‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts.

Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones.

Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be 'dangerous' and detrimental to their diabetes control. Respondents described such foods as 'strength-giving', and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines.

Conclusions. Perceptions that South Asian foodstuffs necessarily comprise 'risky' options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.

Socio-cultural influences on eating practices among female adolescents in Fiji

This thesis examined the sociocultural influences on food and eating practices for both Indigenous-Fijian and Indo-Fijian female adolescents. Findings confirmed the prevalence of traditional customs related to feasting and fasting practices. Weight-change behaviours related to food practices were predicted largely by family and religious influences.

The role of cultural values and religion on views of body size and eating practices among adolescents from Fiji, Tonga and Australia

Objectives This study investigated cultural values related to body image and eating practices in Western and non-Western societies.

Design and Methods In total, 628 Fijian, 463 Indo-Fijian, 598 Tongan, and 534 Australian adolescents completed measures of cultural values and religious influences in relation to the ideal body and eating practices.

Results Fijian and Tongan adolescents were more likely to value a large body. Religious influences were most strongly associated with eating practices for Fijians, Indo-Fijians, and Tongans.

Conclusions The findings support the role of religion in transmitting cultural values regarding eating practices in Pacific Island communities.

Statement of contribution
What is already known on this subject? Previous research has demonstrated that sociocultural factors shape body image and eating behaviours. Most of this research has been conducted in Western countries.

What does this study add? The current study identifies the role of cultural values and religious influences on body image and eating behaviours in a number of different cultural groups. This is the first study to use the same methodology to explore these relationships across Western and Pacific Island communities.

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.

Understanding the link between body dissatisfaction and binge eating: a model comparison approach

 This thesis explored the association between body dissatisfaction and binge eating by comparing three competing theoretical frameworks. Study I utilised a cross-sectional design and collectively these findings suggest the superiority of the dual pathway model (dietary restraint and negative affect) over the objectification theory and the escape model. The purpose of Study II was then to extend on the findings from Study I by further examining in real-time the model/theory that most strongly explained the body dissatisfaction-binge eating relationship. Participants were prompted at random intervals seven times daily across the course of a week to self-report their state body dissatisfaction, current mood experiences, and eating practices. Results revealed that negative mood, but not dietary restraint, significantly mediated the state body dissatisfaction-binge eating relationship. These results highlight that the dual pathway model is robust, but raise the possibility that the dietary restraint path in the model is not well operationalized. In light of the non-significant mediating effect of dietary restraint, this led the researcher to identify various modeling alternatives to further understand the mediating influences of the pathways of negative affect and dietary restraint.

Adoption of obesity prevention policies and practices by Australian primary schools : 2006 to 2013

Despite significant investment in many countries, the extent of schools' adoption of obesity prevention policies and practices has not been widely reported. The aims of this article are to describe Australian schools' adoption of healthy eating and physical activity policies and practices over an 8-year period and to determine if their adoption varies according to schools' size, geographic or socio-economic location. Between 2006 and 2013, a representative randomly selected cohort of primary schools (n = 476) in New South Wales, Australia, participated in four telephone interviews. Repeated measures logistic regression analyses using a Generalised Estimating Equation (GEE) framework were undertaken to assess change over time. The prevalence of all four of the healthy eating practices and one physical activity practice significantly increased, while the prevalence of one physical activity practice significantly decreased. The adoption of practices did not differ by school characteristics. Government investment can equitably enhance school adoption of some obesity prevention policies and practices on a jurisdiction-wide basis. Additional and/or different implementation strategies may be required to facilitate greater adoption of physical activity practices. Ongoing monitoring of school adoption of school policies and practices is needed to ensure the intended benefits of government investment are achieved.

Where is all the pressure coming from? Messages from mothers and teachers about preschool children's appearance, diet and exercise

This study used interviews and qualitative analyses to investigate the nature of the messages that preschool children receive from mothers and teachers about their bodies, general appearance, exercise and eating practices. Participants were 10 female teachers and 53 mothers. The behaviours of the 53 children (24 boys, 29 girls) were also observed to determine the nature of their eating and exercise behaviours. The results demonstrated that both mothers and teachers expressed concerns about their own bodies. Mothers also communicated messages to their daughters about losing weight and messages to their sons about increasing their muscles. Both girls and boys were concerned about their appearance, particularly their clothes and hair. Girls also demonstrated some concerns about losing weight, and boys with increasing muscles. Implications of these results are discussed in terms of designing education programs for mothers, teachers and children to prevent the development of body image concerns and disordered eating among children. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association.

Association between fast food purchasing and the local food environment

Objective: In this study, an instrument was created to measure the healthy and unhealthy characteristics of food environments and investigate associations between the whole of the food environment and fast food consumption.

Design and subjects: In consultation with other academic researchers in this field, food stores were categorised to either healthy or unhealthy and weighted (between +10 and −10) by their likely contribution to healthy/unhealthy eating practices. A healthy and unhealthy food environment score (FES) was created using these weightings. Using a cross-sectional study design, multilevel multinomial regression was used to estimate the effects of the whole food environment on the fast food purchasing habits of 2547 individuals.

Results: Respondents in areas with the highest tertile of the healthy FES had a lower likelihood of purchasing fast food both infrequently and frequently compared with respondents who never purchased, however only infrequent purchasing remained significant when simultaneously modelled with the unhealthy FES (odds ratio (OR) 0.52; 95% confidence interval (CI) 0.32–0.83). Although a lower likelihood of frequent fast food purchasing was also associated with living in the highest tertile of the unhealthy FES, no association remained once the healthy FES was included in the models. In our binary models, respondents living in areas with a higher unhealthy FES than healthy FES were more likely to purchase fast food infrequently (OR 1.35; 95% CI 1.00–1.82) however no association was found for frequent purchasing.

Conclusion: Our study provides some evidence to suggest that healthier food environments may discourage fast food purchasing.

Nutrient and core and non-core food intake of Australian schoolchildren differs on school days compared to non-school days.

Overall the diets of Australian schoolchildren are suboptimal, but differences in nutrient and food intake on school versus non-school days have not been assessed. The aim of this study was to examine differences in nutrient and core and non-core food intake on school days versus non-school days in Australian schoolchildren aged 6-16 years. Cross-sectional analysis of the 2007 Australian Children's Nutrition and Physical Activity Survey. Dietary intake was assessed via one 24-h dietary recall. A school day was defined as Monday-Friday, a non-school day included Saturday, Sunday and public/school holidays. Independent t-tests and χ(2) tests were used to assess differences in continuous and categorical variables, respectively. Multiple linear and logistic regression was used to adjust for confounders. Forty-eight per cent of recalls were completed on a non-school day. On non-school days primary schoolchildren aged 6-11 years (n = 1334) and secondary schoolchildren aged 12-16 years (n = 1362) had significantly higher absolute intakes of sugars, total fat and saturated fat (all P < 0.05). In addition the energy density of foods consumed was greater (P < 0.001), but there was no difference in the energy density of fluids. The sodium density of the diet did not differ across day types. On non-school days, total core food intake was ~30% higher and children were more likely to consume sugar-sweetened beverages, fried potatoes and take-away pizzas and burgers (all P < 0.05). Important differences in the intake of sugar, total fat, and saturated fat and noncore foods exist on non-school days compared to school days in Australian schoolchildren. To improve the diets of schoolchildren there is scope for strategies that target non-school day eating practices.

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.

Social comparisons and negative affect as indicators of problem eating and muscle preoccupation among children

The present study examined the utilization of social comparison practices and the role of negative affect in predicting body dissatisfaction, problem eating, and muscle preoccupation among young children. Participants were 236 children aged between 8 and 10 years. Children's eating, exercising, and muscle concerns were examined using a modified version of the Children's Eating Attitudes Test (ChEAT), which included additional items pertaining to muscle bulk and exercising. Consistent with past findings, body mass index (BMI) was found to be the sole unique indicator of body dissatisfaction for both boys and girls. Utilization of social comparison practices with adults was the main unique indicator of the modified ChEAT factors for boys, while BMI was the main unique indicator of the modified ChEAT factors for girls. In addition, negative affect was associated with binging, food preoccupation, and social pressure to eat for boys and dieting and muscle preoccupation for girls. Findings are discussed in relation to previous studies with adolescents and adults.

Obesity prevention in the family day care setting : impact of the romp & chomp intervention on opportunities for children's physical activity and healthy eating

Background The Romp & Chomp intervention reduced the prevalence of overweight/obesity in pre-school children in Geelong, Victoria, Australia through an intervention promoting healthy eating and active play in early childhood settings. This study aims to determine if the intervention successfully created more health promoting family day care (FDC) environments.
Methods The evaluation had a cross-sectional, quasi-experimental design with the intervention FDC service in Geelong and a comparison sample from 17 FDC services across Victoria. A 45-item questionnaire capturing nutrition- and physical activity-related aspects of the policy, socio-cultural and physical environments of the FDC service was completed by FDC care providers (in 2008) in the intervention (n = 28) and comparison (n = 223) samples.
Results Select results showed intervention children spent less time in screen-based activities (P = 0.03), organized active play (P < 0.001) and free inside play (P = 0.03) than comparison children. There were more rules related to healthy eating (P < 0.001), more care provider practices that supported children’s positive meal experiences (P < 0.001), fewer unhealthy food items allowed (P = 0.05), higher odds of staff being trained in nutrition (P = 0.04) and physical activity (P < 0.001), lower odds of having set minimum times for outside (P < 0.001) and organized (P = 0.01) active play, and of rewarding children with food (P < 0.001).
Conclusions Romp & Chomp improved the FDC service to one that discourages sedentary behaviours and promotes opportunities for children to eat nutritious foods. Ongoing investment to increase children’s physical activity within the setting and improving the capacity and health literacy of care providers is required to extend and sustain the improvements.

Maternal correlates of preschool child eating behaviours and body mass index : a cross-sectional study

To the authors’ knowledge, this is the first study to evaluate maternal child feeding practices, maternal parenting characteristics and mother-child interactions as cross-sectional predictors of child eating and/or weight within the one sample. Maternal pressure for her child to eat was a significant positive correlate of fussiness and a negative correlate of enjoyment. Maternal parenting warmth was associated negatively with child BMIz, while mother-child dysfunctional interaction was associated positively with child BMIz. Our findings suggest that childhood obesity research may be better informed by evaluating not just what mothers do (feeding practices) but also how they parent (parenting behaviours and interactions with their child). Longitudinal studies are needed to identify causal influences of parenting on preschool child eating and weight.