Child Weight Status Research Articles

Maternal Gestational Diabetes Is Associated with High Risk of Childhood Overweight and Obesity: A Cross-Sectional Study in Pre-School Children Aged 2–5 Years

Background and Objectives: Childhood obesity is a global public health concern with long-term and serious health implications. An important factor for childhood obesity is maternal gestational diabetes mellitus (GDM), which in turn impacts maternal and offspring long-term health. This study aimed to investigate the associations between maternal GDM and childhood weight status and multiple anthropometric and sociodemographic factors and perinatal outcomes. Materials and Methods: A total of 5348 children aged 2-5 years old and their paired mothers took part in the study. Questionnaires were utilized to evaluate the sociodemographic factors and perinatal outcomes as well as smoking habits, educational level, economic status, age, and parity status. Children's anthropometric parameters were measured, and maternal medical history, preterm birth records, and anthropometric measures during pregnancy were retrieved by their medical records. Results: Overall, 16.4% of the children aged at 2-5 years were overweight, and 8.2% of them were affected by obesity, leading to a total 24.6% of children with overweight/obesity. Further, 5.5% of the enrolled mothers were diagnosed with gestational diabetes mellitus. GDM doubles the probability of childhood overweight/obesity at ages 2-5 years old independently of multiple confounding factors. Pre-pregnancy overweight and obesity, older maternal age, and smoking are risk factors for GDM, while GDM additionally increases the risk of preterm birth. Children of mothers that developed GDM were at greater risk of overweight or obesity, with the association between GDM and offspring's weight status being independent of confounding factors. Conclusions: GDM is a severe public health issue with prolonged complications for both the mother and their children. Public health approaches and programs need to promote the negative role of pre-pregnancy weight and smoking status as well as the significance of a good glycemic control throughout gestation in women of childbearing age.

The influence of birthweight and breastfeeding status on BMI outcome at first year of primary school: a retrospective study of an Irish child cohort.

This study found an association between BMI outcome at first year of primary school education and sex, birthweight and breastfeeding status in a cohort of children in the North-West of Ireland. The majority of parents did not express concern related to their child's growth at first year of primary education. •One in every four children in Ireland are classified as having overweight or obesity. •Birthweight and breastfeeding status are factors known to be associated with weight status in childhood. •This study investigated whether there was an association between sex, birthweight and breastfeeding status andthe BMI outcome of a cohort of Irish children in their first year of primary school education (median age: 5.2years). •This study also included an exploration of parents concern related to their child's growth at first year of primaryschool education.

Weight status impacts children's incidental statistical learning

The expanding literature investigating the cognitive effects of childhood weight status has not included examinations of incidental statistical learning, the process by which children unintentionally acquire knowledge about patterns in their environments, despite evidence that it underlies many higher-level information processing capabilities. In the present study, we measured event-related potentials (ERPs) while school-aged participants completed a variation of an oddball task in which stimuli predicted the appearance of a target. Children were asked to respond to the target but were not given any information about the existence of predictive dependencies. We found that children with a healthy weight status had larger P3 amplitudes in response to the predictors that were most meaningful in completing the task, a finding that may suggest optimized learning mechanisms influenced by weight status. These findings offer an important first step to understanding how healthy lifestyle factors may influence incidental statistical learning.

Examination of parent-reported differences in children's daily screen use, sleep, and sleep hygiene behaviors during the school year and summer and their association with BMI

ObjectiveThe current study examined school-summer differences in children's sleep patterns and sleep hygiene. Cross-sectional relationships with children's sleep, sleep hygiene, and weight status were explored during the school year and summer. MethodsChildren (5-8 years) and their parents (n = 197 dyads) were recruited from 4 schools in southeastern Texas and via Facebook. Parents reported children's school year and summer sleep, sleep hygiene, and screen media use. Children's body mass index (BMI) was objectively assessed at the beginning and end of the summer. Associations between children's sleep hygiene and screen media use, sleep duration, and weight status were explored. ResultsChildren's sleep midpoint was earlier during the school year (1:54 AM ± 0.03) than in the summer (2:06 AM ± 0.03; t = 4.07, p < .0001). During summer, children increased their screen media use by 38 minutes (t = 2.32, p = .023) and decreased their caffeine intake from 7.43 to 7.0 (with scores ranging from 3 to 15; t = 2.83, p = .006). Greater sleep-inhibiting (β = 0.40, p = .011) and fewer sleep-promoting (β = −0.28, p = .049) behaviors during the school year were associated with having a higher BMI. There were no associations among sleep patterns, sleep hygiene and BMI during summer. ConclusionsMore positive school year sleep hygiene behaviors were supportive of having a healthier weight status. Changes in these behaviors during the summer did not portend worse weight outcomes. Supporting families in the establishment of sleep-promoting behaviors, particularly during the school year may help address the child obesity epidemic.

Examining the effect of parent participation in an adult weight management program on changes in children's weight.

Children of parents participating in weight management programs (WMPs) are more likely to adopt their parents' weight control practices. Little is known about the weight outcomes of children who have a parent participating in a WMP. This study aimed to assess this relationship. Children 2-17 years of age with a parent who participated in a WMP were included in the study. Multilevel linear mixed-effects regression models were used, stratified by child weight status at the time of parental WMP participation (healthy weight, overweight/obesity) to determine change in children's BMIz from before to after parents WMP participation, including covariates of parent BMI and parental feeding practices. Parents (N=77) were mostly white (76%) and female (84%). Children (N=114) had a mean age of 10.5 ± 4.6; 47% had overweight or obesity. Children with overweight or obesity prior to their parent's WMP had a decrease in BMIz (-0.68) after the WMP while children with a healthy weight had no significant change. Children with overweight or obesity had a decrease in BMIz from before to after parent's participation in a WMP. Further research is needed to understand changes in family eating practices that occur during and after parent WMP participation.

The Infant Diet Quality Index Predicts Dietary and Adiposity Outcomes in US Children 2 to 4 years old

BackgroundHealthy nutrition during the first year of life is critical for optimal growth and development. Limited techniques are available to assess diet quality in infancy, and few have been shown to be predictive of dietary and adiposity outcomes in low-income children. ObjectiveThe objectives of this study were to construct an Infant Diet Quality Index (IDQI) to assess the diet quality from birth to 12 mo and to determine whether the IDQI exhibits predictive validity by estimating the longitudinal associations of IDQI scores with diet quality and weight status at 2 to 4 y. DesignData were analyzed from the longitudinal Women, Infants, and Children Infant and Toddler Feeding Practices Study-2 (unweighted, n = 2858; weighted. N = 392,439) using one 24-h dietary recall and survey responses during infancy. The newly constructed IDQI consists of 16 equally-weighted components: 1) breastfeeding duration; 2) exclusive breastfeeding; age of first introduction of: 3) solids, 4) iron-rich cereals, 5) cow milk, 6) sugar-sweetened beverages, 7) salty/sweet snacks, 8) other drinks/liquids, and 9) textured foods; frequency of consuming 10) fruit or 11) vegetables; frequency of consuming different 12) fruit or 13) vegetables; 14) nonrecommended bottle-feeding practices; 15) use of commercial baby foods; and 16) number of meals and snacks. Regression analysis was used to estimate associations between the total IDQI score (range, 0–1) and Healthy Eating Index-2015 (HEI-2015) scores and body mass index z-scores (BMIz) at 2 to 4 y of age, adjusted for covariates (e.g., child age, sex and race/ethnicity; maternal education level, etc.) ResultsThe total IDQI score was positively associated with HEI-2015 at the age of 2 y (β = 16.7; 95% CI: 12.6, 20.9; P < 0.001), 3 y (β = 14.5; 95% CI: 8.1, 21.0; P < 0.001), and 4 y (β = 15.4; 95% CI: 8.4, 22.4; P < 0.001); and negatively associated with BMIz at the age of 2 y (β = -1.24; 95% CI: -2.01, -0.47; P = 0.002) and 4 y (β = -0.92; 95% CI: -1.53, -0.30; P = 0.003). ConclusionsThe IDQI has predictive validity for diet quality and weight status in low-income US children.

Paternal BMI in the preconception period, and the association with child zBMI.

Rapid growth and excess weight in early childhood are associated with obesity risk. While maternal preconception BMI has been identified as a potential risk factor, the role of paternal preconception BMI is less clear. To examine the association between paternal preconception BMI and age- and sex-standardized WHO BMI z-score (zBMI) growth rates, zBMI, and weight status, in 0- to 10-year-old children. To determine whether these associations differed by child sex and maternal preconception weight status. A longitudinal cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!). Children (n = 218) underwent repeated measures of height and weight from birth to 10 years old. Piecewise linear mixed models were used to assess the association between paternal preconception BMI and child zBMI growth rates (zBMI SD units/month) between 0, 4, 30, 48 and 120 months of age. Linear mixed models were used to examine the association with child zBMI, and logistic generalized estimation equations (GEE) were used to assess the association with child weight status. Child sex and maternal preconception weight status were tested as effect modifiers. Paternal preconception BMI was associated with child zBMI growth rate, mean zBMI and weight status in boys, but not girls. A 5 kg/m2 higher paternal preconception BMI was associated with approximately 0.01 zBMI SD unit/month higher growth rate for boys born to mothers with preconception overweight. Higher paternal BMI was associated with higher mean zBMI and increased odds of overweight and obesity in boys, with greater effects seen when mothers had preconception overweight compared to normal weight. Paternal preconception BMI was associated with child zBMI growth rate, zBMI and weight status in boys, with greater effects when the biological mother had preconception overweight or obesity. Further understanding of sex differences in paternal preconception weight effects in children is needed.

Child food portion sizes in the home environment: how do parents decide?

The consumption of larger portion sizes (PS) of food has been implicated in the increased prevalence of childhood obesity. The home is usually the first place children learn about food, however, little is known about how parents determine child PS in the home environment. This narrative review aimed to explore parental beliefs, decisions, strategies and barriers to the provision of appropriate food PS for children in the home environment. Results indicate that parental decisions on child food PS are based on the amounts they serve themselves, personal intuition and knowledge of child appetite. Owing to the habitual nature of food provision, parental decisions on child PS may be taken without conscious thought and/or could be part of a complex decision-making process influenced by several interlinked factors, including parental childhood mealtime experiences, other family members and child weight status. Strategies to determine child-appropriate PS include modelling the desired PS behaviour, use of unit-based food packaging and PS estimation aids, and providing the child with a degree of autonomy to rely on their own appetite cues. A lack of knowledge/awareness of PS guidance is a key barrier identified by parents to the provision of age-appropriate PS, warranting the inclusion of salient child-appropriate PS guidance within national dietary recommendations. Further home-based interventions to improve the provision of appropriate child PS are required, leveraged on parental strategies already in use, as outlined in this review.

Parental Feeding Practices and Children's Eating Behaviours: An Overview of Their Complex Relationship.

Several studies have found an association between eating behaviours and weight status and obesity risk in childhood. Children's eating behaviours arise from a combination of genetic and environmental factors. Parents appear to play a central role in their development as the main responsible for shaping children's feeding environment and eating experiences. The purpose of this paper is to review the literature on parental influences on eating behaviours across childhood, mainly focusing on parental feeding practices. The associations between parental feeding practices and children's eating behaviours have been extensively studied. However, most of the findings come from cross-sectional studies, so the possibility of reverse causality cannot be ruled out (i.e., children's behaviours influencing parents). Most recently, a few longitudinal studies with a cross-lagged design have shown that the relationship between children's eating behaviours and parental feeding practices seems to be bidirectional, where it is not straightforward whether parental feeding practices are a predictor or a consequence of children's eating behaviours. Children's eating behaviours influence parents to adopt certain feeding practices, but these practices also influence children's behaviours over time. Parental feeding practices may have the potential to shape children's eating behaviours and should be targeted to promote the development of non-obesogenic traits. However, parent-child interactions are complex and therefore both parent and child characteristics and the family dynamics should be considered.

Understanding weight status and dietary intakes among Australian school children by remoteness: a cross-sectional study.

To determine whether primary school children's weight status and dietary behaviours vary by remoteness as defined by the Australian Modified Monash Model (MMM). A cross-sectional study design was used to conduct secondary analysis of baseline data from primary school students participating in a community-based childhood obesity trial. Logistic mixed models estimated associations between remoteness, measured weight status and self-reported dietary intake. Twelve regional and rural Local Government Areas in North-East Victoria, Australia. Data were collected from 2456 grade 4 (approximately 9-10 years) and grade 6 (approximately 11-12 years) students. The final sample included students living in regional centres (17·4 %), large rural towns (25·6 %), medium rural towns (15·1 %) and small rural towns (41·9 %). Weight status did not vary by remoteness. Compared to children in regional centres, those in small rural towns were more likely to meet fruit consumption guidelines (OR: 1·75, 95 % CI (1·24, 2·47)) and had higher odds of consuming fewer takeaway meals (OR: 1·37, 95 % CI (1·08, 1·74)) and unhealthy snacks (OR = 1·58, 95 % CI (1·15, 2·16)). Living further from regional centres was associated with some healthier self-reported dietary behaviours. This study improves understanding of how dietary behaviours may differ across remoteness levels and highlights that public health initiatives may need to take into account heterogeneity across communities.

Impact and recovery of the COVID-19 pandemic on weight status of children and adolescents.

Recent evidence suggests the immediate effects of the COVID-19 lockdowns and restrictions have resulted in increased weight in children and adolescents. However, the longer-term effects have not been assessed. The aim of this study was to examine the impact and longer-term effects of the COVID-19 pandemic on BMI and weight status of children and adolescents. This study used routinely collected clinical data from the Sydney Children's Hospitals Network, comprising two socio-demographically diverse children's hospitals in New South Wales, Australia from 2018 to 2021. Of 245 836 individuals ≤18-years assessed, mean BMI percentile increased from 58.7 (SD 31.6) pre-COVID-19 to 59.8 (SD 31.7) (p < .05) post-restrictions and overweight/obesity increased by 5.5% (obesity alone 6.3%), predominantly in children <12-years and from lower socioeconomic backgrounds. The trend in BMI percentile was steady pre-COVID-19 (β=-0.03 [95% CI -0.07, 0.01]), peaked immediately following COVID-19 restrictions (β=1.28 [95% CI 0.24, 2.32]) and returned to pre-pandemic levels over ensuing 21 months (β=-0.04 [95% CI -0.13, 0.04]). Routine anthropometric measurement facilitates ongoing monitoring and evaluation of the weight status of children and adolescents, helping to identify those at-risk. Despite initial BMI and weight increases among children and adolescents, longer-term follow-up highlighted a return to pre-pandemic rates, possibly attributed to state-wide policies aimed at reducing childhood obesity.

Analysis of association between eating behaviours and childhood obesity among pre-school children: A cross-sectional study.

Childhood obesity is a worldwide critical health concern. We aimed to clarify whether eating behaviours increased the risk of childhood obesity. We recruited 2,049 pre-school children aged 3-6 years between 1 December 2021 and 31 January 2022 in Taizhou, China. Children's weight status was classified according to the International Obesity Task Force criteria, and their eating behaviours were evaluated using the Children's Eating Behaviour Questionnaire. Correlation analyses, linear regressions, and one-way ANCOVA. were performed to analyse the association between children's eating behaviours and weight status. In 'Food Avoidant' subscales, the scores of satiety responsiveness (P < 0.001) and slowness in eating (P = 0.001) were negatively associated with body mass index z score among pre-school children of both sexes. In 'Food Approach' subscales, the score of enjoyment of food was positively associated with body mass index z score in both boys (P = 0.007) and girls (P = 0.035), but the association of scores of food responsiveness with body mass index z score was found only in girls (P = 0.001). Our results supported that pre-school children with low scores in 'Food Avoidant' subscales and high scores in 'Food Approach' scales were more likely to become obese.

Perceptions of Primary Caregivers on Children's Weight Status Versus Actual Weight Status in Children Aged 6-15 Years - China, 2021.

Childhood obesity has been linked to adverse health outcomes during both childhood and adulthood. An accurate understanding of children's weight status by primary caregivers is essential for effective weight management strategies. The data utilized in this study were obtained from the 2021 Nutrition Improvement Program for Rural Compulsory Education Students in China. It was found that over one-third of primary caregivers underestimated their children's weight status, and more than half of the primary caregivers of overweight or obese children underreported the weight status of those children. A low level of agreement was observed between primary caregivers' perceptions of their children's weight status and the actual weight status. There is a relatively higher underestimation of children's weight in China, which necessitates more effective strategies to enhance the primary caregivers' perception of their children's weight status, especially in primary caregivers of males, younger children and children in urban areas.

Caregiver Concern About Child Overweight/Obesity in Grandparent Versus Parent-Headed Households in the United States.

To examine the association of caregivers' concern about children's overweight and obesity status with family structure (grandparent versus parent-headed households). Caregivers reported their relation to the child aged 10 to 17 years and the child's weight and height (National Survey of Children's Health 2016-20). Overweight/obesity was calculated using Centers for Disease Control and Prevention growth charts. We estimated associations (prevalence odds ratio) of residing in a grandparent-headed household with lack of weight concern (responding "Yes, it's too low" or "No, not concerned" to "Are you concerned about this child's weight?") among propensity score-matched children with overweight and obesity. Covariates included child's sex, race, ethnicity, age, family poverty ratio, primary household language, highest level of education among reported adults, caregiver mental and emotional health, usual source of care and survey year. The prevalence of child overweight/obesity was higher in grandparent-headed households. Among children with overweight/obesity, 64.65 (SE=3.27)% of grandparents and 66.55 (SE=0.81)% of parents did not express concern about the child's weight status. Among children with obesity, it was 52.42 (SE=4.63)% and 49.04 (SE=1.28)%, respectively. Family structure was not associated with caregiver lack of weight concern in propensity score-matched samples. Appropriate caregiver concern about child's weight status was low in both grandparent and parent-headed households in the United States.

Interpersonal and Environmental Protective Factors and Their Associations With Children's Weight Status.

Both external structure (ie, participating in extracurricular activities) and family factors (ie, parental emotional support) have separately been linked with children's physical health and well-being, however, their combined effects are less well known. The current study examined the longitudinal associations between participating in structured out-of-school activities and parent reports of warmth/emotional support with children's weight status (ie, zBMI) over time. Utilizing longitudinal data from the United States-based Early Childhood Longitudinal Study, Kindergarten Class of 2010 to 2011 (ECLS-K:2011), we employed a confirmatory factor analysis (CFA) and a latent variable cross-lagged path analysis to examine if emotional supportiveness and participation in structured activities predicted lower zBMI over the course of 1 year. The final sample included 18 135 participants. Mean age of the participants was 8.12 years (±0.38 years), and 51% of children were male. Mean zBMI was 0.54 (±1.12). Structure at baseline predicted increased zBMI in year 2 (β = .03, P = .02) but did not predict parent emotional supportiveness at year 2 (β = -.05, P = .09). Parent emotional supportiveness at baseline predicted greater zBMI at year 2 (β = .02, P = <.01) but did not predict structure at year 2 (β = .02, P = .39). zBMI at baseline did not predict structure (β = .02, P = .25) or parent emotional supportiveness at year 2 (β = -.01, P = .55). Our findings were inconsistent with our hypothesis with regard to directionality. Continued refinement about the role of internal structure (ie, family, and parenting practices) may inform public health prevention strategies to support the well-being of children and families.

Less underestimaton of excess weight by the categorical than the visual method. Its determinants and feeding practices in Mexican mothers of children aged 2 to 12 years.

Introduction: perceived body weight refers to the subjectively assessed weight, which may not correspond to the objectively measured weight. Statistics show that 14 % to 83 % of parents misperceive their children's weight status, with a propensity for underestimation. Objective: we compared the accuracy of the visual versus the categorical method. We also identified factors and feeding practices associated with excess weight underestimation. Material and methods: we carried out a cross-sectional study in five states of Mexico with 1,845 mother-child dyads of children aged 2-12 years. The mothers were interviewed about weight perception with two methods, visual and categorical. The Child Feeding Questionnaire identified maternal feeding practices. Actual weight and height were categorized according to WHO criteria. Analysis consisted of Cohen's kappa estimation, multivariate logistic regression, and Mann-Whitney tests. Results: more mothers correctly identified the weight of their children with the categorical than with the visual method (68 % vs 42 %, p < 0.0001). The excess weight underestimation was lower (49 % vs 82 %, p < 0.0001) and the degree of agreement was higher with the categorical method (kappa, 0.39 and 0.08). The better results remained regardless of age. Age 2-5 years increased the odds of overweight/obesity underestimation. Feeding practices differed by weight perception category, child's age, and method of assessment. Conclusions: the categorical method was more accurate. Recognition of correct weight perception is one of the first actions required for controlling childhood overweight/obesity.

What are health professionals' perceptions of conducting routine growth assessments and lifestyle interventions? A qualitative study involving allied health professionals, nurses and doctors in rural and regional New South Wales.

Allied health professionals, nurses and doctors within the New South Wales (NSW) public health system provide trusted health information to a large proportion of families across the state. This means they are well positioned to opportunistically assess and discuss child weight status with families. Prior to 2016, weight status was not routinely addressed in most NSW public health settings, however recent policy changes promote quarterly growth assessments for all children aged under 16years who attend these facilities. The Ministry of Health recommend health professionals use the 5 As framework, a consultation approach to encourage behaviour change, to identify and manage children with overweight or obesity. This study aimed to explore allied health professionals', nurses' and doctors' perceptions of conducting routine growth assessments and providing lifestyle support to families in a local health district in rural and regional NSW, Australia. This descriptive, qualitative study involved online focus groups and semi-structured interviews with health professionals. Audio recordings were transcribed and coded for thematic analysis, with rounds of data consolidation between research team members. Allied health professionals, nurses and doctors who work in a variety of settings within a local health district of NSW participated in one of four focus groups (n=18 participants) or semi-structured interviews (n=4). The predominant themes related to: (1) health professionals' professional identity and their perceived scope of practice; (2) interpersonal qualities of health professionals; (3) the service delivery ecosystem in which health professionals worked. Diversity in attitudes and beliefs about routine growth assessments were not necessarily specific to discipline or setting. Allied health professionals, nurses and doctors recognise the complexities involved in conducting routine growth assessments and providing lifestyle support to families. The 5 As framework used in NSW public health facilities to encourage behaviour change may not allow clinicians to address these complexities in a patient centred way. The findings of this research will be used to inform future strategies aimed at embedding preventive health discussions into routine clinical practice, and to support health professionals to identify and manage children with overweight or obesity.

Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets.

In India, acute respiratory infections (ARIs) are a leading cause of mortality in children under 5 years. Mapping the hotspots of ARIs and the associated risk factors can help understand their association at the district level across India. Data on ARIs in children under 5 years and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhea in children, low birth weight, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM2.5 and PM10 datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. The geographic information system was used for mapping, and ARI hotspots were identified using the Getis-Ord Gi* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors. Acute respiratory infections hotspots were predominantly seen in the north Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap among PM2.5, PM10, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis showed that PM2.5, illiteracy levels, diarrhea in children, and maternal body mass index were associated with ARI. To decrease ARI in children, urgent interventions are required to reduce the levels of PM2.5 and PM10 (major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.

The Relationships between Parenting Practices and Child Health-Related Behaviors in Children with Intellectual Disability: The Moderating Role of Child Body Weight Status.

This study aimed to examine the associations between parenting practices and child health-related behaviors, and the moderating role of child body weight status in children with intellectual disability (ID). A cross-sectional study was conducted among a sample of children with ID in Hong Kong; 440 participants were included in this study. All the variables investigated were collected from questionnaires, except body weight status, which was objectively measured. Logistic regression analysis was used to examine the associations between parenting practices and children's unhealthy behaviors. Interaction items were added to investigate the moderation effect of child body weight status, adjusting for significant background characteristics. Results showed that the parenting practices of "restricting access to unhealthy food and sedentary behaviors (RA)" (OR range: 0.63-0.64) and "using food or sedentary behaviors as rewards (UR)" (OR range: 1.28-1.60) were significantly associated with some eating behaviors, but not with sedentary behaviors. Body weight status significantly moderated these associations. Only RA showed favorable effects on some eating behaviors in children with overweight and obesity (OR range: 0.17-0.28), whereas the effects of UR differed by body weight status. Future research should focus on developing educational interventions which encourage parents to use practices that are tailored towards children's individual characteristics.

Communicating With Head Start Families About Children's Weight Status: A Phenomenological Approach

BackgroundTo support the early identification of childhood obesity, Head Start (HS) implemented a body mass index screening program. This program provides opportunities for HS to communicate with families about children's weight status. Limited research is available describing the methods used to communicate this information. ObjectiveExplore common experiences of HS health/nutrition managers (HNM) when communicating information to families about children's weight status. Study Design, Settings, and ParticipantsTwenty-eight in-depth telephone interviews with HNM across North Carolina (n = 15) and Ohio (n = 13). Study Design/AnalysisPhenomenology guided the study design and analysis. The themes focused on HNM's lived experiences with their body mass index screening program. Interviews were recorded and transcribed verbatim. ResultsFour emergent themes identified: (1) strategies for communicating weight status to families; (2) family response to communication strategies; (3) educational, staff support, and counseling opportunities for families; and (4) challenges engaging families in childhood obesity prevention efforts. Conclusions and ImplicationsHead Start programs acknowledged the importance of communicating children's weight status; however, there are inconsistencies in methods used and information communicated across programs. Head Start programs have community partners who support obesity prevention efforts; however, these partnerships may be underused. More research is needed to explore effective and sensitive communication methods for HS families regarding children's weight status.