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Zhu H, Zhao K, Huang L, Shi W, Tang C, Xu T, Zhu S, Xu Q, Li X, Chen Y, Liu Q, Yang L. Individual, family and social-related factors of eating behavior among Chinese children with overweight or obesity from the perspective of family system. Front Pediatr 2024; 12:1305770. [PMID: 38455395 PMCID: PMC10917944 DOI: 10.3389/fped.2024.1305770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose The purpose of the present study is to examine the factors contributing to the development of eating behavior in overweight and obese children from the perspective of the family system. Methods A cross-sectional survey was conducted by using convenience sampling method to select 388 participants in two primary schools in Jiangsu, China. Individual, family and social-related factors were collected. Individual factors included age, gender, ethnicity, single child, social anxiety, depression, physical activity, sleep duration, screen time. Family factors included family environment, family structure, family function, family income, parenting style, parental feeding behavior, home food environment and marital satisfaction. Social-related factors included place of residence, number of surrounding restaurants and social support. Univariate analysis, correlation analysis and multivariate analysis were used to identify factors of eating behavior among Chinese children with overweight and obese. Results In this study, 388 participants took part with a 94.865% response rate. In the univariate analysis, the significant differences regarding Dutch Eating Behavior Questionnaire (DEBQ) scores were found between children aged 6-9 years and those aged >9 years. Correlation analysis indicated that parent's nutrition literacy (r = 0.118, P < 0.05), pressure to eat (r = 0.212, P < 0.01), perception of child weight (r = -0.112, P < 0.05) and family function (r = -0.563, P < 0.01) were associated with children's eating behavior. With regard to psychosocial factors, children's social anxiety (r = 0.299, P < 0.01) and depressive symptoms (r = 0.081, P < 0.05) were in positive correlation with eating behavior. The independent variables included in the initial model were age, father's employment status, social anxiety, maternal punishment and harshness, parents' nutrition literacy, pressure to eat, family function and perception of child weight. These variables in the final model accounted for 20.7% of the variance. Conclusion We found that age, father's employment status, social anxiety, maternal punishment and harshness, parents' nutrition literacy, pressure to eat, family function and perception of child weight have great effect on children's eating behavior who are overweight or obese. As early childhood is a critical timeline for child development, children's social anxiety, parenting style, parent's nutrition literacy, parent's feeding behavior and family function should be intervened to promote eating behavior. Intervention programs aimed at promoting healthy eating behaviors among children, thereby mitigating the risk of pediatric obesity, should primarily target parents.
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Affiliation(s)
- Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Lidong Huang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Wenbing Shi
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Chulei Tang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Ting Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiaonan Li
- Department of Child Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yinhua Chen
- Department of Child Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Qianqi Liu
- Department of Child Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Linhui Yang
- Department of Child Health Care, Children's Hospital of Nanjing Medical University, Nanjing, China
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Biggs BK, Rodgers KV, Nayman SJ, Hofschulte DR, Loncar H, Kumar S, Lynch BA, Rajjo TI, Wilson DK. Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks. Transl Behav Med 2023; 13:700-709. [PMID: 37053109 PMCID: PMC10848213 DOI: 10.1093/tbm/ibad022] [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: 04/14/2023] Open
Abstract
Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.
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Affiliation(s)
- Bridget K Biggs
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kristi V Rodgers
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Samuel J Nayman
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Haylee Loncar
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Seema Kumar
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamim I Rajjo
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Ardakani A, Monroe-Lord L, Wakefield D, Castor C. Parenting Styles, Food Parenting Practices, Family Meals, and Weight Status of African American Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1382. [PMID: 36674137 PMCID: PMC9864142 DOI: 10.3390/ijerph20021382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Parents influence adolescents' weight status through different strategies used in the home environment, including parenting styles (PSs), food parenting practices (FPPs), and family meal frequency. As the prevalence of obesity is higher among African American adolescents, investigation of which parental strategies serve as an adjustable factor for the prevention of obesity is critical. First, this study aims to examine the relationship between the different parenting influences and obesity statuses of both parents and 10-17-year-old adolescents among African American families. Second, it aims to examine the correlation between PSs and FPPs and frequency of family meals. A total of 211 parent-adolescent dyads completed an online survey using Qualtrics. Four PSs (i.e., authoritative, authoritarian, setting rules/expectations, and neglecting) and four FPPs (i.e., monitoring, reasoning, copying, and modeling) were identified for this study, along with family meal frequency. Body mass index (BMI) percentile and BMI were used to assess the obesity status of the adolescents and parents, respectively. No correlation was found between the adolescents' and parents' obesity status and the PSs and FPPs, while the adolescents' BMI percentile was significantly correlated with parental BMI. However, a higher number of family meals decreased the likelihood of obesity among the adolescents to some extend and depended on the type of BMI used. An authoritative PS was the only style related to family meal frequency, while three FPPs, namely, monitoring, reasoning, and modeling, were related to a greater number of family meals in African American families. The findings of this study can be used in the development of parental education workshops/sessions, with consideration of the cultural differences in African American families, and can help parents to adopt the best parenting strategy to promote the healthy weight status of their adolescents.
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Affiliation(s)
- Azam Ardakani
- Department of Nutritional Sciences, Howard University, Washington, DC 20059, USA
| | - Lillie Monroe-Lord
- Center for Nutrition, Diet and Health, University of the District of Columbia, Washington, DC 20008, USA
| | - Dorothy Wakefield
- Center for Nutrition, Diet and Health, University of the District of Columbia, Washington, DC 20008, USA
| | - Chimene Castor
- Department of Nutritional Sciences, Howard University, Washington, DC 20059, USA
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Wilson DK, Zarrett N, Sweeney AM. The Importance of Addressing Multilevel Transactional Influences of Childhood Obesity to Inform Future Health Behavior Interventions. Pediatr Clin North Am 2022; 69:657-669. [PMID: 35934492 DOI: 10.1016/j.pcl.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We provide a transactional model of health for understanding the early risk of obesity in youth. This model argues that positive health is construed through the choices and actions that youth take within the range of resources and constraints of their biological and contextual situations across time. Social, cognitive, affective, and behavioral regulatory/motivational processes within the child mediate the relation between life experiences and health outcomes and obesity pathways are influenced by cumulative risk or protective processes for health promotion/compromising behaviors influencing health. We provide evidence-based examples of multilevel approaches to obesity prevention and treatment and highlight recommendations for future health behavior interventions.
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Affiliation(s)
- Dawn K Wilson
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC 29208, USA.
| | - Nicole Zarrett
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC 29208, USA
| | - Allison M Sweeney
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208, USA
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Moderating Effects of Parental Feeding Practices and Emotional Eating on Dietary Intake among Overweight African American Adolescents. Nutrients 2021; 13:nu13061920. [PMID: 34204927 PMCID: PMC8229013 DOI: 10.3390/nu13061920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022] Open
Abstract
This study examined the effects of parental feeding practices and adolescent emotional eating (EE) on dietary outcomes among overweight African American adolescents. Based on Family Systems Theory, it was hypothesized that parental feeding practices, such as parental monitoring and responsibility, would buffer the effects of EE on poor dietary quality, whereas practices such as concern about a child’s weight, restriction, and pressure-to-eat would exacerbate this relationship. Adolescents (N = 127; Mage = 12.83 ± 1.74; MBMI% = 96.61 ± 4.14) provided baseline data from the Families Improving Together (FIT) for Weight Loss trial and an ancillary study. Dietary outcomes (fruit and vegetables (F&Vs), energy intake, sweetened beverage, total fat, and saturated fat) were assessed using random 24-h dietary recalls. Validated surveys were used to assess adolescent-reported EE and parental feeding practices. Results demonstrated a significant interaction between EE and parental monitoring (adjusted analyses; B = 0.524, SE = 0.176, p = 0.004), restriction (B = −0.331, SE = 0.162, p = 0.043), and concern (B = −0.602, SE = 0.171, p = 0.001) on F&V intake; under high monitoring, low restriction, and low concern, EE was positively associated with F&V intake. There were no significant effects for the other dietary outcomes. These findings indicate that parental feeding practices and EE may be important factors to consider for dietary interventions, specifically for F&V intake, among overweight African American adolescents.
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The Moderating Effects of the Families Improving Together (FIT) for Weight Loss Intervention and Parenting Factors on Family Mealtime in Overweight and Obese African American Adolescents. Nutrients 2021; 13:nu13061745. [PMID: 34063799 PMCID: PMC8224069 DOI: 10.3390/nu13061745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Few studies have integrated positive parenting and motivational strategies to address dietary outcomes such as frequency of family mealtime. The Families Improving Together (FIT) for Weight Loss trial was a randomized group cohort trial (n = 241 dyads) testing the efficacy of integrating a motivational plus family weight loss (M + FWL) intervention for healthy eating and weight loss in overweight and obese African American adolescents. The current study tested the interaction of parenting styles (responsiveness, demandingness) and parental feeding practices (restriction, concern about child’s weight, pressure to eat) and the FIT intervention on frequency of family mealtime over 16 weeks. Multilevel modeling demonstrated significant interactions between the group-based treatment and responsiveness (p = 0.018) and demandingness (p = 0.010) on family mealtime. For the group-based M + FWL intervention, increased responsiveness and reduced demandingness were associated with increased frequency of family mealtime from baseline to 16 weeks. There was also a negative association between parental restriction and frequency of family mealtime, but a positive association between parental concerns about their adolescent’s weight and frequency of mealtime. These findings are the first to demonstrate that an authoritative or nurturing parenting style moderated intervention effects for improving the frequency of family mealtime in overweight and obese African American adolescents.
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Kipp C, Wilson DK, Sweeney AM, Zarrett N, Van Horn ML. Effects of Parenting and Perceived Stress on BMI in African American Adolescents. J Pediatr Psychol 2021; 46:980-990. [PMID: 33738484 DOI: 10.1093/jpepsy/jsab025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study set out to examine the role of parenting practices in protecting or exacerbating the negative effects of parent and adolescent stress on adolescent body mass index (BMI) over time. Separate longitudinal models were conducted to evaluate how parenting practices interacted with parental perceived stress and adolescent perceived stress in predicting adolescent BMI. METHODS Baseline data were collected from 148 African American adolescents (Mage = 12.93, SD = 1.75; Mz-BMI = 0.78, SD = 0.50; MBMI%-ile = 96.7, SD = 3.90) and their caregivers (Mage = 44.45, SD = 8.65; MBMI = 37.63, SD = 8.21) enrolled in the Families Improving Together for Weight Loss trial. Adolescents self-reported their perceptions of caregiver parenting style and feeding practices. Both caregivers and adolescents self-reported their perceptions of chronic stress. BMI for parents and adolescents was assessed objectively at baseline and 16 weeks post-intervention. RESULTS Hierarchical regression models predicting adolescent BMI z-score (z-BMI) indicated a significant interaction between parental perceived stress and parental pressure to eat. Simple slopes analyses demonstrated that for those parents that exhibit higher pressure to eat, parent stress was positively associated with adolescent z-BMI. CONCLUSIONS These findings provide preliminary support suggesting that certain parenting practices interact with chronic stress on adolescent weight-related outcomes and that future interventions may consider integrating these factors.
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Affiliation(s)
- Colby Kipp
- Department of Psychology, University of South Carolina
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina
| | | | | | - M Lee Van Horn
- Department of Educational Psychology, University of New Mexico
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