The relationship between parental food parenting practices & child eating behavior: A comparison of mothers and fathers.

The objective of this study was to compare the relationships between food parenting practices and child eating behavior among mothers and fathers of young children. This cross-sectional study recruited mothers (n = 127) and fathers (n = 118) of children (4.2 ± 1.3 years old) to complete surveys (face-to-face and online). Each parent completed the Comprehensive Food Parenting Questionnaire, Children's Eating Behavior Questionnaire, and demographic questions. Linear regressions were used to compare the relationships between parental food parenting practices and children's eating behaviors with parent sex as a moderator. Child age and sex served as control variables in each regression. Parent sex was a significant moderator in several relationships between parent food parenting practices and child eating behavior. In the relationship between parental restriction for health (ß = -.14, p = .014) and monitoring (ß = -.13, p = .028) and child slowness in eating, the slope of the interaction was significantly higher for mothers, meaning that when mothers and fathers use the same level of restriction for health and monitoring, child slowness in eating is higher for children of mothers. When mothers and fathers used the same level of restriction for weight, child food responsiveness (ß = .13, p = .003) and emotional overeating (ß = .12, p = .046) was significantly higher for children of fathers. There may be differences in how mothers and fathers implement food parenting practices and/or differences in how these practices impact children. Specifically, for fathers, it seems that the use of restriction for weight is more detrimental for children's eating behaviors compared to when mothers use the same level of restriction for weight.

A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios.

The purpose of this study was to determine whether weight bias exhibited by health care professionals (HCPs) impacts quality of health care provided to individuals with obesity. HCPs (n = 220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. In this within-subjects study design, participants completed the Attitudes Towards Obese Persons (ATOP) scale to assess weight bias and responded to 2 (1 person with obesity and 1 person without obesity) hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores to divide participants into high or low weight bias groups. Within these groups, thematic analysis was used to uncover themes in quality of care based on participants' responses to each scenario. The analysis revealed that HCPs in the high weight bias group gave specific diet and exercise recommendations, offered health advice regarding weight loss, and used less teaching discourse when responding to the patient with obesity. In addition, in both weight bias groups, patients with obesity were started on pharmaceutical therapies sooner. The findings of this study suggest a need to educate HCPs on the importance of empathy and compassion when providing treatment to all patients, regardless of weight, to increase quality of care and ultimately improve patient outcomes.

Practices and preferences: Exploring the relationships between food-related parenting practices and child food preferences for high fat and/or sugar foods, fruits, and vegetables.

The purpose of this study was to determine the relationship between food-related parenting practices and child fruit, vegetable, and high fat/sugar food preferences. Parents (n = 148) of children (3-7 years old) completed the Comprehensive Feeding Practices Questionnaire (CFPQ), the Preschool Adapted Food Liking Scale (PALS), and answered demographic questions. Separate linear regressions were conducted to test relationships between the different food categories on PALS (fruits, vegetables, and high fat/sugar foods) and each food-related parenting practice using race, ethnicity, and income level, and child age and gender as covariates. It was found that when a parent allows a child to control eating, it was negatively associated with a child's preference for fruit (ß = -0.15, p = 0.032) and parent encouragement of child involvement in meal preparation was positively related to child preference for vegetables (ß = 0.14, p = 0.048). Children preferred high fat and sugar foods more if parents used food to regulate child emotions (ß = 0.24, p = 0.007), used food as a reward (ß = 0.32, p < 0.001), pressured the child to eat more food (ß = 0.16, p = 0.045), and restricted unhealthy food (ß = 0.20, p = 0.024). Conversely, children preferred high fat and sugar foods less if parents made healthy food available in the home (ß = -0.13, p = 0.05), modeled healthy eating in front of the child (ß = -0.21, p = 0.021), and if parents explained why healthy foods should be consumed (ß = -0.24, p = 0.011). Although it cannot be determined if the parent is influencing the child or vice versa, this study provides some evidence that coercive feeding practices are detrimental to a child's food preferences.

Comparing Low-income Mothers' and Fathers' Concern for Young Children's Weight.

PURPOSE: The objectives of this study were to compare the relationship of mother and father (1) perceived child weight and child body mass index (BMI) z-score, (2) concern for child's current weight and child BMI z-score, and (3) concern for child's future weight and child BMI z-score. DESIGN AND METHODS: This cross-sectional study included low-income mothers (n=30) and fathers (n=30) with a young child (3 to 10years old) from the same household. Each parent completed select items from the Child Feeding Questionnaire (CFQ) with a trained interviewer. Child BMI z-score was calculated. RESULTS: There was a significant, positive relationship between fathers' perceived child weight and child BMI z-score (p=0.006) and between fathers' concern for a child's future weight and child BMI z-score (p=0.001) but not among mothers. CONCLUSIONS: Cohabitating low-income parents of young children may have conflicting appraisals of their child's BMI z-score and concerns for their child's future weight, and low-income fathers may be more accurate and concerned about their children's weight. PRACTICE IMPLICATIONS: Based on findings from this study, healthcare providers including physicians and nurses should attempt to include fathers in discussions regarding their child's weight for obesity prevention, especially in low-income families.

How Are Fathers' Demographic Characteristics Related to Preschool-Age Children's Weight and Obesity Risk Factors?

Fathers (n = 149) of preschool children were interviewed using the Child Feeding, Role of the Father (ROF), and ROF at Mealtimes (ROFM) questionnaires to determine whether fathers' demographic characteristics are associated with child overweight. Low-income was associated with higher pressure to eat (p = .006) and perceived their child as higher weight (p = .001). Higher education level was associated with lower ROF (p = .018) and ROFM (p = .002) and higher child diet quality (p = .002). Father's BMI was positively associated with ROFM (p = .008). Certain fathers may be important targets in childhood obesity prevention programs.

Association of fathers' feeding practices and feeding style on preschool age children's diet quality, eating behavior and body mass index.

The associations of parental feeding practices and feeding style with childhood obesity have gained more attention in the literature recently; however, fathers are rarely included within these studies. The aim of this research was to determine the relationship of paternal feeding practices on child diet quality, weight status, and eating behavior, and the moderating effect of paternal feeding style on these relationships in preschool age children. This study included a one-time, one-on-one interview with biological fathers of preschoolers (n = 150) to assess feeding practices (Child Feeding Questionnaire), feeding style (Caregiver Feeding Style Questionnaire), child eating behaviors (Child Eating Behavior Questionnaire), and diet quality (24 hour recall, Healthy Eating Index). Height and weight for each father and child were also measured and Body Mass Index (BMI) or BMI z-score calculated. Linear regression was used to test the relationship between paternal feeding practices, style and child diet quality and/or body weight. Overall, the findings revealed that a father's feeding practices and feeding style are not associated with children's diet quality or weight status. However, child eating behaviors are associated with child BMI z-score and these relationships are moderated by paternal feeding practices. For example, child satiety responsiveness is inversely (ß = -.421, p = 0.031) associated with child BMI z-score only if paternal restriction scores are high. This relationship is not significant when paternal restriction scores are low (ß = -.200, p = 0.448). These results suggest that some child appetitive traits may be related to child weight status when exposed to certain paternal feeding practices. Future studies should consider the inclusion of fathers as their feeding practices and feeding style may be related to a child's eating behavior.

Parenting styles, feeding styles, and their influence on child obesogenic behaviors and body weight. A review.

With recommendations to include parents as targets for childhood obesity interventions, there is a need to review the relationship of general parenting influences on childhood obesity. Therefore, the aim of this review is to examine the existing literature regarding the influence of parenting style and/or feeding styles on childhood obesogenic behaviors and body weight. Research articles related to parenting style (n=40) and parental feeding style (n=11) were identified and reviewed. An authoritative style appears to be the most protective parenting and feeding style while the indulgent feeding style is consistently associated with negative health outcomes. Overall, results for parenting style studies are inconsistent due to differences in conceptualization and measurement, while the results for feeding styles are much more cohesive. The literature is lacking in the ability to describe the interplay between parenting and feeding styles and child obesity risk. Recommendations for future research and interventions are discussed in regards to feeding style and influences on childhood obesity.

A Qualitative Analysis of Eating Behaviors Among Food Insecure College Students.

OBJECTIVE: To explore (1) how the cycle of food availability impacts food insecure college students' food-coping behaviors and (2) how access to a campus food pantry impacts food availability. METHODS: Qualitative, semistructured one-on-one interviews via Zoom were transcribed verbatim. Three investigators performed content analysis to identify and compare themes among participants with and without access to a campus food pantry. RESULTS: Forty undergraduate students from Illinois 4-year institutions with (n = 20) and without (n = 20) campus food pantries discussed similar experiences related to their food situation, eating behaviors, and use of resources, resulting in 7 themes: unique challenges of the college environment, childhood experiences, the impact of food insecurity, mental energy, the spectrum of resource management, structural barriers, and hiding hunger. CONCLUSIONS AND IMPLICATIONS: Food insecure students may use coping mechanisms to manage food and resources. The existence of a campus food pantry alone is insufficient to meet the needs of these students. Universities could consider providing additional support (ie, free meals), advertising available resources, or integrating food insecurity screening into other established processes.

A Qualitative Investigation of Parent and Child Perceptions of School Food Allergy Policies in the United States.

BACKGROUND: Many schools implement well-intentioned food allergy policies; however, may not ease parents'/children's worry and concern. The purpose of this study was to (1) explore children's and parents' perceptions their school's food allergy policy and (2) compare these perceptions to the documented school policy. METHODS: Children ages 8 to 18 with a food allergy and their parents (N = 18 pairs) across the US completed one-on-one semi-structured, audio-recorded phone interviews. School food allergy policies were collected from school websites. Content analysis was applied to the transcriptions by two investigators to identify themes among parents and children. RESULTS: Parents and children described policies may impact the child's social and/or emotional well-being. Many opportunities for improvement were provided by parents and children. There is a wide variation in food allergy policies across the schools in this study, and overall, parents and children thought that policy enforcement needs to be improved. CONCLUSIONS: With so much variation in food allergy policies in schools coupled with inconsistent enforcement, parents and children may feel unsafe or unsupported by the school. Schools should adopt a team- or whole-school approach to develop and enforce policies that help protect children with food allergies.

Exploration of Dietetics Graduate Students' Experience in a Flipped Course Using Learning Reflections.

OBJECTIVE: Evaluate graduate students' experience in a flipped metabolism course using periodic learning reflections. METHODS: Two cohorts of graduate students (n = 17, total) were recruited from an advanced metabolism course using a flipped learning approach during the fall 2016 and 2017 semesters. After course completion, 2 investigators used content analysis to develop themes from 8 structured learning reflections. RESULTS: Four themes were developed from the reflections: responsibility for learning, metacognition, team-based learning, and transfer of skills. Resistance to flipped learning peaked at week 4 of the semester. By the end of the semester, students seemed to embrace the flipped approach and self-directed learning. CONCLUSIONS AND IMPLICATIONS: Despite reporting being better self-directed learners by the end of the semester, students may struggle with the flipped learning format early in the semester. Thus, instructors may need to adopt supportive techniques with students initially.

Parental feeding style changes the relationships between children's food preferences and food parenting practices: The case for comprehensive food parenting interventions by pediatric healthcare professionals.

PURPOSE: To determine if parental feeding styles (emotional environment of the meal) moderate the relationship between food parenting practices (goal-directed behaviors) and children's preferences for fruits, vegetables, or high fat/sugar foods. DESIGN AND METHODS: This cross-sectional descriptive study recruited parents (n = 108) of preschool age children. The parents completed several questionnaires. Linear regressions were used to assess the relationship between food parenting practices and children's food preferences as moderated by feeding style, with the authoritative feeding style serving as the reference. RESULTS: Parental feeding styles were found to be moderators between several food parenting practices and child food preferences. When compared with parents with the authoritative feeding style (high demands, responds to child's needs), children like vegetables significantly less if indulgent (low demands, responds to child's needs) parents allow children to control their own eating, or authoritarian (high demands, does not respond to child's needs), or uninvolved (low demands, does not respond to child's needs) parents provide a healthy food environment. The authoritative style was not always preferential. For example, children of uninvolved parents who used food as a reward liked vegetables significantly more than children of parents who had the authoritative feeding style who also used food as a reward. In addition, children of authoritarian parents who modeled healthy eating liked foods high in fat and/or sugar significantly less than children of authoritative parents. PRACTICE IMPLICATIONS: When discussing child diet quality with parents, pediatric nurses should educate parents on both food parenting practices and feeding style, or the meal's emotional climate, as children experience both of these during mealtime interactions. In addition, for educational efforts, it may be advantageous to tailor interventions based upon the parent's feeding style.

Recruitment, Engagement, and Retention of Fathers in Nutrition Education and Obesity Research.

This article provides a perspective about recruiting, engaging, and retaining fathers in research and programming related to nutrition education and childhood obesity prevention. Recent research emphasizes the importance of fathers in childhood obesity prevention, and although father-friendly approaches can emulate other underserved populations, some researchers have acknowledged that differences may exist. Family sciences- related and nutritional sciences-related literature is summarized to provide guidance for nutrition and obesity scholars. Best practices may vary by the type of study and father characteristics; and the venues, content, structure, timing, and approach of research and interventions may need to be tailored for fathers.

An Exploration of How Fathers Attempt to Prevent Childhood Obesity in Their Families.

OBJECTIVE: To understand how fathers of preschool-aged children define overweight and obesity in children, investigate how fathers influence or attempt to influence their child's nutrition and physical activity behavior, and explore the father's perceived role in making decisions regarding his child's weight status. METHODS: Explorative study using an online survey, with 9 open-ended questions. Content analysis using constant comparative method was applied to data. A total of 117 US fathers (35.6 ± 5.55 years, 85% white; 82% had a 4-year degree or more) of preschoolers were included in the final analysis. RESULTS: Four themes emerged from the responses: (1) causes of childhood obesity, (2) prevention and/or treatment strategies, (3) recognition of child excess weight, and (4) barriers to changing behavior. CONCLUSIONS AND IMPLICATIONS: Although qualitative studies with a more representative sample are needed, practitioners could engage both fathers and mothers in interventions aimed at improving a child's health.

Investigating the Relationship of Body Mass Index, Diet Quality, and Physical Activity Level between Fathers and Their Preschool-Aged Children.

BACKGROUND: Diet quality and physical activity are two important factors in determining a child's risk for obesity. In early childhood, parents may serve as role models for these behaviors. However, few studies have examined associations of a father's body mass index (BMI), dietary intake, and physical activity with his preschool-aged child. OBJECTIVE: The purpose of this study was to examine relationships between fathers' and children's body weight, diet quality, and physical activity. DESIGN: This cross-sectional study included one-on-one interviews with fathers (n=150) of preschool-aged children conducted by a trained interviewer (a registered dietitian nutritionist). PARTICIPANTS: To be eligible, biological fathers (n=150) of preschool-aged children (aged 3 to 5 years) were required to regularly eat at least one meal per week with their child and be able to read or speak English. They could be of any race, ethnicity, income, or education level. MAIN OUTCOME MEASURES: During the interview, diet quality was assessed using a single 24-hour recall and the Healthy Eating Index-2010. Physical activity was assessed using the Pre-Physical Activity Questionnaire. Height and weight for each father and child were also measured. BMI and BMI z scores were calculated for fathers and children, respectively. STATISTICAL ANALYSES PERFORMED: Linear regression was used to test relationships between fathers' and children's body weight, diet quality, and physical activity while controlling for income level, race, and ethnicity. RESULTS: Overall, the findings revealed that there were significant, positive relationships between father-child weight status (ß=.03; P=0.05), overall diet quality (ß=.39; P<0.0001), and weekday (ß=.27; P=0.002) and weekend (ß=.62; P=0.001) vigorous physical activity. CONCLUSIONS: These results suggest that there are relationships between fathers' and children's BMI z score, dietary intake, and physical activity level. Future research should consider the inclusion of fathers in obesity prevention programs for young children.

A pilot study to explore how low-income mothers of different ethnic/racial backgrounds perceive and implement recommended childhood obesity prevention messages.

BACKGROUND: Mothers often serve as the "gatekeepers" of food and the eating experience for young children in the home. Children of different ethnic/racial groups have different obesity prevalence rates, but little is known about how mothers of these groups interpret or implement common childhood obesity prevention messages. The purpose of this mixed methods pilot study was to explore comprehension and implementation of common childhood obesity prevention messages and to identify feeding styles among low-income mothers of young children. METHODS: White, black, and Hispanic low-income mothers (n=30) of children ages 3-10 were recruited from Indiana. Mothers were interviewed individually regarding the perception and implementation of eight commonly used nutrition and/or physical activity messages. Other outcomes included the results of the Caregiver Feeding Styles Questionnaire and self-reported weight of mothers and child(ren). Interviews were analyzed using thematic analysis to find common themes among the different ethnic/racial groups. RESULTS: Childhood obesity prevention messages were often interpreted or implemented differently among the different ethnic/racial groups. For example, white mothers cited control as a means to manage a child's weight more often compared to the other racial/ethnic groups, whereas black and Hispanic mothers reported catering to a child's preference more frequently compared to white mothers. CONCLUSION: The pilot study provides evidence that it may be prudent to tailor nutrition messages to mothers of different ethnic/racial backgrounds during nutrition education.