Child Weight Concern Research Articles

Comparing relationships of food parenting practices and concern for child weight between siblings

AbstractThe objective of this cross‐sectional study was to compare the difference in food parenting practices based upon parent concern and/or perception of child weight among siblings. U.S. parents (n = 63) with two or more children between the ages of 2.5 and 10 years old completed the Comprehensive Food Parenting Questionnaire, select items from the Child Feeding Questionnaire, and seven open‐ended questions for each child. There were significant differences in how parents fed siblings. For example, the relationship between concern for child weight and restriction for weight control was stronger for the older child, which was supported by parents' qualitative data.

Parental feeding practices and parental involvement in child feeding in Denmark: Gender differences and predictors

Studies about fathers and feeding are scarce and little is known about predictors of parental involvement in child feeding and of paternal feeding practices. Therefore, this study aimed to examine possible differences between Danish mothers and fathers with regard to their feeding practices and involvement in feeding related tasks, and to assess possible parent-related predictors of parental practices and involvement. A total of 261 mothers and 321 fathers of pre-schoolers completed an online survey with items from validated questionnaires. Gender differences were observed; fathers reported using higher levels of coercive control practices, while mothers reported using higher levels of structure practices and autonomy support practices. Both mothers and fathers reported to be highly involved in feeding their child. Regressions showed that a higher concern for child weight and a higher motivation for child preference when buying food were linked to a higher use of coercive control practices while a higher motivation for health control when buying food, cooking confidence, feeding/general self-efficacy and perceived responsibility for feeding were linked to a higher use of structure and autonomy support practices. The results of this study provide valuable insight into maternal and paternal practices in Denmark and their determinants.

Examining correlates of feeding practices among parents of preschoolers.

Background: Parent feeding practices play a critical role in children's eating behaviors. Limited research has explored child-level correlates of parent feeding practices. Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers US. Methods: Participants included parents (n = 273) of preschoolers (3-5 years), recruited from Early Care and Education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression. Results: For responsive feeding practices, positive associations included child's weight with unintentional modeling (β = .17, 95% CI [0.12, 0.53]), child vegetable consumption with behavioral role modeling (β = 0.22, 95% CI [0.17, 0.44]), and parent monitoring with verbal modeling (β = 0.21, 95% CI [0.12, 0.34]). For controlling feeding practices, parent restriction was positively associated with child weight concern (β = 0.22, 95% CI [0.13, 0.39]) and parent monitoring (β = 0.13, 95% CI [0.01, 0.19]), whereas child vegetable consumption was negatively associated (β = -0.16, 95% CI [-0.27, -0.05]). Pressure to eat was negatively associated with child weight concern (β = -0.18, 95% CI [-0.45, -0.09]), child fruit consumption (β = -0.12, 95% CI [-0.37, -0.01]), household income (β = -0.13, 95% CI [-0.30, -0.02]), and parent weight (β = -0.14, 95% CI [-0.60, -0.05]), Conclusions: Findings highlight the importance of child characteristics when examining correlates of parent feeding practices, demonstrating bidirectional interactions between parent feeding practices and children's eating behaviors. Considering child-level correlates may improve the implementation of responsive feeding practices and reduce controlling feeding practices.

O44 Comparing the Relationship Between Food Parenting Practices and Concern for Child Weight Between Siblings

<h3>Background</h3> Parental concern for child weight can impact food parenting practices utilized; however, most studies only ask parents about 1 child in the family. <h3>Objective</h3> The objective of this study was to compare the difference in food parenting practices based upon parent concern and/or perception of child weight among siblings. <h3>Study Design, Setting, Participants</h3> This quantitative, cross-sectional study recruited U.S. parents (n = 63) who had more than 1 child between the ages of 2.5 (M = 4.12, SD = 1.57) and 10 (M = 7.52, SD=1.97) years old to complete an online survey. Parents were mostly White (75%), non-Hispanic (76%) females (79%). <h3>Measurable Outcome/Analysis</h3> Each parent completed the Comprehensive Food Parenting Questionnaire, child weight concern and perception items from the Child Feeding Questionnaire for their oldest and youngest child (2.5-10 years old). Parents also reported demographic information. Linear regression was utilized to compare the relationships between parent concern and perception of child weight (independent variable) and food parenting practices (dependent variable) for the oldest and youngest child. Child age and gender were used as control variables. <h3>Results</h3> There were differences in the relationships between food parenting practices and weight concern/perception for younger and older children. For example, for the older child only, parents used more pressure to eat if they were less concerned about their child's weight (β = −0.32, SE = 0.15, <i>P</i> = 0.034). Additionally, if parents were highly concerned about their child's weight, they reported more use of restriction for weight control, but this relationship was stronger for the older child (β = 0.55, SE = 0.11, <i>P</i> < 0.001) compared to the younger child (β = 0.34, SE = 0.16, <i>P</i> = 0.039). <h3>Conclusion</h3> Parents may use different food parenting practices for children based upon their perception or concern for their child's weight, which may be counterproductive. Concerned parents may be especially important targets for food parenting interventions.

Estimating and differentiating maternal feeding practices in a country ranked first in childhood obesity.

Mexico ranks first in childhood obesity worldwide. However, little is known about the factors influencing maternal feeding practices. The present study aimed to estimate the prevalence of feeding practices and explore associations between weight concern, weight perception, sociodemographic characteristics and those feeding practices. Cross-sectional. North-eastern Mexico. Mothers aged ≥18 years who were in charge of feeding a singleton child aged 2-6 years with no endocrine disease or visible genetic malformations (n 507). Information on six maternal feeding practices, concern and perception of the child's weight and demographics were collected by interview. The mother's and child's height and weight were measured. The feeding practices questionnaire was subject to content, construct and convergent validity analysis. Then, mean feeding scores were obtained and prevalence and 95 % CI were determined for scores ≥3; multivariate logistic regression was performed. Not modelling (63·5 %; 95 % CI 59·2, 67·8 %) and pressuring to eat (55·6 %; 95 % CI 51·2, 60·0 %) were the most frequent feeding practices, followed by easy access to unhealthy foods (45·4 %; 95 % CI 40·9, 49·8 %) and child control (43·2 %; 95 % CI 38·8, 47·6 %). They prevailed despite concern about the child's excess weight or a perception of the child as overweight/obese. Education was associated with the highest number of practices (educated mothers used more pressuring to eat, less regulation and less easy access; or monitoring was less absent). The frequency of certain feeding practices needs to be improved. Emphasis on the child's weight concern, obesity perception and maternal education is essential for optimizing intervention planning.

Weight-Related Concerns as Barriers to Exclusive Breastfeeding at 6 Months.

Human milk is considered the gold standard for infant nutrition, but more data are needed that examine the constellation of weight-related concerns as barriers to exclusive breastfeeding. The aim of this study was to examine how mothers' concerns regarding their own and their infants' weight, as well as disordered eating behaviors, were associated with breastfeeding self-efficacy and exclusive breastfeeding at 6 months. A prospective, quantitative, and self-report online survey design was used. Participants included 206 women (88.30% White, 59.20% with graduate degrees), with a mean age of 33.04 years ( SD = 4.31 years) and a mean prepregnancy body mass index (BMI) of 24.80 kg/m2 ( SD = 5.50 kg/m2), who had given birth within the past 6 months. Participants who reported not exclusively breastfeeding at 6 months had significantly higher prepregnancy BMI ( p < .001), higher body dissatisfaction ( p = .003), more disordered eating ( p = .036), higher child weight concerns ( p < .001), and lower breastfeeding self-efficacy ( p < .001). Mediation modeling revealed a direct negative relationship between prepregnancy BMI and exclusive breastfeeding at 6 months ( p < .001). Indirect negative relationships between prepregnancy BMI and exclusive breastfeeding at six months via (a) body dissatisfaction, (b) disordered eating, and (c) child weight concern, as well as breastfeeding self-efficacy (entered as concurrent mediators), were all significant. Mothers' weight, body image and eating concerns, concern regarding their children's weight, and breastfeeding self-efficacy may constitute critical barriers to exclusive breastfeeding at 6 months. Interventions to improve breastfeeding duration and confidence should target maternal body image and eating concerns.

Cognitive and affective factors linking mothers' perceived weight history to child feeding.

To explore whether mothers' lifetime experiences with their own weight status and related cognitive and affective factors influence child feeding behavior. Overweight mothers (N = 221) of 4-5 year olds recalled their weight at four time points, and were grouped into weight history trajectories: recently overweight, always overweight, and steady-gain-obese. Objective food choice behavior was assessed in a virtual reality buffet and subjective food restriction for the index child was assessed using a psychometric measure. Mothers' observed food choice was not associated with weight trajectory, but mothers who spent more time being overweight and who weighed more at present were more restrictive of their child's eating. Mothers' concern about child weight increased with more time spent being overweight. Concern for child weight and mothers' body guilt differentially mediated the relationships between weight trajectories and perceived feeding restriction. Considering mothers' lifetime weight experiences may suggest that parental influences on child feeding are amenable to intervention that would otherwise be obscured by static weight measures.

The Influence of Parent Involvement on Child Physical Activity

INTRODUCTION: Regular physical activity (PA) in children is associated with several health benefits, but a majority of children do not achieve the recommended amount of PA. Research suggests that parent involvement in PA predicts greater child PA. Research on other predictors of child PA, such as parent encouragement and parent conversations with their child about PA have evidenced contradictory findings. PURPOSE: This study examined 1) whether more parent involvement in child PA predicts greater child PA; 2) whether more parent conversations with their child about PA predicts greater child PA; 3) whether parent concern for child weight influences the relationship between either parent involvement in child PA, or parent conversations with their child about PA, and child PA. METHODS: Child participants (n=98, 39% female, M-Age=12, M-BMI=23.0) wore an activity monitor for 7 days. A parent of each child completed self-report measures of parent conversations with their child about PA, parent concern for child weight and parent involvement in child PA (i.e. engaging in PA with child or helping child engage in PA). Regression analyses were conducted to examine whether parent conversations with their child about PA or parent involvement in child PA predicted child PA. Moderation analyses were conducted to examine if parent concern for child weight influenced the relationship between parent conversations with their child about PA or parent involvement in child PA and child PA. Analyses included the covariates age, sex, child BMI and whether a sibling participated in the study. RESULTS: Parent involvement in child PA predicted child PA; greater involvement in child PA predicted greater child PA (F(5,92)=3.57, p=0.01, R2 Δ=0.09). Parent conversations with their child about PA did not predict child PA. Parent concern about child weight did not modify the relationship between parent conversations with their child about PA or parent involvement in child PA and child PA. CONCLUSIONS: Consistent with previous research, parent involvement in child PA supports a child’s engagement in PA. Future research should examine factors that may explain the relationship between parent involvement in child PA and child PA, such as different means of parent engagement or characteristics of the child (e.g., child temperament or parenting style).

Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist.

IntroductionInsight into parents’ perceptions of their children’s eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children’s eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers’ eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).Materials and MethodsQuestionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.Results478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).DiscussionThe CEBQ is a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental pressure to eat was strongly associated with children’s food avoidance. Parental restriction, however, was more strongly associated with parents’ concerns about their children’s weights than with children’s food approach. This suggests that childhood obesity interventions should address parents’ perceptions of healthy weight alongside perceptions of healthy eating.

Factors associated with parent concern for child weight and parenting behaviors.

Background: A parent's perception about their child's overweight status is an important precursor or determinant of preventative actions. Acknowledgment of, and concern for, overweight may be moderated by the parent's own weight status whereas engaging in healthy behaviors at home may promote healthy weight status. It is hypothesized that normal weight parents are more likely to engage in healthy behaviors and acknowledge overweight in their own children whereas heavier parents may report more concern about child weight.Methods: A total of 1745 parents of first- through fifth-grade students completed a questionnaire assessing reactions to a school BMI report and perceptions about BMI issues. Specific items included perceptions of child's weight status, concern for child weight status, and preventive practices. Parents also provided information about their own weight status. Relationships between measured child weight, perceived child weight, parent weight, parent concern, and healthy behaviors were examined.Results: Overweight parents were more likely to identify overweight in their child and report concern about their child's weight. Concern was higher for parents of overweight children than of normal weight children. Normal weight parents and parents of normal weight children reported more healthy behaviors.Conclusions: Results support the hypothesis that normal weight parents are more likely to engage in healthy behaviors and that overweight parents are more likely to report concern about child weight. However, overweight parents are also more likely to acknowledge overweight status in their own child. Future research should examine links between parent concern and actual pursuit of weight management assistance.

Child weight and parental feeding practices: a child-responsive model

Purpose– The majority of previous studies on parental feeding practices have focused on the effect of controlling feeding strategies on child eating and weight (i.e. parental influence on children). The present study turns the arrow in the opposite direction, and it aims to test a child-responsive model by exploring the process in which child weight status might influence parental feeding practices, addressing potential mediating effects of parental concern for child weight (i.e. child influence on parents).Design/methodology/approach– A cross-sectional survey was performed among parents of 10- to 12-year olds (n= 963). The survey questionnaire included measures of parental feeding practices and parents’ reports of child weight and height. Stepwise regressions were performed to reveal potential mediating effects of parental concern for child weight status on the associations between child BMI and a wide range of parental feeding practices.Findings– Our results suggest a mediating effect of parental concern for child overweight on the associations between child body mass index and controlling feeding practices such as restriction for weight and health purposes and responsibility for determining child portion sizes.Originality/value– This study provides an extension of previous research on parental feeding–child weight relationship. It includes a wider spectrum of feeding variables, and integrates parental concern for both child who is overweight and child who is underweight as potential mediators of the associations between child weight and parental feeding practices. Moreover, it has its focus on preadolescent children, while previous studies have focused on infants and young children.

Relationships of Kindergarten Children’s BMI amongst Parental Body Dissatisfaction and Dietary Restraint: A Case Study in Hong Kong

Objective: In this study, the aim was to explore the relationships of kindergarten children’s BMI amongst parental factors such as parental BMI, body dissatisfaction, parental dietary restraint, child weight concern and child weight-focused restrictive feeding. Method: 466 kindergarten students’ parents were participated in this study. A self-administrated questionnaire was distributed to parents. Independent t-test, one way ANOVA and Pearson’s correlation were performed to analyze the relationships amongst different factors contributing to children’s BMI. Results: 30% parents and 37% children were found either overweight or obese. The six pathways in the proposed model were all significantly correlated. It was found that parental BMI significantly correlated with body dissatisfaction [r (466)=0.282, p<0.001], which was then associated strongly with parental dietary restraint [r (466)=0.715, p<0.001] and weakly with child weight concern [r (466)=0.146, p=0.002]. The child weight-focused restrictive feeding practice was moderately correlated with both parental dietary restraint [r (466)=0.360, p<0.001] and child weight concern [r (466)=0.320, p<0.001], and then significantly correlated with child BMI [r (466)=0.121, p=0.009]. Conclusion: The results of this study confirmed the presence of upward trend of childhood obesity in Hong Kong. In addition, parental body dissatisfaction was found to be a significant factor to determine parental dietary restraint, which was associated with child weight-focused restrictive feeding and finally affected child BMI.

Relationship between parental perception and concern for child weight and influence on obesogenic parenting practices

Background: Parents’ perception of whether children are overweight can influence parenting practices. The purpose of this study was to examine parental perception of and concern for child weight in relation to parenting practices. Methods: A cross-sectional study of parents (n=75) with pre-school age children. Parents completed the Child Feeding Questionnaire and Parenting Strategies for Obesogenic Behaviors Questionnaire. Perception (overweight vs. not overweight) and concern (concerned vs. not concerned) of child weight were examined in relation to individual strategies (Chi-square) and feeding practices (independent t-tests). Findings were confirmed in analyses adjusted for child race, sex, and weight status. Results: Five percent of parents perceived their child as overweight; 61.3% of parents were concerned about their child becoming overweight; 36% of children were overweight. Parents who perceived their child as overweight agreed their child should always eat all of the food on his/her plate (75%, p=0.031). Concerned parents made sure their child did not eat too many sweets (89%, p=0.005), high fat foods (78%, p=0.001), or favorite foods (59%, p=0.009); kept some foods out of reach (76%, p=0.014); kept track of sweets eaten (87%, p=0.012) and television watched (83%, p=0.046). Parents with concern used restrictive feeding practices (3.6% vs. 2.9%, p=0.003) and had children with a higher BMI percentile (75.0 vs. 51.0, p=0.001). Adjustment for multiple analyses was more conservative (p≤0.003). Conclusions: Parents’ concern as to whether their child is overweight was associated with overall restrictive feeding practices and children with higher body mass. Individual strategies employed by parents with a perception of or concern for overweightness included restriction, monitoring, and pressure to eat.

Parents With Limited Resources Use Highly Controlling Food Behaviors Regardless of Their Child

ObjectiveDetermine the relationship between child weight status and parent's feeding behaviors, especially those considered unhealthy—highly controlling, high contingency and unhealthy food modeling.Study Design, Setting, Participants, and InterventionSNAP-Ed eligible parents (n=191) with children 2 ½ to 5 years old comprised this baseline sample. These parents volunteered for a 6-week program to help them feed their child.Outcome, Measures and AnalysisUpon recruitment, research aides measured the parents' and children's height and weight. Parents completed a questionnaire on child feeding behaviors and concerns about their child's weight. Researchers documented prevalence of various types of feeding behaviors and analyzed the relationship between parental concern for child weight and child feeding behaviors.ResultsParents reported race and ethnicity; 69% were white, 18.6% were black and 12.4% Hispanic. Of parents, 21% were overweight and 50%, obese. Fewer children (36%) were overweight or obese, and few parents (8%) were concerned about their child's weight. Most parents reported highly controlling (75.5%) and high contingency (60%) feeding behaviors, and 68.5% modeled unhealthy snacking. Non directive child feeding behavior correlated with both parent food modeling/availability(r=0.365), with eating fruit and vegetables (r=0.206), and modeling of drinking milk (r=0.214). Parents' concern for their child's weight correlated with both their child's weight (r=0.216) and their own weight (r=0.234), but correlated with none of the child feeding behaviors.Conclusions and ImplicationsThese findings did not support that parents of obese children use more controlling or contingent child feeding behaviors. Nevertheless, it is concerning that so many parents with limited resources reported using unhealthy child feeding practices.FundingSupplemental Nutrition Assistance Program - Education ObjectiveDetermine the relationship between child weight status and parent's feeding behaviors, especially those considered unhealthy—highly controlling, high contingency and unhealthy food modeling. Determine the relationship between child weight status and parent's feeding behaviors, especially those considered unhealthy—highly controlling, high contingency and unhealthy food modeling. Study Design, Setting, Participants, and InterventionSNAP-Ed eligible parents (n=191) with children 2 ½ to 5 years old comprised this baseline sample. These parents volunteered for a 6-week program to help them feed their child. SNAP-Ed eligible parents (n=191) with children 2 ½ to 5 years old comprised this baseline sample. These parents volunteered for a 6-week program to help them feed their child. Outcome, Measures and AnalysisUpon recruitment, research aides measured the parents' and children's height and weight. Parents completed a questionnaire on child feeding behaviors and concerns about their child's weight. Researchers documented prevalence of various types of feeding behaviors and analyzed the relationship between parental concern for child weight and child feeding behaviors. Upon recruitment, research aides measured the parents' and children's height and weight. Parents completed a questionnaire on child feeding behaviors and concerns about their child's weight. Researchers documented prevalence of various types of feeding behaviors and analyzed the relationship between parental concern for child weight and child feeding behaviors. ResultsParents reported race and ethnicity; 69% were white, 18.6% were black and 12.4% Hispanic. Of parents, 21% were overweight and 50%, obese. Fewer children (36%) were overweight or obese, and few parents (8%) were concerned about their child's weight. Most parents reported highly controlling (75.5%) and high contingency (60%) feeding behaviors, and 68.5% modeled unhealthy snacking. Non directive child feeding behavior correlated with both parent food modeling/availability(r=0.365), with eating fruit and vegetables (r=0.206), and modeling of drinking milk (r=0.214). Parents' concern for their child's weight correlated with both their child's weight (r=0.216) and their own weight (r=0.234), but correlated with none of the child feeding behaviors. Parents reported race and ethnicity; 69% were white, 18.6% were black and 12.4% Hispanic. Of parents, 21% were overweight and 50%, obese. Fewer children (36%) were overweight or obese, and few parents (8%) were concerned about their child's weight. Most parents reported highly controlling (75.5%) and high contingency (60%) feeding behaviors, and 68.5% modeled unhealthy snacking. Non directive child feeding behavior correlated with both parent food modeling/availability(r=0.365), with eating fruit and vegetables (r=0.206), and modeling of drinking milk (r=0.214). Parents' concern for their child's weight correlated with both their child's weight (r=0.216) and their own weight (r=0.234), but correlated with none of the child feeding behaviors. Conclusions and ImplicationsThese findings did not support that parents of obese children use more controlling or contingent child feeding behaviors. Nevertheless, it is concerning that so many parents with limited resources reported using unhealthy child feeding practices. These findings did not support that parents of obese children use more controlling or contingent child feeding behaviors. Nevertheless, it is concerning that so many parents with limited resources reported using unhealthy child feeding practices.

Expressing Concern For Child Weight

Expressing Concern For Child Weight

Modifications in parent feeding practices and child diet during family‐based behavioral treatment improve child zBMI

ObjectiveTo examine associations between modifications in parent feeding practices, child diet, and child weight status after treatment and to evaluate dietary mediators.Design and MethodsChildren classified as overweight or obese and 7-11 years old (N=170) completed a 16-session family-based behavioral treatment program (FBT). Anthropometrics (standardized body mass index (zBMI)), Child Feeding Questionnaire, and 24-hr dietary recalls were collected at baseline and post-FBT. Linear regression predicted child zBMI change. Single and multiple mediation tested child dietary modifications as mediators between change in parent feeding practices and child zBMI.ResultsRestrictive parent feeding practices significantly decreased during FBT. Reductions in parent restriction, child weight concern, child total energy intake, and percent energy from fat, and increases in parent perceived responsibility, and child percent energy from protein, predicted reductions in child zBMI. Change in child total energy intake mediated the relation between parent restriction and child zBMI change after accounting for covariates and additional dietary mediators.ConclusionsFBT is associated with a decrease in parental restriction, which is associated with reductions in child relative weight, which was mediated by a decrease in child energy intake. Teaching parents to reduce children's energy intake without being overly restrictive may improve child weight.

Psychosocial predictors of 4-year BMI change in overweight and obese children in primary care

This study aimed to determine whether (1) initial and/or (2) changes in psychosocial functioning predict body mass index (BMI) z-score change over 4 years in overweight/mildly obese 5- to 9-year old children presenting to primary care. Eligible participants (n = 258) were overweight/mildly obese children (IOTF criteria) recruited into the LEAP2 trial (ISRCTN52511065) from 3,958 children visiting general practitioners in Melbourne, Australia from May 2005 to July 2006. Predictors were change scores calculated from repeated measures of parent- and child-reported child health-related quality of life (PedsQL) and self-esteem; child-reported desire to be thinner; and parent-reported child weight concern. Outcome was measured BMI z-score change from baseline to 4 years. The 189 respondents (61% female; 73% retention) showed little mean change in BMI z-score (-0.08) but wide variation (standard deviation 0.50, range -1.32 to 1.20). Only one baseline measure (better parent-reported PedsQL School Functioning) predicted improving BMI z-score. However, parents and children consistently reported that changes in psychosocial functioning (i.e., PedsQL Social and Global Self-esteem) were inversely related to BMI z-score change scores. The strongest predictors of decreases in BMI z-scores were changes in child-reported body-image variables, i.e., improvements in Physical Appearance Self-esteem (β =0.40, 95% CI -0.98 to -0.15, P < 0.01) and declines in Desire to be Thinner (β = 0.33, 95% CI 0.04 to 0.23, P < 0.01). At presentation to primary care, it seems unlikely that targeting the psychosocial factors measured in this study would influence BMI z-score change in overweight/mildly obese children. Subsequent change in psychosocial well-being covaries with BMI z-score change and may have important adolescent ramifications; the causal directions for these associations require further research.

Children Who Are Pressured to Eat at Home Consume Fewer High-Fat Foods in Laboratory Test Meals

Parents use greater pressure to eat with children who weigh less, but the impact of this practice is unclear. The purpose of this cross-sectional study was to determine the association between parental reports of eating pressure and children's actual intake across four identical ad libitum meals. Sixty-eight ethnically diverse, 4- to 6-year-old children from New York, NY, participated in this study from 2005 to 2007. Eating pressure was measured by the Child Feeding Questionnaire. Height and weight were measured and converted to body mass index z scores. Meals consisted of macaroni and cheese, string beans, carrots, grapes, graham crackers, cheese sticks, milk, pudding, and a sugar-sweetened beverage. Multiple regressions were performed to determine the extent to which pressure to eat predicted food intake after adjusting for BMI z score and child weight concern. Pressure to eat was negatively associated with child BMI z score (r=−0.37; P<0.01), energy intake (β=−.30; P<0.05), and energy density (β=−.28; P<0.05). In addition, pressure was negatively associated with intake of macaroni and cheese (β=−.26; P<0.05), whole milk (β=−.27; P<0.05), and pudding (β=−.33; P<0.01), but positively associated with vegetable intake (β=.43; P<0.01). However, both vegetable and milk consumption were low, so results should be interpreted with caution. These findings suggest that greater pressure to eat is associated with lower intake of some high-fat foods in the laboratory, where no pressure is applied.

Parental use of differential restrictive feeding practices with siblings

To investigate associations between sibling weight status, concerns about sibling weight, and parents' differential use of restrictive feeding practices. Participants included 70 mother-father pairs with two biological children between 6 and 12 years old. Each parent completed three Child Feeding Questionnaire (CFQ) subscales (perception of child weight, concern about child weight, and restriction) for each participant sibling. Researchers measured heights and weights and converted child data into Body Mass Index percentiles (BMI%). Multiple regression analysis examined predictors of restrictive feeding practices used by both parents. The nature of differential treatment was examined by calculating Pearson's correlations among sibling differences (older minus younger sibling) in maternal and paternal CFQ reports and sibling BMI%. Concern for child weight, but not actual child BMI% or parental perception of child weight, predicted restrictive feeding practices for both parents. Child gender was not related to child weight status, perception of child weight, concern for child weight, or restriction. Parents were more likely to use differential restrictive feeding practices when they had differential concern for the weight status of their children. However, this differential treatment was not related to differences in actual sibling BMI% or parental perception of child weight. Parental concern for child weight, rather than actual child weight status, predicts restriction by both mothers and fathers. Across families, parents generally tend to use similar feeding practices with each of their children. Within families, parents may have different interactions with each sibling regarding food when differentially concerned about sibling weight status.

The Influence of a Behavioral Weight Management Program on Disordered Eating Attitudes and Behaviors in Children with Overweight

Background Behavioral interventions targeting children with overweight have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth. Objective The purpose of this research was to determine whether youth with overweight receiving one of two behavioral interventions were more likely to report an increase in disordered eating attitudes over time compared to a waitlist control and to determine psychosocial predictors of eating-disordered attitudes at 6-month follow-up. Design Participants were randomized to one of two behavioral lifestyle interventions or a waitlist control. Data were collected at baseline, post-treatment, and 6-month follow-up. Participants/setting Participants were 68 youths with overweight, aged 8 to 13 years, and their parent(s) who lived in rural north central Florida. The project ran from January 2006 to January 2008. Intervention Each treatment condition consisted of 12 group sessions over 16 weeks. Main outcome measures Parents completed a demographic form and the Child Feeding Questionnaire. Children completed the Children's Eating Attitudes Test, Schwartz Peer Victimization Scale, and Children's Body Image Scale. Statistical analyses performed Mixed 2×2 analyses of variance were used to examine the effect of treatment on eating attitudes. Hierarchical linear regression was used to assess whether baseline levels of psychosocial variables predicted disordered eating attitudes at follow-up, controlling for baseline eating attitudes and treatment condition. Results Youth who participated in the behavioral interventions did not report significant increases in disordered eating attitudes over time compared to the waitlist control. Across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices, and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up. Conclusions These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors. Future research should examine the effects of incorporating eating disorder prevention in pediatric weight management programs.