Designing a childhood obesity preventive intervention using the multiphase optimization strategy: The Healthy Bodies Project.

BACKGROUND/AIMS: Preventing the development of childhood obesity requires multilevel, multicomponent, comprehensive approaches. Study designs often do not allow for systematic evaluation of the efficacy of individual intervention components before the intervention is fully tested. As such, childhood obesity prevention programs may contain a mix of effective and ineffective components. This article describes the design and rationale of a childhood obesity preventive intervention developed using the multiphase optimization strategy, an engineering-inspired framework for optimizing behavioral interventions. Using a series of randomized experiments, the objective of the study was to systematically test, select, and refine candidate components to build an optimized childhood obesity preventive intervention to be evaluated in a subsequent randomized controlled trial. METHODS: A 24 full factorial design was used to test the individual and combined effects of four candidate intervention components intended to reduce the risk for childhood obesity. These components were designed with a focus on (a) improving children's healthy eating behaviors and nutrition knowledge, (b) increasing physical activity and reducing sedentary activity in the childcare setting, (c) improving children's behavioral self-regulation, and (d) providing parental web-based education to address child target outcomes. The components were tested with approximately 1400 preschool children, ages 3-5 years in center-based childcare programs in Pennsylvania, the majority of which served predominantly Head-Start eligible households. Primary child outcomes included healthy eating knowledge, physical and sedentary activity, and behavioral self-regulation. Secondary outcomes included children's body mass index and appetitive traits related to appetite regulation. RESULTS: Four intervention components were developed, including three classroom curricula designed to increase preschool children's nutrition knowledge, physical activity, and behavioral, emotional, and eating regulation. A web-based parent education component included 18 lessons designed to improve parenting practices and home environments that would bolster the effects of the classroom curricula. A plan for analyzing the specific contribution of each component to a larger intervention was developed and is described. The efficacy of the four components can be evaluated to determine the extent to which they, individually and in combination, produce detectable changes in childhood obesity risk factors. The resulting optimized intervention should later be evaluated in a randomized controlled trial, which may provide new information on promising targets for obesity prevention in young children. CONCLUSION: This research project highlights the ways in which an innovative approach to the design and initial evaluation of preventive interventions may increase the likelihood of long-term success. The lessons from this research project have implications for childhood obesity research as well as other preventive interventions that include multiple components, each targeting unique contributors to a multifaceted problem.

Measuring adolescents' eating in the absence of hunger in the home environment using subjective and objective measures.

Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents' BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8-741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.

Off the Charts: Identifying and Visualizing Body Mass Index Trajectories of Rural, Poor Youth.

OBJECTIVES: To identify body mass index (BMI) trajectories using methods and graphing tools that maintain and visualize variability of BMIs ≥95th percentile, and to investigate individual differences in early sociodemographic risk, infant growth and feeding patterns, and maternal weight status among these trajectories. STUDY DESIGN: Participants included 1041 predominantly rural, poor families from the Family Life Project, a longitudinal birth cohort. Youth anthropometrics were measured 8 times between ages 2 months and 12 years. Mothers reported sociodemographic information, infant birth weight, and infant feeding at 2 months and reported child weight and height at 2 months and 12 years. At 6 months, mothers reported breastfeeding. At 2 years, maternal weight and height were measured. RESULTS: Three BMI trajectories were identified: "maintained non-overweight," "developed obesity," and "developed severe obesity." Compared with the non-overweight trajectory, children with heavier trajectories were breastfed for a shorter duration and had heavier mothers at all assessments. The children with the "developed obesity" trajectory were not heavier at birth than those with the non-overweight trajectory, yet they displayed a greater change in weight-for-length percentile during infancy; in addition, their mothers had the greatest change in BMI between 2 months and 12 years. Children with the "developed severe obesity" trajectory were heavier at birth and more likely to have been heavy during infancy and to have been fed solid foods early. CONCLUSIONS: Using informed analytical and graphing approaches, we described patterns of growth, and identified early predictors of obesity and severe obesity trajectories among a diverse sample of rural, poor youth. Researchers are urged to consider these approaches in future work, and to focus on identifying protective factors in youth with obesity and severe obesity.

Preschoolers will drink their GREENS! Children accept, like, and drink novel smoothies containing dark green vegetables (DGVs).

Dark green vegetables (DGVs; e.g., spinach) are a nutrient rich source of essential vitamins and minerals; yet, children's intakes of DGVs fall well below dietary recommendations and creative solutions are needed. This study describes preschoolers (3-5 y) willingness to taste, liking, and intake of fruit-based smoothies containing DGVs (i.e., spinach, collards, kale), commonly referred to as "green smoothies," and explores individual differences in children's eating responses. Using a between-subjects design, preschoolers were randomized to either a FRUIT ONLY smoothie condition (n = 36) or FRUIT+DGV smoothie condition (n = 32). Children's acceptance and intake were collected in one tasting session and one ad libitum snack session, respectively. Parents reported on child food pickiness, food responsiveness, and approach, and children's intake of fruits and DGVs. Children self-reported on previous experience with the study fruits and DGVs. The initial tasting session revealed that the majority of children (84.3%) in the FRUIT+DGV condition willingly tasted all five green smoothies and rated the green smoothies as moderately liked (2.3 ± 0.1). Children in the FRUIT+DGV condition consumed 225.7 ± 31.4 g (9.0 ± 1.3 oz; 1.1 ± 0.2 cups; 91.9 ± 12.9 kcals) of their most preferred green smoothie, providing 18.3 ± 3.7 g (or 0.7 ± 0.1 cups) of DGVs. Children's willingness to try, liking, and intake did not differ by smoothie condition. Individual differences in children's intake are reported. In conclusion, children were willing to try fruit smoothies supplemented with DGVs. Children rated the green smoothies as moderately-liked and children's intake during snack met 31% of their weekly USDA recommendations for DGVs. Adding DGVs to fruit-based smoothies may compliment other effective feeding strategies for increasing children's vegetable consumption.

Development of a theory-based questionnaire to assess structure and control in parent feeding (SCPF).

BACKGROUND: Parents shape children's eating environments and act as powerful socialization agents, impacting young children's behavioral controls of food intake. Most feeding measures assess parents' use of control to manage children's intake of energy dense foods. The Structure and Control in Parent Feeding (SCPF) questionnaire was developed to assess more positive aspects of feeding practices with their young children -setting limits, providing routines-that promote self-regulation, as well as controlling feeding practices. METHODS: A mixed method approach was used to develop the SCPF. In 2013, cognitive interviews informed the modification, deletion and/or replacement of items. In 2014, the survey was distributed statewide to mothers of toddlers aged 12 to 36 months participating in the Women, Infants, and Children program. In 2016, exploratory factor analyses was conducted to test our theoretical parenting model and content validity and criterion validity were assessed (n = 334). RESULTS: Exploratory factor analysis (EFA) and second-order EFA revealed a 2-factor, 22-item Structure model and a 2-factor, 12-item Control model. Internal consistencies for all factors exceeded 0.70. As predicted, the Structure superfactor was positivity associated with responsiveness, whereas the Control superfactor was positively associated with demandingness on the Caregiver's Feeding Styles Questionnaire. The Structure subscales were also positively associated with mealtime behaviors and Control subscales were positively associated with control-oriented feeding measures from the Control in Parent Feeding Practices questionnaire. CONCLUSION: The SCPF questionnaire is a reliable tool that can be used to assess aspects of structure- and control-based feeding practices to better understand how parents feed their toddlers.

Measurement of food reinforcement in preschool children. Associations with food intake, BMI, and reward sensitivity.

Progressive ratio (PR) schedules of reinforcement have been used to measure the relative reinforcing value (RRV) of food in humans as young as 8 years old; however, developmentally appropriate measures are needed to measure RRV of food earlier in life. Study objectives were to demonstrate the validity of the RRV of food task adapted for use among for preschool children (3-5 y), and examine individual differences in performance. Thirty-three children completed the RRV of food task in which they worked to access graham crackers. They also completed a snack task where they had free access these foods, liking and hunger assessments, and their heights and weights were measured. Parents reported on their child's reward sensitivity. Overall, children were willing work for palatable snack foods. Boys and older children made more responses in the task, while children with higher BMI z-scores and reward sensitivity responded at a faster rate. Children who worked harder in terms of total responses and response rates consumed more calories in the snack session. This study demonstrates that with slight modifications, the RRV of food task is a valid and developmentally appropriate measure for assessing individual differences in food reinforcement among very young children.

Effects of restriction on children's intake differ by child temperament, food reinforcement, and parent's chronic use of restriction.

Parents' use of restrictive feeding practices is counterproductive, increasing children's intake of restricted foods and risk for excessive weight gain. The aims of this research were to replicate Fisher and Birch's (1999b) original findings that short-term restriction increases preschool children's (3­5 y) selection, intake, and behavioral response to restricted foods, and to identify characteristics of children who were more susceptible to the negative effects of restriction. The experiment used a within-subjects design; 37 children completed the food reinforcement task and heights/weights were measured. Parents reported on their use of restrictive feeding practices and their child's inhibitory control and approach. Overall, the findings replicated those of and revealed that the effects of restriction differed by children's regulatory and appetitive tendencies. Greater increases in intake in response to restriction were observed among children lower in inhibitory control, higher in approach, who found the restricted food highly reinforcing, and who had previous experience with parental use of restriction. Results confirm that the use of restriction does not reduce children's consumption of these foods, particularly among children with lower regulatory or higher appetitive tendencies.

BMI Growth Profiles Among Black Children from Immigrant and US-Born Families.

A large body of research has documented racial/ethnic disparities in childhood obesity in the United States (US) but less work has sought to understand differences within racial groups. Longitudinal studies are needed to describe BMI trajectories across development, particularly for Black children from immigrant families who have been underrepresented in childhood obesity research. The current study utilizes BMI data collected longitudinally from ages 5 to 8 years and growth mixture modeling to (1) identify and visualize growth patterns among Black children from primarily Caribbean immigrant families, and (2) to compare these patterns to growth trajectories among Black children from US-born families. First, we identified four classes or trajectories of growth for Black children from immigrant families. The largest trajectory (70% of the sample) maintained non-overweight throughout the study period. A second trajectory developed overweight by age 8 (25%). Two small trajectory groups demonstrated high rates of moderate and severe obesity-i.e., specifically, a trajectory of accelerated weight gain ending in moderate/severe obesity (3%), and a trajectory of early severe obesity with BMI decreasing slightly with age (2%). We identified a very similar four class/trajectory model among Black children from US-born families, and compared the model to the one for children from immigrant families using multi-group growth mixture modeling. We found that the patterns of growth did not differ significantly between the populations, with two notable exceptions. Among Black children from immigrant families, ∼ 5% were classified into the two heavier BMI trajectories, compared to ∼ 11% of children from US-born families. Additionally, among children with an accelerated weight gain trajectory, children from immigrant families had lower BMIs on average at each time point than children from US-born families. These findings describe the multiple trajectories of weight gain among Black children from immigrant families and demonstrate that although these trajectories are largely similar to those of Black children from US-born families, the differences provide some evidence for lower obesity risk among Black children from immigrant families compared to Black children from US-born families. As this study is the first to describe BMI trajectories for Black children from immigrant families across early and middle childhood, future work is needed to replicate these results and to explore differences in heavier weight trajectories between children from immigrant and US-born families.

Family Psychosocial Assets, Child Behavioral Regulation, and Obesity.

BACKGROUND AND OBJECTIVES: Little attention has been given to the study of early childhood factors that protect against the development of obesity and severe obesity. We investigated whether exposure to familial psychosocial assets and risks in infancy (1-15 months) and early childhood (24-54 months) and child behavioral regulation in early childhood predict longitudinal change in BMI (2 to 15 years). METHODS: Participants included 1077 predominantly non-Hispanic, White, English-speaking mother-child dyads from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development dataset. Cumulative familial asset and risk indices were created using measures (eg, maternal parenting sensitivity, poverty) from 2 developmental periods (1-15 months, 24-54 months). A child behavioral regulation index was created on the basis of behavioral tasks and parent reports. Previously published BMI trajectories (nonoverweight [40th percentile], nonoverweight [70th percentile], overweight/obese, severely obese) were used as the outcome. RESULTS: All indices predicted membership in the overweight/obese trajectory; however, when entered into the same model, only familial assets continued to reduce the odds of membership in this trajectory. Familial assets and child behavioral regulation independently reduced the odds of membership in the severely obese trajectory. Furthermore, child behavioral regulation and familial assets buffered the negative effects of familial risk on BMI trajectory membership. CONCLUSIONS: Early exposure to familial assets and child behavioral regulation may have long-term protective effects on weight gain over early exposure to some familial risk factors (eg, poverty); thus, these indices may help foster obesity resilience.

Profiles of Behavioral Self-Regulation and Appetitive Traits in Preschool Children: Associations With BMI and Food Parenting Practices.

Appetitive traits that contribute to appetite self-regulation have been shown to relate to non-food-related regulation in general domains of child development. Latent profile analysis (LPA) was used to identify typologies of preschool children's behavioral self-regulation (BSR) and appetitive traits related to appetite self-regulation (ASR), and we examined their relation with children's BMIz and food parenting practices. Participants included 720 children and their parents (90% mothers), drawn from the baseline assessment of a childhood obesity preventive intervention. BSR measures included teacher reports of children's inhibitory control, impulsivity and attentional focusing, as well as an observed measure of inhibitory control. ASR was assessed using parents' reports of children's appetitive traits related to food avoidance (e.g., satiety responsiveness, slowness in eating) and food approach (e.g., enjoyment of food, food responsiveness). Children's body mass index z-score (BMIz) was calculated from measured height and weight. Parents' BMI and food parenting practices were also measured. Four profiles were identified that characterized children with dysregulated behavior, higher food approach and lower food avoidance (16%), dysregulated behavior but lower food approach and higher food avoidance (33%), regulated behavior but highest food approach and lowest food avoidance (16%), and highly-regulated behavior, lowest food approach and highest food avoidance (35%). Children's BMIz was highest in the profile consisting of children with dysregulated behavior, higher food approach and lower food avoidance. BMI was similar in the profile with children with regulated behavior but highest food approach and lowest food avoidance; children in this profile also had parents who reported the highest levels of controlling food parenting practices, and the lowest levels of parental modeling of healthy eating. Compared to all other profiles, children in the profile characterized by highly-regulated behavior, lowest food approach and highest food avoidance had the lowest BMIz and had parents who reported food parenting practices characterized by the highest levels of child control in feeding and the lowest levels of pressure to eat. These findings provide evidence of differing patterns of relations between self-regulation across behavioral and eating domains, and children's obesity risk may vary based on these different patterns.

Sorry Parents, Children Consume High Amounts of Candy before and after a Meal: Within-Person Comparisons of Children's Candy Intake and Associations with Temperament and Appetite.

Candy provides little nutritional value and contributes to children's energy intake from added sugars. Factors influencing children's candy intake remain largely unknown. This study describes children's total candy intake (kcal) before and after a meal and examines associations of candy intake in both conditions with children's temperament and appetite among a predominantly White, highly educated sample. Children (n = 38, age 5-8 years) were given free access to 11 candies (5 chocolate, 6 non-chocolate) and non-food alternatives during a pre-meal and a post-meal condition. Parents completed the Child Behavior Questionnaire and the Child Eating Behavior Questionnaire. Total candy intake was less when offered after a meal (209.3 kcal; SD = 111.25) than before a meal when still hungry (283.6 kcal; SD = 167.3), but not statistically different. Individual differences in candy intake between conditions was calculated to categorize children into three groups: "Better Regulators" consumed more candy before a meal (39%), "Consistent/Poorer Regulators" consumed similar amounts before and after a meal regardless of hunger (32%), and "Most Disinhibited" children consumed more candy after a meal when not hungry (29%). The "Better Regulators" group was lowest in negative affect and the "Consistent/Poorer Regulators" group was highest in food responsiveness. Children's candy intake was high relative to daily energy needs both before and after a meal. Child negative affect and food responsiveness appear to be child characteristics that predispose children to poor self-regulation of candy intake before and after a meal.

Executive Function and BMI Trajectories Among Rural, Poor Youth at High Risk for Obesity.

OBJECTIVE: The aim of this study was to identify longitudinal trajectories of conjoint development of executive function (EF) and obesity among a diverse sample of poor, rural youth and to evaluate individual differences in infant growth, parental BMI, and cumulative risk. METHODS: Participants included 948 youth from the Family Life Project. Child anthropometrics were measured at 2 and 6 months and at 2, 3, 4, 5, 7, and 12 years. EF tasks were administered at 3, 4, and 5 years. Mothers reported youth birth weight, parental height and weight, and cumulative risk indicators. RESULTS: Multidimensional growth mixture modeling identified three classes: "High EF - High Obesity Resilience"; "Low EF - Delayed-Onset Severe Obesity"; and "Low EF - Early-Onset Severe Obesity." Youth in the low-EF, early-onset class displayed higher birth weight and BMI at 6 months, whereas the low-EF, delayed-onset class had rapid weight gain during infancy, parents with class II obesity, and greater cumulative risk and was more likely to be Black and female. CONCLUSIONS: Despite increased obesity risk among this sample, the majority of youth exhibited higher EF and some degree of obesity resilience. Youth with EF deficits displayed the greatest risk for severe obesity but had differing BMI trajectories and obesity risk profiles, which has implications for obesity intervention.

Stability and change in snack food likes and dislikes from 5 to 11 years.

Research on the development of snack food likes and dislikes from childhood to adolescence is limited. We investigated both the stability and the change in liking (i.e., "like", "neither like nor dislike", "dislike") and rank-order liking (i.e., liking one food more than others; e.g., "I like chocolate more than cookies") of snack foods from 5 to 11 years in non-Hispanic white girls. Liking of 10 palatable snack foods was assessed biennially. Girls' liking and rank-order liking of snack foods were modestly stable from age 5 to 11, and there was a tendency for initially disliked foods to become more liked.

Delay discounting moderates the effect of food reinforcement on energy intake among non-obese women.

Recent theoretical approaches to food intake hypothesize that eating represents a balance between reward-driven motivation to eat versus inhibitory executive function processes, however this hypothesis remains to be tested. The objective of the current study was to test the hypothesis that the motivation to eat, operationalized by the relative reinforcing value (RRV) of food, and inhibitory processes, assessed by delay discounting (DD), interact to influence energy intake in an ad libitum eating task. Female subjects (n = 24) completed a DD of money procedure, RRV task, and an ad libitum eating task in counterbalanced sessions. RRV of food predicted total energy intake, however the effect of the RRV of food on energy intake was moderated by DD. Women higher in DD and RRV of food consumed greater total energy, whereas women higher in RRV of food but lower in DD consumed less total energy. Our findings support the hypothesis that reinforcing value and executive function mediated processes interactively influence food consumption.

Biobehavioral Dysregulation and its Association with Obesity and Severe Obesity Trajectories from 2 to 15 Years of Age: A Longitudinal Study.

OBJECTIVE: This study aimed to identify obesity trajectories from childhood to adolescence (2-15 years of age) and investigate differences in behavioral, eating, and adrenocortical regulation by trajectory membership. METHODS: A total of 1,077 households from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were included. Anthropometrics were measured 11 times between ages 15 months and 15 years. Behavioral self-regulation was assessed at ages 3 and 4 years. Disordered eating behaviors and awakening cortisol were assessed at age 15 years. RESULTS: Latent growth curve modeling identified four BMI trajectories: two nonoverweight trajectories based on average BMI at the 40th and 70th percentiles and overweight/obesity and severe obesity trajectories. Youth in the severe obesity trajectory exhibited lower behavioral self-regulation in early childhood and lower awakening cortisol at age 15 years compared with youth in the nonoverweight trajectories. Youth in the overweight/obesity and severe obesity trajectories showed higher levels of disordered eating behaviors at age 15 years. CONCLUSIONS: Obesity trajectories were associated with biobehavioral markers of dysregulation in early childhood and adolescence. Dysregulation across biobehavioral domains was particularly apparent among youth who developed severe obesity. Further work is needed to better understand resilience factors that distinguish youth who develop obesity and severe obesity from those who do not.

Parents' and Children's Categorization of Candy are Similar: A Card Sort Protocol.

American children frequently consume candy and, in excess, this may contribute to poor diets with attendant effects on obesity risk. Despite the ubiquity of candy in children's diets, parental concern about children's candy intake, and the diversity of confectionery products available, very little is known about how children and their parents conceptualize candy. Card sorting tasks offer a novel and visual technique to explore and compare an individuals' perceptions of foods and are useful where literacy is limited (e.g. young children). This study aimed to understand and compare how young school-aged children and parents categorize various candy products using a photo card sorting task. In individual laboratory sessions, children (n = 42, 5 to 8 years old) and parents (n = 35) categorized 51 types of candy based on their similarity. A cluster analysis showed that parents created more categories of candies than children (11 versus 8). For example, parents distinguished between candied fruit and candied nuts, whereas children tended to collapse these categories. However, 7 clusters were virtually identical between parents and children (93% similarity). The findings from this study can inform the measurement of candy intake and the development of education materials targeted towards parent feeding around candy.

Candy consumption patterns, effects on health, and behavioral strategies to promote moderation: summary report of a roundtable discussion.

Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt "moderation" in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle.

Maternal controlling feeding practices and girls' inhibitory control interact to predict changes in BMI and eating in the absence of hunger from 5 to 7 y.

BACKGROUND: Mothers use a range of feeding practices to limit children's intake of palatable snacks (eg, keeping snacks out of reach, not bringing snacks into the home), but less is known about the effects of these practices on children's eating and weight outcomes. OBJECTIVE: The objective was to identify distinct feeding practice profiles and evaluate the interactive effects of these profiles and girls' temperament (inhibitory control and approach) on girls' eating behaviors and weight outcomes at 5 and 7 y. DESIGN: Participants included 180 mother-daughter dyads; measures were mothers' reports of controlling feeding practices and girls' height and weight, eating in the absence of hunger (EAH) at 5 y, and inhibitory control (a measure of behavioral inhibition) and approach (a measure of appetitive motivation) at 7 y. RESULTS: Latent profile analysis of maternal feeding practices showed 4 feeding profiles based on maternal use of limit-setting practices and keeping snacks out of girls' physical reach, a restrictive practice: Unlimited Access to Snacks, Sets Limits+Does Not Restrict Snacks, Sets Limits+Restricts High Fat/Sugar Snacks, and Sets Limits+Restricts All Snacks. Girls whose mothers used Sets Limits+Restricts All Snacks had a higher approach and EAH at 5 y. Low inhibitory control girls whose mothers used Sets Limits+Restricts All Snacks or Unlimited Access to Snacks had greater increases in EAH and body mass index (BMI) from 5 to 7 y. CONCLUSIONS: Effects of maternal control on girls' EAH and BMI may differ by the type of practice used (eg, limit-setting or restrictive practices). Girls with low inhibitory control were more susceptible to the negative effects of low and high control.

Preferences predict food intake from 5 to 11 years, but not in girls with higher weight concerns, dietary restraint, and %body fat.

Food preferences (FP) predict food intake in childhood; however, the predictive power of FP may decline among girls as weight concerns (WC) and dietary restraint (DR) increase during preadolescence. To examine longitudinal change in the preference-intake (P-I) relation and assess whether this relation weakens among non-Hispanic white girls (n = 197) with a history of WC and DR from age 5 to 11. Girls' preferences for and intake (kcal) of 10 palatable snack foods were assessed biennially. Height, weight, percent body fat (%BF), WC, and DR were measured. Individual correlation coefficients were calculated per girl to capture within-person P-I correlations at each time of measurement. Overall, FP predicted girls' snack food calorie intakes between 5 and 11 years, but latent profile analysis (LPA) revealed three distinct patterns of change in P-I correlations over time: "strong/stable" P-I correlations were relatively high and became stronger with age; "increasing/later null" P-I correlations were initially weak and became stronger between 5 and 9 years, but dropped to near 0 at 11 years; "initially weak/later strong" P-I correlations were initially null and increased with age. Mixed models revealed that the "increasing/later null" group had greater increases in %BF, and higher WC, DR, and BMI percentiles from 5 to 11 years, compared to the other groups. In summary, FP predicted snack food calorie intake among most girls during childhood, but waned as a predictor of calorie intake at age 11 for a subset of girls with increasing %BF, and higher WC, DR, and BMIs.