Melissa L. Horning

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

OBJECTIVE To summarize the research literature on associations between family meal frequency and dietary outcomes as well as weight status across the lifespan. METHODS Reviewed literature of family or shared meals with dietary and weight outcomes in youth, adults, and older adults. RESULTS Across 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. CONCLUSIONS AND IMPLICATIONS Now 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.

HOME Plus: Program design and implementation of a family-focused, community-based intervention to promote the frequency and healthfulness of family meals, reduce children’s sedentary behavior, and prevent obesity

BackgroundInvolvement in meal preparation and eating meals with one’s family are associated with better dietary quality and healthy body weight for youth. Given the poor dietary quality of many youth, potential benefits of family meals for better nutritional intake and great variation in family meals, development and evaluation of interventions aimed at improving and increasing family meals are needed. This paper presents the design of key intervention components and process evaluation of a community-based program (Healthy Home Offerings via the Mealtime Environment (HOME) Plus) to prevent obesity.MethodsThe HOME Plus intervention was part of a two-arm (intervention versus attention-only control) randomized-controlled trial. Ten monthly, two-hour sessions and five motivational/goal-setting telephone calls to promote healthy eating and increasing family meals were delivered in community-based settings in the Minneapolis/St. Paul, MN metropolitan area. The present study included 81 families (8-12 year old children and their parents) in the intervention condition. Process surveys were administered at the end of each intervention session and at a home visit after the intervention period. Chi-squares and t-tests were used for process survey analysis.ResultsThe HOME Plus program was successfully implemented and families were highly satisfied. Parents and children reported that the most enjoyable component was cooking with their families, learning how to eat more healthfully, and trying new recipes/foods and cooking tips. Average session attendance across the ten months was high for families (68%) and more than half completed their home activities.ConclusionsFindings support the value of a community-based, family-focused intervention program to promote family meals, limit screen time, and prevent obesity.Trial registrationNCT01538615

Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial

BackgroundFamily meal frequency has been shown to be strongly associated with better dietary intake; however, associations with weight status have been mixed. Family meals-focused randomized controlled trials with weight outcomes have not been previously conducted. Therefore, this study purpose was to describe weight-related outcomes of the HOME Plus study, the first family meals-focused randomized controlled trial to prevent excess weight gain among youth.MethodsFamilies (n = 160 8-12-year-old children and their parents/guardians) were randomized to intervention (n = 81) or control (n = 79) groups. Data were collected at baseline (2011–2012), post-intervention (12-months post-baseline) and follow-up (21-months post-baseline). The intervention included ten monthly group sessions (nutrition education; hands-on meal and snack planning, preparation, and skill development; screen time reductions) and five motivational, goal-setting phone calls. The main outcome was child body mass index (BMI) z-score.ResultsGeneral linear models, adjusted for baseline values and demographics, showed no significant treatment group differences in BMI z-scores at post-intervention or follow-up; however, a promising reduction in excess weight gain was observed. Post-hoc stratification by pubertal onset indicated prepubescent children in the intervention group had significantly lower BMI z-scores than their control group counterparts.ConclusionsThe study used a strong theoretical framework, rigorous design, quality measurement and a program with high fidelity to test a family meals-focused obesity prevention intervention. It showed a modest decrease in excess weight gain. The significant intervention effect among prepubescent children suggests the intervention may be more efficacious among relatively young children, although more research with appropriately powered samples are needed to replicate this finding.Trial registrationThis study is registered at www.clinicaltrials.gov NCT01538615. Registered 01/17/2012.

A Systematic Review on the Affordability of a Healthful Diet for Families in the United States

OBJECTIVES As obesity rates remain alarmingly high, the importance of healthful diets is emphasized; however, affordability of such diets is disputed. Market basket surveys (MBSs) investigate the affordability of diets for families that meet minimum daily dietary requirements using actual food prices from grocery stores. This review paper describes the methods of MBSs, summarizes methodology, price and affordability findings, limitations, and suggests related policy and practice implications. DESIGN AND SAMPLE This is a systematic review of 16 MBSs performed in the United States from 1985 to 2012. A comprehensive multidisciplinary database search strategy was used to identify articles meeting inclusion criteria. RESULTS Results indicated MBS methodology varied across studies and price data indicated healthful diets for families are likely unaffordable when purchased from small- to medium-sized stores and may be unaffordable in larger stores when compared to the Thrifty Food Plan. CONCLUSIONS Using a social ecological approach, public health nurses and all public health professionals are prime advocates for increased affordability of healthful foods. This study includes policy advocacy, particularly in support of Supplemental Nutrition Assistance Program benefits for low-income families. Future research implications are provided, including methodological recommendations for consistency and quality of forthcoming MBS research.

Reasons Parents Buy Prepackaged, Processed Meals: It Is More Complicated Than “I Don't Have Time”

Objective: To investigate reasons why parents purchase prepackaged, processed meals and associations with parental cooking self‐efficacy, meal‐planning ability, and home food availability. Methods: This secondary data analysis uses Healthy Home Offerings via the Mealtime Environment Plus study data from parents of children aged 8–12 years (n = 160). Associations between reasons why parents purchase prepackaged, processed meals and the outcomes were assessed with chi‐square, Fisher exact, and t tests. Results: The most frequently endorsed reasons for purchasing prepackaged, processed meals included lack of time (57%) and family preferences (49%). Five of 6 reasons were associated with lower parental cooking self‐efficacy and meal‐planning ability. Some reasons were associated with less‐healthful home food environments; few reasons varied by socio‐demographic characteristics. Conclusions and Implications: Because lower cooking self‐efficacy and meal‐planning ability are associated with most reasons reported for purchasing prepackaged, processed meals, strategies to increase these attributes for parents of all backgrounds may reduce reliance on prepackaged processed meals for family mealtimes.

Family Home Food Environment and Nutrition-Related Parent and Child Personal and Behavioral Outcomes of the Healthy Home Offerings via the Mealtime Environment (HOME) Plus Program: A Randomized Controlled Trial

BACKGROUND Research has demonstrated a significant positive association between frequent family meals and childrens dietary intake; however, the promotion of healthful family meals has not been rigorously tested for key food environment and nutrition-related behavioral outcomes in a randomized trial. OBJECTIVE To describe family home food environment and nutrition-related parent and child personal and behavioral outcomes of the Healthy Home Offerings via the Mealtime Environment Plus program, the first rigorously tested family meals intervention targeting childhood obesity prevention. DESIGN Randomized controlled trial. Baseline, postintervention (12 months, 93% retention), and follow-up (21 months, 89% retention) data (surveys and dietary recalls) were collected. PARTICIPANTS/SETTING Children aged 8 to 12 years (N=160) and their parents were randomized to intervention (n=81) or control (n=79) groups. INTERVENTION The intervention included five parent goal-setting calls and 10 monthly sessions delivered to families in community settings that focused on experiential nutrition activities and education, meal planning, cooking skill development, and reducing screen time. MAIN OUTCOME MEASURES Family home food environment outcomes and nutrition-related child and parent personal and behavioral outcomes. STATISTICAL ANALYSES PERFORMED Analyses used generalized linear mixed models. Primary comparisons were contrasts between intervention and control groups at postintervention and follow-up, with adjustments for child age and parent education. RESULTS Compared with control parents, intervention parents showed greater improvement over time in scores of self-efficacy for identifying appropriate portion sizes, with significant differences in adjusted means at both post-intervention (P=0.002) and follow-up (P=0.01). Intervention children were less likely to consume at least one sugar-sweetened beverage daily at post-intervention than control children (P=0.04). CONCLUSIONS The Healthy Home Offerings via the Mealtime Environment Plus program involved the entire family and targeted personal, behavioral, and environment factors important for healthful changes in the home food environment and childrens dietary intake. The intervention improved two nutrition-related behaviors and this may inform the design of future family meal interventions.

An Exploration of How Family Dinners Are Served and How Service Style Is Associated With Dietary and Weight Outcomes in Children

Objective: To explore how families serve meals and how different service styles are associated with responsive feeding and child dietary and weight outcomes. Methods: Baseline data from a subset (n = 75) of randomized controlled trial participants (Healthy Home Offerings via the Mealtime Environment (HOME) Plus study, aged 8–12 years) were analyzed using a series of linear regression models. Adjusted means (95% confidence intervals) and beta coefficients (SEs) are presented. Results: Families were most likely to report plated meal service (36% of families), followed by family‐style (29%). Family‐style was significantly associated with a lower mean level of food restriction (P = .01). No significant associations were observed between style of meal service and child outcomes (all P > .05). Conclusions and Implications: Although plated meal service may seem like a desirable strategy for ensuring that children eat a healthier diet, the current results did not provide support for this association. Evidence was found to support the use of family‐style meal service to promote the use of responsive feeding.

Family dinner frequency interacts with dinnertime context in associations with child and parent BMI outcomes

For youth and parents, frequent family meals have been consistently associated with positive dietary outcomes but less consistently associated with lower body mass index (BMI). Researchers have speculated dinnertime context (dinnertime routines, parent dinnertime media use) may interact with family meal frequency to impact associations with BMI. The present study evaluates the associations and interactions between dinnertime context measures and family dinner frequency with parent and child BMI. This cross-sectional study uses baseline data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus randomized control trial that aimed to prevent childhood obesity. Participants (160 parent–child dyads) completed psychosocial surveys and were measured for height and weight. General linear models tested associations and interactions between dinnertime context measures and family dinner frequency with parent and child BMI, adjusted for race and economic assistance. Lower parent dinnertime media use and higher dinnertime routines were significantly associated with lower child BMI z scores but not parent BMI scores. Interaction–moderation findings suggest higher family dinner frequency amplifies the healthful impact of the dinnertime context on child BMI z scores. Additionally, findings emphasize that promoting frequent family meals along with consistent routines and reduction in parent dinnertime media use may be important for the prevention of childhood obesity.

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior

AIM The purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients. BACKGROUND Physical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes. METHODS This quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010-June 2016 (N=419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined. RESULTS Younger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p<0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n=1639) or Surveillance (n=1183). Few were Case Management (n=46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p=0.03) and change in Physical activity Knowledge (p<0.001). CONCLUSION This study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected.