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Papaioannou MA, Power TG, O’Connor TM, Fisher JO, Micheli NE, Hughes SO. Child Weight Status: The Role of Feeding Styles and Highly Motivated Eating in Children. CHILDREN 2023; 10:children10030507. [PMID: 36980065 PMCID: PMC10047856 DOI: 10.3390/children10030507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/26/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children’s food motivation interacted with mothers’ feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4–5 years (Time 1) and 7–9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children’s eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations.
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Affiliation(s)
- Maria A. Papaioannou
- Department of Pediatrics, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Thomas G. Power
- Department of Human Development, Washington State University, Pullman, WA 99164, USA
| | - Teresia M. O’Connor
- Department of Pediatrics, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jennifer O. Fisher
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, Philadelphia, PA 19122, USA
| | - Nilda E. Micheli
- Department of Pediatrics, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sheryl O. Hughes
- Department of Pediatrics, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-798-7017
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Samuels SL, Hu P, Maciejewski KR, Li F, Dziura J, Savoye M, Sharifi M. Real-world effectiveness of the Bright Bodies healthy lifestyle intervention for childhood obesity. Obesity (Silver Spring) 2023; 31:203-213. [PMID: 36502287 PMCID: PMC9780185 DOI: 10.1002/oby.23627] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to examine the extent to which Bright Bodies, a high-intensity, family-based pediatric weight management intervention, improved BMI for participants since publication of the randomized controlled trial establishing efficacy in 2007 and to describe adaptations to the program. METHODS For participants enrolled from 2008 to 2018, linear mixed-effects models were used to estimate monthly change in BMI expressed as percentage of the 95th percentile (%BMIp95) during participants' first beginner-level program. RESULTS The sample included 396 youth individuals (mean age: 11.7 [SD 2.8] years, 61.6% female, 37.1% non-Hispanic Black, 26.3% Hispanic or Latino, 53.8% with public insurance, 80.1% with severe obesity). Across the 11 years, participants' %BMIp95 reduced on average by 1.63% (95% CI: 1.44%-1.82%) per month during their first program (mean duration: 10 weeks) after adjusting for age, sex, season and year, starting %BMIp95, race and ethnicity, and insurance category. Greater reduction in %BMIp95 was associated with male versus female sex, spring/fall versus winter seasons, enrollment in 2008 to 2018 versus 2015 to 2018, and higher starting %BMIp95 (p value for all <0.001). Adaptations since 2007 included pragmatic changes to increase engagement and address funding shortages. CONCLUSIONS These results suggest sustained clinical effectiveness of Bright Bodies in the context of real-world adaptations.
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Affiliation(s)
- Stephanie L. Samuels
- Section of Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Yale University School of Medicine
| | - Pamela Hu
- Section of Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Yale University School of Medicine
| | | | - Fangyong Li
- Yale Center for Analytical Sciences, Yale University School of Public Health
| | - James Dziura
- Yale Center for Analytical Sciences, Yale University School of Public Health
| | - Mary Savoye
- Section of Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Yale University School of Medicine
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Center for Implementation Science, Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
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Parker SM, Barr M, Stocks N, Denney-Wilson E, Zwar N, Karnon J, Kabir A, Nutbeam D, Roseleur J, Liaw ST, McNamara C, Frank O, Tran A, Osborne R, Lau AYS, Harris M. Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial. BMJ Open 2022; 12:e060393. [PMID: 36450426 PMCID: PMC9716831 DOI: 10.1136/bmjopen-2021-060393] [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: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate a multifaceted intervention on diet, physical activity and health literacy of overweight and obese patients attending primary care. DESIGN A pragmatic two-arm cluster randomised controlled trial. SETTING Urban general practices in lower socioeconomic areas in Sydney and Adelaide. PARTICIPANTS We aimed to recruit 800 patients in each arm. Baseline assessment was completed by 215 patients (120 intervention and 95 control). INTERVENTION A practice nurse-led preventive health check, a mobile application and telephone coaching. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were measured at baseline, 6 and 12 months, and included patient health and eHealth literacy, weight, waist circumference and blood pressure. Secondary outcomes included changes in diet and physical activity, preventive advice and referral, blood lipids, quality of life and costs. Univariate and multivariate analyses of difference-in-differences (DiD) estimates for each outcome were conducted. RESULTS At 6 months, the intervention group, compared with the control group, demonstrated a greater increase in Health Literacy Questionnaire domain 8 score (ability to find good health information; mean DiD 0.22; 95% CI 0.01 to 0.44). There were similar differences for domain 9 score (understanding health information well enough to know what to do) among patients below the median at baseline. Differences were reduced and non-statistically significant at 12 months. There was a small improvement in diet scores at 6 months (DiD 0.78 (0.10 to 1.47); p=0.026) but not at 12 months. There were no differences in eHealth literacy, physical activity scores, body mass index, weight, waist circumference or blood pressure. CONCLUSIONS Targeted recruitment and engagement were challenging in this population. While the intervention was associated with some improvements in health literacy and diet, substantial differences in other outcomes were not observed. More intensive interventions and using codesign strategies to engage the practices earlier may produce a different result. Codesign may also be valuable when targeting lower socioeconomic populations. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12617001508369) (http://www.ANZCTR.org.au/ACTRN12617001508369.aspx). TRIAL PROTOCOL The protocol for this trial has been published (open access; https://bmjopen.bmj.com/content/8/6/e023239).
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Nicholas Zwar
- Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jon Karnon
- Flinders Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Don Nutbeam
- Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jackie Roseleur
- Flinders Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carmel McNamara
- College of Nursing and Health Sciences, Flinders University, Adelaide, New South Wales, Australia
| | - Oliver Frank
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - An Tran
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Burwood, Victoria, Australia
| | - Annie Y S Lau
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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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.
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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
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Cuffey J, Lepczyk CA, Zhao S, Fountain-Jones NM. Cross-sectional association of Toxoplasma gondii exposure with BMI and diet in US adults. PLoS Negl Trop Dis 2021; 15:e0009825. [PMID: 34597323 PMCID: PMC8513882 DOI: 10.1371/journal.pntd.0009825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/13/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022] Open
Abstract
Toxoplasmosis gondii exposure has been linked to increased impulsivity and risky behaviors, which has implications for eating behavior. Impulsivity and risk tolerance is known to be related with worse diets and a higher chance of obesity. There is little known, however, about the independent link between Toxoplasma gondii (T. gondii) exposure and diet-related outcomes. Using linear and quantile regression, we estimated the relationship between T. gondii exposure and BMI, total energy intake (kcal), and diet quality as measured by the Health Eating Index-2015 (HEI) among 9,853 adults from the 2009–2014 National Health and Nutrition Examination Survey. Previous studies have shown different behavioral responses to T. gondii infection among males and females, and socioeconomic factors are also likely to be important as both T. gondii and poor diet are more prevalent among U.S. populations in poverty. We therefore measured the associations between T. gondii and diet-related outcomes separately for men and women and for respondents in poverty. Among females <200% of the federal poverty level Toxoplasmosis gondii exposure was associated with a higher BMI by 2.0 units (95% CI [0.22, 3.83]) at median BMI and a lower HEI by 5.05 units (95% CI [-7.87, -2.24]) at the 25th percentile of HEI. Stronger associations were found at higher levels of BMI and worse diet quality among females. No associations were found among males. Through a detailed investigation of mechanisms, we were able to rule out T. gondii exposure from cat ownership, differing amounts of meat, and drinking water source as potential confounding factors; environmental exposure to T. gondii as well as changes in human behavior due to parasitic infection remain primary mechanisms. Toxoplasmosis gondii (T. gondii) is a parasite that infects over 10 percent of the US population. T. gondii infection can cause serious health problems for some people, but most infections remain undiagnosed and subclinical. When an individual is infected, T. gondii can chronically reside in muscle and central nervous system (including brain) tissue. Previous studies have found that individuals with prior exposure to T. gondii may engage in more risky and impulsive behaviors, and risk tolerance and impulsivity may be related with individual’s diet. Our study examines whether individuals with T. gondii exposure have higher body mass index (BMI) and worse diets. We further discuss and test for alternative explanations that prevent us from establishing a causal relationship between T. gondii and BMI/diet. Overall, our results show that T. gondii exposure is related with higher BMI and worse diets among lower-income females in the US. Our results uncover a novel correlate of BMI and diets, and suggest the importance of investigating the broader public health impacts of chronic T. gondii infection.
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Affiliation(s)
- Joel Cuffey
- Department of Agricultural Economics and Rural Sociology, Auburn University, Auburn, Alabama, United States of America
- * E-mail:
| | - Christopher A. Lepczyk
- School of Forestry and Wildlife Sciences, Auburn University, Auburn, Alabama, United States of America
| | - Shuoli Zhao
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States of America
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Baranowski T, Motil KJ. Simple Energy Balance or Microbiome for Childhood Obesity Prevention? Nutrients 2021; 13:nu13082730. [PMID: 34444890 PMCID: PMC8398395 DOI: 10.3390/nu13082730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022] Open
Abstract
Obesity prevention interventions generally have either not worked or had effects inadequate to mitigate the problem. They have been predicated on the simple energy balance model, which has been severely questioned by biological scientists. Numerous other etiological mechanisms have been proposed, including the intestinal microbiome, which has been related to childhood obesity in numerous ways. Public health research is needed in regard to diet and the microbiome, which hopefully will lead to effective child obesity prevention.
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