Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review.

Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.

Examining child schooling/care location and child temperament as predictors of restaurant-related behaviors during the COVID-19 pandemic: findings from a nationally representative survey.

Purpose: Emerging research highlights impacts of the COVID-19 pandemic on U.S. families, including changes in eating behavior and increased child body mass index. Aims of the present study were to examine whether child temperament and at-home vs. out-of-home childcare/school predicted families' restaurant-related behaviors during the pandemic. Examining energy balance-related behaviors, like restaurant patronage, during the pandemic can help better understand lasting impacts on child health behaviors and health outcomes. Methods: An online survey was administered to U.S. parents with a 4-to-8-year-old child in October 2020 (n = 1,000). Linear and logistic regression examined whether child temperament and at home vs. out-of-home childcare/school predicted: (1) the frequency the child consumed restaurant meals (take-out, delivery, dine-in), (2) who chose the child's restaurant meal, and (3) parent-reported reasons for the child's meal choice. Income, education, employment, race/ethnicity, and regional COVID-19 restrictions were tested as covariates. Results: Parents with children higher on negative affectivity reported more frequent restaurant use in-person (p < 0.05) and via delivery (p < 0.05) compared to parents of children lower on negativity. Child negativity was also linked with parent-reported reasons for children's restaurant meal choices. Parents of children receiving at-home childcare/schooling used delivery services less frequently than those receiving out-of-home care or schooling (p < 0.01). Conclusion: These findings suggest that individual and family factors may impact restaurant use and the meal selection process for children using restaurants during and beyond the COVID-19 era. Continued examination of individual differences in the impacts of the COVID-19 pandemic can facilitate intervention and policy approaches that fit with different families' needs.

Parents of 5-to-12-year-old children with food allergies report more frequent use of structure-based food parenting practices.

Objectives: Food parenting practices (FPP) can have effects on children's eating behaviors. Over 8 million children in the US have food allergies, however, little is known about FPP for those who have children with food allergies. The objective of this study was to describe FPP among children with food allergies. Methods: Recruited across the United States using ResearchMatch in February and March 2021, parents of children ages 5-12 years (n = 346; n = 77 with food allergies) completed a single, online survey which measured health history, demographics, and FPP. Linear regressions were used to examine associations between FPP of children with and without food allergies, and associations between food allergy factors and FPP. Results: Parents of children with food allergies reported greater use of limit exposure than parents of children without food allergies (B = 0.131; [CI], 0.021-0.293; P = 0.024), with no differences in other types of FPP. Conclusions: Parents of children with food allergies reported more frequent structure-based FPP than parents of children without food allergies. More work is needed to explore mechanisms that promote positive food parenting among this population.

Food parenting at-home vs. in restaurants among African American parents of 3-to-8-year-old children.

Feeding style refers to the approach that parents use to feed their child and the emotional climate during eating. Indulgent styles, characterized by low structure and high responsiveness, have been linked to childhood weight gain. Few studies have examined feeding styles within out-of-home contexts (e.g., restaurants), which are common eating environments for many families. This study sought to examine feeding styles at-home and in restaurants among African American parents. 52 African American parents with a 3-to-8-year-old child (M = 35.6 years, 86% mothers, 57% annual household income <$50,000, 57% Associate's degree or higher) who regularly dined at restaurants completed an online survey in winter 2022-2023. Parents reported on demographics, anthropometrics, and their feeding styles at home and in restaurants via The Caregiver's Feeding Style Questionnaire. Findings indicated that the indulgent style was the most common overall. Indulgent styles were more prevalent in restaurants (χ2 = 7.4, p = 0.007) than home, and authoritarian styles more prevalent at home (χ2 = 4.5, p = 0.03). Child weight status differed by feeding style in both contexts (p ≤ 0.04); indulgent styles in restaurants were linked to higher BMI z-scores, while authoritarian styles at home were linked to lower BMI z-scores. Higher parent BMI was linked to increased likelihood of having an indulgent style at home (OR = 1.13, p = 0.03), while lower parent BMI was linked to increased likelihood of the uninvolved style at home (OR = 0.76, p = 0.049). Overall, indulgent styles were common and more prevalent in restaurants, where they were linked to higher child weight status. Findings may inform future health promotion efforts in out-of-home eating contexts.

Optimal Defaults in Online Grocery Shopping: A Secondary Analysis to Explore Impacts in Multiresident Households and Families.

OBJECTIVE: To examine whether household type (eg, families with children) moderated the effects of an optimal defaults grocery intervention and examine intervention effects on grocery purchases to be consumed by the participant vs others in the household. METHODS: Participants (n = 65) diagnosed with or at risk for type 2 diabetes were recruited and randomized into an optimal default online grocery intervention or an online or in-person control group. Grocery receipt data were coded into Dietary Approaches to Stop Hypertension nutritional quality scores, and energy, carbohydrate, and sugar content were calculated. Repeated measures analysis of variance examined household types (eg, single vs multi-resident) as moderators of intervention effects. Parallel models explored foods purchased for the participant and foods purchased for other household members separately. RESULTS: Household type was not a significant moderator of intervention effects on nutritional quality or other nutrients of interest (P > 0.10). The default intervention significantly increased the nutritional quality of groceries purchased across household types and for other household members besides the participant (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Optimal defaults may improve grocery purchases across different household types and extend to others in the household, supporting use across household types.

Toddler dietary patterns from the INSIGHT randomized clinical trial comparing responsive parenting versus control: A latent class analysis.

OBJECTIVE: The aim of this study was to examine the effect of a responsive parenting (RP) intervention on toddler diet and explore associations with mothers' infant feeding practices and child weight status. METHODS: INSIGHT tested an RP intervention designed for the prevention of obesity against a safety control among primiparous mothers and their infants. Mothers reported on feeding practices, as well as toddler diet with a Food Frequency Questionnaire (n = 229). Trained research staff obtained child anthropometrics at age 2 years. RESULTS: Latent class analysis identified three dietary patterns: high fruits and vegetables (HFV, 31%); meat, potatoes, and added sugars (MPAS, 24%); and high juice, low fruits and vegetables (JLFV, 45%). Toddler dietary pattern was not related to study group (RP, control) or child weight status at age 2 years. Mothers who reported more structure-based feeding had toddlers that were more likely to have the healthier, HFV dietary pattern than MPAS and JLFV. Findings for control-based feeding practices were mixed; maternal restriction was associated with the HFV dietary pattern, whereas the use of food as a reward was associated with MPAS and JLFV. CONCLUSIONS: Mothers' structure-based feeding practices in infancy, as well as some control-based feeding practices, were associated with later healthier toddler dietary patterns.

Differences in food parenting at home versus restaurants among parents of 3-to-8-year-old children.

Indulgent parent feeding styles have been linked to less healthful eating behaviors and higher BMI among children. Restaurants are becoming a frequent eating environment for children. Frequent intake of food from restaurants has been associated with increased weight status, making restaurants a target for childhood obesity prevention efforts. Currently, little research has considered parent feeding styles in restaurants and how they might differ from the home setting. Given the increased frequency of children's restaurant consumption, examining parent feeding styles in restaurants may contribute to future research in this area. Therefore, the objective of this study was to examine parent feeding styles at home and in restaurants. Parents whose 3-to-8-year-old children dined out regularly completed a one-time, online survey in February/March 2022. The Caregiver's Feeding Style Questionnaire assessed parent feeding styles at home and in restaurants. Differences in feeding styles were examined across settings. Indulgent feeding styles were most common overall. Parents (n = 117; 92% mothers; 85% white; 61% reported household income > $75,000/year) reported higher demandingness at home (M = 2.6 ± 0.5) compared to restaurants (M = 2.4 ± 0.5; t(116) = 6.7, P < 0.001). Parents were more likely to use indulgent feeding styles (X2 = 11.6, P < 0.001) and less likely to use authoritarian feeding styles (X2 = 4.6, P < 0.05) in restaurants compared to the home, suggesting parent feeding styles are less structured in restaurants. Results may have implications for future healthy eating interventions in away-from-home contexts.

Effects of a grocery shopping intervention designed to improve diet adherence in diabetes: a randomized trial.

OBJECTIVE: The goal of this study was to examine the potential of an optimal-defaults intervention to promote grocery purchases corresponding to a diet for diabetes. METHODS: In total, 65 adults diagnosed with or at increased risk for type 2 diabetes who grocery shopped at one of two study stores were randomized to one of three groups: Defaults, Online, or Control. All groups received diabetes-friendly recipes. In addition, the Online group was asked to grocery shop online during a 3-week intervention, and the Defaults group was asked to shop online, with their online grocery carts prefilled with food items needed to prepare provided recipes. Participants provided weekly grocery receipt data at baseline, at each week of the 3-week intervention, and at post-intervention. RESULTS: Overall, the Defaults group had grocery purchases of a significantly greater nutritional quality versus other groups (F = 16.3, p < 0.001). Between-group comparisons of least-squares means showed consistent effects of the Defaults intervention while intervention components were in place, with a similar pattern for energy and carbohydrate content of grocery purchases. CONCLUSIONS: These results build upon emerging evidence that optimal defaults can promote healthier grocery purchases. Continued examination of this approach could promote healthy food acquisition in accordance with individual dietary preferences and needs.

Family Food Insecurity, Food Acquisition, and Eating Behavior Over 6 Months Into the COVID-19 Pandemic.

OBJECTIVES: Describe coronavirus disease 2019 (COVID-19)-related employment and food acquisition changes for food-secure and food-insecure households. Examine associations between food insecurity, parent food acquisition, and child eating. METHODS: A nationally representative cross-sectional survey with parents (N = 1,000) in Fall 2020. Measures included sociodemographics, food retail regulations, food insecurity, frequency of meals, changes in parent employment, food preparation, and food acquisition because of COVID-19. RESULTS: Parents that reported recent food insecurity were more likely to report COVID-19-related employment changes (eg, job loss, reduced hours) and food acquisition changes. Food insecurity was modestly associated with more frequent in-person restaurant dining (B = 0.12, t(999) = 4.02, P < 0.001), more frequent restaurant delivery (B = 0.13, t(999) = 4.30, P < 0.001), less frequent homecooked meals (B = -0.14, t(999) = 4.56, P < 0.001) but was not associated with take-out (B = 0.02, t(999) = 0.62, P = 0.54). CONCLUSIONS AND IMPLICATIONS: Food insecurity was associated with employment changes, parent food acquisition, and children's consumption of homecooked and restaurant meals during COVID-19. Future work could explore resources that help parents acquire affordable, nutritious food.

Switching up sides: Using choice architecture to alter children's menus in restaurants.

U.S. children's frequent consumption of restaurant foods has been associated with low vegetable consumption. Use of choice architecture in restaurants has been shown to increase children's orders of healthy sides, but what children consume when healthy sides are included is unknown. The purpose of the present study was to investigate whether altering the choice architecture of children's meals by restructuring the menu, using optimal defaults and vice-virtue bundles, would impact ordering of side dishes and consumption of a vegetable side dish during a restaurant meal. Families with a child between 4-8y attended three dinners at a university-based restaurant. Children's meals included choice of entree (macaroni-and-cheese or chicken tenders) and default side: all carrots (150 g; Menu-1), small fries (50 g)/large carrots (100 g; Menu-2), and small carrots (50 g)/large fries (100 g; Menu-3). Participants could opt-out of the default side for: only fries (Menu-1) or only fries or carrots (Menus-2/3). All foods were pre- and post-weighed to determine consumption. Descriptive statistics examined children's ordering behavior. Repeated measures ANOVA examined differences in consumption of study foods. A paired samples t-test examined differences in french fry consumption (Menus-2/3). Forty-eight children (6.2 ± 1.3 years; 25 male) participated. Most children remained with the default side (Meal-1: 90%; Meal-2: 88%; Meal-3: 85%). Significant differences were seen in children's consumption of french fries (t = -2.57, p = .014) where children ate more during meal 3 compared to meal 2. There were no significant differences in carrot consumption. Use of optimal defaults led to increased orders of healthy sides and steady consumption across the meal conditions. However, use of an optimal, vice-virtue bundle led to a decrease in consumption of french fries. Further investigation of optimal default use on children's menus is warranted.

Examining Parent Preferences for the Use of Behavioral Economic Strategies on Children's Menus in Restaurants.

BACKGROUND: A majority of children's restaurant meals are nutritionally deficient; use of behavioral economics may improve healthful menu selections. Parents play a role in children's restaurant meal selection, thus understanding parent preferences for potential behavioral economic strategies is warranted. OBJECTIVE: To examine parent-derived and -stated preferences for selected attributes of children's restaurant menus, which included behavioral economic strategies (eg, optimal defaults and vice-virtue bundles). DESIGN: A descriptive, cross-sectional, within-subjects survey integrating a conjoint design was developed along with 8 children's menus. Menus were manipulated by varying levels of attributes (meal price, healthful side dishes, number of side dish items, healthful entrées, and cost for sugar-sweetened beverages [SSB]). Parents rated menus and attributes using Likert scales. PARTICIPANTS/SETTING: A national sample of US parents with children 4 to 10 years (n = 463) were recruited in August of 2019 via Amazon's Mechanical Turk. ANALYSIS: A conjoint (regression) analysis was conducted to derive parent preference for each attribute and overall menu preference. Descriptive statistics (means) described overall stated parent menu preferences and ratings. Cluster analysis segmented parents into groups with similar preferences. RESULTS: Derived preferences showed parents had the strongest preference for choice of side dishes (ß = .73) and low-priced menus (ß = .51), and weak preferences for inclusion of healthful entrées (ß = .04) and added cost for SSB (ß = .18). Parents stated preference was for a menu that included healthful entrées, was low priced, and featured choices for side dishes. Cluster analysis revealed half of parents preferred the low-cost children's menu with the other half of parents split evenly across preferences related to health, choice, and traditional menus. CONCLUSION: Parents stated preference was for a socially desirable menu featuring healthful entrée options and added cost for SSB, which was contrary to the conjoint derived menu preferences. Understanding parent preferences may help guide nutrition professionals working to build a more healthful food environment through the use of behavioral economic strategies.

Food Acquisition and Daily Life for U.S. Families with 4-to 8-Year-Old Children during COVID-19: Findings from a Nationally Representative Survey.

Evidence of short-term impacts of the coronavirus disease 2019 (COVID-19) pandemic on family life is emerging. Continued research can shed light on potential longer-term impacts. An online survey of U.S. parents with 4- to 8-year-old children (n = 1000) was administered in October 2020. The survey examined parent-reported impacts of COVID-19 on lifestyle (e.g., work, child-care, grocery shopping), as well as current family food acquisition and eating behaviors (e.g., cooking, restaurant use). Descriptive statistics were calculated, incorporating sampling weights based on sociodemographics. In terms of COVID-19 impacts, parents reported increases in working from home, decreased work hours, and increased child care and instruction, with most children attending school or receiving care at home. Parents reported increased home cooking and online grocery shopping; only 33% reported increased take-out or delivery from restaurants. About half of parents reported that their child dined at restaurants, 62% reported getting take-out, and 57% reported delivery from restaurants at least 2-3 times per month. About half viewed dining at restaurants as safe, while take-out and delivery were seen as safe by around three-quarters. Approximately two-thirds reported recent food insecurity. These nationally-representative results illustrate possible longer-lasting shifts in family life, with the potential to impact health and well-being. Sociodemographic differences and research and policy implications are discussed.

Picture Perfect: How Attaining the Ideal Meal is Not So Easy for Parents of Young Children.

OBJECTIVE: To explore parental perspectives on the ideals and realities of family mealtimes. DESIGN: Mini-focus groups (n = 7). SETTING: Rural Colorado, US. PARTICIPANTS: Parents (n = 30) were recruited at Head Start/preschool centers. PHENOMENON OF INTEREST: Parent perspectives on mealtimes with preschool-aged children. ANALYSIS: Transcripts were analyzed using thematic analysis. RESULTS: Three categories of themes emerged: participant conceptions of ideal family meals, challenges to achieving their ideal family meal, and parental solutions. The theme of participant conceptions of ideal family meals composed family togetherness, children liking and eating the prepared food, healthfulness of food, and a nonchaotic mealtime. Challenges to achieving their ideal family meal included work schedules, disruptive child behaviors, child pickiness, snacking, and negative role-modeling. Finally, parental solutions to challenges incorporated having flexible meal timings, considering child preferences in premeal preparations, role-modeling, and numerous other parenting strategies. CONCLUSIONS AND IMPLICATIONS: While parents valued many aspects of a version of the ideal meal rooted in historical standards, families faced many challenges in trying to attain that ideal. Although parents employed various strategies to combat mealtime challenges, parental expectations for preschool-aged children's mealtime behaviors may be unrealistic for the developmental stage of early childhood. Future interventions could help parents develop age-appropriate mealtime expectations.

Examining Front-of-Package Product Names and Ingredient Lists of Infant and Toddler Food Containing Vegetables.

OBJECTIVE: To investigate the alignment between vegetables and fruits listed in the ingredients of commercially produced infant and toddler food (ITF) and inclusion in front-of-package product names. DESIGN: A database of commercial ITF containing vegetables (n = 548) was created. Inclusion of each vegetable or fruit in the product name (yes/no), form (ie, whole/puree, juice/juice concentrate, etc), and ingredient list position (ie, first, second) were recorded. Vegetables were classified per US Department of Agriculture categories; fruits were classified into 2 categories. ANALYSIS: Chi-square tests of association tested associations between product name inclusion and (1) vegetable and fruit category, (2) form, and (3) form by category. RESULTS: Associations were observed between vegetable and fruit categories and inclusion in product names [χ2 (6, N = 1,462) = 70.3, P < 0.001]. Vegetables in the US Department of Agriculture dark green category were more likely to appear in product names (94%; standardized residual [SR] = 2.1), as were other vegetables (62%; SR = 4.9). Vegetable and fruit forms were associated with inclusion in product name [χ2 (4, N = 1,462) = 206.6, P < 0.001]. Juice/juice concentrates were less likely to be included in names (32.4%; SR = -5.4). CONCLUSIONS AND IMPLICATIONS: Substantial discrepancies exist between ITF ingredient lists and front-of-package product names. When only front-of-package information informs purchases, caregivers may not be purchasing products that facilitate children's building of vegetable preferences.

Reducing Visual Differences in Whole Grain Bread Prepared with Hard Red and Hard White Wheat: Application for Sensory Studies.

Consumer taste preference can be influenced by visual preference. To eliminate the influence of visual preference in the sensory evaluation of whole grain wheat, a reproducible method to eliminate color differences between Whole Grain breads prepared from hard white wheat (HWW) and hard red wheat (HRW) was evaluated. Response surface methodology (RSM) was used to match the color of HWW to HRW with the addition of commercially available dye solutions: McCormick black (red #40, yellow #5, blue #1), red (red #40, red #3, yellow #6), and yellow (yellow #5). Bread color was assessed by L* , a* , and b* color parameters according to the CIELAB international system of color measurement. Four replicates of the control and dye treated breads were analyzed. Initial color values for HRW were L* = 56.8 ± 0.40; a* = 8.04 ± 0.44; b* = 21.34 ± 0.46. RSM was used to predict dye addition levels to match color between HWW and HRW. With the addition of black (0.457 µL/mL), red (0.574 µL/mL), and yellow (1.165 µL/mL) dye to HWW, breads could be produced with L* , a* , and b* values of no statistical difference to the HRW (P < 0.05). A timed storage trail demonstrated the need to standardize the time between bread production and feeding studies. Visual bias can hinder assessment of wheat varieties in sensory studies. A reproducible method of dying wheat was developed that can be used to reduce this bias in sensory studies. PRACTICAL APPLICATIONS: The ability to control color variability is a critical tool in determining perceived quality in sensory analysis of breads. In this study, a method to reduce or eliminate visual bias between breads made from different varieties of wheat was developed. This method is applicable to any foods where dye could be added to reduce or eliminate color bias in sensory studies.