Parental Feeding Practices and Children's Eating Behaviours: An Overview of Their Complex Relationship

Sharing the motherload: A review and development of the CO-Parent conceptual model for early childhood obesity prevention

Fathers remain under-represented in early childhood obesity prevention research and interventions, despite growing evidence that paternal biopsychosocial factors and behaviors from pre- and post-conception can influence lifelong offspring health. Informed by a literature review of high-quality evidence, "CO-Parent" (childhood obesity-Parent) is a new conceptual model underpinned by couple interdependence theory and a socioecological framework. Literature was searched for the concepts parental AND weight-related behaviors AND child weight or weight-related behaviors, in databases including MEDLINE, PsycINFO, Global Health, Scopus, and SocINDEX. Prior evidence syntheses were prioritized as source data to inform model development. "CO-Parent" illustrates the interdependent and independent effects of maternal and paternal weight, weight-related behaviors, and well-being, across preconception, pregnancy, postpartum, and the early years on child weight-related behaviors and weight up to age five. The influences of public policy, social, environmental, economic, community, and other complex modifiable mediating factors are included in the model. The "CO-Parent" conceptual model paves the way for a paradigm shift by recognizing fathers as key figures in early childhood obesity prevention initiatives, encouraging them to "share the motherload." It highlights both the independent and interdependent roles fathers play in the epidemiology of obesity starting from preconception. CO-Parent also provides the foundations necessary to guide future theory and research to be more inclusive of fathers to further understanding of the independent and interdependent influences of parents in early childhood obesity prevention.

Responsive feeding practices among Arabic and Mongolian speaking migrant mothers in Australia: A qualitative study

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi-structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian-speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic-speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian-speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic-speaking mothers often supplemented with formula top-ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic-speaking mothers used food-based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure-feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds.

Understanding the Interaction Between Family Dynamics and Childhood Obesity in the Middle Eastern Population: A Qualitative Study

OBJECTIVE(S)

We aim to understand the interaction between family dynamics and lifestyle behaviors of school-age children with overweight or obesity in Oman. The outcomes would clarify the mediating familial determinants that contribute to childhood obesity in the Middle East population.

DESIGN

A qualitative phenomenological approach.

SAMPLE

Mothers of school-age children with overweight or obesity.

MEASUREMENTS

Semi-structured interviews were conducted following an interview guide, and thematic analysis was used to identify key themes and subthemes.

RESULTS

The study identified three main themes based on data collected from 12 participants. The first theme, "Children's Lifestyle Behaviors," highlighted the need to address unhealthy food consumption, low physical activity, and inconsistent sleeping habits. The second theme, "Parenting Lifestyle behaviors," underscored the importance of regaining control over children's eating behaviors, fostering shared interest in outdoor activities, and establishing a consistent sleep routine. Lastly, the third theme, "Determinants of Parenting Lifestyle Behaviors," identified factors such as parental stress, the high cost of healthy options, cultural influence on healthy eating, limited outdoor activity options, and the availability of unhealthy snacks in schools.

CONCLUSION

Our study underscores the need for family-centered obesity programs that address several determinants of parenting lifestyle behaviors, including psychological, financial, social, and environmental challenges.

Diet, growth, nutritional status and predictors of severity of feeding difficulties in autistic children with co-occurring pediatric feeding disorder

BACKGROUND

Feeding difficulties are commonly reported in autistic children. However, there is limited data on the presentation, severity, and impact of feeding difficulties in autistic children in Asia.

AIMS

To describe the dietary patterns, growth and nutritional status of autistic children with pediatric feeding disorder (PFD), and identify factors associated with more severe feeding difficulties.

STUDY DESIGN

A retrospective review of electronic medical records.

SUBJECTS

Autistic children (aged between 0 and 18 years) with PFD, who attended a multidisciplinary feeding clinic between August 2013 and December 2022.

OUTCOME MEASURES

The children's parents provided a 3-day food diary, which was verified by the dietitian and analyzed for their nutritional content using Foodworks 10 Professional. Food selectivity was classified as mild, moderate or severe, based on the number of food groups accepted and the absolute number of foods accepted in each group. Information regarding demographics, height, weight, medical information, developmental history (autism diagnosis, cognition, adaptive skills) and relevant nutritional bloodwork were collected. Parents also completed two validated questionnaires (the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), which assessed childhood mealtime behaviors; and the Caregiver Feeding Style Questionnaire (CFSQ), which determined caregiver/ parental feeding styles). Factors associated with higher BPFAS total frequency scores (TFS) (representing more severe feeding difficulties) and food selectivity were analyzed.

RESULTS

There were a total of 98 patients (82 males), with mean ± SD (range) age of 59.2 ± 27.5 (17-169) months. They had mild (19.4 %), moderate (22.4 %) and severe (58.2 %) food selectivity, respectively. While the majority had normal weight (84.7 %) and height (88.8 %) for age, 69.4 % had diets deficient in calories, macronutrients or micronutrients (iron, calcium). Comparison between groups according to parental feeding style found that there was a significant difference in BFPAS TFS between different parental feeding styles (p < 0.001). Post-hoc testing revealed that parents who reported an authoritarian parental feeding style on the CFSQ were significantly more likely to report higher frequencies of difficult feeding behaviors on the BPFAS (98.3 ± 15.8), while an uninvolved parental feeding style was associated with the lowest BPFAS TFS (80.9 ± 11.0), Bonferroni-adjusted p < 0.001; indulgent (p = 0.012) and authoritative (p = 0.096). Intellectual impairment and Malay ethnicity were associated with more severe food selectivity [adjusted odds ratio 123.7 (95 % CI 3.09-4945.4, p = 0.01) and 38.0 (95 % CI 1.35-1074.18, p = 0.03)], respectively.

CONCLUSIONS

In this retrospective cohort, autistic children with PFD were at significant nutritional risk despite demonstrating normal growth patterns, with specific patient profiles being associated with more severe feeding difficulties.

Getting school-provided meals to the table: an international multiple-case study of school food service

A school food service, which is the way children access food during the school day, is one of the many aspects in creating a health-promoting school environment. School-provided meal services differ greatly, depending on the country, region and school contexts, however, there is limited understanding of the diverse meal delivery within these settings. Therefore, the aim of this study was to understand different school-provided meal systems across different countries and contexts. This study used a qualitative, naturalistic observation, using an interpretative epistemology and a multiple-case design to explore food service across seven schools, mapped against a school meal food service framework. This included three schools with an established school-provided meal system (England, France and Sweden) and four schools with emerging school-provided meal systems (Australia). Mapping captured findings across the domains of Menu offering, Food service system, Administration, Eating environment, Mealtime experience and Post-meal. Results demonstrate the need for tailored school food programmes, designed appropriate to the country, region and school context, including considering cultural underpinnings and available resources. Furthermore, a positive eating environment and elements of student choice and responsibility were all noted as principles important in a school food service. This knowledge can be used to inform planning of future systems, particularly for regions transitioning into a school-provided meal model, and those looking to implement improvements to existing systems.

Selective Feeding-An Under-Recognised Contributor to Picky Eating

Background: Amongst children presenting to an interdisciplinary clinic with complaints of picky eating, we aim to identify the proportion who have underlying selective feeding and to describe its implications on growth and nutrition, as well as parental coping responses. Methods: We conducted a retrospective chart review of first-visit consults from January 2020 to July 2022. Caregiver and child mealtime behaviours were assessed using the standardised Caregiver's Feeding Styles Questionnaire (CFSQ) and by direct observation. Caloric intake and oromotor skills were assessed by dietitians and speech therapists, respectively. Medical concerns were addressed by the doctor. Results: Out of 152 children referred for concerns of "picky eating", 128 (84.2%) were diagnosed as having selective eating, while the rest were diagnosed with delayed oromotor skills, poor appetite, oral aversion and 4 were deemed to have normal feeding behaviour for their age. Of the 128 selective eaters, 67 (52%) children had comorbidities such as autism spectrum disorder (ASD) (n = 59), attention-deficit/hyperactivity (ADHD) (n = 2) and underlying medical conditions (n = 6). The remaining 61 children were "otherwise well". Of the "otherwise well" children, 47.5% had inadequate caloric intake and 31% had failure to thrive. The commonest feeding style among caregivers of "otherwise well" picky eaters was authoritarian (36%). The majority (80%) of these caregivers also experienced helplessness. Conclusions: We conclude that picky eating in young children is a symptom with several possible underlying aetiologies. It is associated with nutritional consequences for the child and significant stress on caregivers. Being able to recognise those who need referral for specialist intervention and multidisciplinary management (such as selective feeding and delayed oromotor skills) would be important.

Effect of fast-food environments on children's eating behaviour: A random effect within between analysis within the Generation R Study

BACKGROUND

Focussing on appetitive traits associated with obesity, this study aimed to estimate the association between the fast-food environment and satiety responsiveness, enjoyment of food and food responsiveness.

METHODS

We used data from the Generation R Study. We included 2008 children with repeated measurements at the age of 4-10 years old. Three eating behaviour subscales from the Child Eating Behaviour Questionnaire (CEBQ) were used as outcomes. Geographical Information System data were used to map individual-level exposure to fast-food outlets within 400 m from home. Random Effect Within Between (REWB) models were used to derive estimates. We tested for moderation of the associations with parental restriction at baseline using the parent-reported Child Feeding Questionnaire (CFQ).

RESULTS

We did not find evidence of between-associations of fast-food exposure and eating behaviour subscales. Considering within-associations, an increase in absolute fast-food exposure was associated with a significant marginal increase in satiety responsiveness (β: 0.02 [95% confidence interval: 0.00-0.03]). No moderation by parental restriction was found.

CONCLUSIONS

In environments with ubiquitous fast-food outlets, an increased exposure to fast-food outlets does not seem to have a substantial impact on eating behaviour. Further research is needed to better understand how fast-food exposure contributes to overweight.

Association of Parent and Child Intuitive Eating: A Scoping Review

Children's eating behaviors are dependent on childhood food experiences, which involve their parental feeding practices, home food environments, and modeling of eating behavior. Intuitive eating (IE) promotes eating based on internal hunger and satiety cues. IE has been associated with improvements in mental and physical health. There has been increasing interest in exploring the association between parent and child IE. The aim of this scoping review was to synthesize current literature reporting on parent and child IE associations. Four databases (MEDLINE, EMBASE, Web of Science and CINAHL) were searched using keywords focusing on IE, parents, and children. Inclusion criteria were reporting on parental and/or child IE, and reporting on parent-child relationships. After screening, 15 studies were retained. From these, 3 main correlations were described. Parental IE was associated with child feeding, child weight concerns, and the home food environment. As well, environmental factors (i.e., family cohesion, food security) were associated with components of child IE. Moreover, IE was directly correlated between parents and children. Overall, this study highlights how child IE behaviors may be shaped by both parental IE and the broader environments that they are raised within. Additional high-quality studies are required to verify these findings.

Feeding Behaviour and Nutritional Status among Children Aged 6 to 23 Months Old in Bahi District in Tanzania

Background

The survival, well-being, and development of young children depend on optimal infant and young child feeding (IYCF) practices. It is imperative to assess nutrition status and feeding behaviour practices in order to develop interventions. The objective of this study is to assess nutrition status, feeding behaviour, and its association with nutrition status among children aged 6 to 23 months old in Bahi district, Tanzania.

Methods

A community-based, cross-sectional study was employed. A multistage sampling technique was used. Bahi district council, wards, and village were randomly selected, and then a systematic random sampling method was used to select participants. Anthropometric measurements were used to determine the nutrition status of children. Process for the Promotion of Child Feeding (ProPAN) manual guided assessment of feeding behaviours associated with nutrition status. Z-score was used to determine the level of malnutrition; the chi-square test and logistic regression were used as descriptive and inferential statistical tests, respectively, to determine the association between nutrition status and feeding behaviour.

Results

Out of 395 children aged between 6 and 23 months, 62.8% were stunted, 25.3% were underweight, and 6.6% were wasted. In the multivariable analysis, the results reveal that stunting was significantly associated with perception of exclusive breastfeeding (number of months) (AOR 4.24, 95%CI: 2.012-8.284) and number of feeds per day (AOR 2.02, 95%CI: 1.00-6.314). With regard to perception of exclusive breastfeeding (number of months), the children whose mothers perceived that children supposed to be breastfed for more than six months were four times more likely to be not stunted compared to those who were perceived to be breastfed less than three months, and the children whose mothers' fed them twice to three times were two times more likely to be not stunted compared to the children who were fed only two times.

Conclusion

Bahi district council has a higher prevalence rate of stunting, underweight, and wasting among children aged 6 to 23 months. Feeding on the first colostrum, exclusive breastfeeding, and breastfeeding for more than six months are the main determinants of nutrition status.

A design thinking-led approach to develop a responsive feeding intervention for Australian families vulnerable to food insecurity: Eat, Learn, Grow

BACKGROUND

Design thinking is an iterative process that innovates solutions through a person-centric approach and is increasingly used across health contexts. The person-centric approach lends itself to working with groups with complex needs. One such group is families experiencing economic hardship, who are vulnerable to food insecurity and face challenges with child feeding.

OBJECTIVE

This study describes the application of a design thinking framework, utilizing mixed methods, including co-design, to develop a responsive child-feeding intervention for Australian families-'Eat, Learn, Grow'.

METHODS

Guided by the five stages of design thinking, which comprises empathizing, defining, ideating, prototyping, and testing. We engaged with parents/caregivers of a child aged 6 months to 3 years through co-design workshops (n = 13), direct observation of mealtimes (n = 10), a cross-sectional survey (n = 213) and semistructured interviews (n = 29). Findings across these methods were synthesized using affinity mapping to clarify the intervention parameters. Parent user testing (n = 12) was conducted online with intervention prototypes to determine acceptability and accessibility. A co-design workshop with child health experts (n = 9) was then undertaken to review and co-design content for the final intervention.

RESULTS

Through the design thinking process, an innovative digital child-feeding intervention was created. This intervention utilized a mobile-first design and consisted of a series of short and interactive modules that used a learning technology tool. The design is based on the concept of microlearning and responds to participants' preferences for visual, brief and plain language information accessed via a mobile phone. User testing sessions with parents and the expert co-design workshop indicated that the intervention was highly acceptable.

CONCLUSIONS

Design thinking encourages researchers to approach problems creatively and to design health interventions that align with participant needs. Applying mixed methods-including co-design- within this framework allows for a better understanding of user contexts, preferences and priorities, ensuring solutions are more acceptable and likely to be engaged.

Food Behaviour and Metabolic Characteristics of Children and Adolescents with Type 1 Diabetes: Relationship to Glycaemic Control

Diet is an essential element of treating and managing type 1 diabetes (T1D). However, limited research has examined food behaviour in children and adolescents with T1D and their relationship to glycaemic control. This study evaluated food behaviour, metabolic characteristics and their impact on the glycaemic control of children and adolescents with T1D. Two hundred and fifty-eight participants with T1D (6-15 years, duration of diabetes >1 year) were recruited. Demographic, anthropometric and clinical data were collected. Questionnaires on food neophobia and food preferences were administered. The Child Food Questionnaire (CFQ) also assessed parental feeding practices. An analysis of food behaviour showed that food neophobia was inversely associated with the liking of vegetables, fruits, fish, sweets and carbohydrates. Moreover, by analysing parental feeding practices, an inverse association of "Pressure to eat", "Monitoring" and "Restriction" with liking for vegetables and carbohydrates emerged. Considering glycaemic control, increased food neophobia and the parent practices "Restriction", "Pressure to eat" and "Concern about weight" were found in participants with glycated haemoglobin (HbA1c) values >8.5%. Finally, higher body mass index (BMI) and total cholesterol values were observed in subjects with HbA1c values >8.5%. These findings contribute to a better understanding of eating behaviour, metabolic status and their complex relationship with glycaemic control.

Willingness for more vegetarian meals in school canteens: Associations with family characteristics and parents' food choice motives in a French community

The school meal system could contribute to the transition towards more sustainable food system by promoting plant-based meals. Knowing whether parents want more vegetarian school meals for their children is a prerequisite for a successful implementation. The present study aimed to estimate the proportion of parents who would opt for more vegetarian school meals for their children and to study associations of willingness with family characteristics and food choice motives. An online survey was sent to parents whose children are registered for school canteen in Dijon (France). We collected child-level information, data on family sociodemographic characteristics, and data on dietary habits and food choice motives of the family. We examined family characteristics associated with the willingness to increase the frequency of vegetarian school meals from one meal per week to two or daily. Generalized linear models were performed. In total, 49% of parents were willing to opt for a second weekly vegetarian meal and 26% for a daily vegetarian meal for their children (n = 1261). Parents willing to opt for more vegetarian meal were more likely to have higher education, be flexitarian or vegetarian and to currently opt for pork-free meals for their children, and their children attended the school canteen less frequently. Environmental motives were positively associated with the willing to opt for a second weekly vegetarian meal; familiarity and sensory appeal motives were negatively associated. Health and animal welfare motives were positively associated with the willing to opt for a daily vegetarian meal and sensory appeal was negatively associated. Increasing the frequency of vegetarian school meals would satisfy a demand expressed by parents but must be accompanied by interventions enhancing pleasure of eating vegetarian meals.

User-centered design and development of a web-based tool to support healthy feeding practices by parents of urban minority youth at risk for childhood obesity

Objectives

Technology, mobile health (mHealth), and "eHealth" are broadly used in childhood overweight and obesity interventions. However, the impact of technology-based interventions where parents or caregivers are involved is unclear. Thus, the objective of this manuscript is to provide valuable insights about the development of a parent-child web-based tool to promote healthy eating among preadolescents.

Methods

The tool development was an iterative process and comprised of two phases. In Phase 1, formative research (focus groups and interviews) were conducted with parents of children around the topics of dietary behaviors, technology use, and proposed intervention components. In Phase 2, a brief survey, focus groups, interviews, and user-centered approaches were used to confirm/finalize content, assess the website wireframe, and conduct usability testing.

Results

From the Phase 1 formative research, parents preferred reading/looking up health-related information on larger laptop/tablet screens, but preferred smartphones when reading "on-the-go." Suggestions for an online health tool included quick/easy/low-cost recipes, tips for healthy feeding and involving their children around healthy dietary-related behaviors, clear tool navigation, and using pictures/visuals. In Phase 2, when finalizing the tool wireframe and content, parents preferred a variety of motivational healthy feeding tips, local family-oriented community events, and a simple layout with minimal clicking to access links. During usability testing, parents responded positively to the content (healthy feeding tips, recipes, coupons, and free community events) and the clean layout.

Conclusions

Formative research and user-centered approaches with parents of preadolescents resulted in a web-based, mobile-friendly health promotion tool.

Development of a New Questionnaire to Assess Parental Perceived Barriers When Promoting Healthy Eating Habits in Young Children: First Findings

Social cognitive models suggest a crucial role played by perceived barriers in promoting healthy behaviors, including healthy eating. We aimed to develop a new questionnaire to assess parental perceived barriers to healthy feeding in young children and perform the instrument's preliminary psychometric evaluation. The initial pool of items was developed based on reviews and qualitative studies. First, we conducted an online, descriptive, cross-sectional study with 278 parents of 2-6-year-old children to examine its factorial structure and internal consistency. Then, a second study with 168 parents from a similar population assessed convergent/discriminant and known-groups validity. The exploratory factorial analysis confirmed the scale's theoretical structure. Five scales were found: Child-Related Barriers, Parent-Related Barriers-Vegetables and Fruit, Parent-Related Barriers-Added Sugars, Social Context-Related Barriers, and Cost-Related Barriers. All scales presented adequate reliability. We found weak to moderate, negative, and significant correlations between child- and parent-related barriers regarding vegetables and fruits, feeding practices to promote children's eating self-regulation, and food parenting self-efficacy. Additionally, parents who perceived their children as easy and well-regulated reported significantly fewer child-related barriers than parents with poorly self-regulated and inhibited children. The results support the instrument's preliminary psychometric adequacy regarding its validity and reliability and corroborate earlier empirical studies about the main parental barriers when promoting young children's healthy eating habits.

Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy

Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person's lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents' socio-economic conditions on children's consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance "OKkio alla Salute" (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, "less healthy" behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours.

Comparing the use of food and physical activity parenting practices: Parents of children with overweight and obesity versus parents of children with a healthy weight

Background

Paediatric overweight and obesity are caused by a complex imbalance between energy intake and expenditure. Parents may influence this imbalance through energy balance-related parenting practices. This study aims to compare the use of energy balance-related parenting practices between parents of children with overweight and obesity and children with a healthy weight.

Methods

This study compares energy balance-related parenting practices among a group of parents with children with overweight and obesity at the start of a lifestyle intervention (N = 107) and children with a healthy weight (N = 137). Specifically, it compares the feeding practices 'overt control' (open control over eating), 'encouragement', 'instrumental feeding', 'emotional feeding', and 'covert control' (hidden control over eating), as well as the physical activity parenting practice 'promoting physical activity'. Multiple regression analyses are used to calculate associations between child weight groups and parenting practices when corrected for children's characteristics.

Results

Parents of children with overweight and obesity reported significantly different scores on control over eating practices than parents of children with a healthy weight, namely a significantly higher score on covert control (B = 0.397, S.E. 0.123, p = 0.001) and a significantly lower score for overt control (B = -0.136, S.E. 0.068, p = 0.046).

Conclusion

Covert control is reported more, while overt control is reported less in parents of children with overweight and obesity compared to parents of children with a healthy weight, even after correction for the child's, family, and maternal characteristics. Future longitudinal research and intervention trials are recommended to determine whether and how the use of control over eating practices changes.

The relationship between family diet consumption, family environment, parent anxiety and nutrition status children during the COVID-19 pandemic: a longitudinal study

Background

The COVID-19 pandemic has exacerbated the trends of childhood overweight, obesity, and malnutrition, as well as increased psychological stress and family conflicts among family members. It is important to explore the relationship between changes in the family environment during the COVID-19 on child nutrition.

Objective

This study aims to analyze the nutritional status of Chinese children during the COVID-19 pandemic and its relationship with family diet, family environment, and parental anxiety, in order to provide evidence for further interventions in children's nutritional status.

Method

This study included 7,645 primary and secondary school students and their parents from five schools in Chengdu, China. Chi-square tests were used to analyze the categorical variables of children's malnutrition, overweight, obesity, and parental anxiety. T-tests were used to assess changes in the continuous variable of family environment between two rounds of follow-up surveys. Multiple logistic regression analysis was employed to examine the impact of changes in family diet during the COVID-19 pandemic on children's nutritional status. Generalized estimating equations were used to analyze the effects of family environment and parental anxiety on childhood obesity.

Result

The prevalence of malnutrition and obesity decreased from 11.64% and 11.60% in wave 1 to 4.96% and 10.50% in wave 2, and the rate of overweight increased from 13.11% in wave 1 to 13.73% in wave 2. Children whose families reduced consumption of staple foods during the COVID-19 were more likely to be frail, and families increased consumption of sugary drinks, take-out or meal delivery services, living in towns, family environmental barriers, and parental anxiety were risk factors for overweight obesity. Mother's education level in middle and high school and low age were protective factors for overweight obesity.

Conclusion

The physical environment of the family, the emotions of family members, and children's perceptions of the family's soft environment can influence children's eating behaviors, children's nutritional intake, and malnutrition and obesity in children under public health emergencies, and family-based dietary interventions may be effective. Parents can increase consumption of healthy foods and improve the family environment, which improve their growth.

Affect, Body, and Eating Habits in Children: A Systematic Review

The present review investigates the complex associations between children's affective states, body perceptions, and eating habits, thus providing crucial insights for potential health interventions. Following PRISMA guidelines, three databases were searched for peer-reviewed studies exploring the relationship between eating habits, emotional states, and body image perceptions in a population of children (5 to 11 years old). A total of seven articles were included. Our findings revealed a pattern of associations between negative emotional states, like anxiety and depressive feelings, and maladaptive eating behaviors. Additionally, explicit influences from parental feeding practices, peer pressure, socioeconomic factors, and children's body perceptions were observed to shape eating habits, with a pronounced tendency among older girls towards dieting and food preoccupation. Our results underline the intertwining nature of age, gender, and emotional states. Furthermore, our findings accentuate the urgency for comprehensive interventions that acknowledge and address the complex interplay of emotional, familial, and socioeconomic factors alongside children's body image perceptions. The criticality of continued research, particularly ones employing longitudinal designs and diverse demographic samples, is highlighted as we strive to understand and navigate such multifaceted relationships to enhance children's health and well-being.

Binge-Eating Precursors in Children and Adolescents: Neurodevelopment, and the Potential Contribution of Ultra-Processed Foods

Binge-eating disorder (BED) is a highly prevalent disorder. Subthreshold BED conditions (sBED) are even more frequent in youth, but their significance regarding BED etiology and long-term prognosis is unclear. A better understanding of brain findings associated with BED and sBED, in the context of critical periods for neurodevelopment, is relevant to answer such questions. The present narrative review starts from the knowledge of the development of emotional self-regulation in youth, and the brain circuits supporting emotion-regulation and eating behaviour. Next, neuroimaging studies with sBED and BED samples will be reviewed, and their brain-circuitry overlap will be examined. Deficits in inhibition control systems are observed to precede, and hyperactivity of reward regions to characterize, sBED, with overlapping findings in BED. The imbalance between reward/inhibition systems, and the implication of interoception/homeostatic processing brain systems should be further examined. Recent knowledge of the potential impact that the high consumption of ultra-processed foods in paediatric samples may have on these sBED/BED-associated brain systems is then discussed. There is a need to identify, early on, those sBED individuals at risk of developing BED at neurodevelopmental stages when there is a great possibility of prevention. However, more neuroimaging studies with sBED/BED pediatric samples are needed.