Lori A. Francis

‘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.

Self-regulation and Rapid Weight Gain in Children From Age 3 to 12 Years

OBJECTIVE To examine the extent to which self-regulatory capacities, measured behaviorally at ages 3 and 5 years, were linked to rapid weight gain in children from age 3 to 12 years. Self-regulation failure, or the inability to control an impulse or behavior, has been implicated as a mechanism in the development of overweight. DESIGN Prospective longitudinal cohort study. SETTING Home and laboratory-based settings in 10 sites across the United States. PARTICIPANTS Data were drawn from 1061 children as part of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure Self-regulatory capacity was measured in 2 behavioral protocols; children participated in a self-control procedure at age 3 years and a delay of gratification procedure at age 5 years. MAIN OUTCOME MEASURES Age- and sex-specific body mass index (BMI) z scores were calculated based on measured BMI at 6 points. RESULTS Mixed-modeling analyses were used to examine differences in the rate of weight gain over time based on the extent to which children exhibited the ability to self-regulate in the behavioral procedures. Compared with children who showed high self-regulation in both behavioral protocols at ages 3 and 5 years, children who exhibited a compromised ability to self-regulate had the highest BMI z scores at each point and the most rapid gains in BMI z scores over the 9-year period. Effects of pubertal status were also noted for girls. CONCLUSION Self-regulation failure in early childhood may predispose children to excessive weight gain through early adolescence.

Mental Health Problems and Overweight in a Nationally Representative Sample of Adolescents: Effects of Race and Ethnicity

OBJECTIVES. In this study we examined the relation between mental health problems and weight in a population-based study of youth aged 12 to 17 years and whether the association between mental health problems and weight is moderated by race and ethnicity. METHODS. We used 2003 National Survey on Childrens Health data. Logistic regression was used to arrive at adjusted odds ratios showing the relation between BMI and mental health problems. RESULTS. Compared with their nonoverweight counterparts, both white and Hispanic youth who were overweight were significantly more likely to report depression or anxiety, feelings of worthlessness or inferiority, behavior problems, and bullying of others. Odds ratios relating mental health problems and BMI in black subjects were not statistically significant except for physician diagnosis of depression. CONCLUSIONS. Our results suggest that, when addressing youth overweight status, mental health problems also need to be addressed. Given that the relationship between mental health problems and youth overweight differs according to race/ethnic group, public health programs that target overweight youth should be cognizant of potential comorbid mental health problems and that race/ethnicity may play a role in the relationship between mental health and overweight status.

Parent overweight predicts daughters' increase in BMI and disinhibited overeating from 5 to 13 years.

Objective: To assess whether parental overweight status and disinhibited overeating are predictive of daughters’ accelerated weight gain and disinhibited overeating.

The Beneficial Effect of Family Meals on Obesity Differs by Race, Sex, and Household Education: The National Survey of Children's Health, 2003-2004

Studies have indicated that family meals may be a protective factor for childhood obesity; however, limited evidence is available in children with different racial, socioeconomic, and individual characteristics. The purpose of this study was to examine family meal frequency as a protective factor for obesity in a US-based sample of non-Hispanic white, non-Hispanic black, and Hispanic children age 6 to 11 years, and to identify individual, familial, and socioeconomic factors that moderate this association. Data were from the 2003 National Survey of Childrens Health (n=16,770). Multinomial logistic regression analyses were used to test the association between family meal frequency and weight status, and the moderating effects of household structure, education, poverty level, and sex, by racial group. Non-Hispanic white children who consumed family meals every day were less likely to be obese than those eating family meals zero or a few days per week. A moderating effect for sex was observed in non-Hispanic black children such that family meal frequency was marginally protective in boys but not in girls. Higher family meal frequency was a marginal risk factor for obesity in Hispanic boys from low-education households, but not in girls from similar households. In conclusion, family meals seem to be protective of obesity in non-Hispanic white children and non-Hispanic black boys, whereas they may put Hispanic boys living in low-education households at risk. Greater emphasis is needed in future research on assessing why this association differs among different race/ethnic groups, and evaluating the influence of the quality and quantity of family meals on child obesity.

Generation, Language, Body Mass Index, and Activity Patterns in Hispanic Children

BACKGROUND The acculturation hypothesis proposes an overall disadvantage in health outcomes for Hispanic immigrants with more time spent living in the U.S., but little is known about how generational status and language may influence Hispanic childrens relative weight and activity patterns. PURPOSE To investigate associations among generation and language with relative weight (BMI z-scores), physical activity, screen time, and participation in extracurricular activities (i.e., sports, clubs) in a U.S.-based, nationally representative sample of Hispanic children. METHODS Participants included 2012 Hispanic children aged 6-11 years from the cross-sectional 2003 National Survey of Childrens Health. Children were grouped according to generational status (first, second, or third), and the primary language spoken in the home (English versus non-English). Primary analyses included adjusted logistic and multinomial logistic regression to examine the relationships among variables; all analyses were conducted between 2008 and 2009. RESULTS Compared to third-generation, English speakers, first- and second-generation, non-English speakers were more than two times more likely to be obese. Moreover, first-generation, non-English speakers were half as likely to engage in regular physical activity and sports. Both first- and second-generation, non-English speakers were less likely to participate in clubs compared to second- and third-generation, English speakers. Overall, non-English-speaking groups reported less screen time compared to third-generation, English speakers. CONCLUSIONS The hypothesis that Hispanics lose their health protection with more time spent in the U.S. was not supported in this sample of Hispanic children.

Improving women's preconceptional health: findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women's health study.

PURPOSE Improving the health of women before pregnancy is an important strategy for reducing adverse pregnancy outcomes for mother and child. This paper reports the first pretest-posttest results from a randomized trial of a unique, multidimensional, small group format intervention, Strong Healthy Women, designed to improve the health behaviors and health status of preconceptional and interconceptional women. METHODS Nonpregnant pre- and interconceptional women ages 18-35 were recruited in 15 low-income rural communities in Central Pennsylvania (n = 692). Women were randomized in a ratio of 2-to-1 to intervention and control groups; participants received a baseline and follow-up health risk assessment at 14 weeks and completed questionnaires to assess behavioral variables. The analytic sample for this report consists of 362 women who completed both risk assessments. Outcomes include measures of attitudinal and health-related behavior change. MAIN FINDINGS Women in the intervention group were significantly more likely than controls to report higher self-efficacy for eating healthy food and to perceive higher preconceptional control of birth outcomes; greater intent to eat healthy foods and be more physically active; and greater frequency of reading food labels, physical activity consistent with recommended levels, and daily use of a multivitamin with folic acid. Significant dose effects were found: Each additional intervention session attended was associated with higher perceived internal preconceptional control of birth outcomes, reading food labels, engaging in relaxation exercise or meditation for stress management, and daily use of a multivitamin with folic acid. CONCLUSIONS The attitudinal and behavior changes attributable to the intervention were related primarily to nutrition and physical activity. These results show that these topics can be successfully addressed with pre- and interconceptional women outside the clinical setting in community-based interventions.

National School Lunch Program Participation and Sex Differences in Body Mass Index Trajectories of Children From Low-Income Families

OBJECTIVES To investigate participation patterns in the National School Lunch Program (NSLP) among low-income children from kindergarten to fifth grade and to examine the ways in which participation influences sex differences in the trajectories of body mass index (BMI) through the eighth grade. DESIGN Longitudinal, secondary data analysis. SETTING Sample of low-income US children who entered kindergarten in 1998. PARTICIPANTS Girls (n = 574) and boys (n = 566) from low-income families who participated in the Early Childhood Longitudinal Study, Kindergarten Cohort. MAIN EXPOSURE Participation in the NSLP. MAIN OUTCOME MEASURES Temporary and persistent patterns of NSLP participation, and age-specific and sex-specific BMI raw scores calculated at 5 data points. RESULTS Among the low-income children who attended schools that participated in the NSLP, both the children who persistently participated in the program and those who temporarily participated in the program displayed similar socioeconomically disadvantaged factors. Nonlinear mixed models indicated a larger rate of change in BMI (ie, an increase) among low-income, participating girls than among low-income, nonparticipating girls; however, mean BMIs did not significantly differ between low-income girls who participated and those who did not participate. No significant differences were observed among low-income boys. CONCLUSIONS Results suggest that participation in the NSLP is associated with rapid weight gain for low-income girls but not for low-income boys.

Design of the Central Pennsylvania Women's Health Study (CePAWHS) Strong Healthy Women Intervention: Improving Preconceptional Health

Considerable evidence suggests that modifiable risk factors for adverse pregnancy outcomes such as preterm birth and low birthweight include obesity, sedentary behavior, and infections. There is a growing consensus that the preconceptional and interconceptional periods may be an ideal time for preventive intervention targeting these risk factors; enhancing health before pregnancy would subsequently reduce the risk for poor pregnancy outcomes. This paper provides an overview of the development of a health behavior intervention, Strong Healthy Women, that aims to improve women’s preconceptional and interconceptional health. We describe the rationale, delivery, and targeted outcomes of the program, as well as the design of an ongoing trial currently testing program efficacy. The content areas are also discussed and include pregnancy-conception, stress, physical activity, nutrition, infection, sources of smoke in the home, and substance use. This intervention protocol may offer researchers and healthcare professionals a framework for designing other programs aiming to improve women’s preconceptional health.

Depressive Symptoms Are Associated with Excess Weight and Unhealthier Lifestyle Behaviors in Urban Adolescents

BACKGROUND Adolescence is a critical period for the development of depressive symptoms and obesity. This study examined the association of depressive symptoms with standardized BMI (BMI z-score), lifestyle behaviors, and self-efficacy measures in a sample of urban adolescents. METHODS A school-based study was conducted among adolescents (N=1508) enrolled from 11 public schools. Depressive symptoms were assessed with Kandels depressive symptoms scale for adolescents. Fruit and vegetable intake and intake of energy-dense foods were assessed by a short food frequency questionnaire. Sedentary behavior and physical activity (PA) were obtained by self-report. Height and weight were measured directly and BMI z-scores were calculated. Mixed-effects models were used to examine the association of depressive symptoms with BMI z-score and lifestyle behaviors, accounting for clustering at school level and adjusting for confounders. Self-efficacy measures were evaluated as potential mediators. RESULTS The sample was 53% female, 75% Hispanic, and 82% US born, with a mean age of 13.9 years. Higher depressive symptoms were associated with higher BMI z-score (β=0.02; p=0.02), intake of energy-dense foods (β=0.42; p<0.001), and sedentary behavior (β=0.48; p<0.001), but lower PA (β=-0.03; p=0.01). There was an interaction by gender in the association of depressive symptoms and PA. Self-efficacy mediated the association of depressive symptoms and PA. CONCLUSIONS Obesity prevention and treatment programs should consider addressing the role of negative emotions as part of their preventive strategies.