI: 0.00 to 0.04), in NTR (β = 0.04, 95% CI: 0.02 to 0.06), and in TCHAD (β = 0.03, 95% CI: -0.02 to 0.07). Aggressive behavior was prospectively associated with higher fat mass (β = 0.03, 95% CI: 0.01 to 0.05) but not fat-free mass. There was no evidence that BMI or body composition preceded aggressive behavior. CONCLUSIONS More aggressive behavior was prospectively associated with higher BMI and fat mass. This suggests that aggression contributes to the obesity problem, and future research should study whether these behavioral pathways to childhood obesity are modifiable.
Collapse
Affiliation(s)
- Ivonne P. M. Derks
- Department of Child & Adolescent Psychiatry/PsychologyErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
- Generation R Study GroupErasmus Medical CenterRotterdamthe Netherlands
| | - Koen Bolhuis
- Department of Child & Adolescent Psychiatry/PsychologyErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
- Generation R Study GroupErasmus Medical CenterRotterdamthe Netherlands
| | - Zeynep Yalcin
- Department of Child & Adolescent Psychiatry/PsychologyErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
| | - Romy Gaillard
- Department of PediatricsErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
- Department of EpidemiologyErasmus Medical CenterRotterdamthe Netherlands
| | - Manon H. J. Hillegers
- Department of Child & Adolescent Psychiatry/PsychologyErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
- Department of PsychiatryRudolf Magnus Brain Center, Utrecht University Medical CenterUtrechtthe Netherlands
| | - Henrik Larsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
- School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Sebastian Lundström
- Center for Ethics, Law and Mental HealthUniversity of GothenborgGothenborgSweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and BiostatisticsKarolinska InstituteStockholmSweden
| | | | - Meike Bartels
- Department of Biological PsychologyVrije UniversityAmsterdamthe Netherlands
| | - Dorret I. Boomsma
- Department of Biological PsychologyVrije UniversityAmsterdamthe Netherlands
| | - Henning Tiemeier
- Department of Child & Adolescent Psychiatry/PsychologyErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
- Department of Social and Behavioral SciencesHarvard T. H. Chan School of Public Health, Harvard UniversityBostonMassachusettsUSA
| | - Pauline W. Jansen
- Department of Child & Adolescent Psychiatry/PsychologyErasmus Medical Center–Sophia Children's HospitalRotterdamthe Netherlands
- Department of Psychology, Education and Child StudiesErasmus University RotterdamRotterdamthe Netherlands
| |
Collapse
|
47
|
Too indulgent or not sensitive enough: mothering in the current historical era and its relevance to childhood obesity. Int J Obes (Lond) 2019; 41:1457-1458. [PMID: 28972590 DOI: 10.1038/ijo.2017.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
48
|
Volger S, Rigassio Radler D, Rothpletz-Puglia P. Early childhood obesity prevention efforts through a life course health development perspective: A scoping review. PLoS One 2018; 13:e0209787. [PMID: 30592757 PMCID: PMC6310279 DOI: 10.1371/journal.pone.0209787] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction The obesity rate in preschool children in the United States (US) is 13.9%, while even higher rates are associated with racial and ethnic minorities and children from low-income families. These prevalence patterns underscore the need to identify effective childhood obesity prevention programs. Method A scoping review was conducted following Arksey and O’Malley’s framework to provide an overview of the types, effectiveness and cost-effectiveness of obesity prevention interventions and policies in children up to 6 years old. Inclusion criteria were studies at least 6-months duration; included a weight-based outcome, conducted in the US, English publications from January 2001 to February 2018. Exclusions: studies in overweight/obese children and obesity treatments, no comparator group. Evidence was characterized across the early life course and multiple-levels of influence. Results From the 2,180 records identified, 34 met the inclusion criteria. Less than half of the interventions initiated during pregnancy, infancy or preschool reported a significant improvement in a weight-based outcome. All interventions included strategies to influence individual- or interpersonal-level health behaviors, yet few removed obstacles in the healthcare system, physical/built environment, or sociocultural environment. The majority (78%) of the interventions occurred during preschool years, with 63% conducted in early childcare education settings serving low-income families. The health impact of the state-wide and national policies on children under age 6 years remains unclear. There was considerable uncertainty around estimates of the health and economic impacts of obesity prevention interventions and policies. Conclusion There is a need to intensify early childhood obesity preventive efforts during critical periods of health development in the US. Future studies should estimate the feasibility, program effectiveness, and cost of implementing multilevel obesity prevention interventions and policies. Addressing these research gaps will provide stakeholders with the scientific evidence necessary to facilitate funding and policy decisions to decrease the prevalence of early childhood obesity.
Collapse
Affiliation(s)
- Sheri Volger
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America
- * E-mail:
| | - Diane Rigassio Radler
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America
| | - Pamela Rothpletz-Puglia
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, United States of America
| |
Collapse
|
49
|
Overweight and obesity in preschool aged children and risk of mental health service utilization. Int J Obes (Lond) 2018; 43:1325-1333. [PMID: 30546134 DOI: 10.1038/s41366-018-0280-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/16/2018] [Accepted: 11/04/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine if overweight or obesity in preschool-age children is associated with mental health service utilization in later childhood. SUBJECTS Overall, 10,522 children 2 to <5 years, with no previous history of mental health service utilization, were identified from primary care electronic medical records (EMRs) across Ontario, Canada. METHODS This was a retrospective longitudinal cohort study. Height and weight data were extracted and body mass index z-scores (zBMI) were calculated using the World Health Organization Growth Standards. Mental health service utilization, between ages 5 and <19, was defined using administrative billing codes for mental health outpatient visits, emergency department visits, and hospitalizations. A multivariable Cox proportional hazards model was performed. RESULTS In total, 74.9% of children were healthy weight (zBMI between -2 and ≤1), 18.8% of children were at risk of overweight (zBMI between 1 and ≤2), 4.9% were overweight (zBMI > 2 and ≤3), and 1.5% had obesity (zBMI > 3). The median follow-up time was 2.2 years (IQR 1.0-4.2). The overall incidence rate of mental health service use was 44.5 events per 1000 person-years. The hazard ratio for girls with obesity was 2.73 (95% CI 1.62-4.60; p < 0.001) compared to girls with healthy weight. Compared to boys with healthy weight, boys 'at risk of overweight' and overweight were 1.22 (95% CI 1.03-1.44; p = 0.02) and 1.43 (95% CI 1.09-1.87; p = 0.01) times at higher risk of an incident mental health visit. CONCLUSION Our study shows an association between weight status in preschool school aged children and higher incidence of mental health service use in later childhood. This relationship was strongest in girls. Future research is needed to understand this relationship by mental health diagnosis, sex, and age.
Collapse
|
50
|
McCrickerd K. Cultivating self-regulatory eating behaviours during childhood: The evidence and opportunities. NUTR BULL 2018. [DOI: 10.1111/nbu.12355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- K. McCrickerd
- Clinical Nutrition Research Centre (CNRC); Singapore Institute for Clinical Sciences (SICS); Agency of Science, Technology and Research (A*STAR); Singapore
| |
Collapse
|