Child Weight Outcomes Research Articles

Adherence to Behavioral Targets and Treatment Attendance During a Pediatric Weight Control Trial

Better weight loss outcomes are achieved in adults and youth who adhere to obesity treatment regimens (i.e., session attendance and prescribed changes in weight control behaviors). However, more research is needed regarding children’s adherence to a range of behaviors relevant for weight maintenance over long-term follow-up. Overweight children (N=101, aged 7-12 years), along with an overweight parent, participated in a 20-week family-based behavioral weight loss treatment (FBT) and were then assigned to either a behaviorally-focused or socially-focused 16-week weight maintenance treatment (MT). Treatment attendance and child and parent adherence (i.e., reported use of skills targeted within treatment) were examined in relation to child percent overweight change from baseline to post-FBT, post-MT, and 2-year follow-up. Higher attendance predicted better child weight outcomes at post-MT, but not at 2-year follow-up. Adherence to self-regulatory skills/goal-setting skills predicted child weight outcomes at 2-year follow-up among the behaviorally-focused MT group. Future research is needed to examine mediators of change within family-based weight control interventions, including behavioral and socially-based targets. Incorporating self-regulatory weight maintenance skills into a comprehensive MT may maximize children’s sustained weight control.

The Supplemental Nutrition Assistance Program, Financial Stress, and Childhood Obesity

The Supplemental Nutrition Assistance Program (SNAP) is the largest nutritional assistance program addressing food insecurity in the United States. Due to the program's reach, SNAP has been called upon to address other nutrition-related challenges facing low-income Americans, including childhood obesity. This study considers the effect of SNAP participation on child weight outcomes after controlling for household financial stress, an important determinant of child overweight status that disproportionately affects low-income households. Using data from theSurvey of Household Finances and Childhood Obesityand instrumental variable methods, we find that SNAP participation is negatively associated with obesity among eligible children.

Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps

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.

Children’s weight status and maternal and paternal feeding practices

Child obesity has become a major concern of health researchers. This study explores the association between parental feeding practices and children's weight status. The study also examines whether maternal and paternal feeding practices lead to significantly different children's weight outcomes. By analyzing samples of 312 children (aged 9-11 and 13-15) and their parents, randomly selected from the Houston Metropolitan Statistical Area, the results show that parental feeding practices are linked to children's weight status. The finding that maternal and paternal feeding practices do not have significantly different effects on children's weight highlights an equivalent role of maternal and paternal feeding practices in shaping children's weight status.

Expanding the understanding of how parenting influences the dietary intake and weight status of children: A cross‐sectional study

AbstractAim: The present study explored whether existing tools measuring parenting could be combined to assess an expanded parenting definition, specifically to include co‐participation in food‐related activities and teaching children about nutrition. The relationships between parenting, child dietary intake and weight outcomes were explored.Methods: The sample included 93 children aged 4–13 years and their parent/caregiver. Child outcomes were dietary intake and body mass index z‐score. Parent measures included demographics, nutrition knowledge and parenting practices. Exploratory factor analysis was used to identify underlying dimensions of parenting. Hierarchical linear regression was used to investigate the independent effects of parenting on child outcomes (body mass index z‐score, fruit and vegetable, fibre, saturated and total fat) after adjustment for covariates.Results: Five factors were extracted, accounting for 44% of the total variance (α= 0.77–0.87). The regression model for kilojoules explained 31% of the variance (P= 0.001), with a significant independent contribution from construct ‘guide and reward’ (β=−0.249, P= 0.027). For child body mass index z‐score, the model explained 25% of variance, and parenting constructs ‘guide and reward’ (β= 0.274, P= 0.015) and ‘concern about intake’ (β=−0.273, P= 0.008) made significant contributions.Conclusions: The present study adds to our understanding of parenting influences on children's dietary intake and weight status. Results support the inclusion of parenting strategies in obesity prevention interventions. Future research should explore the range of ways parenting influences children's diet and risk of obesity, preferably longitudinally.

Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

BackgroundInsights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development.MethodsQuestionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics.ResultsSeveral child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI.ConclusionAlthough most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.

The Screening Tool of Feeding Problems applied to children (STEP-CHILD): Psychometric characteristics and associations with child and parent variables

The present study evaluated the 23-item Screening Tool for Feeding Problems (STEP; Matson & Kuhn, 2001) with a sample of children referred to a hospital-based feeding clinic to examine the scale's psychometric characteristics and then demonstrate how a children's revision of the STEP, the STEP-CHILD is associated with child and parent variables. Participants included 142 children (95 boys, 47 girls; mean age = 61.4 months; 43 with autism, 51 with other special needs, 48 with no special needs). Children ranged in age from 24 months to 18 years. Factor analysis revealed a 15-item STEP-CHILD with six subscales of child feeding problems: CHEWING PROBLEMS, RAPID EATING, FOOD REFUSAL, FOOD SELECTIVITY, VOMITING, and STEALING FOOD. Mediation analysis documented that “overly permissive” actions by parents (such as infrequent insistence on eating during meals, or frequent preparation of Special Meals for children different than the family meal) explained over 34% of the links between children's feeding problems and poor weight and diet outcomes.

Psychosocial and familial impairment among overweight youth with social problems

Emerging research indicates that overweight children with social impairments are less responsive to weight control interventions over the long term. A better understanding of the breadth and psychosocial correlates of social problems among overweight youth is needed to optimize long-term weight outcomes. A total of 201 overweight children, aged 7-12 years, participated in a randomized controlled trial of two weight maintenance interventions following family-based behavioral weight loss treatment. Children with HIGH (T ≥ 65) versus LOW (T<65) scores on the Child Behavior Checklist Social Problems subscale were compared on their own and their parents' pre-treatment levels of psychosocial impairment using multivariate analysis of variance. Hierarchical regression was used to identify parent and child predictors of social problems in the overall sample. HIGH (n = 71) children evidenced greater eating disorder psychopathology and lower self-worth, as well as a range of interpersonal difficulties, compared with LOW children (n = 130; ps<0.05). Compared with parents of LOW children, parents of HIGH children reported greater levels of their own general psychopathology (p<0.05). Parent psychopathology significantly added to the prediction of social problems in the full sample beyond child sex and z-BMI (ps<0.01). A substantial minority of overweight youth experience deficits across the social domain, and such deficits appear to be associated with impairment in a broad range of other psychosocial domains. Augmenting weight loss interventions with specialized treatment components to address child and parent psychosocial problems could enhance socially-impaired children's long-term weight outcomes and decrease risk for later development of psychiatric disturbances.

The effects of soft drink taxes on child and adolescent consumption and weight outcomes

Childhood and adolescent obesity is associated with serious adverse lifetime health consequences and its prevalence has increased rapidly. Soft drink consumption has also expanded rapidly, so much so that soft drinks are currently the largest single contributors to energy intake. In this paper, we investigate the potential for soft drink taxes to combat rising levels of child and adolescent obesity through a reduction in consumption. Our results, based on state soft drink sales and excise tax information between 1989 and 2006 and the National Health Examination and Nutrition Survey, suggest that soft drink taxation, as currently practiced in the United States, leads to a moderate reduction in soft drink consumption by children and adolescents. However, we show that this reduction in soda consumption is completely offset by increases in consumption of other high-calorie drinks.

The Effects of Soft Drink Taxes on Child and Adolescent Consumption and Weight Outcomes

Childhood and adolescent obesity is associated with serious lifetime health consequences and has seen a recent rapid increase in prevalence. Soft drink consumption has also expanded rapidly, so much so that soft drinks are currently the largest single contributors to energy intake. In this paper, we investigate the potential for soft drink taxes to combat rising levels of adolescent obesity through a reduction in consumption. Our results, based on state soft drink sales and excise tax information between 1988 and 2006 and the National Health Examination and Nutrition Survey, suggest that soft drink taxation, as currently practiced in the United States, leads to a moderate reduction in soft drink consumption by children and adolescents. However, we show that this reduction in soda consumption is completely offset by increases in consumption of other high calorie drinks.