Effects of providing personalized feedback of child's obesity risk on mothers' food choices using a virtual reality buffet

How shared versus unshared parental contribution to child risk influences guilt responses

The extent to which parents experience guilt related to their child's health may depend on their perceptions of their contribution to these outcomes. The impact of the child's "other" biological parent's (OBP) contribution to child health on guilt responses is understudied. Some models posit a diffusion-of-responsibility process, while others favor a heightened-risk-heightened-guilt model. The present study examines how perceived OBP contribution to child risk affects guilt among a sample of parents with self-reported overweight. Parents who perceived their child's OBP to also have overweight experienced more guilt for passing down genetic and family environment-based obesity risk to their child, which suggests that perceptions of shared risk contribution promote guilt-related outcomes. Additionally, risk information endorsing a gene-environment interaction liability framing was the most responsive to OBP weight status. These results support a heightened-risk-heightened-guilt process. Future work should consider guilt when developing child health interventions to avoid undesirable emotional outcomes among parents.

Developing and assessing a kin keeping scale with application to identifying central influencers in African American family networks

Promoting family communication about inherited disease risk is an arena in which family systems theory is highly relevant. One family systems' construct that can support promotion of family communication regarding inherited disease risk is the notion of "kin keeping." However, kin keeping and whether it might be capitalized on to encourage family communication about inherited risk has been understudied. The goal of this report was to propose a broadened conceptualization of kin keeping that distinguishes between a structural functional perspective (role conceptualization) and transitional behaviors (skill conceptualization), and to develop and evaluate a scale that would enable this assertion to be tested among a sample of African American community health workers. We developed a scale using four steps: item development using concept analysis and content validity, scale development among a national sample (n = 312), scale evaluation using exploratory factor analysis (n = 52), and scale reduction. We then posed suppositions of associations that would indicate whether the developed kin keeping measure was assessing a specific family role or set of behaviors. Our results included the development of the first quantitative measure of kin keeping (9- and 15-item scales). Model fit for 9-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.09, SMRM = 0.06) and model fit for 15-item scale (CFI = 0.97, AFGI = 0.89, RMSEA = 0.06, SMRM = 0.05). These findings allow us to move toward more rigorous research about the role of kin keeping on information sharing and health decision making. Results also suggest that, contrary to the historical structural functional conceptualization of kin keeping as a role, kin keeping might also be conceptualized as a behavior or set of modifiable behaviors. Ultimately, the kin keeping scale could be used to operationalize kin keeping in various theoretical models and frameworks, guide intervention development to encourage or train for kin keeping behaviors, and test assumptions of whether families vary in the density of kin keeping.

Understanding the Process of Family Cancer History Collection and Health Information Seeking

PROBLEM ADDRESSED

To better understand the factors associated with family cancer history (FCH) information and cancer information seeking, we model the process an individual undergoes when assessing whether to gather FCH and seek cancer information and compare models by sociodemographics and family history of cancer. We used cross-sectional data from the Health Information National Trends Survey (HINTS 5, Cycle 2) and variables (e.g., emotion and self-efficacy) associated with the Theory of Motivated Information Management to assess the process of FCH gathering and information seeking. We completed path analysis to assess the process of FCH gathering and stratified path models.

RESULTS

Those who felt they could lower their chances of getting cancer (emotion) were more confident in their ability to complete FCH on a medical form (self-efficacy; B = 0.11, p < .0001) and more likely to have discussed FCH with family members (B = 0.07, p < .0001). Those who were more confident in their ability to complete a summary of their family history on a medical form were more likely to have discussed FCH with family members (B = 0.34, p < .0001) and seek other health information (B = 0.24, p < .0001). Stratified models showed differences in this process by age, race/ethnicity, and family history of cancer.

IMPLICATIONS FOR PUBLIC HEALTH RESEARCH AND PRACTICE

Tailoring outreach and education strategies to address differences in perceived ability to lower chances of getting cancer (emotion) and confidence in the ability to complete FCH (self-efficacy) could help encourage less engaged individuals to learn about their FCH and gather cancer information.

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

Food Desires and Hedonic Discrimination in Virtual Reality Varying in Product–Context Appropriateness among Older Consumers

Immersive virtual reality (VR) videos can replicate complex real-life situations in a systematic, repeatable and versatile manner. New product development trajectories should consider the complexities of daily life eating situations. The creation of immersive contexts of a product with varying levels of appropriateness could be a useful tool for product developers in evaluating the extent to which context may influence food acceptance and eating behavior. This study explored virtual reality (VR) as an efficient context-enhancing technology through evaluations of protein-enriched rye breads and compared the effects of a VR-simulated congruent (VR restaurant) and incongruent (VR cinema) contexts on the acceptance in older consumers. A total of 70 participants were immersed in the two VR contexts and a neutral control context in a randomized order. The responses indicating the desire and liking for rye breads were measured, and the extent of immersion during context exposure was assessed by levels of the sense of presence and engagement. Immersive VR induced positive sensations of presence and a heightened level of engagement. The VR restaurant and neutral contexts were perceived as more appropriate for consuming rye breads and induced higher desire and liking for rye breads, which supported the notion of the alignment of congruent contexts with food desire and liking. The study provides new perspectives, practical methodologies, and discoveries in regard to the creation and application of VR-immersed contexts in food product evaluation. Moreover, it focused on a consumer segment (older consumers) that has seldom been investigated in previous relevant studies. The findings suggest that immersive VR technology, as a tool for evaluating contextual factors, is important for new product development. The good user experience among older consumers further indicated the potential value of VR as a context-enhancing tool for product development.

Cybersickness Variability by Race: Findings From 6 Studies and a Mini Meta-analysis

Background

With the influx of medical virtual reality (VR) technologies, cybersickness has transitioned from a nuisance experienced during leisure activities to a potential safety and efficacy concern for patients and clinicians. To improve health equity, it is important to understand any potential differences in cybersickness propensity among demographic groups, including racial groups.

Objective

This study aims to explore whether cybersickness propensity differs across racial groups.

Methods

We collected self-reported cybersickness ratings from 6 racially diverse independent samples within 1 laboratory group (N=931). In these studies, the participants were asked to perform tasks in VR such as traversing environments, pointing at and selecting objects, and interacting with virtual humans.

Results

Significant racial differences in cybersickness were found in 50% (3/6) of studies. A mini meta-analysis revealed that, on average, Black participants reported approximately one-third of SD less cybersickness than White participants (Cohen d=−0.31; P<.001), regardless of the nature of the VR experience. There was no overall difference in reported cybersickness between the Asian and White participants (Cohen d=−0.11; P=.51).

Conclusions

Racial differences in cybersickness indicate that researchers, practitioners, and regulators should consider patient demographics when evaluating VR health intervention outcomes. These findings lay the groundwork for future studies that may explore racial differences in cybersickness directly.

How beliefs about weight malleability and risk perceptions for obesity influence parents' information seeking and feeding

This study surveyed 185 parents to determine whether their perceived risk of their child developing obesity and their implicit theories about the malleability of weight independently and/or interactively predict their child-feeding and pursuit of child-related obesity risk information. Higher risk perceptions were associated with healthier feeding intentions and more information seeking. More incremental (malleable) beliefs predicted healthier feeding intentions and greater pursuit of environmental, but not genetic, information. Contrary to hypotheses, the influence of implicit theories and risk perceptions were primarily independent; however, more incremental beliefs predicted less "junk food" feeding among only parents with lower perceived risk.

Parental reward-based eating drive predicts parents' feeding behaviors and Children's ultra-processed food intake

Reward-based eating drive is associated with individual consumption, but there has been a paucity of research on the relationships between parental reward-based eating, child feeding behaviors, and child food consumption. Child feeding behaviors likely to be associated with parental reward-based eating drive include the provision of ultra-processed foods, as they are designed to be hyperpalatable and are associated with disordered food intake. The present study uses a virtual reality (VR) buffet restaurant environment to examine parents' food choice behaviors for their children and a food frequency assessment to measure the children's reported consumption over the course of a week. Results found that parental reward-based eating drive significantly predicted ultra-processed calories chosen by parents for their children in the VR Buffet, as well as the amount of ultra-processed food children ate according to the food frequency assessment. Both of these effects were significantly mediated by the healthfulness of the home food environment. This study is among the first to demonstrate associations between parental reward-based eating drive and child-focused food behavior and to elucidate a mediating effect of the home food environment on such relationships. These findings may be useful for the development of family-based interventions to improve child feeding and ultimately child health.

Parents' genetic attributions for children's eating behaviors: Relationships with beliefs, emotions, and food choice behavior

Considering genetic influences on children's eating behavior could result in reduced self-efficacy for healthy child feeding and less healthy feeding behavior among parents. Indeed, one's eating behaviors are typically thought of as the volitional aspects of weight management that one can directly control. The current study assessed parental genetic attributions for their child's eating behavior, and relationships between these attributions and self-efficacy, guilt, and feeding behaviors. Participants included 190 parents of a child between 4 and 7 years old. Parents' genetic attributions for child eating behaviors were lower than genetic attributions related to child weight. Higher genetic attributions for child eating behaviors were related to lower self-efficacy for feeding the right amounts of food, higher-calorie food choices for the child in a virtual reality-based buffet simulation, and higher levels of guilt. The current findings suggest that heightened beliefs about role of genetics in children's eating behavior is associated with maladaptive affect and behavior among parents. This should be kept in mind when considering whether, when, and how to provide information to parents highlighting the role of genetics in children's eating behavior.

Investigating the Efficacy of Genetic, Environmental, and Multifactorial Risk Information When Communicating Obesity Risk to Parents of Young Children

BACKGROUND

Effectively communicating with parents about children's obesity risk is of critical importance for preventive medicine and public health.

PURPOSE

The current study investigates the efficacy of communications focused on two primary causes of obesity: genes and environment.

METHODS

We compared parental feeding responses to messages focused on (i) genetics alone, (ii) family environment alone, (iii) genetics-family environment interaction (G × FE), and (iv) no causal message. We also examined whether parental guilt mediates the effect of message type on feeding. Our sample consisted of 190 parents, half mothers and half fathers, of children 3-7 years old. After receiving one of the four types of messages, parents chose foods for their child using the Virtual Reality Buffet measure. Parents responded to questionnaires in the lab and at 1-week follow-up.

RESULTS

In the VR Buffet, parents did not feed their children differently in message provision conditions versus control. There were, however, differences among message provision conditions wherein mothers who received any genetic information chose higher-calorie meals in the VR Buffet. At 1-week follow-up, parents who received information about genetics alone reported feeding their child more junk food and fatty meat on self-report food frequency assessments; there were no such differences for sugary beverages, sugary foods, or fast foods. Parental guilt was typically higher for participants who received family environment information alone but did not mediate the relation between information provision and feeding outcomes.

CONCLUSIONS

While none of the messages improved feeding above the control condition, GxFE messages were associated with a better overall profile of outcomes. As such, it may be beneficial for messaging for parents about children's obesity risk to include content that reflects the complexity of genetic and environmental contributions to obesity risk.

Usability Study of a Novel Tool: The Virtual Cafeteria in Nutrition Education

OBJECTIVE

This study aimed to evaluate the usability of the virtual cafeteria (VC) and determine its suitability for further studies in portion size education and rehabilitation of nutrition.

METHODS

The study was conducted with 73 participants (aged 18-40 years). The VC, where the participants performed the task of assembling a meal, was created as a virtual reality simulation of a buffet-style cafeteria (94 food and 10 beverage items). The participants were asked to complete the System Usability Scale, which regards ≥70 points as acceptable, and to give comments about the VC.

RESULTS

The mean System Usability Scale score was 79.4 ± 12.71 (range, 22.2-97.2). Approximately 68% of the participants described positive qualities for the VC. The participants with technical background reported the VC as more usable (96%) than the others (74%) (χ² = 5,378; df = 1, P = 0.025).

CONCLUSIONS AND IMPLICATIONS

Offered as a novel tool for education and rehabilitation of nutrition, the VC was confirmed to feature good usability.

Effects of Fruit and Vegetable Feeding Messages on Mothers and Fathers: Interactions Between Emotional State and Health Message Framing

BACKGROUND

There is a pressing need to craft optimal public health messages promoting healthy feeding behaviors among parents. How these messages influence such feeding decisions are affected by multiple interactive factors including emotional states, message framing, and gender, but these factors have not been studied in the domain of parents' feeding of their children.

PURPOSE

To evaluate the role of message framing, emotional state, and parent gender on feeding choices that parents make for their children.

METHODS

In 2016-2017, 190 parents (126 mothers) of 4- to 7-year-old children were randomly assigned to an anger or fear emotion induction and read either a gain- or loss-framed message about the importance of children's fruit and vegetable (FV) consumption prior to choosing foods for their child from a virtual reality buffet.

RESULTS

Mothers in an angry state who received a gain-framed message chose relatively more FV for their child in the virtual buffet, F(3, 180) = 4.77, p = .027. However, fathers in this group did not feed more FV, but rather reported greater intention to improve future FV feeding, F(3, 180) = 4.91, p = .028.

CONCLUSIONS

Providing gain-framed messages to parents, particularly mothers, in an anger state may be most effective for motivating healthy dietary choices for children.

CLINICAL TRIAL INFORMATION

clinicaltrials.gov NCT02622035.

Association of parental guilt with harmful versus healthful eating and feeding from a virtual reality buffet

OBJECTIVE

Parents often report guilt about what they feed their child, but no studies have examined how this guilt might affect their child-feeding or own eating behavior. Some studies suggest that guilt motivates healthy behaviors, yet others show that guilt impairs the self-control needed to abstain from unhealthy behaviors.

METHOD

One hundred ninety parents reported how guilty they felt about their current child-feeding habits. Parents then chose food for their child in a virtual reality buffet and reported their intentions to improve child-feeding and own eating behavior in the future. Finally, parents were offered candy while they completed an unrelated survey.

RESULTS

Parents with greater guilt reported stronger intentions to improve both feeding (b = .27, p = .010) and eating (b = .21, p = .019) in the future. However, among parents with higher (but not lower) BMI, those who reported greater guilt served more unhealthy foods for their child in the buffet (b = .32, p = .010) and were more likely to eat candy at the end of the study (b = .92, p = .004). Further analyses revealed that guilt only predicted greater feeding intentions when parents had served relatively more unhealthy foods in the buffet (b = .43, p < .001).

CONCLUSIONS

Findings echo the mixed conceptualization of guilt shown in previous literature on health behavior. More research is necessary to understand the long-term influence of guilt on eating and feeding behavior and the circumstances under which guilt is associated with detrimental versus healthy behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Acceptability of early childhood obesity prediction models to New Zealand families

OBJECTIVE

While prediction models can estimate an infant's risk of developing obesity at a later point in early childhood, caregiver receptiveness to such information is largely unknown. We aimed to assess the acceptability of these models to New Zealand caregivers.

METHODS

An anonymous questionnaire was distributed online. The questionnaire consisted of multiple choice and Likert scale questions. Respondents were parents, caregivers, and grandparents of children aged ≤5 years.

RESULTS

1,934 questionnaires were analysed. Responses were received from caregivers of various ethnicities and levels of education. Nearly two-thirds (62.1%) of respondents would "definitely" or "probably" want to hear if their infant was at risk of early childhood obesity, although "worried" (77.0%) and "upset" (53.0%) were the most frequently anticipated responses to such information. With lower mean scores reflecting higher levels of acceptance, grandparents (mean score = 1.67) were more receptive than parents (2.10; p = 0.0002) and other caregivers (2.13; p = 0.021); males (1.83) were more receptive than females (2.11; p = 0.005); and Asian respondents (1.68) were more receptive than those of European (2.05; p = 0.003), Māori (2.11; p = 0.002), or Pacific (2.03; p = 0.042) ethnicities. There were no differences in acceptance according to socioeconomic status, levels of education, or other ethnicities.

CONCLUSIONS

Almost two-thirds of respondents were receptive to communication regarding their infant's risk of childhood obesity. While our results must be interpreted with some caution due to their hypothetical nature, findings suggest that if delivered in a sensitive manner to minimise caregiver distress, early childhood obesity risk prediction could be a useful tool to inform interventions to reduce childhood obesity in New Zealand.

Modeling Dynamic Food Choice Processes to Understand Dietary Intervention Effects

Background

Meal construction is largely governed by nonconscious and habit-based processes that can be represented as a collection of in dividual, micro-level food choices that eventually give rise to a final plate. Despite this, dietary behavior intervention research rarely captures these micro-level food choice processes, instead measuring outcomes at aggregated levels. This is due in part to a dearth of analytic techniques to model these dynamic time-series events.

Purpose

The current article addresses this limitation by applying a generalization of the relational event framework to model micro-level food choice behavior following an educational intervention.

Method

Relational event modeling was used to model the food choices that 221 mothers made for their child following receipt of an information-based intervention. Participants were randomized to receive either (a) control information; (b) childhood obesity risk information; (c) childhood obesity risk information plus a personalized family history-based risk estimate for their child. Participants then made food choices for their child in a virtual reality-based food buffet simulation.

Results

Micro-level aspects of the built environment, such as the ordering of each food in the buffet, were influential. Other dynamic processes such as choice inertia also influenced food selection. Among participants receiving the strongest intervention condition, choice inertia decreased and the overall rate of food selection increased.

Conclusions

Modeling food selection processes can elucidate the points at which interventions exert their influence. Researchers can leverage these findings to gain insight into nonconscious and uncontrollable aspects of food selection that influence dietary outcomes, which can ultimately improve the design of dietary interventions.

Mothers' and fathers' cognitive and affective responses to epigenetics concepts

Advances in our understanding of epigenetics present new opportunities to improve children's health through the counseling of parents about epigenetics concepts. However, it is important to first evaluate how parents respond to this type of information and determine the consequences of educating parents about epigenetics. We have taken an initial step toward this goal by assessing parental responses to an epigenetics learning module. Parents (n = 190, 126 mothers) responded to pre- and post-module survey questions. Prior to the module, parents reported that mothers' lifestyles prior to conception were more important for children's health than fathers' lifestyles prior to conception (t = 4.49, df = 316.5, P < 0.0001). However, after the module, there was no difference between ratings of the importance of mothers' and fathers' preconception lifestyles (t = 1.18, df = 319.8, P = NS). Furthermore, after viewing the module, parents increased their ratings of the importance of both mothers' (t = -5.65, df = 294.8, P < 0.0001) and father's (t = -9.01, df = 287.2, P < 0.0001) preconception lifestyles for child health. After viewing the module, most parents reported feelings of guilt and negativity regarding epigenetics (78 and 55%, respectively). When compared with lean parents, parents with overweight more often reported feelings of guilt (χ ² =10.27, P = 0.001). This work represents an important first step in evaluating parental responses to epigenetics concepts.

Parental Defensiveness about Multifactorial Genomic and Environmental Causes of Children's Obesity Risk

Background: Future integration of genomics into weight management may target children with overweight given prospects for prevention. Meanwhile, parents learn about weight-related genomics primarily through the media, and little is known about parental reactions to complex genomic and environmental causes underlying children's obesity risk. Methods: Three hundred twenty-four parents with overweight who have a child 3-13 years of age were recruited through Amazon Mechanical Turk. Parents were randomized to read an article highlighting one of three causes of obesity risk: genetics only, family environment only, gene-family environment interactions (G × FE), or read a control article. Results: Parents who perceived their child to be overweight exhibited increased risk perception and guilt over parents of lean children overall, but exhibited decreased worry in response to the G × FE message. Furthermore, parents of children with overweight who received the G × FE message did not exhibit heightened risk perception or guilt, reported that the message was less relevant, and that they paid less attention to it. Conclusions: Multifactorial causal information about children's obesity risk elicits unintended consequences among parents whose children are most at-risk for obesity in adulthood. As these messages are most accurate, it is crucial to investigate effective ways to communicate the holistic nature of obesity risk to parents.

A Bayesian hierarchical logistic regression model of multiple informant family health histories

Background

Family health history (FHH) inherently involves collecting proxy reports of health statuses of related family members. Traditionally, such information has been collected from a single informant. More recently, research has suggested that a multiple informant approach to collecting FHH results in improved individual risk assessments. Likewise, recent work has emphasized the importance of incorporating health-related behaviors into FHH-based risk calculations. Integrating both multiple accounts of FHH with behavioral information on family members represents a significant methodological challenge as such FHH data is hierarchical in nature and arises from potentially error-prone processes.

Methods

In this paper, we introduce a statistical model that addresses these challenges using informative priors for background variation in disease prevalence and the effect of other, potentially correlated, variables while accounting for the nested structure of these data. Our empirical example is drawn from previously published data on families with a history of diabetes.

Results

The results of the comparative model assessment suggest that simply accounting for the structured nature of multiple informant FHH data improves classification accuracy over the baseline and that incorporating family member health-related behavioral information into the model is preferred over alternative specifications.

Conclusions

The proposed modelling framework is a flexible solution to integrate multiple informant FHH for risk prediction purposes.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0700-5) contains supplementary material, which is available to authorized users.

Social and behavioral science priorities for genomic translation

This commentary highlights the essential role of the social and behavioral sciences for genomic translation, and discusses some priority research areas in this regard. The first area encompasses genetics of behavioral, social, and neurocognitive factors, and how integration of these relationships might impact the development of treatments and interventions. The second area includes the contributions that social and behavioral sciences make toward the informed translation of genomic developments. Further, there is a need for behavioral and social sciences to inform biomedical research for effective implementation. The third area speaks to the need for increased outreach and education efforts to improve the public's genomic literacy such that individuals and communities can make informed health-related and societal (e.g., in legal or consumer settings) decisions. Finally, there is a need to prioritize representation of diverse communities in genomics research and equity of access to genomic technologies. Examples from National Institutes of Health-based intramural and extramural research programs and initiatives are used to discuss these points.

Cognitive and affective factors linking mothers' perceived weight history to child feeding

BACKGROUND/OBJECTIVES

To explore whether mothers' lifetime experiences with their own weight status and related cognitive and affective factors influence child feeding behavior.

SUBJECTS/METHODS

Overweight mothers (N = 221) of 4-5 year olds recalled their weight at four time points, and were grouped into weight history trajectories: recently overweight, always overweight, and steady-gain-obese. Objective food choice behavior was assessed in a virtual reality buffet and subjective food restriction for the index child was assessed using a psychometric measure.

RESULTS

Mothers' observed food choice was not associated with weight trajectory, but mothers who spent more time being overweight and who weighed more at present were more restrictive of their child's eating. Mothers' concern about child weight increased with more time spent being overweight. Concern for child weight and mothers' body guilt differentially mediated the relationships between weight trajectories and perceived feeding restriction.

CONCLUSIONS

Considering mothers' lifetime weight experiences may suggest that parental influences on child feeding are amenable to intervention that would otherwise be obscured by static weight measures.

Validity of assessing child feeding with virtual reality

Assessment of parents' child feeding behavior is challenging, and there is need for additional methodological approaches. Virtual reality technology allows for the creation of behavioral measures, and its implementation overcomes several limitations of existing methods. This report evaluates the validity and usability of the Virtual Reality (VR) Buffet among a sample of 52 parents of children aged 3-7. Participants served a meal of pasta and apple juice in both a virtual setting and real-world setting (counterbalanced and separated by a distractor task). They then created another meal for their child, this time choosing from the full set of food options in the VR Buffet. Finally, participants completed a food estimation task followed by a questionnaire, which assessed their perceptions of the VR Buffet. Results revealed that the amount of virtual pasta served by parents correlated significantly with the amount of real pasta they served, rs = 0.613, p < .0001, as did served amounts of virtual and real apple juice, rs = 0.822, p < .0001. Furthermore, parents' perception of the calorie content of chosen foods was significantly correlated with observed calorie content (rs = 0.438, p = .002), and parents agreed that they would feed the meal they created to their child (M = 4.43, SD = 0.82 on a 1-5 scale). The data presented here demonstrate that parent behavior in the VR Buffet is highly related to real-world behavior, and that the tool is well-rated by parents. Given the data presented and the potential benefits of the abundant behavioral data the VR Buffet can provide, we conclude that it is a valid and needed addition to the array of tools for assessing feeding behavior.

[Electronic media in obesity prevention in childhood and adolescence]

BACKGROUND

The increasing prevalence of childhood obesity is - amongst other factors - due to changed leisure time habits with decreased physical activity and increased media consumption. However, electronic media such as tablets and smartphones might also provide a novel intervention approach to prevent obesity in childhood and adolescence.

OBJECTIVES

A summary of interventions applying electronic media to prevent childhood obesity is provided to investigate short term effects as well as long term results of these interventions.

METHODS

A systematic literature search was performed in PubMed/Web of Science to identify randomized and/or controlled studies that have investigated the efficacy of electronic media for obesity prevention below the age of 18.

RESULTS

A total of 909 studies were identified, and 88 studies were included in the analysis. Active video games did increase physical activity compared to inactive games when applied within a peer group. Interventions via telephone had positive effects on certain lifestyle-relevant behaviours. Interventions via mobile were shown to decrease dropout rates by sending regular SMS messages. To date, interventions via smartphones are scarce for adolescents; however, they might improve cardiorespiratory fitness. The results from internet-based interventions showed a trend towards positive effects on lifestyle-relevant behaviors. The combination of different electronic media did not show superior results compared to interventions with only one medium. Interventions via TV, DVD or video-based interventions may increase physical activity when offered as an incentive, however, effects on weight status were not observed.

DISCUSSION

Children and adolescents currently grow up in a technology- and media-rich society with computers, tablets, smartphones, etc. used daily. Thus, interventions applying electronic media to prevent childhood obesity are contemporary. Available studies applying electronic media are however heterogeneous in terms of applied medium and duration. Positive effects on body composition were not observed, but only on certain lifestyle-relevant behaviours. In addition, these effects could only be seen in the short term. Follow-up data are currently scarce.

Let's Move Together

BACKGROUND

Due to shared health behaviors and disease risk, families may be more effective targets for health promotion. This study assessed whether providing family health history (FHH)-based risk information for heart disease and diabetes affected encouragement to engage in physical activity (PA) and healthy weight (HW) maintenance and co-engagement in physical activity among 320 Mexican-origin parents and their 1,081 children.

METHOD

At baseline and 10 months, parents indicated who they encouraged and who encouraged them to engage in PA/HW, and with whom they co-engaged in PA. Households were randomized to receive FHH-based assessments either by one or all adult household members. Primary analyses consisted of regression analyses using generalized estimating equations.

RESULTS

At baseline, parents reported encouraging their child for both PA and HW in 37.6% of parent-child dyads and reported receiving children's encouragement for both in 12.1% of dyads. These increased to 56.8% and 17.5% at 10 months ( p < .001). Co-engagement in PA increased from 11.4% to 15.7% ( p < .001), with younger children (30.4%) and mother-daughter dyads (26.8%) most likely to co-engage at 10 months. Providing FHH-based risk information to all adult household members (vs. one) was associated with increased parent-to-child encouragement of PA/HW ( p = .011) at 10 months but not child-to-parent encouragement. New encouragement from parent-to-child ( p = .048) and from child-to-parent ( p = .003) predicted new 10-month PA co-engagement.

DISCUSSION

Providing FHH information on a household level can promote parental encouragement for PA/HW, which can promote greater parent-child co-engagement in PA. In this high-risk population with a cultural emphasis on family ties, using FHH-based risk information for all adult household members may be a promising avenue to promote PA.

The "Smart Dining Table": Automatic Behavioral Tracking of a Meal with a Multi-Touch-Computer

Studying how humans eat in the context of a meal is important to understanding basic mechanisms of food intake regulation and can help develop new interventions for the promotion of healthy eating and prevention of obesity and eating disorders. While there are a number of methodologies available for behavioral evaluation of a meal, there is a need for new tools that can simplify data collection through automatic and online analysis. Also, there are currently no methods that leverage technology to add a dimension of interactivity to the meal table. In this study, we examined the feasibility of a new technology for automatic detection and classification of bites during a laboratory meal. We used a SUR40 multi-touch tabletop computer, powered by an infrared camera behind the screen. Tags were attached to three plates, allowing their positions to be tracked, and the saturation (a measure of the infrared intensity) in the surrounding region was measured. A Kinect camera was used to record the meals for manual verification and provide gesture detection for when the bites were taken. Bite detections triggered classification of the source plate by the SUR40 based on saturation flux in the preceding time window. Five healthy subjects (aged 20–40 years, one female) were tested, providing a total sample of 320 bites. Sensitivity, defined as the number of correctly detected bites out of the number of actual bites, was 67.5%. Classification accuracy, defined as the number of correctly classified bites out of those detected, was 82.4%. Due to the poor sensitivity, a second experiment was designed using a single plate and a Myo armband containing a nine-axis accelerometer as an alternative method for bite detection. The same subjects were tested (sample: 195 bites). Using a simple threshold on the pitch reading of the magnetometer, the Myo data achieved 86.1% sensitivity vs. 60.5% with the Kinect. Further, the precision of positive predictive value was 72.1% for the Myo vs. 42.8% for the Kinect. We conclude that the SUR40 + Myo combination is feasible for automatic detection and classification of bites with adequate accuracy for a range of applications.

Evaluation of the Families SHARE workbook: an educational tool outlining disease risk and healthy guidelines to reduce risk of heart disease, diabetes, breast cancer and colorectal cancer

BACKGROUND

Common diseases such as heart disease, diabetes, and cancer are etiologically complex with multiple risk factors (e.g., environment, genetic, lifestyle). These risk factors tend to cluster in families, making families an important social context for intervention and lifestyle-focused disease prevention. The Families Sharing Health Assessment and Risk Evaluation (SHARE) workbook was designed as an educational tool outlining family health history based risk of heart disease, type 2 diabetes, breast cancer, and colorectal cancer. The current paper describes the steps taken to develop and evaluate the workbook employing a user-centered design approach.

METHODS

The workbook was developed in four steps, culminating in an evaluation focusing on understanding and usability of the tool. The evaluation was based on two Phases of data collected from a sample of mothers of young children in the Washington, D.C., area. A baseline assessment and follow-up approximately two weeks after receipt of the workbook were conducted, as well as focus groups with participants. The design of the workbook was refined in response to participant feedback from the first evaluation Phase and subsequently re-evaluated with a new sample.

RESULTS

After incorporating user-based feedback and revising the workbook, Phase 2 evaluation results indicated that understanding of the workbook components improved for all sections (from 6.26 to 6.81 on a 7-point scale). In addition, 100% of users were able to use the algorithm to assess their disease risk and over 60% used the algorithm to assess family members' disease risk. At follow-up, confidence to increase fruit, vegetable and fiber intake improved significantly, as well.

CONCLUSIONS

The Families SHARE workbook was developed and evaluated resulting in a family health history tool that is both understandable and usable by key stakeholders. This educational tool will be used in intervention studies assessing the effectiveness of family genomics health educators who use the Families SHARE workbook to disseminate family risk information and encourage risk reducing behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01498276 . Registered 21 December 2011.

Mothers’ guilt responses to children’s obesity risk feedback

This study explored the influence of family health history-based obesity risk feedback for their child on 147 overweight mothers’ guilt related to children’s lifestyle behaviors and passing down a genetic propensity for overweight. Mothers were randomized to receive, or not, obesity risk feedback for their 4- to 5-year-old child and then made food choices for them using a virtual reality–based buffet. Receipt of risk information increased lifestyle- and genetics-related guilt. Choosing fewer unhealthful foods for the child attenuated both types of guilt. Work in this area may aid in development of obesity risk feedback strategies that enhance child feeding.

Drivers of overweight mothers' food choice behaviors depend on child gender

BACKGROUND

National data suggest a higher prevalence of obesity among boys. One possible cause could be the food choices made by parents on behalf of their children.

OBJECTIVES

This study sought to determine whether and how mothers' food choices for their children differ by child gender and to understand the drivers of these differences.

DESIGN

Data were analyzed from a randomized controlled trial conducted using a virtual reality-based buffet restaurant. Overweight mothers filled out questionnaires and received an information module. They were then immersed in a virtual buffet restaurant to select a lunch for their 4- to 5-year-old child.

RESULTS

Of the 221 overweight mothers recruited, 55% identified their daughters as the child for whom they would be choosing the food. The caloric content of boys' meals was 43 calories higher than girls' (p = .015). This difference was due to extra calories from the less healthy food category (p = .04). Multivariate analyses identified more predictors of calorie choices for daughters' than sons' meals. Predictors of calories chosen for girls included: having both biological parents overweight (β = 0.26; p = .003), mother's weight (β = 0.17; p = .05), mother's education (β = -0.28; p = .001), her restriction of her child's food intake (β = -0.20; p = .02), and her beliefs about the importance of genetics in causing obesity (β = 0.19; p = .03). Mother's weight was the sole predictor of boys' meal calories (β = 0.20; p = .04).

CONCLUSIONS

Differences in dietary choices made for young girls and boys may contribute to lifelong gender differences in eating patterns. A better understanding of differences in feeding choices made for girls versus boys could improve the design of childhood obesity prevention interventions.