Jennifer S. Savage

Parental Influence on Eating Behavior: Conception to Adolescence

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, childrens learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in childrens eating behavior, providing both genes and environment for children. For example, they influence childrens developing preferences and eating behaviors by making some foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for childrens growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices.

Repeated exposure and associative conditioning promote preschool children’s liking of vegetables ☆

Most young children do not meet current dietary recommendations, consuming too many energy-dense foods and too few nutrient-dense foods like vegetables. We compared two approaches to increasing childrens liking of vegetables by having them repeatedly taste small portions of vegetables that were initially not liked, presented either alone (repeated exposure; RE) or with a liked dip (associative conditioning; AC). We first conducted a between-subjects experiment, where classrooms at a childcare center were each assigned a vegetable that most children did not like, and individual children were assigned to either the RE or AC condition. A second experiment was conducted to test whether the same results would be obtained using a within-subjects design, in which each child was assigned to repeatedly taste two vegetables that were not liked, one presented with dip and one without. In both experiments, vegetable liking was assessed before, during, and after a series of eight tasting trials, and vegetable intake was measured before and after the tasting trials in Experiment 1. In both experiments, childrens vegetable liking increased from pre- to post-test, but there was no evidence of associative conditioning effects. Increases in vegetable liking, as well as intake, were similar across conditions. Although the addition of the liked dip did not augment overall effects on vegetable liking, there was some evidence that the liked dips could be used to encourage initial tasting of vegetables. In both experiments and both conditions, increases in liking were detected by the sixth exposure to the vegetable. Additional tasting trials did not produce additional increases in liking, but the increases in liking were sustained throughout the experiments. The current evidence suggests that administering few small tastes of vegetables that are initially not liked can have a lasting impact on preschool childrens liking and intake of those vegetables.

Effects of restriction on children’s intake differ by child temperament, food reinforcement, and parent’s chronic use of restriction ☆

Parents’ use of restrictive feeding practices is counterproductive, increasing children’s intake of restricted foods and risk for excessive weight gain. The aims of this research were to replicate Fisher and Birch’s (1999b) original findings that short-term restriction increases preschool children’s (3–5 y) selection, intake, and behavioral response to restricted foods, and to identify characteristics of children who were more susceptible to the negative effects of restriction. The experiment used a within-subjects design; 37 children completed the food reinforcement task and heights/weights were measured. Parents reported on their use of restrictive feeding practices and their child’s inhibitory control and approach. Overall, the findings replicated those of and revealed that the effects of restriction differed by children’s regulatory and appetitive tendencies. Greater increases in intake in response to restriction were observed among children lower in inhibitory control, higher in approach, who found the restricted food highly reinforcing, and who had previous experience with parental use of restriction. Results confirm that the use of restriction does not reduce children’s consumption of these foods, particularly among children with lower regulatory or higher appetitive tendencies.

Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial

IMPORTANCE Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking. OBJECTIVE To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year. DESIGN, SETTING, AND PARTICIPANTS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015. INTERVENTIONS At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participants home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors. MAIN OUTCOMES AND MEASURES Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The interventions effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain. RESULTS Of the mothers included in the study, 246 were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full time (72%) at time of enrollment. The mean conditional weight gain score was lower among infants in the RP group compared with the control group (-0.18; 95% CI, -0.36 to -0.001), reflecting that the RP infants gained weight more slowly than control group infants (0.18; 95% CI, 0.02-0.34); this effect did not differ by feeding mode (predominantly fed breast milk or not). Infants in the RP group also had lower mean weight-for-length percentiles at 1 year than infants in the control group (57.5%; 95% CI, 52.56%-62.37% vs 64.4%; 95% CI, 59.94%-69.26%; P = .04) and were less likely to be overweight at age 1 year (5.5% vs 12.7%; P = .05). CONCLUSIONS AND RELEVANCE An RP intervention is associated with reduced rapid weight gain during the first 6 months after birth and overweight status at age 1 year. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01167270.

Serving smaller age-appropriate entrée portions to children aged 3–5 y increases fruit and vegetable intake and reduces energy density and energy intake at lunch

BACKGROUND Previous portion size research in children has focused on the impact of large entrée portions on childrens intake, but less attention has been given to how intake at a meal is affected across a broader range of entrée portions. OBJECTIVE The objective was to assess the effect of serving a range of entrée portions on childrens ad libitum intake and energy density consumed at the meal. DESIGN A within-subject design was used to examine the effect of varying entrée portions (ie, 100, 160, 220, 280, 340, and 400 g) on childrens ad libitum energy intake of macaroni and cheese and fixed portions of unsweetened applesauce, green beans, and whole-wheat roll served with the entree. Seventeen children (10 girls), aged 3 to 6 y, were served a series of 6 lunches, which varied only in entrée portion size, once per week. Weight, height, and weighed food intake were measured. RESULTS Increasing portion size increased childrens entrée intake (P < 0.01) and decreased intake of other foods served with the entrée, including fruit and vegetables (P < 0.0001). As a result, children consumed a more-energy-dense (kcal/g) lunch as portion size increased (P < 0.0001). Further examination showed that BMI percentile moderated the positive association between portion size and entrée intake (P < 0.01); overweight children showed greater increases in entree intake with increasing entrée portion. CONCLUSION Serving smaller age-appropriate entrée portions may be one strategy to improve childrens nutritional profile by decreasing intake of energy-dense foods and by promoting intake of fruit and vegetables served with the entree.

Alternatives to restrictive feeding practices to promote self‐regulation in childhood: a developmental perspective

Intake of energy‐dense snack foods is high among US children. Although the use of restrictive feeding practices has been shown to be counterproductive, there is very limited evidence for effective alternatives to restriction that help children moderate their intake of these foods and that facilitate the development of self‐regulation in childhood. The developmental literature on parenting and child outcomes may provide insights into alternatives to restrictive feeding practices. This review paper uses a model of parental control from the child development and parenting literatures to (i) operationally define restrictive feeding practices; (ii) summarize current evidence for antecedents and effects of parental restriction use on childrens eating behaviours and weight status, and (iii) highlight alternative feeding practices that may facilitate the development of childrens self‐regulation and moderate childrens intake of palatable snack foods. We also discuss recent empirical evidence highlighting the role of child temperament and food motivation related behaviours as factors that prompt parents to use restrictive feeding practices and, yet, may increase childrens dysregulated intake of forbidden foods.

The Addition of a Plain or Herb-Flavored Reduced-Fat Dip Is Associated with Improved Preschoolers' Intake of Vegetables

This quasiexperimental study used a within-subjects experimental design to determine whether adding herbs and/or spices to a reduced-fat dip increased childrens willingness to taste, liking of, and consumption of vegetables. Participants were preschool children aged 3 to 5 years who attended a child-care center in Central Pennsylvania in late 2008 and early 2009. First, childrens familiarity with and liking of six raw vegetables and five dips (reduced-fat plain, herb, garlic, pizza, and ranch) were assessed. In Experiment 1 (n=34), children tasted a vegetable they liked, one they disliked, and one they refused, with a reduced-fat plain dip and their favorite reduced-fat herb-flavored dip. In Experiment 2 (n=26 or n=27), they rated their liking of celery and yellow squash, with and without their favorite reduced-fat herb dip (pizza or ranch), and their intake of those vegetable snacks was measured. In Experiment 1, the herb-flavored dip was preferred over the plain dip (P<0.01), and children were three times more likely to reject the vegetable alone, compared with eating the vegetable paired with an herb dip (P<0.001). In Experiment 2, children ate significantly more of a previously rejected or disliked vegetable (celery and squash) when offered with a preferred reduced-fat herb dip than when the vegetable was served alone (P<0.05). These findings suggest that offering vegetables with reduced-fat dips containing familiar herb and spice flavors can increase tasting and thereby promote liking, acceptance, and consumption of vegetables, including vegetables previously rejected or disliked.

Do children eat less at meals when allowed to serve themselves

BACKGROUND The effect of self-serving on young childrens energy intake is not well understood. OBJECTIVE The objective was to examine individual differences in the effects of plated and self-served entrée portions on childrens energy intake. DESIGN Two within-subjects experiments were used to examine ad libitum intake at meals in 63 children aged 3-5 y when 400 g of a pasta entrée was either plated or available for children to self-serve. Child age, sex, BMI, and responsiveness to increasing portion size (defined as individual slope estimates relating ad libitum intake of the entrée across a range of entrée portions) were evaluated as predictors of self-served portions. RESULTS Childrens entrée and meal intakes did not differ between the self-served and plated conditions for the total sample or by child weight status. However, larger self-served entrée portions were associated with greater entrée and meal intakes. Children who served themselves larger entrée portions tended to be overweight and more responsive to portion size (ie, greater increases in entrée intake as plated portion size increased). Last, self-served portion predicted both entrée and meal intake over and above BMI z score and responsiveness to portion. CONCLUSIONS Contrary to our hypothesis, relative to plated portions, allowing children to self-serve the entrée portion did not reduce energy intake. Children who were more responsive to portion-size effects were likely to self-serve and eat larger entrée portions. Self-serving is not a one-size-fits-all approach; some children may need guidance and rules to learn how to self-select appropriate portion sizes.

Measurement of food reinforcement in preschool children. Associations with food intake, BMI, and reward sensitivity.

Progressive ratio (PR) schedules of reinforcement have been used to measure the relative reinforcing value (RRV) of food in humans as young as 8 years old; however, developmentally appropriate measures are needed to measure RRV of food earlier in life. Study objectives were to demonstrate the validity of the RRV of food task adapted for use among for preschool children (3-5 y), and examine individual differences in performance. Thirty-three children completed the RRV of food task in which they worked to access graham crackers. They also completed a snack task where they had free access these foods, liking and hunger assessments, and their heights and weights were measured. Parents reported on their childs reward sensitivity. Overall, children were willing work for palatable snack foods. Boys and older children made more responses in the task, while children with higher BMI z-scores and reward sensitivity responded at a faster rate. Children who worked harder in terms of total responses and response rates consumed more calories in the snack session. This study demonstrates that with slight modifications, the RRV of food task is a valid and developmentally appropriate measure for assessing individual differences in food reinforcement among very young children.

Patterns of weight control strategies predict differences in women's 4-year weight gain.

The purpose of this study was to explore whether differences in patterns of weight control strategies predict 4‐year weight change among women. Participants (N = 176), were assessed at baseline and biennially on three occasions. Weight control strategies were assessed by the Weight Loss Behavior Scale. Height and weight were measured to calculate BMI. Latent class analysis (LCA) identified groups of women differing in their reported weight control strategies. Repeated measures were employed to examine the relationship between using different types of weight control strategies and weight change before and after adjusting for education, income, and initial BMI. LCA yielded a three‐group solution: use of none (N), healthy (H), and healthy plus unhealthy (H+U) weight control strategies. The N group had the lowest initial BMIs. Womens pattern of weight gain differed by latent group membership after adjusting for covariates: H+U group gained significantly more weight (4.56 kg) than the N group (1.51 kg) and H group (1.02 kg). Similar patterns emerged predicting weight change between years 2 and 4: H+U group gained significantly more weight (2.86 kg) than the H group (0.03 kg) and N group (0.44 kg). H+U weight control group had higher scores on weight concerns, dietary restraint, and eating attitudes than women in the H or N groups. These findings provide evidence that self‐reported weight control attempts do not necessarily lead to large weight gains; rather the amount of weight gain may depend on the type of weight control strategies that women are practicing.