Picky eating in an obesity intervention for preschool-aged children \u2013 what role does it play, and does the measurement instrument matter?

Pernilla Sandvik,Matteo Bottai,Anna Ek,Karin Eli,Paulina Nowicka,Maria Somaraki

doi:10.1186/s12966-019-0845-y

Abstract

IntroductionResearch on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used. This study examines the role of picky eating in a randomized controlled obesity intervention for preschoolers using subscales from two instruments: The Child Eating Behavior Questionnaire (CEBQ) and the Lifestyle Behavior Checklist (LBC).MethodThe study includes 130 children (mean age 5.2 years (SD 0.7), 54% girls, mean Body Mass Index (BMI) z-score 2.9 (SD 0.6)) and their parents (nearly 60% of non-Swedish background, 40% with university degree). Families were randomized to a parent-group treatment focusing on evidence-based parenting practices or to standard treatment focusing on lifestyle changes. The children’s heights and weights (BMI z-score) were measured at baseline, and at 3, 6 and 12 months post baseline. At these time-points, picky eating was reported by parents using the CEBQ (Food Fussiness scale, 6 items) and 5 items from the LBC. Child food intake was reported with a Food Frequency Questionnaire (FFQ). Pearson correlation was used to study associations between baseline picky eating and baseline BMI z-scores and food intake. Mixed effects models were used to study associations between the two measurements of picky eating and changes in picky eating, to assess the effects of changes in picky eating on BMI z-scores, and to evaluate baseline picky eating as a predictor of changes in BMI z-scores.ResultsNeither the standard treatment nor the parent-group treatment reduced the degree of picky eating (measured with CEBQ or LBC). Baseline picky eating measured with the CEBQ was associated with a lower BMI z-score and lower intake of vegetables. Children with a higher degree of picky eating at baseline (measured with the CEBQ) displayed a lower degree of weight loss. When degree of picky eating was examined, for 25% of the children, the CEBQ and the LBC yielded diverging results.ConclusionsBaseline picky eating may weaken the effectiveness of obesity treatment, and assessments should be conducted before treatment to adjust the treatment approach. Different measurements of picky eating may lead to different results. The CEBQ seems more robust than the LBC in measuring picky eating.Trial registrationClinicaltrials.gov, NCT01792531. Registered 15 February 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01792531

Highlights

Research on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used
Neither the standard treatment nor the parent-group treatment reduced the degree of picky eating
Baseline picky eating may weaken the effectiveness of obesity treatment, and assessments should be conducted before treatment to adjust the treatment approach

Summary

Introduction

Research on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used. We have recently published data from Sweden showing a significantly lower prevalence of picky eating in preschoolers with obesity compared to children with underweight, normal weight and overweight [6]. Parents of children with obesity who are classified as picky eaters are more likely to perceive their child as having normal weight compared to children with obesity classified as non-picky eaters [6]. This indicates that parents may perceive picky eating as more problematic than their child’s weight [6]

Methods

Results

Conclusion