Child weight status: Relationships with mother-child mealtime interactions and child eating behaviours

This doctoral thesis highlighted how mother-child interactions surrounding responsiveness, affect, maternal control and child compliance may be influential to children’s self-regulatory behaviours around food and eating, in turn impacting their weight. Support was found for the potential role of such interactions as risk factors in childhood overweight and obesity.

Great 'app-eal' but not there yet: a review of iPhone nutrition applications relevant to child weight management

Aims: There is increasing interest in the use of smartphone applications (apps) for delivering child obesity management interventions and supporting lifestyle behaviour change; however, there has been very little academic research on their development. Our aim is to review nutrition-related apps designed for children currently available in Australia for their usefulness in education or support behavioural interventions for child obesity. Methods: Apps available for download in iTunes Australia between 2 April and 3 June 2013 which were suitable for children >12 years were identified. Key words were chosen to identify apps applicable to children, focusing on nutrition. Results: A total of 27 apps were included. Most apps (24/27) were not based on evidence-informed recommendations. A third of apps were developed in the USA (n = 10; 37%) and were free (67%), nine apps required upfront payment, with a mean cost of $A2.80 (range $A0.99-$A7.49). The most common nutrition features were the promotion of energy balance (n = 12 apps) and guidance on appropriate portion size (n = 15). The most common behaviour change feature was goal setting (n = 15). The five apps that scored most highly against the characteristics reviewed were: Calorie Counter Pro by My Net Diary, Weight Watchers, Swap It Don't Stop It, Control My Weight by CalorieKing and Rate What I Ate-Photo Diet Tracker. Conclusions: Very few apps were identified that could be used in education or support behavioural interventions for child obesity. There is a need to harness this technology and evaluate the applicability and use within childhood obesity research interventions.

An observational approach to testing bi-directional parent–child interactions as influential to child eating and weight

Obesity among children has been on the rise globally for the past few decades. Previous research has centred mainly on self/parent-reported measures examining only uni-directional parental feeding styles and practices. Recent discussions in the literature have raised the importance of bi-directional parent–child interactions in influencing children's weight status. The aims of this paper are to highlight the importance of an observational approach when investigating positive bi-directional parent–child interactions during mealtimes and to outline how these interactions may be linked to positive child eating and weight outcomes. We examine the current literature on self-reported parental patterns and argue for the influential roles of responsiveness, affect and parental control dimensions within the parent–child dyad. Information about the ways in which the parent and the child can influence each other on these dimensions, as observed in parent–child interactions around food, is likely to provide greater insights into the aetiology of childhood obesity.

Associations between family circumstance and weight status of Australian children

To examine associations between weight status and multiple indicators of family circumstance in Australian elementary school children. Data were combined from the 2001 Children's Leisure Activities Study (CLAS Study) and 2002/3 Health, Eating and Play Study (HEAP Study), involving 2520 children in Grades Prep (mean age 6 years) and 5-6 (mean age 11 years) in Melbourne, Australia. Children's body mass index (BMI) was calculated from measured height and weight. Weight status (non-overweight or overweight) was determined according to International Obesity Taskforce cut-off points and BMI was transformed to z-scores based on the 2000 US growth chart data. Parents reported family circumstance (number of parents in the home, marital status, presence of siblings, parental education, parental employment status, parental work hours [HEAP Study only]) and parental BMI. Regression analyses were conducted for the sample overall and separately for young girls, young boys, older girls and older boys. Children in single-parent homes, those without siblings, and those with less educated mothers and fathers tended to have higher z-BMIs (p=0.002, p=0.003, p<0.001 and p<0.001, respectively) and were more likely to be overweight (p=0.003, p<0.001, p<0.001 and p=0.02, respectively). Associations were stronger for older children. Parental employment and work hours were not consistently associated with child weight status. The multivariable models did not demonstrate a cumulative explanatory effect (R2=0.02), except when maternal BMI was included (R2=0.07). Individual measures of family circumstance were differentially associated with child weight status and appeared to be largely independent of other measures of family circumstance. Childhood overweight interventions may need to be tailored based on the age, gender, maternal BMI and family circumstances of the target group.

Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study

This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5–6-year-old and 188 10–12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, children's BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5–6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10–12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.

Maternal feeding practices predict weight gain and obesogenic eating behaviours in young children : a prospective study

Background Maternal feeding practices have been proposed to play an important role in early child weight gain and obesogenic eating behariours. However, to date longitudinal investigations in young children exploring these relationships have been lacking. The aim of the present study was to explore prospective relationships between maternal feeding practices, child weight gain and obesogenic eating behaviours in 2-year-old children. The competing hypothesis that child eating behaviours predict changes in maternal feeding practices was also examined.

Methods A sample of 323 mother (mean age = 35 years, + 0.37) and child dyads (mean age = 2.03 years, + 0.37 at recruitment) were participants. Mothers completed a questionnaire assessing parental feeding practices and child eating behaviours at baseline and again one year later. Child BMI (predominantly objectively measured) was obtained at both time points.

Results Increases in child BMI z-scores over the follow-up period were predicted by maternal instrumental feeding practices. Furthermore, restriction, emotional feeding, encouragement to eat, weight-based restriction and fat restriction were associated prospectively with the development of obesogenic eating behaviours in children including emotional eating, tendency to overeat and food approach behaviours (such as enjoyment of food and good appetite). Maternal monitoring, however, predicted decreases in food approach eating behaviours. Partial support was also observed for child eating behaviours predicting maternal feeding practices.

Conclusions Maternal feeding practices play an important role in the development of weight gain and obesogenic eating behaviours in young children and are potential targets for effective prevention interventions aiming to decrease child obesity.

Reported and observed controlling feeding practices predict child eating behavior after 12 months

BACKGROUND: Controlling feeding practices are linked to children's self-regulatory eating practices and weight status. Maternal reports of controlling feeding practices are not always significantly related to independently rated mealtime observations. However, prior studies only assessed 1 mealtime observation, which may not be representative of typical mealtime settings or routines. OBJECTIVES: The first aim was to examine associations between reported and observed maternal pressure to eat and restriction feeding practices at baseline (T1) and after ∼12 mo (T2). The second aim was to evaluate relations between maternal and child factors [e.g., concern about child weight, child temperament, child body mass index (BMI)-for-age z scores (BMIz)] at T1 and reported and observed maternal pressure to eat and restriction feeding practices (T1 and T2). The third aim was to assess prospective associations between maternal feeding practices (T1) and child eating behaviors (T2) and child BMIz (T2). METHODS: A sample of 79 mother-child dyads in Victoria, Australia, participated in 2 lunchtime home observations (T1 and T2). BMI measures were collected during the visits. Child temperament, child eating behaviors, maternal parenting styles, and maternal feeding practices were evaluated at T1 and T2 via questionnaires. Associations were assessed with Pearson's correlation coefficients, paired t tests, and hierarchical regressions. RESULTS: Reported restriction (T1) was inversely associated with observed restriction at T1 (r = -0.24, P < 0.05). Reported pressure to eat (T2) was associated with observed pressure to eat (T2) (r = 0.48, P < 0.01) but only for mothers of girls. Maternal weight concern was associated with reported restriction at T1 (r = 0.29, P < 0.01) and T2 (r = 0.36, P < 0.01), whereas observed restriction (T1) was prospectively associated child BMI at T2 (β = -0.18, P < 0.05). CONCLUSIONS: Maternal reports may not always reflect feeding practices performed during mealtimes; it is possible some mothers may not be aware of their practices or observations may not capture covert controlling strategies.

Systematic research review of observational approaches used to evaluate mother-child mealtime interactions during preschool years.

The family meal and social interactions during the meal are important events in a child's life. Specifically, mealtime interactions have been linked to child weight status, the development of children's eating patterns, and socialization. Mealtime interactions may be observed and evaluated to provide insights into this important event beyond self-reported measurements.

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis

BACKGROUND: Despite the crucial need to develop targeted and effective approaches for obesity prevention in children most at risk, the pathways explaining socioeconomic disparity in children's obesity prevalence remain poorly understood.

METHODS: We conducted a systematic review of the literature that investigated causes of weight gain in children aged 0-5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries. Major electronic databases were searched from inception until December 2015. Key words identified studies addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and child weight in disadvantaged samples.

RESULTS: A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity precluded identification of independent effects of each of these risk factors.

CONCLUSIONS: This review has highlighted significant gaps in our mechanistic understanding of the relative importance of different aspects of parent and child behaviours in disadvantaged population groups.

Health-related quality of life of overweight and obese children

Context: The negative effects of childhood overweight and obesity on quality of life (QOL) have been shown in clinical samples but not yet in population-based community samples.

Objective: To determine relationships between weight and health-related QOL reported by parent-proxy and child self-report in a population sample of elementary school children.

Design, Setting, and Participants: Cross-sectional data collected in 2000 within the Health of Young Victorians Study, a longitudinal cohort study commenced in 1997. Individuals were recruited via a random 2-stage sampling design from primary schools in Victoria, Australia. Of the 1943 children in the original cohort, 1569 (80.8%) were resurveyed 3 years later at a mean age of 10.4 years.

Main Outcome Measures: Health-related QOL using the PedsQL 4.0 survey completed by both parent-proxy and by child self-report. Summary scores for children'S total, physical, and psychosocial health and subscale scores for emotional, social, and school functioning were compared by weight category based on International Obesity Task Force cut points.

Results: Of 1456 participants, 1099 (75.5%) children were classified as not overweight; 294 (20.2%) overweight; and 63 (4.3%) obese. Parent-proxy and child self-reported PedsQL scores decreased with increasing child weight. The parent-proxy total PedsQL mean (SD) score for children who were not overweight was 83.1 (12.5); overweight, 80.0 (13.6); and obese, 75.0 (14.5); P < .001. The respective child self-reported total PedsQL mean (SD) scores were 80.5 (12.2), 79.3 (12.8), and 74.0 (14.2); P < .001. At the subscale level, child and parent-proxy reported scores were similar, showing decreases in physical and social functioning for obese children compared with children who were not overweight (all P < .001). Decreases in emotional and school functioning scores by weight category were not significant.

Conclusion: The effects of child overweight and obesity on health-related QOL in this community-based sample were significant but smaller than in a clinical sample using the same measure.

Association between the family environment and television viewing in Australian children

Aim: To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status.

Methods: Parents reported the amount of time children watched TV/video both for ‘the previous school day’ and ‘usually’ and described aspects of the family environment influencing TV access as part of a large cross-sectional study in the Barwon South-western region of Victoria, Australia. Child weight status was  based on measured height and weight. All data were collected in 2003/2004.

Results: A total of 1926 children aged 4–12 years participated. Parent-reported mean ± SE TV time for the previous school day was 83 ± 1.5 min. Children who lived in a family with tight rules governing TV viewing time (22%), or who never watched TV during dinner (33%), or had only one TV in the household (23%) or had no TV in their bedroom (81%) had significantly less TV time than their  counterparts. Overweight or obese children had more TV time than healthy weight children 88 ± 2.9 versus 82 ± 1.7 min per day (P = 0.04). They were also more likely to live in a household where children had a TV in their bedroom than healthy weight children (25% vs. 17%, P < 0.001).

Conclusion: Strategies to reduce TV time should be included as part of broader strategies to prevent childhood obesity. They should include messages to parents about not having a TV in children’s bedrooms, encouraging family rules restricting TV viewing, and not having the TV on during dinner.

Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey

Introduction: Childhood overweight/obesity is associated with poor physical and psychosocial health in clinical samples. However, there is little information on the health status of overweight and obese children in the community, who now represent a large proportion of the child population. We examined parent-reported child health and well-being and parent concern about child weight by body mass index (BMI) category in a population sample of primary school children.

Design: A stratified two-stage random cluster sample of 24 primary schools representative of the state of Victoria, Australia.

Measures: BMI (weight/height2) transformed to normalised Z-scores using the 1990 UK Growth Reference; the Child Health Questionnaire (CHQ), a 13-scale 50-item parent-completed measure of health and well-being; parent self-reported height and weight; parent concern about child's weight.

Results: Data were available for 2863 children aged 5-13 y (50.5% male), of whom 17% were overweight and 5.7% obese. Using logistic regression analyses with 'normal weight' as the referent category, obese boys were at greater risk of poor health (ie <15th centile) on seven of the 12 CHQ scales: Physical Functioning (odds ratio (OR) 2.8), Bodily Pain (OR 1.8), General Health (OR 3.5), Mental Health (OR 2.8), Self Esteem (OR 1.8), Parent Impact¾Emotional (OR 1.7) and Parent Impact¾Time (OR 1.9). Obese girls were at greater risk of poor health on only two scales: General Health (OR 2.1) and Self Esteem (OR 1.8). Forty-two percent of parents with obese children and 81% with overweight children did not report concern about their child's weight. Parents were more likely to report concern if the child was obese (OR 21.3), overweight (OR 3.5) or underweight (OR 5.4) than normal weight (P<0.05). Concern was not related to child gender, parental BMI or parental education after controlling for child BMI. Perceived health and well-being of overweight/obese children varied little by weight category of the reporting parent (overweight vs non-overweight).

Conclusions: Parents were more likely to report poorer health and well-being for overweight and obese children (particularly obese boys). Parental concern about their child's weight was strongly associated with their child's actual BMI. Despite this, most parents of overweight and obese children did not report poor health or well-being, and a high proportion did not report concern. This has implications for the early identification of such children and the success of prevention and intervention efforts.

Parent–child interactions and obesity prevention : a systematic review of the literature

Child obesity research has generally not examined multiple layers of parent–child relationships during weight-related activities such as feeding, eating and play. A literature review was conducted to locate empirical studies that measured parent– child interactions and child eating and child weight variables; five papers met the inclusion criteria and were included in the review. The findings of the review revealed that parent–child relationships are an important element in explaining the unhealthy trend of childhood obesity. We argue that prevention/intervention strategies must extend on the current models of parenting by targeting the family from a bi-directional perspective, and focusing, specifically, on the mutually responsive orientation that exists in the parent–child relationship.

Healthy eating and obesity prevention for preschoolers : data collected from a randomised controlled trial

This data offers insights into child eating habits and daily dietary intake, duration of daily child physical and sedentary activities, parental knowledge of nutrition, child and parent Body Mass Index (BMI), parental behaviours and cognitions pertaining to feeding, eating and physical activity, parental concern for child weight, and child food neophobia.It includes survey data and physical measurements (height and weight) of participants.