The family food environment and its relationship with eating behaviours in early childhood (2.0 – 5.0 years) and the implications for obesity development

Abstract

Introduction: Childhood obesity is an issue of great public health concern. [1] The early childhood period (2.0 – 5.0 years) provides a unique and critical window in which to address the emergence of obesity, as it is during this time that children become active participants in the socio-cultural exchanges that contribute to obesity development. [2] According to the behavioural susceptibility theory, obesity emerges when genetic susceptibility and environmental circumstances interact and obesogenic behaviours ensue. [2] Consequently, interventions in early childhood that target behaviour change through environmental modification, offer promise in prevention of childhood obesity. In this regard, the family food environment (FFE), as the ‘first ecological niche of children,’ encompasses a range of potentially modifiable environmental factors. [3-7] Conceptualised to comprise the interpersonal and micro-environment influences within the home, the FFE may consequently provide an avenue from which to affect change in ‘obesogenic’ behaviours, such as children’s eating behaviours. [3-7] It has been estimated that environmental factors, such as those within the FFE, account for approximately 45% of variance in children’s eating behaviours and 28% of variance in child BMI. [3, 4]Current understanding of the array of FFE variables that, individually or collectively, interact with children’s eating behaviours to contribute to obesity status in early childhood appears fragmented and fails to draw a comprehensive picture of environmental exposures. Furthermore, understanding of differences in children’s eating behaviours based on psycho-social variables is limited. A greater understanding of these contributors to eating behaviours could lead to the development of novel strategies for behaviour change and obesity prevention. This thesis aimed to draw a comprehensive picture of the FFE of Australian children during early childhood and develop an understanding of the influence this environment has on children’s eating behaviours and obesity status. This thesis further aimed to determine parent’s acceptability towards intervention opportunities, particularly those delivered online and those designed to address identified child feeding issues within the FFE, as a means of altering children’s eating behaviours and reducing obesity risk.Method: Two cross-sectional studies were conducted. The first study consisted of an online survey (survey 1) of 1186 parents of Australian children (2.0 – 5.0 years of age) recruited via Facebook®. Data on variables conceptualised within the FFE were collected, along with data on children’s eating behaviours, self-reported parent and child BMI, and psycho-social variables. The second survey (survey 2) recruited a new sample of 310 parents of Australian children (2.0 – 5.0 years of age) via Facebook®. Items in this survey were designed to assess parent’s acceptability towards child feeding intervention opportunities, particularly those delivered online, with items aligning with the constructs of the health belief model (HBM) and social cognitive theory (SCT). All data analysis were performed quantitatively using SPSS (SPSS Inc., Chicago, IL, USA).Results: Data analysis from survey 1 (n=977) demonstrated that food responsiveness and satiety responsiveness were associated with child body mass index z-score (BMIz), controlling for psycho-social variables (B=0.188, p=0.020 and B=-0.260, p=0.013, respectively). A range of FFE variables (e.g. parent’s feeding practices, parent’s shopping skills, having sufficient money to buy food each week, parent’s nutrition related beliefs), were seen to interact with these eating behaviours, however, only parent’s use of overt restriction was positively associated with child BMIz (B=0.132, p=0.048). This relationship was mediated by food responsiveness (accounting for 5.75% of the effect, controlling for demographic variables). As a more authentic reflection of the FFE exposure experienced by children, factor analysis showed four factors of FFE variables to be related to child BMI category (n=758); scores for ‘Negative feeding strategies’ (p=0.046) and ‘Negative nutrition-related beliefs’ (p=0.004) increased with child BMI category, while scores for ‘Use of TV and devices’ (p=0.049) and ‘Parent’s nutrition knowledge’ (p=0.032) decreased with child BMI category. ‘Negative feeding strategies’ and ‘Negative nutrition-related beliefs’ were both also positively associated with food responsiveness (B=0.305, p=0.000 and B=0.117, p=0.018, respectively). Results from survey 2 indicated that parents may be more inclined to engage with child feeding interventions that frame core messages around fussy eating behaviours, as opposed to obesity directly. Barriers within FFEs, particularly lack of time and money, and child tantrums, should be addressed in such future child feeding intervention, that are preferably delivered online (although face-to-face interventions still hold appeal, particularly for lower educated parents).Conclusion and implications for practice: The findings of this thesis provide support for early childhood obesity prevention interventions to focus on the intermediary role of children’s eating behaviours, particularly food responsiveness, by targeting variables within the FFE. Interventions should aim to engage parents by framing content towards fussy eating as a key issue of concern, while addressing relevant barriers in creating a healthful FFE. Internet based platforms appear promising for use in future intervention delivery.