Jayne A. Fulkerson

Healthy Home Offerings via the Mealtime Environment (HOME): Feasibility, Acceptability, and Outcomes of a Pilot Study

The primary objective was to develop and test the feasibility and acceptability of the Healthy Home Offerings via the Mealtime Environment (HOME) program, a pilot childhood obesity prevention intervention aimed at increasing the quality of foods in the home and at family meals. Forty‐four child/parent dyads participated in a randomized controlled trial (n = 22 in intervention and n = 22 in control conditions). The intervention program, held at neighborhood facilities, included five, 90‐min sessions consisting of interactive nutrition education, taste testing, cooking skill building, parent discussion groups, and hands‐on meal preparation. Children (8–10‐year olds) and parents (89% mothers) completed assessments at their home at baseline, postintervention, and 6‐month follow‐up, including psychosocial surveys, anthropometry, 24‐h dietary recalls, and home food availability and meal offering inventories. Feasibility/acceptability was assessed with participant surveys and process data. All families completed all three home‐based assessments. Most intervention families (86%) attended at least four of five sessions. Nearly all parents (95%) and 71% of children rated all sessions very positively. General linear models indicated that at postintervention, compared to control children, intervention children were significantly more likely to report greater food preparation skill development (P < 0.001). There were trends suggesting that intervention children had higher consumption of fruits and vegetables (P < 0.08), and higher intakes of key nutrients (all P values <0.05) than control children. Obesity changes did not differ by condition. Not all findings were sustained at 6‐month follow‐up. Obesity prevention programming with families in community settings is feasible and well accepted. Results demonstrate the potential of the HOME program.

Focus Groups with Working Parents of School-aged Children: What's Needed to Improve Family Meals?

OBJECTIVEnTo conduct focus groups to identify parents perceptions of barriers to family meals and elucidate ideas to guide the development of interventions to overcome barriers.nnnMETHODSnFocus groups were conducted with a convenience sample of 27 working parents in urban community settings.nnnRESULTSnParents reported enjoying the sharing/bonding at meals, but they reported limited time for meal preparation and frequent multi-tasking at mealtime. They wanted their childrens help with meal preparation, but they were concerned about the time and mess involved. They were frustrated with the limited range of food items their children would eat. Preferred program ideas included feeding tips/recipes, meal planning/preparation, and changing food offerings.nnnCONCLUSIONS AND IMPLICATIONSnFindings indicate a need for creative programs and professional nutrition guidance to facilitate family engagement in planning and cooking quick, healthful meals; development of skill building; and increasing healthful food consumption.

A Review of Associations Between Family or Shared Meal Frequency and Dietary and Weight Status Outcomes Across the Lifespan

OBJECTIVEnTo summarize the research literature on associations between family meal frequency and dietary outcomes as well as weight status across the lifespan.nnnMETHODSnReviewed literature of family or shared meals with dietary and weight outcomes in youth, adults, and older adults.nnnRESULTSnAcross the lifespan, eating with others, particularly family, is associated with healthier dietary outcomes. Among children and adolescents, these findings appear to be consistent for both boys and girls, whereas mixed findings are seen by gender for adult men and women. The findings of associations between family or shared meals and weight outcomes across the lifespan are less consistent and more complicated than those of dietary outcomes.nnnCONCLUSIONS AND IMPLICATIONSnNow is the time for the field to improve understanding of the mechanisms involved in the positive associations seen with family meal frequency, and to move forward with implementing interventions aimed at increasing the frequency of, and improving the quality of, food served at family meals, and evaluating their impact. Given the more limited findings of associations between family or shared meals and weight outcomes, capitalizing on the positive benefits of family and shared meals while addressing the types of foods served, portion sizes, and other potential mechanisms may have a significant impact on obesity prevention and reduction. Future research recommendations are provided.

What's for dinner? Types of food served at family dinner differ across parent and family characteristics.

OBJECTIVEnTo examine the types of food served at family dinner in the homes of adolescents and correlations with parent and family sociodemographic characteristics, psychosocial factors and meal-specific variables.nnnDESIGNnA cross-sectional population-based survey completed by mail or telephone by parents participating in Project F-EAT (Families and Eating and Activity in Teens) in 2009-2010.nnnSETTINGnHomes of families with adolescents in Minneapolis/St. Paul urban area, MN, USA.nnnSUBJECTSnParticipants included 1923 parents/guardians (90·8% female; 68·5% from ethnic/racial minorities) of adolescents who participated in EAT 2010.nnnRESULTSnLess than a third (28%) of parents reported serving a green salad at family dinner on a regular basis, but 70% reported regularly serving vegetables (other than potatoes). About one-fifth (21%) of families had fast food at family dinners two or more times per week. Variables from within the sociodemographic domain (low educational attainment) psychosocial domain (high work-life stress, depressive symptoms, low family functioning) and meal-specific domain (low value of family meals, low enjoyment of cooking, low meal planning, high food purchasing barriers and fewer hours in food preparation) were associated with lower healthfulness of foods served at family dinners, in analyses adjusted for sociodemographic characteristics.nnnCONCLUSIONSnThere is a need for interventions to improve the healthfulness of food served at family meals. Interventions need to be suitable for parents with low levels of education; take parent and family psychosocial factors into account; promote more positive attitudes toward family meals; and provide skills to make it easier to plan and prepare healthful family meals.

Food-Related Parenting Practices and Adolescent Weight Status: A Population-Based Study

OBJECTIVE: To examine food-related parenting practices (pressure-to-eat and food restriction) among mothers and fathers of adolescents and associations with adolescent weight status within a large population-based sample of racially/ethnically and socioeconomically diverse parent-adolescent pairs. METHODS: Adolescents (N = 2231; 14.4 years old [SD = 2.0]) and their parents (N = 3431) participated in 2 coordinated population-based studies designed to examine factors associated with weight status and weight-related behaviors in adolescents. Adolescents completed anthropometric measurements and surveys at school. Parents (or other caregivers) completed questionnaires via mail or phone. RESULTS: Findings suggest that the use of controlling food-related parenting practices, including pressure-to-eat and restriction, is common among parents of adolescents. Mean restriction levels were significantly higher among parents of overweight and obese adolescents compared with nonoverweight adolescents. However, levels of pressure-to-eat were significantly higher among nonoverweight adolescents. Results indicate that fathers are more likely than mothers to engage in pressure-to-eat behaviors and boys are more likely than girls to be on the receiving end of parental pressure-to-eat. Parental report of restriction did not differ significantly by parent or adolescent gender. No significant interactions by race/ethnicity or socioeconomic status were seen in the relationship between restriction or pressure-to-eat and adolescent weight status. CONCLUSIONS: Given that there is accumulating evidence for the detrimental effects of controlling feeding practices on children’s ability to self-regulate energy intake, these findings suggest that parents should be educated and empowered through anticipatory guidance to encourage moderation rather than overconsumption and emphasize healthful food choices rather than restrictive eating patterns.

Eat this, not that! Parental demographic correlates of food-related parenting practices

To understand how parents of adolescents attempt to regulate their childrens eating behaviors, the prevalence of specific food-related parenting practices (restriction, pressure-to-eat) by sociodemographic characteristics (parent gender, race/ethnicity, education level, employment status, and household income) were examined within a population-based sample of parents (n=3709) of adolescents. Linear regression models were fit to estimate the association between parent sociodemographic characteristics and parental report of food restriction and pressure-to-eat. Overall, findings suggest that use of controlling food-related parenting practices, such as pressuring children to eat and restricting childrens intake, is common among parents of adolescents, particularly among parents in racial/ethnic minority subgroups, parents with less than a high school education, and parents with a low household income. Results indicate that that social or cultural traditions, as well as parental access to economic resources, may contribute to a parents decision to utilize specific food-related parenting practices. Given that previous research has found that restriction and pressure-to-eat food-related parenting practices can negatively impact childrens current and future dietary intake, differences in use of these practices by sociodemographic characteristics may contribute, in part, to the disparities that exist in the prevalence of overweight and obesity among adolescents by their race/ethnicity and socioeconomic status.

Parental role modeling of fruits and vegetables at meals and snacks is associated with children’s adequate consumption

Research has shown that parental role modeling of healthful eating behaviors is positively correlated to childrens dietary intake and fruit and vegetable (F&V) preferences. The purpose of this study is to (1) examine associations between parent and child report of parental role modeling of F&V consumption at snacks and dinner and (2) determine whether parental role modeling is associated with children meeting daily F&V recommendations. Parent-child dyads (N = 160) participating in the HOME Plus study completed baseline surveys on parental role modeling of F&V at snacks and dinner. Children also completed 24-hour dietary recalls. Spearman correlations and chi-square/Fishers exact tests were used to examine relationships between parent and child report of parental role modeling of F&V at snacks and dinner and whether children met daily recommendations. On average, children consumed less than three daily servings of F&V with only 23% consuming the recommended servings. Statistically significant correlations were seen between parent and child report of parental role modeling fruit at dinner and green salad at dinner. Children who reported parental role modeling of vegetables at snack and salad at dinner were significantly more likely, than those who did not, to meet daily F&V recommendations. Parents who reported role modeling fruit at snack were significantly more likely to have children who met daily F&V recommendations. Results indicate that children are aware of their parents eating behaviors and on occasion report this behavior similarly to their parents. Parents should be encouraged to utilize the opportunity to role model healthful dietary intake, especially at snacks, where consumption of F&V appears low.

The protective role of family meals for youth obesity: 10-year longitudinal associations

OBJECTIVEnTo examine whether having family meals as an adolescent protects against becoming overweight or obese 10 years later as a young adult.nnnSTUDY DESIGNnData from Project Eating and Activity in Teens -III, a longitudinal cohort study with emerging young adults, were used. At baseline (1998-1999), adolescents completed surveys in middle or high schools, and at 10-year follow-up (2008-2009) surveys were completed online or via mailed surveys. Young adult participants (n = 2117) were racially/ethnically and socioeconomically diverse (52% minority; 38% low income) between the ages of 19 and 31 years (mean age = 25.3; 55% female). Logistic regression was used to associate weight status at follow-up with family meal frequency 10 years earlier during adolescence, controlling and testing for interactions with demographic characteristics.nnnRESULTSnAll levels of baseline family meal frequency (ie, 1-2, 3-4, ≥5 family meals/wk) during adolescence were significantly associated with reduced odds of overweight or obesity 10 years later in young adulthood compared with never having family meals as an adolescent. Interactions by race indicated that family meals had a stronger protective effect for obesity in black vs white young adults.nnnCONCLUSIONSnFamily meals during adolescence were protective against the development of overweight and obesity in young adulthood. Professionals who work with adolescents and parents may want to strategize with them how to successfully carry out at least 1 to 2 family meals per week in order to protect adolescents from overweight or obesity in young adulthood.

Eating Breakfast and Dinner Together as a Family: Associations with Sociodemographic Characteristics and Implications for Diet Quality and Weight Status

BACKGROUNDnResearch has shown that adolescents who frequently share evening meals with their families experience more positive health outcomes, including diets of higher nutritional quality. However, little is known about families eating together at breakfast.nnnOBJECTIVEnThis study examined sociodemographic differences in family meal frequencies in a population-based adolescent sample. In addition, this study examined associations of family breakfast meal frequency with dietary quality and weight status.nnnDESIGNnCross-sectional data from EAT 2010 (Eating and Activity in Teens) included anthropometric assessments and classroom-administered surveys completed in 2009-2010.nnnPARTICIPANTS/SETTINGnParticipants included 2,793 middle and high school students (53.2% girls, mean age=14.4 years) from Minneapolis/St Paul, MN, public schools.nnnMAIN OUTCOME MEASURESnUsual dietary intake was self-reported on a food frequency questionnaire. Height and weight were measured.nnnSTATISTICAL ANALYSES PERFORMEDnRegression models adjusted for sociodemographic characteristics, family dinner frequency, family functioning, and family cohesion were used to examine associations of family breakfast frequency with dietary quality and weight status.nnnRESULTSnOn average, adolescents reported having family breakfast meals 1.5 times (standard deviation=2.1) and family dinner meals 4.1 times (standard deviation=2.6) in the past week. There were racial/ethnic differences in family breakfast frequency, with the highest frequencies reported by adolescents of black, Hispanic, Native American, and mixed race/ethnicity. Family breakfast frequency was also positively associated with male sex, younger age, and living in a two-parent household. Family breakfast frequency was associated with several markers of better diet quality (such as higher intake of fruit, whole grains, and fiber) and lower risk for overweight/obesity. For example, adolescents who reported seven family breakfasts in the past week consumed an average of 0.37 additional daily fruit servings compared with adolescents who never had a family breakfast meal.nnnCONCLUSIONSnResults suggest that eating breakfast together as a family can have benefits for adolescents dietary intake and weight status.

Changes in the frequency of family meals from 1999 to 2010 in the homes of adolescents: trends by sociodemographic characteristics.

OBJECTIVEnTo examine secular trends from 1999 to 2010 in family meal frequency in a population-based sample of adolescents across sociodemographic characteristics.nnnMETHODSnA repeated cross-sectional design was used. Participants were from middle schools and high schools in the Minneapolis/St. Paul area and included 3,072 adolescents (mean age = 14.6 ± 1.8 years) in 1999 and 2,793 adolescents (mean age = 14.4 ± 2.0 years) in 2010 from diverse ethnic/racial and socioeconomic backgrounds. Trends in family meal frequency were examined using inverse probability weighting to control for changes in sociodemographic characteristics over time.nnnRESULTSnFamily meal frequency remained fairly constant from 1999 to 2010 in the overall sample, but decreases were found in population subgroups including girls, middle school students (grade: 6-8), Asians, and youth from low socioeconomic backgrounds. Among youth from the lowest socioeconomic backgrounds, the mean number of family meals in the past week decreased from 4.0 in 1999 to 3.6 in 2010 (p = .003). Furthermore, the percentage of youth from low socioeconomic backgrounds eating five or more meals in the past week decreased from 46.9% in 1999 to 38.8% in 2010 (p < .001). In contrast, family meal frequency tended to increase over time among youth from higher socioeconomic backgrounds.nnnCONCLUSIONSnThe widening gap in family meal frequency between youth from low and high socioeconomic backgrounds is concerning, particularly given the greater risk for poor health outcomes among low-income youth. Given findings from other studies suggesting multiple benefits of family meals, interventions to increase family meal frequency are needed that target adolescents and their families from the most vulnerable segments of the population.