Leann L. Birch

Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness

The Child Feeding Questionnaire (CFQ) is a self-report measure to assess parental beliefs, attitudes, and practices regarding child feeding, with a focus on obesity proneness in children. Confirmatory factor analysis tested a 7-factor model, which included four factors measuring parental beliefs related to childs obesity proneness, and three factors measuring parental control practices and attitudes regarding child feeding. Using a sample of 394 mothers and fathers, three models were tested, and the third model confirmed an acceptable fit, including correlated factors. Internal consistencies for the seven factors were above 0.70. With minor changes, this same 7-factor model was also confirmed in a second sample of 148 mothers and fathers, and a third sample of 126 Hispanic mothers and fathers. As predicted, four of the seven factors were related to an independent measure of childrens weight status, providing initial support for the validity of the instrument. The CFQ can be used to assess aspects of child-feeding perceptions, attitudes, and practices and their relationships to childrens developing food acceptance patterns, the controls of food intake, and obesity. The CFQ is designed for use with parents of children ranging in age from about 2 to 11 years of age.

Childhood overweight: a contextual model and recommendations for future research

The prevalence of overweight among children has doubled within the past two decades. Increases in the rate of childhood overweight are of particular concern due to the negative health and psychological effects noted among overweight children. As shown by previous research, the development of childhood overweight involves a complex set of factors from multiple contexts that interact with each other to place a child at risk of overweight. This multifaceted system can be conceptualized using Ecological Systems Theory (EST). EST highlights the importance of considering the context(s), or ecological niche, in which a person is located in order to understand the emergence of a particular characteristic. In the case of a child, the ecological niche includes the family and the school, which are in turn embedded in larger social contexts including the community and society at large. In this review, EST is used as a framework with which to summarize research assessing predictors of childhood overweight. Specifically, child characteristics that place children at risk of the development of overweight (including dietary intake, physical activity, and sedentary behaviour) will be reviewed while taking into consideration the influence of the familial environment, the school environment, and the community and larger social environments. It is concluded that future research needs to adopt a broader contextual approach in order to understand and intervene against the processes leading to the development of overweight among children and that the use of theories or paradigms such as EST will facilitate developing and testing models of causal processes.

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.

Does parenting affect children's eating and weight status?

BackgroundWorldwide, the prevalence of obesity among children has increased dramatically. Although the etiology of childhood obesity is multifactorial, to date, most preventive interventions have focused on school-aged children in school settings and have met with limited success. In this review, we focus on another set of influences that impact the development of childrens eating and weight status: parenting and feeding styles and practices. Our review has two aims: (1) to assess the extent to which current evidence supports the hypothesis that parenting, via its effects on childrens eating, is causally implicated in childhood obesity; and (2) to identify a set of promising strategies that target aspects of parenting, which can be further evaluated as possible components in childhood obesity prevention.MethodsA literature review was conducted between October 2006 and January 2007. Studies published before January 2007 that assessed the association between some combination of parenting, child eating and child weight variables were included.ResultsA total of 66 articles met the inclusion criteria. The preponderance of these studies focused on the association between parenting and child eating. Although there was substantial experimental evidence for the influence of parenting practices, such as pressure, restriction, modeling and availability, on child eating, the majority of the evidence for the association between parenting and child weight, or the mediation of this association by child eating, was cross-sectional.ConclusionTo date, there is substantial causal evidence that parenting affects child eating and there is much correlational evidence that child eating and weight influence parenting. There are few studies, however, that have used appropriate meditational designs to provide causal evidence for the indirect effect of parenting on weight status via effects on child eating. A new approach is suggested for evaluating the effectiveness of intervention components and creating optimized intervention programs using a multiphase research design. Adoption of approaches such as the Multiphase Optimization Strategy (MOST) is necessary to provide the mechanistic evidence-base needed for the design and implementation of effective childhood obesity prevention programs.

Dietary Recommendations for Children and Adolescents: A Guide for Practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Dietary Recommendations for Children and Adolescents A Guide for Practitioners: Consensus Statement From the American Heart Association

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

‘Finish your soup’: Counterproductive effects of pressuring children to eat on intake and affect

The authors examined whether pressuring preschoolers to eat would affect food intake and preferences, using a repeated-measures experimental design. In the experimental condition, children were pressured to eat by a request to finish their food. We collected intake data, heights and weights, child-feeding practices data, and childrens comments about the food. Children consumed significantly more food when they were not pressured to eat and they made overwhelmingly fewer negative comments. Children who were pressured to eat at home had lower body mass index percentile scores and were less affected by the pressure in the lab setting than children who were not pressured at home. These data provide experimental evidence supporting previous correlational research indicating that pressure can have negative effects on childrens affective responses to and intake of healthy foods.

Preventing childhood obesity: what works?

Rates of overweight in North American children and adolescents have increased dramatically since the 1970s. Childhood obesity has reached epidemic proportions and calls for prevention and treatment programs to reverse this trend have been made. However, the evidence base needed for effective action is still incomplete, especially for childhood obesity prevention programs. This paper focuses on primary prevention of childhood obesity and has three aims: (1) to briefly describe current primary prevention approaches for childhood obesity and the evidence for their impact; (2) to elucidate promising, but untested intervention strategies using an ecological framework and evidence from experimental and epidemiological research on factors influencing childrens eating and weight status; and (3) to introduce a multiphase strategy for screening intervention components and building and evaluating potent interventions for childhood obesity. Most childhood obesity prevention programs have focused on school-aged children and have had little success. We suggest that, given these findings, prevention efforts should be expanded to explore other contexts in which children live as possible settings for intervention efforts, including the family and childcare settings. Given that 25% of preschool children are already overweight, intervening with children before school entry should be a priority. A review of experimental research on the developing controls of food intake in infancy and childhood suggests possible intervention strategies, focusing on parenting and aspects of the feeding environment. Epidemiological findings point to even earlier modifiable risk factors, including gestational weight gain, maternal prepregnancy weight, and formula feeding. However, the potential impact of altering these risk factors remains to be evaluated. In response to this problem, we suggest a new, multiphase method for accomplishing this, including screening intervention components, refining intervention designs and confirming component efficacy to build and evaluate potent, optimized interventions.

Myths, Presumptions, and Facts about Obesity

BACKGROUND Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information. METHODS Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations. RESULTS We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations. CONCLUSIONS False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.).

Specific Social Influences On the Acceptance of Novel Foods In 2–5-Year-Old Children

Social influences have been shown to be very important to overcome food neophobia in young children. However, there is no experimental evidence about whether social influences on food acceptance are specific, that is if models eating the same food as the child are more effective in promoting food acceptance than models eating a different food. We assessed childrens behavior towards novel foods when an adult model (a) was not eating (Presence condition), (b) was eating a food of a Different color (Different color condition), and (c) was eating a food of the Same color (Same color condition). We tested 27 children (ages 2- to 5-years-old) recruited from The Pennsylvania State University day-care facilities. Results show that children accepted and ate their novel food more in the Same color condition than in the Different color and in the Presence conditions. Therefore, in young children food acceptance is promoted by specific social influences. These data indicate that children are more likely to eat new food if others are eating the same type of food than when others are merely present or eating another kind of food.