Nadia Corsini

Interventions that involve parents to improve children's weight-related nutrition intake and activity patterns - what nutrition and activity targets and behaviour change techniques are associated with intervention effectiveness?

Parent involvement is an important component of obesity prevention interventions. However, the best way to support parents remains unclear. This review identifies interventions targeting parents to improve childrens weight status, dietary and/or activity patterns, examines whether intervention content and behaviour change techniques employed are associated with effectiveness. Seventeen studies, in English, 1998–2008, were included. Studies were evaluated by two reviewers for study quality, nutrition/activity content and behaviour change techniques using a validated quality assessment tool and behaviour change technique taxonomy. Study findings favoured intervention effectiveness in 11 of 17 studies. Interventions that were considered effective had similar features: better study quality, parents responsible for participation and implementation, greater parental involvement and inclusion of prompt barrier identification, restructure the home environment, prompt self‐monitoring, prompt specific goal setting behaviour change techniques. Energy intake/density and food choices were more likely to be targeted in effective interventions. The number of lifestyle behaviours targeted did not appear to be associated with effectiveness. Intervention effectiveness was favoured when behaviour change techniques spanned the spectrum of behaviour change process. The review provides guidance for researchers to make informed decisions on how best to utilize resources in interventions to support and engage parents, and highlights a need for improvement in intervention content reporting practices.

Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study

This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5-6-year-old and 188 10-12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, childrens BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5-6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10-12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.

Combined Home and School Obesity Prevention Interventions for Children What Behavior Change Strategies and Intervention Characteristics Are Associated With Effectiveness

This review identifies studies describing interventions delivered across both the home and school/community setting, which target obesity and weight-related nutrition and physical activity behaviors in children. Fifteen studies, published between 1998 and 2010, were included and evaluated for effectiveness, study quality, nutrition/activity content, behavior change techniques, and theoretical basis, using validated assessment tools/taxonomies. Seven studies were rated as effective. Behavior change techniques used to engage families, and techniques associated with intervention effectiveness were coded. Effective studies used about 10 behavior change techniques, compared with 6.5 in ineffective studies. Effective interventions used techniques including providing general information on behavior–health links, prompting practice of behavior, and planning for social support/social changes. Different behavior change techniques were applied in the home and school setting. The findings of this review provide novel insights into the techniques associated with intervention effectiveness that can inform the development of public health obesity prevention strategies.

Rewards can be used effectively with repeated exposure to increase liking of vegetables in 4–6-year-old children

OBJECTIVE To examine whether parents offering a sticker reward to their child to taste a vegetable the child does not currently consume is associated with improvements in childrens liking and consumption of the vegetable. DESIGN A randomized controlled trial evaluated the effectiveness of exposure only (EO) and exposure plus reward (E + R), relative to a control group, on childrens liking and consumption of a target vegetable. Assessments were conducted at baseline and 2 weeks from baseline (post-intervention). Follow-up assessments were conducted at 4 weeks and 3 months from baseline. SETTING The study took place in Adelaide, South Australia. Participants were self-selected in response to local media advertisements seeking to recruit parents finding it difficult to get their children to eat vegetables. SUBJECTS Participants were 185 children (110 boys, seventy-five girls) aged 4-6 years and their primary caregiver/parent (172 mothers, thirteen fathers). RESULTS The E + R group was able to achieve more days of taste exposure. Both EO and E + R increased liking at post-intervention compared with control and no further change occurred over the follow-up period. All groups increased their intake of the target vegetable at post-intervention. Target vegetable consumption continued to increase significantly over the follow-up period for E + R and control but not for EO. CONCLUSIONS The findings provide support for the effectiveness of using a sticker reward with a repeated exposure strategy. In particular, such rewards can facilitate the actual tastings necessary to change liking.

Managing young children's snack food intake. The role of parenting style and feeding strategies

One major contributor to the problem of childhood overweight and obesity is the over-consumption of foods high in fat, salt and sugar, such as snack foods. The current study aimed to examine young childrens snack intake and the influence of feeding strategies used by parents in the context of general parenting style. Participants were 611 mothers of children aged 2-7 years who completed an online questionnaire containing measures of general parenting domains and two particular feeding strategies, restriction and covert control. It was found that greater unhealthy snack intake was associated with higher restriction and lower covert control, while greater healthy snack intake was associated with lower restriction and higher covert control. Further, the feeding strategies mediated the association between parental demandingness and responsiveness and child snack intake. These findings provide evidence for the differential impact of controlling and positive parental feeding strategies on young childrens snack intake in the context of general parenting.

Maternal responses to difficult food request scenarios: Relationships with feeding style and child unhealthy snack intake

This study sought to identify parent-feeding behaviours in real-life difficult feeding situations through the use of a set of scenarios. These were then used to examine links between parent feeding and child snack intake. Mothers of children aged 2–7 years (n = 611) completed an online survey containing five snack food request scenarios, two commonly used parent-feeding scales (Restriction and Covert Control), and reported on their child’s snack intake. Results showed that parent-feeding styles (restrictive or covert) translated into specific behaviours in response to the scenarios. These parent behaviours predicted children’s intake of unhealthy snack food over and above the feeding style.

Three Broad Parental Feeding Styles and Young Children's Snack Intake.

Objective: The aim of this study was to identify broad overarching feeding styles that parents may use and their effects on pre-school-aged children’s healthy and unhealthy snack intake. Design: Cross sectional study Methods: Mothers (n = 611) of children aged 2–7 years (mean age 3.9 years) completed an online survey assessing parent-feeding strategies and parent-reported child snack intake. Data were analysed in two phases. First, principal components analysis identified three major feeding styles that were labelled overt control, covert control and parent modelling. Then, structural equation modelling was used to see whether these factors were related differentially to reported child snack intake. Results: The intake of healthy snack food was associated with higher covert control and parent modelling and lower overt control. The reverse was true for unhealthy snack intake, with the intake of these foods associated with lower covert control and parental modelling, and higher overt control. Conclusion: Our findings show that parent-feeding styles that attempt to control the child’s environment seem to have a positive impact on snack intake, while styles aimed at controlling the child (overt control) seem to have a detrimental impact.

Use of social networking sites and associations with skin tone dissatisfaction, sun exposure, and sun protection in a sample of Australian adolescents

Objective: Previous research has indicated that greater exposure to traditional media (i.e. television, film, and print) predicted skin cancer risk factors in adolescents; however, the relationship between social media usage and these outcomes remains unexplored. We examined whether social networking site (SNS) usage, and the particular manner of this use, was associated with skin tone dissatisfaction, sun exposure and sun protection among Australian adolescents. We also explored sex differences in SNS usage related to tanning. Method: A total of 1856 South Australian secondary school students completed the Australian School Students Alcohol and Drug 2014 survey. SNS usage related to tanning comprised posting pictures, posting text, viewing pictures, viewing text and liking or sharing posts. Results: Adolescents spent 214.56 minutes, on average, per day using SNSs. Behaviours related to tanning that involved pictures (i.e. viewing pictures, posting pictures, and liking or sharing content) were significantly associated with more skin tone dissatisfaction, more sun exposure and less sun protection. Females performed all SNS-linked behaviours more frequently than did males, with the exception of posting text. Conclusion: Australian adolescents spend a considerable amount of time using SNSs, and their behaviours related to tanning on these SNSs are significantly associated with skin cancer risk factors.

“That's enough now!”: a prospective study of the effects of maternal control on children's snack intake

The aim of this study was to investigate maternal feeding strategies as prospective predictors of young childrens snack intake. Participants were 252 mothers of children aged 3-11 years old who completed questionnaire measures of parent feeding strategies (Restriction and Covert Control) and reported on their childs healthy and unhealthy snack intake at two time points separated by three years. Longitudinal regression models showed no prediction of healthy snack food intake. However, Time 1 parental restrictive feeding predicted greater unhealthy snack intake at Time 2, while Time 1 covert feeding strategies predicted lower unhealthy snack intake at Time 2. Structural equation modeling showed that these associations were independent of known covariates that influence childrens snack intake (child and parent weight, education level and SES). The results provide longitudinal evidence for the negative impact of restrictive parent feeding strategies on childrens snack intake and highlight the importance of dissuading parents from using this type of feeding control. Instead, parents should be encouraged to use more covert feeding strategies that are associated with less unhealthy snack intake over the longer term.

Eating in the absence of hunger in young children: The role of maternal feeding strategies

Restrictive feeding strategies have been associated with increased eating in the absence of hunger in a small number of studies of young girls. The aim of the present study was to examine a broader range of maternal feeding styles and eating in the absence of hunger in both girls and boys aged 3-5 years old. Participants were 184 mother-child dyads. Mothers completed a questionnaire containing measures of feeding strategies (Restriction, Pressure to Eat and Covert Control). Children consumed a lunch meal and then completed the Eating in the Absence of Hunger protocol. For girls, restrictive feeding was associated with increased eating in the absence of hunger. For boys, pressure to eat more was negatively associated with eating in the absence of hunger. Covert control was not associated with eating in the absence of hunger. Overall, the findings suggest that maternal feeding practices have a differential effect on the eating behaviours of girls and boys. In addition, results from this study indicate that controlling maternal feeding strategies, such as restrictive feeding, have a detrimental impact on young childrens eating behaviours and may interfere with their ability to self-regulate eating.