Reexamining obesigenic families: parents' obesity-related behaviors predict girls' change in BMI

Teaching gene-environment interaction concepts with narrative vignettes: Effects on knowledge, stigma, and behavior motivation

Gene-environment interaction (GxE) concepts underlie a proper understanding of complex disease risk and risk-reducing behavior. Communicating GxE concepts is a challenge. This study designed an educational intervention that communicated GxE concepts in the context of eating behavior and its impact on weight, and tested its efficacy in changing knowledge, stigma, and behavior motivation. The study also explored whether different framings of GxE education and matching frames with individual eating tendencies would result in stronger intervention impact. The experiment included four GxE education conditions and a control condition unrelated to GxE concepts. In the education conditions, participants watched a video introducing GxE concepts then one of four narrative vignettes depicting how a character's experience with eating hyperpalatable or bitter tasting food (reward-based eating drive vs. bitter taste perception scenario) is influenced by genetic or environmental variations (genetic vs. environmental framings). The education intervention increased GxE knowledge, genetic causal attributions, and empathetic concern. Mediation analyses suggest that causal attributions, particularly to genetics and willpower, are key factors that drive downstream stigma and eating behavior outcomes and could be targeted in future interventions. Tailoring GxE education frames to individual traits may lead to more meaningful outcomes. For example, genetic (vs. environmental) framed GxE education may reduce stigma toward individuals with certain eating tendencies among individuals without such tendencies. GxE education interventions would be most likely to achieve desired outcomes such as reducing stigma if they target certain causal beliefs and are strategically tailored to individual attributes.

Study protocol for clinical trial of the FIT Families multicomponent obesity intervention for African American adolescents and their caregivers: Next step from the ORBIT initiative

INTRODUCTION

This study will test the effectiveness of FIT Families (FIT), a multicomponent family-based behavioural intervention, against a credible attention control condition, Home-Based Family Support (HBFS). This protocol paper describes the design of a randomised clinical trial testing the efficacy of the FIT intervention. The protocol will assess the efficacy of FIT to improve health status in African American adolescents with obesity (AAAO) and their primary caregivers on primary (percent body fat) and secondary (physical activity, metabolic control, weight loss) outcomes and its cost-effectiveness.

METHODS

180 youth/caregiver dyads are randomised into FIT or HBFS, stratified by age, gender and baseline per cent overweight. The proposed study follows a two condition (FIT, HBFS) by four assessment time points. Tests will be conducted to identify potential relationship of baseline demographic and clinical variables to our dependent variables and see whether they are balanced between groups. It is hypothesised that youth/caregiver dyads randomised to FIT will show significantly greater reductions in percent body fat over a 12-month follow-up period compared with AAAO receiving HBFS. Preliminary findings are expected by November 2023.

ETHICS

This protocol received IRB approval from the Medical University of South Carolina (Pro00106021; see 'MUSC IRB 106021 Main Approval.doxc' in online supplemental materials).

DISSEMINATION

Dissemination activities will include summary documents designed for distribution to the broader medical community/family audience and submission of manuscripts, based on study results, to relevant peer-reviewed scientific high-impact journals.

TRIAL REGISTRATION NUMBER

NCT04974554.

The importance of the taste preferences and sensitivity of mothers and their children in the aspect of excessive body weight of children

INTRODUCTION

Food selection among adults and mostly children depends mainly on the taste of a dish. Poor taste sensitivity as well as strong preferences for sweet and fat taste may be the factors predisposing children to become overweight and/or develop obesity. Family environment, including mothers' eating habits and preferences, may affect children's taste perception and preferences. The aim of the study was to assess taste perception and preferences in children and their mothers in relation to their weight status.

METHODS

Sensory tests were carried out using puddings with different sugar and fat content. In all study participants anthropometric measurements (weight and height with BMI calculation) were performed.

RESULTS

The study results did not reveal any differences in the taste sensitivity of overweight/obese and normative body weight children. Similarity was found in the perception of different levels of sweet/fat flavors among children and parents. Overweight/obese children were two times more likely to choose a very fat and very sweet taste compared to normal weight children. The results showed that children prefer a sweet taste more often than their mothers. Mothers' fat taste preferences were important - the fatter the taste they selected, the greater the percentage of children with obesity.

DISCUSSION

Mothers' taste sensitivity may affect children's perception of the quality (intensity) of flavors. Normal-weight children chose a low fat and low sweet taste more frequently than those with excess of body weight. The role of parents in shaping taste preferences is of utmost importance and should be based on limiting the consumption of products rich in sugar and/or fat.

A synthesis of early antecedents of eating behavior and weight status in girls: The legacy of girls' NEEDS project

Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the 'thin ideal' got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.

Influence of parental physical activity on offspring's nutritional status: an intergenerational study in the 1993 Pelotas birth cohort

OBJECTIVE

To investigate the influence of parental physical activity on offspring's nutritional status in the 1993 Pelotas (Brazil) birth cohort.

DESIGN

Birth cohort study.

SETTING

The main outcomes were overweight and obesity status of children. The main exposure was parental physical activity over time, measured during the 11, 15 and 18 years of age follow-ups. The exposure was operationalised as cumulative, and the most recent measure before the birth of child. We adjusted Poisson regression models with robust variance to evaluate crude and adjusted associations between parental physical activity and offspring's nutritional status. All analyses were stratified according to the sex of the parent.

PARTICIPANTS

A total of 874 members from the 1993 Pelotas (Brazil) birth cohort followed-up at 22 years of age with their first-born child were analysed.

RESULTS

Children were, on average, 3·1 years old. Crude analyses showed that the mother's cumulative physical activity measure had an indirect association with the prevalence of children's obesity. The most recent maternal physical activity measure before the birth of the child was associated with 41 % lower prevalence of obesity in children, even after adjustment for confounders.

CONCLUSIONS

The most recent maternal physical activity measure was indirectly associated with the prevalence of obesity in children. No associations were found for fathers, reinforcing the hypothesis of a biological effect of maternal physical activity on offspring's nutritional status.

HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood

BACKGROUND

Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood.

METHODS

The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022.

DISCUSSION

This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses.

TRIAL REGISTRATION

ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.

Family Social Capital: Links to Weight-Related and Parenting Behaviors of Mothers with Young Children

Family social capital includes the social relationships, values, and norms shared by a family and is positively linked with children’s mental and physical health status. This cross-sectional study addresses a gap in the literature related to family social capital vis-à-vis weight-related behaviors and home environments of 557 mothers and their young children (ages 2 to 9 years). Mothers completed an online survey comprised of valid, reliable questionnaires assessing family relationships and weight-related behavioral and home environment measures. The measures that determined family social capital (i.e., supportive, engaged parenting behaviors; family cohesion; family conflict; and family meal frequency) yielded distinct tertile groups that differed significantly (p < 0.001) on every family social capital measure with large effect sizes. Analysis of variance with Tukey post-hoc test revealed greater family social capital was linked to significantly better maternal health, dietary intake, physical activity, and sleep behavior. Additionally, maternal modeling of healthy eating and physical activity, child feeding practices, and home environments was higher in groups with greater family social capital. Child mental and physical health, physical activity, and sleep quality were better in families with greater family social capital. Findings suggest greater family social capital is linked to healthier weight-related behaviors and home environments. Future intervention studies should incorporate strategies to build family social capital and compare longitudinal outcomes to traditional interventions to determine the relative value of family social capital on health behaviors.

The Correlation Between Parental Perceptions and Readiness to Change with Participation in a Pediatric Obesity Program Serving a Predominantly Black Urban Community: A Retrospective Cohort Study

BACKGROUND

This study assessed whether maternal BMI and perceptions about weight and reported level of readiness to change was correlated with compliance to a pediatric lifestyle modification program targeting a hard-to-reach urban population with a high prevalence of severe obesity.

METHODS

The Parental Readiness Questionnaire (PRQ) was administered to the child's mother at program entry. The PRQ consisted of forty-seven multiple-choice and 10-point Likert scale questions regarding family demographics, exercise and eating habits, attitudes about health, body image, and weight, and the desire to improve nutrition and physical activity. Analysis was performed on PRQs of participants to compare parental perceptions and readiness for change with compliance to program requirements. Analysis was conducted on 596 questionnaires and compliance was categorized into three groups based on attendance to follow-up visits.

RESULTS

Significant differences were found between short-term and long-term follow-up groups in regards to parental perception of one's health as well as the health, weight, and body image of their child. Differences were found in perceptions of one's own weight and body image as well as the health of one's self and child between the group with a maternal BMI < 35 and the group with a maternal BMI ≥ 35. A lower maternal BMI was associated with a better perception of one's own weight, body image, and health, as well as the health of the child.

CONCLUSION

Positive parental perceptions on weight were correlated with improved compliance to a pediatric lifestyle modification program.

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.

Using a sibling-adoption design to parse genetic and environmental influences on children's body mass index (BMI)

Dietary and physical activity behaviors formed early in life can increase risk for childhood obesity and have continued negative consequences for lifelong health. Previous research has highlighted the importance of both genetic and environmental (e.g., cultural environment or parental lifestyle) contributions to obesity risk, although these studies typically involve genetically-related individuals residing in the same household, where genetic similarity and rearing environment are inextricably linked. Here we utilize a sibling-adoption design to independently estimate genetic and environmental contributions to obesity risk in childhood and describe how these influences might vary as children age. As part of a prospective adoption study, the current investigation used data from biological siblings reared either apart or together, and nonbiological siblings reared together to estimate the contributions of genetics and environment to body mass indices (BMI) in a large cohort of children (N = 711). We used a variance partitioning model to allocate variation in BMI to that which is due to shared genetics, common environment, or unique environment in this cohort during middle childhood and adolescence. We found 63% of the total variance in BMI could be attributed to heritable factors in middle childhood sibling pairs (age 5-11.99; 95% CI [0.41,0.85]). Additionally, we observed that common environment explained 31% of variation in BMI in this group (95% CI [0.11,0.5]), with unique environment and error explaining the remaining variance. We failed to detect an influence of genetics or common environment in older sibling pairs (12-18) or pairs spanning childhood and adolescence (large sibling age difference), but home type (adoptive versus birth) was an important predictor of BMI in adolescence. The presence of strong common environment effects during childhood suggests that early interventions at the family level in middle childhood could be effective in mitigating obesity risk in later childhood and adolescence.

The role of maternal social networks on the outcomes of a home-based childhood obesity prevention pilot intervention

BACKGROUND

Despite evidence that obesity and related behaviors are influenced by social networks and social systems, few childhood obesity initiatives have focused on social network factors as moderators of intervention outcomes, or targets for intervention strategies.

OBJECTIVES

This pilot study examines associations between maternal social network characteristics hypothesized to influence health behaviors, and the target outcomes of a family-centered childhood obesity prevention initiative. The pilot intervention entailed the provision of healthy eating and activity components as part of an existing home visiting program (HVP) delivered to mothers and infants, to test the feasibility of this approach for improving mother diet, physical activity, and weight status; and infant diet and weight trajectory.

METHODS

Mothers and their infants (N=50 dyads) receiving services from our HVP partner were recruited and randomized to receive the HVP core curriculum with or without a nutrition and physical activity enhancement module for six months. Assessments of mothers' social network characteristics, mother/infant food intake and mother physical activity, and mothers' postpartum weight retention and children's growth velocity were conducted at baseline and post-intervention.

RESULTS

Several features of mothers' social networks, including the receipt of health-related social support, were significantly associated with the focal intervention outcomes (p < .05) at follow-up, controlling for study condition.

CONCLUSIONS

Integrating childhood obesity prevention into HVPs appears promising. Future family-based interventions to prevent childhood obesity may be enhanced by including social network intervention strategies. For example, by addressing family network characteristics that impede healthy behavior change, or enhancing networks by fostering social support for healthy behavior and weight change.

Distribution of body mass index in children with different parental risk: Findings of a family-based cohort study in a West-Asian population

Using quantile regression analysis, the current study, conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) aimed to assess the effects of parental risk clusters on different percentiles of Body Mass Index (BMI) distribution in children. Participants included 2296 school-aged children who had participated in the baseline assessment of the TLGS and were followed for an approximate duration of fifteen years. Parental socio-demographic, behavioral and clinical characteristics were considered to determine risk clusters. Comparing of the high- to the low-risk parental clusters showed that after adjusting for age in boys, BMI was significantly higher at the 75^th (1.82, p = 03), 85^th (1.78, p = 0.007) and 95^th (1.66, p = 0.03) percentiles; and in girls it was significantly higher at the 25^th (1.45, p = 0.003), 50^th (1.05, p = 0.015), 95^th (2.31, p = 0.018) and 97^th (2.44, p = 0.006) percentiles in the high risk cluster. Our data indicate that during a long-term follow up, children with a high-risk family are more likely to have higher BMI, compared to their counterparts in low-risk families, a difference observed mainly at the upper percentiles of BMI distribution for both genders and at all ages, findings that should be considered for strategies aimed at preventing childhood obesity and its consequences.

Physical Activity, Screen Time, and Dietary Intake in Families: A Cluster-Analysis With Mother-Father-Child Triads

Background: The co-occurrence of multiple health behaviors such as physical activity, diet, and sedentary behavior affects individuals' health. Co-occurence of different health behaviors has been shown in a large number of studies. This study extended this perspective by addressing the co-occurrence of multiple health behaviors in multiple persons. The objective was to examine familial health behavioral patterns by (1) identifying clusters of families with similar behavior patterns and (2) characterizing the clusters by analyzing their correlates.

Methods: Cross-sectional data were collected from 198 families (mother, father, and child). Mothers, fathers, and children completed questionnaires assessing health related behaviors (physical activity, consumption of “healthy” and “unhealthy” foods, and screen time), the perception of Family Health Climate (regarding physical activity and nutrition) and demographics. Twelve variables (four health behaviors of three family members) were included in a cluster analysis conducted with Ward's Method and K-means analysis. Chi-square tests and analyses of variance were performed to characterize the family clusters regarding their demographics and their perception of Family Health Climate.

Results: Three clusters of families with specific behavioral patterns were identified: “healthy behavior families” with levels of physical activity and consumption of healthful foods above average and levels of media use and consumption of sweets below average; “unhealthy behavior families” with low levels of consumption of healthful foods and high levels of screen time; “divergent behavior families” with unhealthier behavioral patterns in parents and healthier screen time and eating behaviors combined with low physical activity levels in children. Family Health Climate differed between family clusters with most positive ratings in “healthy behavior families” and least positive ratings in “unhealthy behavior families.” “Divergent behavior families” rated the nutrition climate nearly as high as “healthy behavior families” while they rated the physical activity climate nearly as low as the “unhealthy behavior families.”

Conclusions: The study shows that co-occurrence of multiple health behaviors occurs on the family level. Therefore, focusing the family as a whole instead of individuals and targeting aspects related to the Family Health Climate in interventions could result in benefits for both children and adults and enhance effectivity of intervention programs.

Clustering of Obesity-Related Risk Behaviors Among Families With Preschool Children Using a Socioecological Approach: Cross-Sectional Study

BACKGROUND

Limited attention has been given to assessing home environments of parents with preschool-aged children using a socioecological approach to better understand potential influencers of obesity risk.

OBJECTIVE

The purpose of this cross-sectional study was to examine the clustering of obesity-related risk behaviors among mothers with preschool children.

METHODS

Mothers with preschool-aged children (ages 2 to 5 years) who participated in the online Home Obesogenic Measure of Environments (HOMES) survey were examined in clustering of four healthy recommended behaviors (ie, mother's fruit and vegetable intake ≥5 per day, sedentary screen time <4 hours per day, sugar-sweetened beverage intake <1 time/day, and increased physical activity level). Frequencies and percents of the clustering variables were conducted along with Spearman rank order correlations to determine significant associations. Ward's method with squared Euclidean distances were performed for the cluster analysis using the four standardized continuous variables. Identification of total cluster number was determined by visually inspecting the dendogram. Sociodemographic, intrapersonal, social environment, and home physical environment characteristic differences between cluster groups were further examined by independent t tests and chi-square analysis to validate findings.

RESULTS

Of the 496 participants (72.6%, 360/496 white; age mean 32.36, SD 5.68 years), only a third (37.1%, 184/496) consumed five or more servings of fruits/vegetables daily, had low sedentary screen time of <4 hours/day, and reported moderate to high levels of physical activity (34.1%, 169/496). More than half (57.7%, 286/496) consumed <1 sugar-sweetened beverage serving daily. A positive correlation (r=.34, P<.001) between physical activity level and fruit/vegetable intake (≥5 servings/day), and a positive correlation (r=.15, P=.001) between low sedentary screen time (<4 hours/day) and low sugar-sweetened beverage intake (<1 serving/day) were found. Ward's hierarchical analysis revealed a two-cluster solution: less healthy/inactive moms (n=280) and health conscious/active moms (n=216). Health conscious/active moms were significantly (P<.010) likely to be more physically active, have lower sedentary screen time, lower daily intake of sugar-sweetened beverages, and greater daily intake of fruits and vegetables compared to less healthy/inactive moms. Less healthy/inactive moms were significantly more likely to have a higher body mass index and waist circumference compared to the other cluster; however, there were no significant sociodemographic differences. There were many intrapersonal (eg, importance of physical activity for child and self) and home physical environment (eg, home availability of fruits/vegetables and salty/fatty snacks) characteristic differences between clusters, but few significant differences emerged for social environment characteristics (eg, family meals, family cohesion).

CONCLUSIONS

Findings may have implications in tailoring future obesity prevention interventions among families with young children.

Chemical and non-chemical stressors affecting childhood obesity: a systematic scoping review

Childhood obesity in the United States has doubled over the last three decades and currently affects 17% of children and adolescents. While much research has focused on individual behaviors impacting obesity, little research has emphasized the complex interactions of numerous chemical and non-chemical stressors found in a child's environment and how these interactions affect a child's health and well-being. The objectives of this systematic scoping review were to (1) identify potential chemical stressors in the context of non-chemical stressors that impact childhood obesity; and, (2) summarize our observations for chemical and non-chemical stressors in regards to child-specific environments within a community setting. A review was conducted to identify chemical and non-chemical stressors related to childhood obesity for the childhood life stages ranging from prenatal to adolescence. Stressors were identified and grouped into domains: individual behaviors, family/household behaviors, community stressors, and chemical exposures. Stressors were related to the child and the child's everyday environments and used to characterize child health and well-being. This review suggests that the interactions of chemical and non-chemical stressors are important for understanding a child's overall health and well-being. By considering these relationships, the exposure science research community can better design and implement strategies to reduce childhood obesity.

The marketing plan and outcome indicators for recruiting and retaining parents in the HomeStyles randomized controlled trial

Background

Despite the critical importance of successful recruitment and retention to study integrity, reporting of recruitment and retention strategies along with factors associated with successful recruitment and retention of participants in health-related interventions remain rare, especially for health and obesity prevention programs. Thus, the purpose of this article is to retrospectively examine the recruitment and retention marketing plan used in the online HomeStyles randomized controlled trial (RCT) and discuss outcomes associated with completion of the intervention.

Methods

The HomeStyles RCT is an online intervention developed to motivate parents of young children to gain the skills and self-confidence needed to shape home environments and lifestyles to be protective against childhood obesity. Using the seven Ps of services marketing (i.e., people, place, product, physical evidence, price, promotion, and process), a comprehensive and systematic plan for recruitment and retention was implemented and outcomes assessed.

Results

A total of 489 parents with a young child aged 2 to < 6 years were eligible to participate, a final capture rate of 33%. Only 23% of Hispanic participants chose to use the Spanish-language version of HomeStyles intervention materials, below the demand anticipated. However, Hispanic enrollment overall was substantially higher than the U.S. population proportion (i.e., 17%). The number of participants prematurely leaving the study was similar in both treatment groups, indicating attrition was not differential. Completers reported high satisfaction of HomeStyles, using a 1–5 scale (strongly disagree to strongly agree) on guide attractiveness, interestingness, and usefulness. Despite all the retention efforts, the average monthly recruitment accrual rate of ~ 33 eligible enrolled participants at baseline (i.e., 489 participants/15-month recruitment period), declined to ~ 18, 11, 9, and 8 remaining recruited participants/month at midpoint, post, follow-up, and long-term follow-up surveys, respectively. In general, survey completers were significantly more likely to be female and perceived their child’s health status to be better, and they were significantly less likely to be restrictive of their child’s food intake.

Conclusions

The findings of the present study highlight the need for far-reaching, concentrated, and varied recruitment strategies; sufficient time in the research plan for recruitment and retention activities; and creative, tireless, flexible, persistent project staff for health-related interventions.

HomeStyles, A Web-Based Childhood Obesity Prevention Program for Families With Preschool Children: Protocol for a Randomized Controlled Trial

Background

The home environment is where young children spend most of their time, and is critically important to supporting behaviors that promote health and prevent obesity. However, the home environment and lifestyle patterns remain understudied, and few interventions have investigated parent-led makeovers designed to create home environments that are supportive of optimal child health and healthy child weights.

Objective

The aim of the HomeStyles randomized controlled trial (RCT) is to determine whether the Web-based HomeStyles intervention enables and motivates parents to shape the weight-related aspects of their home environments and lifestyle behavioral practices (diet, exercise, and sleep) to be more supportive of their preschool children’s optimal health and weight.

Methods

A rigorous RCT utilizing an experimental group and an attention control group, receiving a bona fide contemporaneous treatment equal in nonspecific treatment effects and differing only in subject matter content, will test the effect of HomeStyles on a diverse sample of families with preschool children. This intervention is based on social cognitive theory and uses a social ecological framework, and will assess: intrapersonal characteristics (dietary intake, physical activity level, and sleep) of parents and children; family interpersonal or social characteristics related to diet, physical activity, media use, and parental values and self-efficacy for obesity-preventive practices; and home environment food availability, physical activity space and supports in and near the home, and media availability and controls in the home.

Results

Enrollment for this study has been completed and statistical data analyses are currently underway.

Conclusions

This paper describes the HomeStyles intervention with regards to: rationale, the intervention’s logic model, sample eligibility criteria and recruitment, experimental group and attention control intervention content, study design, instruments, data management, and planned analyses.

Parental Correlates of Body Weight Status Among High School Students in Tehran

This study aimed to determine the parental correlates of body weight status among adolescents in Tehran. The participants were 465 high school students and their parents who resided in Tehran. Body weight and height of the students were measured, and body mass index (BMI)-for-age and body weight status of the students were determined according to the world health organization growth reference (2007). Parents of the students completed a self-administered questionnaire including socio-demographic information, self-reported parental body weight and height, and parental perception of student's body weight status. About half of the parents had an incorrect perception about body weight status of their children with higher rates of underestimation than overestimation. The percentage of parents who correctly perceived body weight status of the students decreased from 100.0% in severe thinness group to 14.0% in obese group. There were no significant associations between marital status, occupation, and education of parents and BMI-for-age of the students. While, both BMI of mother and BMI of father were significantly associated with students' BMI-for-age (r = 0.29 and r = 0.27, respectively; P < 0.05). A great number of parents had incorrect perception regarding body weight status of their offspring; this was true specifically for parents of overweight and obese students. Both parental BMI and parental perception regarding students' body weight status were associated with students' BMI-for-age, indicating the need for parental involvement in weight management programs targeting adolescents.

Intergenerational Social Networks and Health Behaviors Among Children Living in Public Housing

OBJECTIVES

In a survey of families living in public housing, we investigated whether caretakers' social networks are linked with children's health status.

METHODS

In 2011, 209 children and their caretakers living in public housing in suburban Montgomery County, Maryland, were surveyed regarding their health and social networks. We used logistic regression models to examine the associations between the perceived health composition of caretaker social networks and corresponding child health characteristics (e.g., exercise, diet).

RESULTS

With each 10% increase in the proportion of the caretaker's social network that exercised regularly, the child's odds of exercising increased by 34% (adjusted odds ratio = 1.34; 95% confidence interval = 1.07, 1.69) after the caretaker's own exercise behavior and the composition of the child's peer network had been taken into account. Although children's overweight or obese status was associated with caretakers' social networks, the results were no longer significant after adjustment for caretakers' own weight status.

CONCLUSIONS

We found that caretaker social networks are independently associated with certain aspects of child health, suggesting the importance of the broader social environment for low-income children's health.

Parental correlations of physical activity and body mass index in young children--he GECKO Drenthe cohort

Background

Parental behavior can influence the development of overweight in children. The aim of this study is to examine whether parental BMI and parental physical activity are associated with BMI, waist circumference and physical activity in young children.

Methods

In 3–4 year old children, weight, height and waist circumference were measured. Children’s physical activity was measured in a subgroup (n = 299) using a tri-axial activity monitor, Tracmor_D. Data are represented as activity counts per minute (total physical activity) and as percentage of time in sedentary, light, moderate and vigorous intensity physical activity (generated from a subsample of Actigraph data using cut points from Butte et al.). Parental weight and height were self-reported and parental physical activity was assessed by the validated questionnaire SQUASH.

Results

In total 1554 children (age 3.9 ± 0.1 years, BMI 15.8 ± 1.3 kg/m2 and waist circumference 52.4 ± 3.5 cm) were included. Eleven percent were overweight or obese. A higher maternal BMI was related to higher levels of children’s sedentary activity (r = 0.120, p = 0.04 and to lower levels of children’s total and moderate physical activity (r = −0.158, p = 0.007 and r = −0.154, p = 0.008, respectively). Parental BMI was positively correlated with children’s BMI and waist circumference (r = 0.20–0.27, p < 0.001). Higher maternal total physical activity levels were not related to children’s total physical activity level, but were related to higher levels of children’s moderate and vigorous physical activity (ρ = 0.132, p = 0.046 and ρ = 0.132, p = 0.046, respectively). No correlations between total, moderate or vigorous physical activity levels of the parents with the child’s BMI or waist circumference were found. Looking at physical activity domains maternal physical activity in active commuting, either walking or biking, showed a negative correlation with BMI of the child (ρ = −0.062, p = 0.042).

Conclusions

Higher maternal BMI and lower maternal physical activity levels were related to lower levels of children’s physical activity. More active commuting by the mother and a lower parental BMI were related to a lower BMI of the children. Energy-balance related behavior of the parents may contribute to a healthier BMI of both preschool children and their parents.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Parental guidance advised: associations between parental television limits and health behaviors among obese children

OBJECTIVE

To examine associations between parental limits on TV viewing and child health behaviors.

METHODS

We surveyed 816 parents of children 6 to 12 years of age who were participating in a primary care-based obesity intervention. The main exposures were parental limits placed on child TV viewing time and TV content. Outcomes included screen-related behaviors, sleep habits, eating routines, and physical activity. We performed bivariate and multivariable analyses to examine independent associations of parental TV viewing rules with our outcomes.

RESULTS

In multivariable analyses adjusted for child age, sex, race/ethnicity; parental education and US-born status; income and primary language, children whose parents set limits on TV time were less likely to have a TV in their bedroom (odds ratio [OR] 0.45; 95% confidence interval [CI] 0.31, 0.64) or to fall asleep while watching TV (OR 0.47; 95% CI 0.34, 0.67). Children with parental limits spent fewer weekday hours watching TV (-0.38 hours/day; 95% CI -0.54, -0.21), playing video or computer games (-0.15 hours/day; 95% CI -0.25, -0.04), and using the Internet (-0.08 hours/day; 95% CI -0.15, -0.006). In addition, children with limits on TV time were less likely to eat breakfast (OR 0.73; 95% CI 0.53, 0.99) or dinner (OR 0.53; 95% CI 0.39, 0.73) with the TV on, and they slept longer during weeknights: 0.21 hours/day (95% CI 0.05, 0.36). Moreover, children whose parents set rules on TV programming content were also less likely to have a TV in their bedroom (OR 0.37; 95% CI 0.18, 0.79).

CONCLUSIONS

The relationship between parental limits on TV viewing and obesogenic child behaviors deserves further investigation.

The childhood obesity epidemic as a result of nongenetic evolution: the maternal resources hypothesis

Over the past century, socioenvironmental evolution (eg, reduced pathogenic load, decreased physical activity, and improved nutrition) led to cumulative increments in maternal energy resources (ie, body mass and adiposity) and decrements in energy expenditure and metabolic control. These decrements reduced the competition between maternal and fetal energy demands and increased the availability of energy substrates to the intrauterine milieu. This perturbation of mother-conceptus energy partitioning stimulated fetal pancreatic β-cell and adipocyte hyperplasia, thereby inducing an enduring competitive dominance of adipocytes over other tissues in the acquisition and sequestering of nutrient energy via intensified insulin secretion and hyperplastic adiposity. At menarche, the competitive dominance of adipocytes was further amplified via hormone-induced adipocyte hyperplasia and weight-induced decrements in physical activity. These metabolic and behavioral effects were propagated progressively when obese, inactive, metabolically compromised women produced progressively larger, more inactive, metabolically compromised children. Consequently, the evolution of human energy metabolism was markedly altered. This phenotypic evolution was exacerbated by increments in the use of cesarean sections, which allowed both the larger fetuses and the metabolically compromised mothers who produced them to survive and reproduce. Thus, natural selection was iatrogenically rendered artificial selection, and the frequency of obese, inactive, metabolically compromised phenotypes increased in the global population. By the late 20th century, a metabolic tipping point was reached at which the postprandial insulin response was so intense, the relative number of adipocytes so large, and inactivity so pervasive that the competitive dominance of adipocytes in the sequestering of nutrient energy was inevitable and obesity was unavoidable.

Latino family childcare providers' beliefs, attitudes, and practices related to promotion of healthy behaviors among preschool children: a qualitative study

BACKGROUND

The continuing rise of obesity among Latinos is a public health concern with an immediate need for early prevention. Changes in family structures have increased demand and reliance for child care for young children. Latino children are the fastest-growing segment of the child population in the United States, and research shows that Latino families use preschools and day care centers much less than those of other ethnic groups, apparently because of cultural preferences for family-like care.

OBJECTIVES

Given that many low income Latino children attend family child care homes (FCCHs), there is a need to explore the role that FCCH providers may play in establishing and reinforcing children's early healthful eating and physical activity behaviors and consequently in the prevention of childhood obesity.

DESIGN

Using purposive sampling, six focus groups were conducted in Spanish with licensed Latino FCCH providers (n = 44). Data was analyzed to identify recurrent themes.

RESULTS

Latino FCCH providers described how they play an influential role in promoting healthful eating and physical activity behaviors of preschool children in their care. They also identified many barriers and challenges in establishing and maintaining healthful nutrition and physical activity behaviors, including high cost of healthy foods, cold weather, and physical environment of FCCH.

CONCLUSIONS

Latino FCCH providers can have a strong impact in promoting healthful behaviors in low-income, Latino communities. They may be able to effectively deliver interventions targeting low-income, minority families to promote healthful eating and physical activity behaviors and prevent child obesity.

Physical activity barriers and facilitators among working mothers and fathers

Background

The transition to parenthood is consistently associated with declines in physical activity. In particular, working parents are at risk for inactivity, but research exploring physical activity barriers and facilitators in this population has been scarce. The purpose of this study was to qualitatively examine perceptions of physical activity among working parents.

Methods

Working mothers (n = 13) and fathers (n = 12) were recruited to participate in one of four focus group sessions and discuss physical activity barriers and facilitators. Data were analyzed using immersion/crystallization in NVivo 10.

Results

Major themes for barriers included family responsibilities, guilt, lack of support, scheduling constraints, and work. Major themes for facilitators included being active with children or during children’s activities, being a role model for children, making time/prioritizing, benefits to health and family, and having support available. Several gender differences emerged within each theme, but overall both mothers and fathers reported their priorities had shifted to focus on family after becoming parents, and those who were fitting in physical activity had developed strategies that allowed them to balance their household and occupational responsibilities.

Conclusions

The results of this study suggest working mothers and fathers report similar physical activity barriers and facilitators and would benefit from interventions that teach strategies for overcoming barriers and prioritizing physical activity amidst the demands of parenthood. Future interventions might consider targeting mothers and fathers in tandem to create an optimally supportive environment in the home.

Learning to eat: birth to age 2 y

During the first 2 y of life, development is rapid and includes dramatic changes in eating behavior. Individual patterns of food preferences and eating behaviors emerge and differ depending on the foods offered and on the contexts of feeding during this early period of dietary transition. In this review, we discuss evidence on ways in which early learning influences food preferences and eating behavior, which, in turn, shape differences in dietary patterns, growth, and health. Although the evidence reviewed indicates that this early period of transition provides opportunities to influence children's developing intake patterns, there is no consistent, evidence-based guidance for caregivers who are feeding infants and toddlers; the current Dietary Guidelines are intended to apply to Americans over the age of 2 y. At present, the evidence base with regard to how and what children learn about food and eating behavior during these first years is limited. Before developing guidance for parents and caregivers, more scholarship and research is necessary to understand how infants and toddlers develop the food preferences and self-regulatory processes necessary to promote healthy growth, particularly in today's environment. By the time they reach 2 y of age, children have essentially completed the transition to "table foods" and are consuming diets similar to those of other family members. This article discusses parenting and feeding approaches that may facilitate or impede the development of self-regulation of intake and the acceptance of a variety of foods and flavors necessary for a healthy diet. We review the limited evidence on how traditional feeding practices, familiarization, associative learning, and observational learning affect the development of eating behavior in the context of the current food environment. Areas for future research that could inform the development of anticipatory guidance for parents and caregivers responsible for the care and feeding of young children are identified.

Maternal inactivity: 45-year trends in mothers' use of time

OBJECTIVE

To examine 45-year trends in time use and physical activity energy expenditure (PAEE) in a nationally representative sample of US mothers.

PARTICIPANTS AND METHODS

We quantified time allocation to physical activity (PA), sedentary behaviors (SED), and PAEE from 1965 to 2010 in mothers with older children (MOC) (>5 to ≤18 years) and mothers with younger children (MYC) (≤5 years). Physical activity was the sum of time allocated to housework, child care, laundry, food preparation, postmeal cleanup, and exercise. Sedentary behavior was the sum of time spent in a vehicle and using screen-based media. Physical activity energy expenditure was calculated using body weights from national surveys and metabolic equivalents.

RESULTS

From 1965 to 2010, the time allocated to PA decreased by 11.1 h/wk (from 32.0 to 20.9 h/wk) in MOC and by 13.9 h/wk (from 43.6 to 29.7 h/wk) in MYC. The time spent in SED increased by 7.0 h/wk in MOC (from 17.7 to 24.7 h/wk) and increased by 5.7 h/wk in MYC (from 17.0 to 22.7 h/wk). Physical activity energy expenditure decreased by 1237.6 kcal/wk (176.8 kcal/d) in MOC (from 5835.3 to 4597.7 kcal/wk), and in MYC, PAEE decreased by 1572.5 kcal/wk (224.6 kcal/d), from 7690.5 to 6118.0 kcal/wk.

CONCLUSION

There was a significant reallocation of time by mothers from PA (eg, housework) to SED (eg, watching television) between 1965 and 2010. Given the essential role of PA for health and the potential for the intergenerational transmission of obesity and obesogenic behaviors, these results suggest that maternal inactivity may be an important target for the primary prevention of chronic noncommunicable diseases and obesity.

Overweight and obesity among Hispanic children entering foster care: a preliminary examination of polyvictimization

This retrospective medical chart review examined the prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) in Hispanic foster children aged 2-18 years in Los Angeles, California. Logistic regression was used for boys and girls separately to analyze polyvictimization (i.e., one vs. two or more types of maltreatment), type of maltreatment (abuse vs. neglect), and age-group as risk factors for overweight and obesity. Almost 40% of participants were overweight/obese, with the highest prevalence (47.7%) observed among children aged 12-18. Children aged 6-18 were at an increased risk of overweight/obesity and obesity compared with children aged 2-5. Although polyvictimization has been shown to have adverse health effects, in this study, it was related to slightly lower odds of obesity for boys but was unrelated to high weight for girls. Addressing the obesity epidemic among Hispanic foster children is vital to preventing continued obesity and the development of obesity-related health problems, especially by focusing on important community and family influences.

Weight changes in children in foster care for 1 year

OBJECTIVE

The aims of this study of predominately racial/ethnic minority children in foster care (N=360, birth to 19 years old) in Los Angeles, CA were to examine the (1) prevalence of obesity (≥ 95 percentile) and overweight/obese (≥ 85 percentile) upon entrance to foster care (T1) and after 1 year in foster care (T2); (2) comparison of high weight categories to national statistics; (3) relationship of changes in weight status to age, reason for entry into foster care, and placement.

METHODS

Chi-square test and McNemar test comparing paired proportions were used to determine whether there were significant changes in the proportion of high weight categories between T1 and T2. Chi-square test or Fisher's exact test were used to evaluate the association between age, placement, and reason for foster care with the change in weight category. Changes in weight were categorized as (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, or (4) remained normal.

RESULTS

The proportion of obese and obese/overweight children between ages 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics. Of children at all ages, 64.7% of children of all ages entered foster care with a normal weight and stayed in the normal range during their first year in foster care, 12.2% decreased their weight, 15.4% remained overweight or obese, and 7.7% increased their weight. Age and parental substance use was related to change in weight category from T1 to T2.

CONCLUSION

Children did not become more overweight or obese in foster care; however 28% of the children were obese or overweight upon entry into foster care. Children who are 6 years or older and obese upon entering foster care should be targeted for weight reduction. The pediatric community and child welfare system need to work together by including weight percentiles in the foster care file and training/monitoring child welfare caregivers in weight reduction interventions.

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

BACKGROUND

Providing personalized genetic-risk feedback of a child's susceptibility to adult-onset health conditions is a topic of considerable debate. Family health history (FHH), specifically parental overweight/obesity status, is a useful assessment for evaluating a child's genetic and environmental risk of becoming obese. It is unclear whether such risk information may influence parents' efforts to reduce their child's risk of obesity.

PURPOSE

To evaluate whether telling mothers the magnitude of their child's risk of becoming obese based on personal FHH influenced food choices for their young child from a virtual reality-based buffet restaurant.

METHODS

Overweight/obese mothers of a child aged 4-5 years who met eligibility criteria (N=221) were randomly assigned to one of three experimental arms, which emphasized different health information: arm 1, food safety control (Control); arm 2, behavioral-risk information (BRI) alone or arm 3, behavioral-risk information plus personal FHH-based risk assessment (BRI+FHH). Mothers donned a head-mounted display to be immersed in a virtual restaurant buffet, where they selected virtual food and beverages as a lunch for their child.

RESULTS

Mothers who were randomized to BRI+FHH filled the index child's plate with an average of 45 fewer calories than those in the Control arm (P<0.05); those in the BRI arm filled the plate with 35 fewer calories than the Control arm, a non-significant difference. Calorie restriction was greatest among mothers in the BRI+FHH arm who received the weaker-risk message (that is, only one overweight parent).

CONCLUSIONS

The influence of communicating a child's inherited risk of obesity on mothers' feeding practices may vary by the risk level conveyed. High-risk messages may best be coupled with strategies to increase mother's perceptions that efforts can be undertaken to reduce risk and build requisite behavioral skills to reduce risk.

Psychosocial factors associated with depressive mood in Israeli obese adolescents

This study aimed to compare levels of depressive symptoms between normal-weight and obese Israeli adolescents and to identify sociodemographic factors that may explain differences in depression between these groups. Thirty normal-weight and 49 obese patients aged 12–18 years participated in this study. The obese group had a significantly higher depression score. On linear regression analysis, obesity, lower parental income, and lower self-esteem were significantly associated with a higher depression score. This model explained 32.4 percent of the variance. The results indicate that psychosocial assessment and identification of depressive signs should be considered integral components in the management of adolescent obesity.

A parent focused child obesity prevention intervention improves some mother obesity risk behaviors: the Melbourne inFANT program

Background

The diets, physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal. The family environment, as the first ecological niche of children, exerts an important influence on the onset of children’s habits. Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives. The focus on parent’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well.

Objective

To assess the effect of a parent-focused early childhood obesity prevention intervention on first-time mothers’ diets, physical activity and TV viewing time.

Methods

The Melbourne InFANT Program is a cluster-randomized controlled trial which involved 542 mothers over their newborn’s first 18 months of life. The intervention focused on parenting skills and strategies, including parental modeling, and aimed to promote development of healthy child and parent behaviors from birth, including healthy diet, increased physical activity and reduced TV viewing time. Data regarding mothers’ diet (food frequency questionnaire), physical activity and TV viewing times (self-reported questionnaire) were collected using validated tools at both baseline and post-intervention. Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups. Analysis of covariance was used to measure the impact of the intervention.

Results

The scores of both the "High-energy snack and processed foods" and the "High-fat foods" dietary patterns decreased more in the intervention group: -0.22 (−0.42;-0.02) and −0.25 (−0.50;-0.01), respectively. No other significant intervention vs. control effects were observed regarding total physical activity, TV viewing time, and the two other dietary patterns, i.e. “Fruits and vegetables” and “Cereals and sweet foods”.

Conclusions

These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively. Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention.

Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial

Relatively little research has assessed the association between obesogenic behaviors in parents and their children. The objective of the present analysis was to examine cross-sectional associations in television (TV)/video viewing, sugar-sweetened beverage intake, and fast food intake between mothers and their preschool aged children. We studied baseline data among 428 participants in High Five for Kids, a randomized controlled trial of behavior change among overweight and obese children of ages 2-6.9 years. The main exposures were whether mothers viewed TV/videos <1 h/day, drank <1 serving/day of sugar-sweetened beverages, and ate fast food <1 time/week. The main outcomes were whether children met these goals for the same behaviors. Using multivariate logistic regression adjusted for maternal and child characteristics, we estimated odds ratios of children meeting the behavioral goals. The majority of mothers ate fast food <1 time/week (73%) and drank <1 serving/day of sugar-sweetened beverages (73%), while few mothers viewed <1 h/day of TV/videos (31%). Most children met the fast food goal (68%), but not the goals for sugar-sweetened beverages (31%) or TV/video viewing (13%). In adjusted models, the odds ratios for a child meeting the goal were 3.2 (95% confidence interval (CI) 1.7, 6.2) for TV/video viewing, 5.8 (95% CI 2.8, 12.0) for sugar-sweetened beverage intake, and 17.5 (95% CI 9.8, 31.2) for fast food intake if their mothers met the goal for the same behavior. Obesogenic behaviors of mothers and preschool aged children were strongly associated. Our findings lend support to obesity prevention strategies that target parental behavior and the family environment.

Overweight and obesity among maltreated young adolescents

PURPOSE

(1) To identify and compare rates of body mass index (BMI)≥ 85% (overweight/obesity) and BMI ≥ 95% (obesity) in maltreated versus comparison young adolescents; (2) to determine whether demographic/psychological characteristics are related to high BMI; (3) to determine whether type of maltreatment is related to high BMI in maltreated young adolescents.

METHODS

We compared a sample of maltreated young adolescents to a comparison sample of adolescents from the same neighborhood. The maltreated sample (n=303) of young adolescents (ages 9-12) came from referrals from the county child welfare department in Los Angeles, CA from new cases of maltreatment opened in specified zip codes. A comparison sample (n=151) was recruited from the same zip codes. The total sample (both maltreated and comparison) was 77% Black or Hispanic and 23% White or biracial with 53% males and 47% females. A stepwise logistic regression was used to examine predictors of high BMI with demographic/psychological covariates and maltreatment group. The maltreated young adolescents were selected and the logistic model included all covariates as well as an interaction between gender and each maltreatment type (neglect, sexual, and physical abuse).

RESULTS

Maltreated young adolescents were similar to comparison adolescents in obesity prevalence (27.1% and 34.4%, respectively), although comparison young adolescents were 1.7 times more likely to have overweight/obesity than the maltreated young adolescents (95% CI=1.13-2.76). No demographic variables predicted high BMI. For the comparison young adolescents, depression slightly increased the odds of overweight/obesity (OR=1.08, 95% CI=1.01-1.15). Being neglected reduced the odds of being in the overweight/obesity and obesity group when combining genders. For females, but not males, sexual and physical abuse slightly reduced the odds of obesity.

CONCLUSIONS

Both the maltreated and comparison young adolescents had a high prevalence of overweight and obesity, which puts them at risk for health problems. Maltreatment reduced the odds of having a high BMI for adolescents in this study, which is opposite to research in adults. Further exploration of the mechanism of how maltreatment is related to weight as adolescents age, with specific emphasis on differences between genders, is needed.

Competitive Food Sales in Schools and Childhood Obesity: A Longitudinal Study

The vast majority of American middle schools and high schools sell what is known as "competitive foods", such as soft drinks, candy bars, and chips, to children. The relationship between consumption of sugar-sweetened drinks and snacks and childhood obesity is well established but it remains unknown whether competitive food sales in schools are related to unhealthy weight gain among children. We examined this association using data from the Early Childhood Longitudinal Study Kindergarten Cohort. Employing fixed effects models and a natural experimental approach, we found that children's weight gain between 5(th) and 8(th) grades was not associated with the introduction or the duration of exposure to competitive food sales in middle school. Also, the relationship between competitive foods and weight gain did not vary significantly by gender, race/ethnicity, or family SES, and remained weak and insignificant across several alternative model specifications. One possible explanation is that children's food preferences and dietary patterns are firmly established before adolescence. Also, middle school environments may dampen the effects of competitive food sales because they so highly structure children's time and eating opportunities.

Less traditional diets in Chinese mothers and children are similarly linked to socioeconomic and cohort factors but vary with increasing child age

Global shifts toward an increasingly Western diet and rises in nutrition-related noncommunicable diseases necessitate systematic examination of dietary change in adults and children. This study longitudinally examined mother and child dietary intakes and their relationship with socioeconomic factors across 4 mutually exclusive cohorts followed over 6- to 7-y time periods (cohort A: 1991-1997, cohort B: 1993-2000, cohort C: 1997-2004, cohort D: 2000-2006). The cohorts included 966 mother-child pairs (children 3-5 y at baseline) from the China Health and Nutrition Survey. Dietary intake was assessed using 24-h recall and household food consumption data; dietary variables were the percentage of total energy from animal-source foods (ASF), fats/oils, and grains. Mother-child comparison of dietary variables used average annual change measures, Spearman partial correlations, random effects models, and seemingly unrelated regression models and estimation. Whereas children were earlier adopters and maintainers of a less traditional Chinese diet, mothers experienced greater shifts away from the traditional Chinese diet with increasing child age. Mother-child correlations for the dietary variables ranged from 0.46 to 0.89 (P < 0.001). Similar increased intake of ASF and decreased intake of grains were reported for mothers and children of urban (vs. rural) residence and with higher levels of maternal education (P < 0.001). A comparable cohort effect was shown, with mothers and children consuming a less traditional Chinese diet in the later (C and D) compared to earlier (A and B) cohorts (P < 0.05). Our findings provide insight into dietary changes in mothers and children within the context of a rapidly changing nutrition and socioeconomic environment.

Parental sedentary restriction, maternal parenting style, and television viewing among 10- to 11-year-olds

OBJECTIVE

To examine whether parenting styles or practices were associated with children's television (TV) viewing.

METHODS

A total of 431 parent-child dyads (10- to 11-year-old children) from Bristol, United Kingdom, were included. Child and parent TV viewing were self-reported and categorized as <2, 2 to 4, or >4 hours/day. Children reported maternal parenting style (authoritarian, authoritative, or permissive). Child-reported maternal and paternal sedentary restriction scores were combined to create a family-level restriction score. Multinomial logistic regression was used to examine whether child TV viewing was predicted by parenting style or family restriction.

RESULTS

A greater proportion of children with permissive mothers watched >4 hours of TV per day, compared with children with authoritarian or authoritative mothers (P = .033). A greater proportion of children for whom both parents demonstrated high restriction watched <2 hours of TV per day (P < .001). The risk of watching 2 to 4 hours (vs <2 hours) of TV per day was 2.2 times higher for children from low-restriction families (P = .010). The risk of watching >4 hours (vs <2 hours) of TV per day was 3.3 times higher for children from low-restriction families (P = .013). The risk of watching >4 hours of TV per day was 5.2 times higher for children with permissive (versus authoritative) mothers (P = .010).

CONCLUSIONS

Clinicians need to talk directly with parents about the need to place limitations on children's screen time and to encourage both parents to reinforce restriction messages.

Relationship of social cognitive theory concepts to mothers' dietary intake and BMI

Women tend to have the greatest responsibility for and influence on the home food environment. Understanding theoretical concepts as they pertain to mothers' food-related behaviours could inform the development of interventions that enhance mothers' ability to create healthy family food environments that support optimal child development and help attenuate obesity rates. Likert scales assessed Social Cognitive Theory concepts [i.e. self-efficacy, self-regulation (sets goals, self-reward, self-monitoring, environmental structuring), outcome expectations] and coping of 201 mothers in the context food-related activities. ANOVA determined whether diet and BMI differed among mothers scoring in the highest, middle, and lowest tertiles on the Likert scales. For self-efficacy, coping, sets goals, and outcome expectations scales, lowest tertile mothers had significantly higher BMIs than highest tertile mothers. The lowest tertile for self-efficacy, self-reward, and self-monitoring consumed significantly less fibre, vitamin C, magnesium, potassium, and fruit and vegetables than upper tertiles. On the self-efficacy scale, the lowest tertile consumed significantly more calories, fat, and cholesterol than higher tertiles. Environmental structuring scale findings indicate users of television during dinner had significantly lower intakes of fibre, vitamin C, magnesium, potassium, and fruits and vegetables than those almost never using TV during dinner. Stepwise regression revealed self-monitoring, environmental structuring, self-reward, and outcome expectations were significant positive predictors of self-efficacy. Self-monitoring was a significant positive predictor of outcome expectations. Associations between theoretical concepts, mothers' dietary intakes, and BMIs point to the need to incorporate components that build self-efficacy, self-regulation, outcome expectations, and coping skills into health promotion interventions.

Influence of contextual and individual level risk factors on adiposity in a preschool child cohort in Ho Chi Minh City, Vietnam

OBJECTIVE

To identify risk factors associated with changes in BMI and sum of skinfold thickness (SSF) in a cohort of preschool children in Ho Chi Minh City (HCMC), Vietnam.

METHODS

This one year follow-up study, using multi-stage cluster sampling, was conducted from 2005-2006 with 526 children aged 4-5 years in preschools in urban HCMC. Information on neighborhood, preschool and home environments, socio-economic status, the child and parental characteristics were collected using interview-administered questionnaires. Dietary intake and physical activity were measured using modified, validated questionnaires. Weight, height, and triceps, subscapular and suprailiac skinfold thickness were measured. Generalized estimating equations (GEEs) were used to assess the longitudinal relationships between the risk factors and the development of adiposity.

RESULTS

A variety of factors at different levels were associated with changes in BMI and SSFs. As safety of the neighborhood increased, BMI and SSFs decreased (coefficients for BMI: -0.59; 95% CI: -1.16 to -0.01 for girls and -0.80; 95% CI: -1.53, -0.08 for boys, and coefficients for SSFs: -2.71; 95% CI: -5.07, -0.35 for girls and -4.16, 95% CI: -8.28, -0.05). Having both parents overweight was strongly predictive of an increase in BMI (1.18, 0.21-2.16). Maternal pre-pregnant BMI status, breast-feeding, and high birth weight were also related to change in adiposity.

CONCLUSION

Contextual variables in the community and home environment, and parental characteristics appeared to be more important than individual factors for explaining on changes in adiposity in this child population.

A randomised controlled trial for overweight and obese parents to prevent childhood obesity--Early STOPP (STockholm Obesity Prevention Program)

BACKGROUND

Overweight and obesity have a dramatic negative impact on children's health not only during the childhood but also throughout the adult life. Preventing the development of obesity in children is therefore a world-wide health priority. There is an obvious urge for sustainable and evidenced-based interventions that are suitable for families with young children, especially for families with overweight or obese parents. We have developed a prevention program, Early STOPP, combating multiple obesity-promoting behaviors such unbalanced diet, physical inactivity and disturbed sleeping patterns. We also aim to evaluate the effectiveness of the early childhood obesity prevention in a well-characterized population of overweight or obese parents. This protocol outlines methods for the recruitment phase of the study.

DESIGN AND METHODS

This randomized controlled trial (RCT) targets overweight and/or obese parents with infants, recruited from the Child Health Care Centers (CHCC) within the Stockholm area. The intervention starts when infants are one year of age and continues until they are six and is regularly delivered by a trained coach (dietitian, physiotherapist or a nurse). The key aspects of Early STOPP family intervention are based on Swedish recommendations for CHCC, which include advices on healthy food choices and eating patterns, increasing physical activity/reducing sedentary behavior and regulating sleeping patterns.

DISCUSSION

The Early STOPP trial design addresses weaknesses of previous research by recruiting from a well-characterized population, defining a feasible, theory-based intervention and assessing multiple measurements to validate and interpret the program effectiveness. The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge, this longitudinal RCT is the first attempt to demonstrate whether an early, long-term, targeted health promotion program focusing on healthy eating, physical activity/reduced sedentary behaviors and normalizing sleeping patterns could be effective. If proven so, Early STOPP may protect children from the development of overweight and obesity.

TRIAL REGISTRATION

The protocol for this study is registered with the clinical trials registry clinicaltrials.gov, ID: ES-2010).

Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: postintervention results

The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children. The Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group-randomized controlled trial assessing the feasibility and effectiveness of a teacher-delivered weight control intervention for black preschool children. The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools. Children enrolled in the nine schools randomized to the intervention group received a 14-week weight control intervention delivered by their classroom teachers. Children in the nine control schools received a general health intervention. Height and weight, physical activity, screen time, and diet data were collected at baseline and postintervention. At postintervention, children in the intervention schools engaged in more moderate-to-vigorous physical activity (MVPA) than children in the control schools (difference between adjusted group means = 7.46 min/day, P = 0.02). Also, children in the intervention group had less total screen time (-27.8 min/day, P = 0.05). There were no significant differences in BMI, BMI Z score, or dietary intake. It is feasible to adapt an obesity prevention program to be taught by classroom teachers. The intervention showed positive influences on physical activity and screen time, but not on diet. Measuring diet and physical activity in preschool children remains a challenge, and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision.

Associations between parent behavior and adolescent weight control

OBJECTIVE

To evaluate associations between parent behaviors (i.e., parent weight change, self-monitoring of their behavior, and feeding practices and attitudes) and changes in adolescent BMI and weight following 16-weeks of behavioral weight control (BWC) intervention.

METHOD

Adolescents (N = 86) 13-16 years old and 30-90% overweight (M = 60.54%, SD = 15.10%) who completed BWC intervention and their parents. Adolescents were randomized to 1 of 2 interventions involving 16 consecutive weeks of active treatment with 4 biweekly maintenance sessions. Adolescent weight and BMI were measured at baseline and 16-weeks. Feeding practices were measured at baseline. Parent self-monitoring was measured during the intervention.

RESULTS

The only independently significant predictor of adolescent BMI change (p < .01) was parent BMI change. Greater parent self-monitoring (p < .01) predicted greater adolescent weight loss. Greater parent pressure to eat predicted less adolescent weight loss (p < .01).

CONCLUSIONS

Findings highlight the potential importance of parent weight-related behaviors and feeding practices in the context of adolescent BWC.

Latina mothers' beliefs and practices related to weight status, feeding, and the development of child overweight

OBJECTIVE

To examine maternal beliefs and practices related to weight status, child feeding, and child overweight in the Latino culture that may contribute to the rising rates of overweight among preschool Latino children in the United States.

DESIGN AND SAMPLE

This 2-phase qualitative study relies on data obtained in 6 focus groups with a total of 31 primarily Spanish-speaking, low-income mothers, followed by 20 individual, in-depth interviews with women participating in a health promotion educational program.

MEASURES

Child-feeding beliefs, practices, and weight status perceptions were elicited.

RESULTS

The findings indicated that most respondents reported personal struggles with weight gain, particularly during and after pregnancy, and were concerned that their children would become obese. Although subjects understood the health and social consequences related to overweight, many discussed the pressures of familial and cultural influences endorsing a "chubby child."

CONCLUSIONS

Education and interventions that incorporate "culturally mediated" pathways to address mothers' feeding practices are essential for the prevention and control of childhood overweight among low-income Latinos. Nurses should be aware of the social and cultural influences on Latina mothers' beliefs and practices related to weight status and feeding practices and address these in their education approaches to prevent childhood overweight and obesity with this population group.

Mediators of maternal depression and family structure on child BMI: parenting quality and risk factors for child overweight

Risk factors for child obesity may be influenced by family environment, including maternal depression, family structure, and parenting quality. We tested a path model in which maternal depression and single parent status are associated with parenting quality, which relates to three risk factors for child obesity: diet, leisure, and sedentary behavior. Participants included 4,601 5th-grade children and their primary caregivers who participated in the Healthy Passages study. Results showed that associations of maternal depression and single parenthood with child BMI are mediated by parenting quality and its relation to children's leisure activity and sedentary behavior. Interventions for child obesity may be more successful if they target family environment, particularly parenting quality and its impact on children's active and sedentary behaviors.

Formative assessment in the development of an obesity prevention component for the expanded food and nutrition education program in Texas

This study conducted formative research (surveys, focus groups) to assess the nutrition education needs of clients in the Texas Expanded Food and Nutrition Education Program prior to curriculum revision. Participants were current Expanded Food and Nutrition Education Program participants in 3 Texas cities (Austin, Houston, San Antonio). Data were used to tailor the curriculum to the target population. This research provides evidence that members of the target audience can provide valuable insights into a particular topic. Formative work prior to intervention development should be conducted to identify key issues regarding a particular topic and to evaluate potential educational approaches.

Parent-child interactions and objectively measured child physical activity: a cross-sectional study

Background

Parents influence their children's behaviors directly through specific parenting practices and indirectly through their parenting style. Some practices such as logistical and emotional support have been shown to be positively associated with child physical activity (PA) levels, while for others (e.g. monitoring) the relationship is not clear. The objectives of this study were to determine the relationship between parent's PA-related practices, general parenting style, and children's PA level.

Methods

During the spring of 2007 a diverse group of 99 parent-child dyads (29% White, 49% Black, 22% Hispanic; 89% mothers) living in low-income rural areas of the US participated in a cross-sectional study. Using validated questionnaires, parents self-reported their parenting style (authoritative, authoritarian, permissive, and uninvolved) and activity-related parenting practices. Height and weight were measured for each dyad and parents reported demographic information. Child PA was measured objectively through accelerometers and expressed as absolute counts and minutes engaged in intensity-specific activity.

Results

Seventy-six children had valid accelerometer data. Children engaged in 113.4 ± 37.0 min. of moderate-vigorous physical activity (MVPA) per day. Children of permissive parents accumulated more minutes of MVPA than those of uninvolved parents (127.5 vs. 97.1, p < 0.05), while parents who provided above average levels of support had children who participated in more minutes of MVPA (114.2 vs. 98.3, p = 0.03). While controlling for known covariates, an uninvolved parenting style was the only parenting behavior associated with child physical activity. Parenting style moderated the association between two parenting practices - reinforcement and monitoring - and child physical activity. Specifically, post-hoc analyses revealed that for the permissive parenting style group, higher levels of parental reinforcement or monitoring were associated with higher levels of child physical activity.

Conclusions

This work extends the current literature by demonstrating the potential moderating role of parenting style on the relationship between activity-related parenting practices and children's objectively measured physical activity, while controlling for known covariates. Future studies in this area are warranted and, if confirmed, may help to identify the mechanism by which parents influence their child's physical activity behavior.

The Lifestyle Behaviour Checklist: evaluation of the factor structure

OBJECTIVE

Childhood overweight and obesity have been identified as a significant global health problem, and have multiple health and socio-emotional sequelae. The family context and parenting behaviours in particular play an important role in childhood overweight and obesity; however, limited research has explored the relationship between parenting and child obesity. The aim of this research was to refine the content of a tool designed to assess child lifestyle behaviour problems and parents' confidence in managing these behaviours.

DESIGN

Content revisions of the Lifestyle Behaviour Checklist (LBC) were undertaken, and the psychometric properties were examined.

SUBJECTS

One hundred and fifty-six parents of an overweight or obese child completed the LBC, as well as questionnaires regarding child behaviour in general and parenting practices.

RESULTS

The results of this study support the validity of the revised LBC as a measure of parental concerns about weight-related problem behaviour, and provide evidence for a four-factor structure and strong internal consistency.