Myles S. Faith

Evaluating Parents and Adult Caregivers as ‘Agents of Change’ for Treating Obese Children – Evidence for Parent Behavior Change Strategies and Research Gaps: A Scientific Statement from the American Heart Association

This scientific statement addresses parents and adult caregivers (PACs) as “agents of change” for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental “involvement” in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.

Fundamental constructs in food parenting practices: a content map to guide future research

Although research shows that food parenting practices can impact childrens diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.

Is Meat Male? A Quantitative Multimethod Framework to Establish Metaphoric Relationships

Metaphors are increasingly recognized as influencing cognition and consumption. While these linkages typically have been qualitatively generated, this article presents a framework of convergent quantitative methodologies that can further document the validity of a metaphor. To illustrate this multimethod framework, the authors explore whether there is a metaphoric link between meat and maleness in Western cultures. The authors address this in six quantifiable studies that involve (1) implicit associations, (2) free associations, (3) indirect-scenario-based inferences, (4) direct measurement profiling, (5) preference and choice, and (6) linguistic analysis and conclude that there is a metaphoric relationship between mammal muscle meat and maleness.

Percentage of body fat cutoffs by sex, age, and race-ethnicity in the US adult population from NHANES 1999–2004

BACKGROUNDnTo date, there is no consensus regarding adult cutoffs of percentage of body fat or estimated cutoffs on the basis of nationally representative samples with rigorous body-composition measurements.nnnOBJECTIVEnWe developed cutoffs of percentage of body fat on the basis of the relation between dual-energy x-ray absorptiometry-measured fat mass and BMI (in kg/m(2)) stratified by sex, age, and race-ethnicity by using 1999-2004 NHANES data.nnnDESIGNnA simple regression (percentage of body fat = β(0) + β(1) × 1 ÷ BMI) was fit for each combination of sex (men and women), 3 age groups (18-29, 30-49, and 50-84 y of age), and 3 race-ethnicity groups (non-Hispanic whites, non-Hispanic blacks, and Mexican Americans). Model fitting included a consideration of complex survey design and multiple imputations. Cutoffs of percentage of body fat were computed that corresponded to BMI cutoffs of 18.5, 25, 30, 35, and 40 on the basis of estimated prediction equations.nnnRESULTSnR(2) ranged from 0.54 to 0.72 for men (n = 6544) and 0.58 to 0.79 for women (n = 6362). In men, the percentage of body fat that corresponded to a BMI of 18.5, 25, 30, 35, and 40 across age and racial-ethnic groups ranged from 12.2% to 19.0%, 22.6% to 28.0%, 27.5% to 32.3%, 31.0% to 35.3%, and 33.6% to 37.6%, respectively; the corresponding ranges in women were from 24.6% to 32.3%, 35.0% to 40.2%, 39.9% to 44.1%, 43.4% to 47.1%, and 46.1% to 49.4%, respectively. The oldest age group had the highest cutoffs of percentage of body fat. Non-Hispanic blacks had the lowest cutoffs of percentage of body fat. Cutoffs of percentage of body fat were higher in women than in men.nnnCONCLUSIONSnCutoffs of percentage of body fat that correspond to the current US BMI cutoffs are a function of sex, age, and race-ethnicity. These factors should be taken into account when considering the appropriateness of levels of percentage of body fat.

Genetics of Food Intake Self-Regulation in Childhood: Literature Review and Research Opportunities

Pediatric obesity results from a daily energy imbalance between intake and expenditure, an imbalance potentially as slight as ∼30-50 kcal/day (e.g., a few extra sips of cola or bites of a cookie). That an ‘energy gap so small may be so powerful suggests the importance of understanding mechanisms of food intake self-regulation (FISR). This review focuses on 4 behavioral indices of FISR in childhood: (1) eating in the absence of hunger; (2) eating rate; (3) caloric compensation and satiety responsiveness, and (4) food responsiveness. Evidence from pediatric samples around the world indicates that these traits are associated with body mass index, are heritable, and are linked to polymorphisms in the FTO gene. We review these data, also discussing their relevance to practical issues of parental feeding styles, portion sizes, and health literacy and numeracy. Research gaps and opportunities for future investigation are discussed. Multidisciplinary approaches and study designs that can address gene-environment interactions are needed to advance the science of FISR and stimulate new avenues for childhood obesity prevention.

Inverse Association between Fruit and Vegetable Intake and BMI even after Controlling for Demographic, Socioeconomic and Lifestyle Factors

Objective: To estimate fruit and vegetable (FV) intake levels of US adult population and evaluate the association between FV intake and BMI status after controlling for confounding demographic, socioeconomic and lifestyle factors. We also sought to identify moderating factors. Methods: We used 2007 Behavior Risk Factors Surveillance System (N > 400,000) data. FV intake was dichotomized as ≧5 servings (FV5+) versus <5 servings/ day. BMI status was categorized as normal, overweight, and obese. Identification of moderators was performed by testing interactions between BMI status and other variables using bivariate analyses followed by multiple logistic regression analysis incorporating complex survey sampling design features. Results: Only 24.6% of US adults consumed ≧5 servings per day and less than 4% consumed 9 or more servings. Overweight (% FV5+ = 23.9%) and obese (21.9%) groups consumed significantly less FV than the normal-weight (27.4%) group (p < 0.0001). This inverse association remained significant even after controlling for potential confounding factors. Multivariate analysis identified five significant moderators (p < 0.0001) after controlling for all evaluated variables: race, sex, smoking status, health coverage, and physical activity. Notably, physically inactive obese males tended to consume the least FV (% FV5+ = 14.7%). Conclusion: Current US population FV intake level is below recommended levels. The inverse association between FV intake and obesity was significant and was moderated by demographic, socioeconomic status, and lifestyle factors. These factors should be considered when developing policies and interventions to increase FV intake.

Infant BMI or Weight-for-Length and Obesity Risk in Early Childhood.

BACKGROUND: Weight-for-length (WFL) is currently used to assess adiposity under 2 years. We assessed WFL- versus BMI-based estimates of adiposity in healthy infants in determining risk for early obesity. METHODS: Anthropometrics were extracted from electronic medical records for well-child visits for 73u2009949 full-term infants from a large pediatric network. World Health Organization WFL and BMI z scores (WFL-z and BMI-z, respectively) were calculated up to age 24 months. Correlation analyses assessed the agreement between WFL-z and BMI-z and within-subject tracking over time. Logistic regression determined odds of obesity at 2 years on the basis of adiposity classification at 2 months. RESULTS: Agreement between WFL-z and BMI-z increased from birth to 6 months and remained high thereafter. BMI-z at 2 months was more consistent with measurements at older ages than WFL-z at 2 months. Infants with high BMI (≥85th percentile) and reference WFL (5th–85th percentiles) at 2 months had greater odds of obesity at 2 years than those with high WFL (≥85th percentile) and reference BMI (5th–85th percentiles; odds ratio, 5.49 vs 1.40; P < .001). At 2 months, BMI had a higher positive predictive value than WFL for obesity at 2 years using cut-points of either the 85th percentile (31% vs 23%) or 97.7th percentile (47% vs 29%). CONCLUSIONS: High BMI in early infancy is more strongly associated with early childhood obesity than high WFL. Forty-seven percent of infants with BMI ≥97.7th percentile at 2 months (versus 29% of infants with WFL ≥97.7th percentile at 2 months) were obese at 2 years. Epidemiologic studies focused on assessing childhood obesity risk should consider using BMI in early infancy.

Parental feeding practices and associations with child weight status. Swedish validation of the Child Feeding Questionnaire finds parents of 4-year-olds less restrictive ☆

The Child Feeding Questionnaire (CFQ) assesses parental feeding attitudes, beliefs and practices concerned with child feeding and obesity proneness. The questionnaire has been developed in the U.S., and validation studies in other countries are limited. The aim of this study was to examine the psychometric properties of the CFQ in Sweden and the associations between parenting practices and childrens weight status. Based on records from the Swedish population register, all mothers of 4-year-olds (nu2009=u20093007) from the third largest city in Sweden, Malmö, were contacted by mail. Those who returned the CFQ together with a background questionnaire (nu2009=u2009876) received the CFQ again to enable test-retest evaluation; 564 mothers completed the CFQ twice. We used confirmatory factor analysis to test whether the original 7-factor model was supported. Good fit (CFIu2009=u20090.94, TLIu2009=u20090.95, RMSEAu2009=u20090.04, SRMRu2009=u20090.05) was obtained after minor modifications such as dropping 2 items on restriction and adding 3 error covariances. The internal reliability and the 2-week test-retest reliability were good. The scores on restriction were the lowest ever reported. When the influence of parenting practices on child BMI (dependent variable) was examined in a structural equation model (SEM), child BMI had a positive association with restriction and a negative association with pressure to eat. Restriction was positively influenced by concern about child weight. The second SEM treated parenting practices as dependent variables. Parental foreign origin and child BMI had direct effects on restriction, while pressure to eat was also influenced by parental education. While the results of the study support the usefulness of the CFQ in Sweden, carefully designed cross-cultural comparisons are needed to explain why the levels of restrictive feeding in Swedish families are the lowest reported.

Child food neophobia is heritable, associated with less compliant eating, and moderates familial resemblance for BMI

The heritability of food neophobia, the tendency to avoid new foods, was tested in 4‐7‐year‐old twins. We also examined whether food neophobia is associated with parent‐child feeding relations or child body fat.

Effects on Cognitive Performance of Eating Compared With Omitting Breakfast in Elementary Schoolchildren

Objective: The objective of this laboratory-based pilot study was to test the effects of consuming, compared with omitting, breakfast across 6 cognitive domains and on levels of perceived energy and well-being. Methods: In a crossover design, 21 boys and girls, 8 to 10 years of age, were assessed once a week for 2 weeks. On each test day, subjects performed a series of 8 computerized cognitive performance tasks using the CogState© software program throughout the morning, but they either consumed or did not consume breakfast. In addition, subjects repeatedly rated their perceived energy level, fatigue, overall well-being, and cheerfulness using a 100-mm Visual Analog Scale. Results: Results showed no significant main effect of breakfast condition (p > .17) or breakfast condition-by-time interaction (p > .09) for any of the cognitive performance tasks. On the day when children consumed breakfast, they felt significantly more cheerful (p = .02) and indicated to have more energy (p = .04) than on the day when they skipped breakfast. Conclusion: Among children who regularly consume breakfast, skipping breakfast once significantly decreased their perceived level of energy and cheerfulness, but it did not affect their cognitive performance throughout the morning. More experimental studies are needed to assess the effects of different types of breakfast on cognitive performance in children over a prolonged period of time while controlling for familial factors that may affect cognitive performance in children.