Madeleine Sigman-Grant

About Feeding Children : Mealtimes in Child-Care Centers in Four Western States

This study was conducted to describe mealtimes and explore routines, policies, and training in child-care centers. Following an intensive review of mealtimes, staff and director questionnaires were created. Using a stratified random sampling protocol and following the Tailored Design Method, directors and staff from licensed child-care centers from California, Colorado, Idaho, and Nevada were surveyed. Center and staff characteristics were compared among the four states and three census areas using analysis of variance and chi(2) analyses, as appropriate. To adjust for multiple comparisons, a stringent P value of <0.001 was used for post hoc comparisons. Responses were received from 568 centers (representing 1,190 staff and 464 directors). Mealtimes generally occurred in the classroom, where an adult sat at the table with the children, served some food, poured the drinks, and ate some of the center-provided food. Less than half of centers reported using family-style service, although this style allows children the opportunity to self-serve food. Staff received substantially less training on feeding children (42%) than on nutrition (68%) and child development (95%). These findings bring focus to the need to educate child-care staff and directors about the impact of mealtime environments on child health and development.

Factors Perceived to Influence Dietary Fat Reduction Behaviors

Abstract Dietary change is an inherently complex process. Although dietary fat reduction is an important issue in nutrition education, factors facilitating this type of change have not been fully examined. By accumulating information from individuals who have already been successful in initiating and maintaining dietary fat reduction, practical means of assisting others can be learned. This study collected information from 155 participants between the ages of 30 and 55. Participants were included if they reported the initiation of sustained dietary fat reduction strategies beginning at least 5 years prior to recruitment. Data used to examine individual patterns of dietary fat reduction were collected via in-depth, semistructured, retrospective interviews. Qualitative analyses identified 134 factors that played a role in facilitating the adoption of multiple fat reduction strategies. The factors identified were further classified into two categories: unplanned and planned. Unplanned factors were defined as life events or occurrences that are not nor should they be intentionally included in ones life as a means of dietary improvement (e.g., market influence, health issues, disease diagnosis). Planned factors were defined as occurrences often intentionally included in ones life to facilitate dietary change (e.g., going on a weight loss diet, acquiring an appliance, making a resolution).They frequently resulted from mediation by an unplanned factor.These factors can be used to help nutrition educators identify specific times conducive to initiating dietary change, as well as techniques for facilitating dietary fat reduction.

Family Resiliency: A Neglected Perspective in Addressing Obesity in Young Children

BACKGROUNDnTraditional research primarily details child obesity from a risk perspective. Risk factors are disproportionately higher in children raised in poverty, thus negatively influencing the weight status of low-income children. Borrowing from the field of family studies, the concept of family resiliency might provide a unique perspective for discussions regarding childhood obesity, by helping to identify mediating or moderating protective mechanisms that are present within the family context.nnnMETHODSnA thorough literature review focusing on (1) components of family resiliency that could be related to childhood obesity and (2) factors implicated in childhood obesity beyond those related to energy balance was conducted. We then conceptualized our perspective that understanding resiliency within an obesogenic environment is warranted.nnnRESULTSnBoth family resiliency and childhood obesity prevention rely on the assumptions that (1) no one single answer can address the multifactorial nature involved with adopting healthy lifestyle behaviors and (2) the pieces in this complex puzzle will differ between families. Yet, there are limited holistic studies connecting family resiliency measures and childhood obesity prevention. Combining mixed methodology using traditional measures (such as general parenting styles, feeding styles, and parent feeding behaviors) with potential family resiliency measures (such as family routines, family stress, family functioning, and family structure) might serve to broaden understanding of protective strategies.nnnCONCLUSIONSnThe key to future success in child obesity prevention and treatment may be found in the application of the resiliency framework to the exploration of childhood obesity from a protective perspective focusing on the family context.

Is family sense of coherence a protective factor against the obesogenic environment

Despite greater risk for poor nutrition, inactivity, and overweight, some low-income children are able to maintain a healthy weight. We explore if a strong family sense of coherence (FSOC) acts as a protective factor against childhood obesity for low-income preschool children. Families with a strong FSOC view challenges as predictable, understandable, worthy of engaging, and surmountable. Data were collected from 321 low-income mothers and their preschool children in five states between March 2011 and May 2013. FSOC was assessed using the Family Sense of Coherence Scale. A 16-item checklist was used to assess practicing healthy child behaviors (fruit and vegetable consumption and availability, physical activity, and family meals) and limiting unhealthy child behaviors (sweetened beverage and fast food consumption, energy dense snack availability, and screen time). Child body mass index (BMI) z-scores were calculated from measured height and weight. FSOC was significantly associated with practicing healthy child behaviors (βxa0=xa00.32, pxa0<xa0.001). We did not find a statistically significant association between FSOC and limiting unhealthy child behaviors or child BMI z-scores in fully adjusted models. Our results suggest the importance of family functioning in predicting health behaviors around food consumption and availability, physical activity, and family meals.

The impact of environmental, parental and child factors on health-related behaviors among low-income children

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S.nnnSAMPLEnThis was a cross sectional study of caregivers of preschool children (nxa0=xa0432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregivers body mass index, we found significant associations between PHCB and higher mealtime ritualizations (β: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (β: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (β:xa0-0.19, 95% CI:xa0-0.29;xa0-0.10). More parental covert control (β: 0.44, 95% CI: 0.35; 0.54), more parental overt control (β: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (β:xa0-0.25, 95% CI:xa0-0.34;xa0-0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Principles of health care ethics and the WHO/UNICEF 10 steps to successful breastfeeding.

11 When health care professionals promote, support, and protect breastfeeding, they rely on their past experience as well as evidence-based protocols. In addition, they base their recommendations on values. These values can be articulated in the form of ethical principles that complement and strengthen evidence-based recommendations. This commentary explores basic tenets of health care ethics in relationship to the World Health Organization’s (WHO’s) 10 Steps to Successful Breastfeeding. In particular, we delineate how adherence to the 10 steps is critical in respecting a mother’s basic rights. Furthermore, for those health care professionals who are reluctant to promote, support, and protect breastfeeding, ethical considerations may stimulate them to reflect on their practice. A common way to begin an ethical assessment of clinical health care practice is to determine whether decisions are made according to one or more of 4 principles, dubbed the Four Principles of Bioethics by Beauchamp and Childress. These are (1) autonomy, (2) beneficence, (3) nonmalificence (acting not to harm the patient), and (4) justice. For the purposes of this commentary, a modified version of these principles will be used. This modification was adopted in the International Physician Charter on Professionalism in 2002, which presents the principles in a more clinically relevant form. The 3 principles for this article are (1) the principle of respect for patient autonomy, (2) the principle of promoting patient welfare, and (3) the principle of res pect for social justice. Along with these 3 principles, the following set of professional responsibilities is helpful in understanding the ethical environment under which health care professionals should work in regard to breastfeeding: commitment to professional competence, commitment to honesty with patients, commitment to maintaining appropriate relations with patients, commitment to improving quality of care, commitment to improving access to care, commitment to scientific knowledge, commitment of managing trust by managing conflicts of interest, and commitment to professional responsibilities.