Development and validation of the baby eating behaviour coding system (BEBECS) to assess eating behaviour during complementary feeding.

Eating behaviour in children is a matter of study for which diverse tools have been designed. Coding systems for videotaped meals allow the extraction of detailed in vivo information; however, there is no tool available for infants following a Baby-Led Weaning (BLW) method. This study aimed to create and validate a new tool to assess eating behaviour in infants during weaning, applicable regardless of the complementary feeding method. The Baby Eating Behaviour Coding System (BEBECS) was developed comprising time variables, behaviours, feeder-led actions, and other meal-related variables. Sixty videos of infants aged 6-18 months following spoon-feeding (SF) or BLW methods were coded by two trained coders. These scores were analysed together with intake and maternal ratings of liking and calmness. Additionally, combined analysis and internal comparison assessed the possible differences in BEBECS variables between SF and BLW. Inter-rater and test-retest reliability had good to excellent agreement: Cohen's Kappa >0.75, Lin's CCC >0.70, and Intraclass Correlation Coefficient >0.75, for almost all variables. Infants' liking and intake of the offered food correlated positively with meal duration and total count of mouth approaches but negatively with having leftovers and time between mouth approaches. Infants' calmness and tiredness were negatively correlated. More food than initially offered was available during the meal in BLW but not in SF. There was a tendency towards more autonomous behaviour in BLW infants regarding changes observed in the time the food was in the mouth at each stage (6, 12, and 18 months). In conclusion, BEBECS has the potential to be a valid tool for application in the research of infant eating behaviour during weaning by trained coders.

The effectiveness of acceptance and commitment therapy upon weight management and psychological well-being of adults with overweight or obesity: A systematic review.

Several studies have examined acceptance and commitment therapy's (ACT) effectiveness for addressing physical and psychological distress people with obesity can face. Nevertheless, no review focusing specifically on ACT analysing randomized controlled trials (RCT) has been done up to date in this field. The present systematic review was developed following the PRISMA statement and aimed to examine ACT's effects on weight management and psychological well-being of adults with overweight or obesity. A conjunction of keywords related to ACT and excess weight was searched in four databases (Medline, PubMed, Psycinfo and Scopus) for articles meeting inclusion criteria. The literature search yielded 2,074 papers, and 16 were included in the review, finally. In 71.43% of the studies, ACT was effective to enhance psychological well-being; in 50% effectively targeted process variables and health behaviours related to weight management; in 31.82% of studies, physical variables were improved; and 21.38% of studies showed evidence in favour of ACT for eating behaviour modification. The present review supports ACT for promoting emotional aspects of individuals immersed in such weight-related battles and highlights the benefits of psychological well-being-oriented ACT in the context of obesity treatment. More studies targeting psychological well-being primarily and with longer follow-ups are required.

A quasi-experimental intervention protocol to characterize the factors that influence the acceptance of new foods by infants: mothers' diet and weaning method. Dastatuz project.

BACKGROUND: Children usually refuse to eat and taste fruits and vegetables; and turning unhealthy eating habits around is an important social challenge in industrialized countries. The Dastatuz project aims to study children food neophobia and to enhance fruit and vegetable acceptance. METHODS: A quasi-experimental, multicentre, controlled and prospective intervention study is proposed, in which early factors influencing new food acceptance will be studied. Mothers in the third trimester of pregnancy (n = 144) and their infants will be the study population. Experimental groups will be established based on mothers´ fruit and vegetable intake (standard or high intake) and weaning method (baby lead weaning vs spoon feeding). The project will assess the possible impact of maternal diet and complementary feeding on infants eating behaviour until 18 months of age. Outcome measures will comprise maternal diet and psychological features during pregnancy and breast-feeding (validated questionnaires). Compositional and physicochemical analysis of milk during breastfeeding will also be carried out. During weaning, until 18 months of age, children's diet will be assessed with 24 h recalls and acceptance of new fruits and vegetables will be studied using video recording. DISCUSSION: If the intervention is effective, this research work would have a high potential to be transferred to future public health programs or nutrition guidelines, as a feasible solution to achieve a higher intake of fruits and vegetables among children. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov. Identifier: NCT04262102 . Registration date: February 10, 2020 - Retrospectively registered.

Shopping for food with children: A strategy for directing their choices toward novel foods containing vegetables.

Involving children in the different steps of meal preparation has been suggested as a strategy for enhancing dietary habits in childhood. It has previously been shown that involving children in cooking can increase their willingness to taste novel foods and direct their food choices towards foods containing vegetables. The objective of the present study was to assess the effect of involving children in food purchasing on food choices, intake, liking and appetite. A between-subject experiment was conducted with 86 children (from 8 to 10 years old). Forty-three children (PURCHASE group) participated in a workshop dedicated to purchasing the necessary ingredients online for the preparation of three unfamiliar foods containing vegetables: apple and beetroot juice, zucchini tortilla sandwich and spinach cookies. Forty-three children (CONTROL group) participated instead in a creativity workshop. Afterwards, all the children were invited to choose, for an afternoon snack, between three familiar vs. unfamiliar foods: orange vs. apple and beetroot juice, potatoes vs. zucchini tortilla sandwich and chocolate vs. spinach cookie. The mean number of unfamiliar foods chosen per child was higher in the PURCHASE (0.70 ± 0.14) vs. CONTROL (0.19 ± 0.07) group (P = 0.003). The liking for 1 of the 3 unfamiliar foods was higher in the PURCHASE group (P < 0.05). We did not find any difference between the two groups in food intake estimation and in the levels of subjective appetite. This study demonstrates that involving children in purchasing food can help in directing their food choices towards unfamiliar foods containing vegetables. It highlights the importance of involving children in the different steps of meal preparation for decreasing food neophobia.

Psychometric properties of the Spanish Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R).

Based on the original 22-item single-factor questionnaire, the 10-item second-order Acceptance and Action Questionnaire for Weight-Related Difficulties-Revised (AAQW-R) was developed for measuring weight-related experiential avoidance. This instrument showed good psychometric properties, and it has been validated to different contexts. However, no Spanish validation has been conducted, to date. Therefore, the aim of this study was to analyze the psychometric properties of the Spanish version of the instrument in a sample of adults from the Spanish context across the whole body mass index spectrum (N = 393). Confirmatory factor analysis was performed to examine the fit of the first- and second-order AAQW-R structures. Internal reliability, construct validity, external reliability, and sensitivity to change were also analyzed. The Spanish AAQW-R presented a good fit to the data, the overall scale and subscale scores showed acceptable-to-good internal consistencies, and adequate construct validity. Likewise, test-retest reliability parameters were high, and the instrument showed sensitivity to change. The findings demonstrate that the Spanish AAQW-R is an instrument with good psychometric properties, supporting its use for measuring adults' weight-related experiential avoidance in both research and clinical settings within the Spanish context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Prevention of eating disorders from the different psychological perspectives]. / Prevención de los trastornos de la conducta alimentaria desde las diferentes perspectivas psicológicas.

Introduction: Objective: to systematically review and quantify the effectiveness of preventive interventions for eating disorders (TCA). Method: numerous electronic databases have been used with different keywords to compile randomized controlled studies carried out from 2009 to 2019 in relation to the prevention of eating disorders. Results: one hundred and thirteen articles were included, 21 for universal prevention, 84 for selective, and 8 for indicated. Small or moderate effect sizes were found in reducing risk factors for eating disorders that occur up to three years after the intervention. For universal prevention, media education has proven to be the intervention that significantly reduces concern about body image and weight for both women and men. Regarding selective prevention, cognitive dissonance (CD) interventions were superior to control interventions to reduce TCA symptoms. Cognitive behavioral therapy (CBT) has shown higher effect sizes relative to TCA risk factors at the nine-month follow-up. Healthy Weight program reduced eating disorder risk factors and body mass index. Likewise, multicomponent interventions were effective in reducing behaviors associated with eating disorders. No indicated preventive intervention was shown to be effective in reducing risk factors for eating disorders. Conclusion: interventions based on CD, media education, CBT, the Healthy Weight program and multicomponent interventions are presented as promising preventive interventions to reduce risk factors for eating disorders. However, the decline in the incidence of eating disorders is uncertain. Obesity prevention interventions require further research, as well as those based on mindfulness, which have increased in recent years.

Introducción: Objetivo: revisar sistemáticamente y cuantificar la efectividad de las intervenciones preventivas de los trastornos de la conducta alimentaria (TCA). Método: numerosas bases de datos electrónicas se han utilizado con diferentes palabras clave para recopilar los estudios aleatorizados controlados llevados a cabo desde 2009 a 2019 en relación a la prevención de los TCA. Resultados: ciento trece artículos fueron incluidos, 21 para la prevención universal, 84 para la selectiva y 8 para la indicada. Se han encontrado tamaños del efecto pequeños o moderados en la reducción de los factores de riesgo de los TCA que ocurren hasta tres años después de la intervención. Para la prevención universal, la educación mediática ha demostrado ser la intervención que reduce significativamente la preocupación por la imagen y el peso corporal tanto para mujeres como para hombres. En relación a la prevención selectiva, las intervenciones de disonancia cognitiva (DC) fueron superiores a las intervenciones de control para reducir los síntomas de los TCA. La terapia cognitivo-conductual (TCC) ha mostrado tamaños de efecto superiores en relación a los factores de riesgo de los TCA en el seguimiento de nueve meses. El programa Healthy Weight redujo los factores de riesgo de los TCA y el índice de masa corporal. Asimismo, las intervenciones multicomponente fueron efectivas en la reducción de las conductas asociadas a los TCA. Ninguna intervención preventiva indicada demostró ser efectiva para reducir los factores de riesgo de los TCA. Conclusión: las intervenciones basadas en la DC, la educación mediática, la TCC, el programa Healthy Weight y las intervenciones multicomponente se presentan como prometedoras intervenciones preventivas para reducir los factores de riesgo de los TCA. No obstante, la bajada en la incidencia de los TCA es incierta. Las intervenciones de prevención de la obesidad requieren mayor investigación, así como las basadas en el mindfulness, las cuales han aumentado en los últimos años.

The Effectiveness of an Acceptance and Commitment Therapy and Mindfulness Group Intervention for Enhancing the Psychological and Physical Well-Being of Adults with Overweight or Obesity Seeking Treatment: The Mind&Life Randomized Control Trial Study Protocol.

Although several interventions that target obesity have been examined, the success of these interventions in generating and maintaining positive results has yet to be confirmed. This study protocol therefore presents a trial aimed at analyzing the effectiveness of a well-being-centered acceptance and commitment therapy (ACT)- and mindfulness-based group intervention following the valued-based healthy living (VHL) approach (Mind&Life intervention) for individuals experiencing overweight-related distress. A randomized controlled trial with two parallel groups will be conducted in 110 adults attending primary care units with overweight or obesity. Participants will be randomly allocated to one of the two study conditions. Interventions will either be the treatment as usual (TAU) or the Mind&Life intervention-an ACT- and mindfulness-based intervention-plus the TAU intervention. Quality of life, weight self-stigma, general health status, eating habits, physical activity, eating behavior, anthropometric, body composition, cardiovascular, and physiological variables, as well as process variables, will be examined at baseline, posttreatment, 6-month follow-up, and 1-year follow-up. This trial aims to offer a novel psychological approach for addressing the psychological and physical impairments suffered by people with overweight or obesity in the current environment. ClinicalTrials.gov identifier: NCT03718728.

Child Involvement in Choosing a Recipe, Purchasing Ingredients, and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia.

OBJECTIVE: To investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment. DESIGN: Quasi-experimental. SETTING: Two schools in Bilbao, Spain. PARTICIPANTS: A total of 202 children (aged 8-9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group. INTERVENTION: Three 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities. MAIN OUTCOME MEASURES: Food neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches. ANALYSIS: Chi-square test of independence, ANCOVA, and t tests were performed. RESULTS: Students from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups. CONCLUSIONS AND IMPLICATIONS: Both interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.

Effects of Exercise in Addition to a Family-Based Lifestyle Intervention Program on Hepatic Fat in Children With Overweight.

OBJECTIVE: Pediatric hepatic steatosis is highly prevalent and closely related to type 2 diabetes. This study aimed to determine whether the addition of supervised exercise to a family-based lifestyle and psycho-educational intervention results in greater reduction of percentage of hepatic fat (HF), adiposity, and cardiometabolic risk factors in children with overweight/obesity. RESEARCH DESIGN AND METHODS: The study subjects of this nonrandomized, two-arm, parallel design clinical trial were 116 overweight/obese children (10.6 ± 1.1 years of age, 53.4% girls) living in Vitoria-Gasteiz (Spain). For 22 weeks, they followed either a lifestyle and psycho-education program (control intervention [CInt], N = 57), consisting of two family-based education sessions/month, or the same plus supervised exercise (intensive intervention [II], N = 59) focused mainly on high-intensity aerobic workouts (3 sessions/week, 90 min/session). The primary outcome was the change in percentage of HF (as measured by MRI) between baseline and the end of the intervention period. Secondary outcomes included changes in BMI, fat mass index (FMI), abdominal fat (measured by DEXA), blood pressure, triglycerides, HDL, LDL, γ-glutamyl transferase, glucose, and insulin concentrations. RESULTS: A total of 102 children completed the trial (N = 53 and N = 49 in the CInt and II groups, respectively). Percentage of HF decreased only in the II group (-1.20 ± 0.31% vs. 0.04 ± 0.30%, II and CInt groups, respectively), regardless of baseline value and any change in adiposity (P < 0.01). BMI, FMI, abdominal fat (P ≤ 0.001), and insulin (P < 0.05) were reduced in both groups. CONCLUSIONS: Multicomponent intervention programs that include exercise training may help to reduce adiposity, insulin resistance, and hepatic steatosis in overweight/obese children.

Trait anxiety and self-concept among children and adolescents with food neophobia.

Food problems in children and adolescents often have a detrimental effect on the emotional and psychological wellbeing of their parents. However, the impact of such problems on the psychological wellbeing of children and adolescents themselves has been less widely studied. The purpose of this study was to determine whether children and adolescents with food neophobia differed in trait anxiety and dimensions of self-concept from their neophilic and their average peers. A community sample of 831 participants (368 males and 463 females) between the ages of 8 and 16 were classified into six groups based on scores obtained on the Spanish Child Food Neophobia Scale (i.e., neophobic, average, and neophilic) and their age (i.e., children vs. adolescents). Compared with their neophilic peers, children with food neophobia showed higher levels of trait anxiety and a poorer social, physical, and academic self-concept. Among adolescents similar results were observed for trait anxiety and physical self-concept, but instead of social and academic self-concept it was family self-concept which distinguished between neophobic and neophilic participants. These results suggest that food neophobia is associated with trait anxiety and with some dimensions of self-concept. This highlights the need to ascertain the threshold between 'normal' and 'problematic' eating behaviors, since the fact that a behavior is to some extent usual does not imply that it is harmless.

[The importance of involving boys and girls in food preparation]. / La importancia de involucrar a niños y niñas en la preparación de las comidas.

Child food neophobia is usually associated with a lower consumption of fruits and vegetables, and the latter, is related to a less healthy diet. Different types of programs have been conducted in order to reduce food neophobia and thus increase the intake of fruits and vegetables in childhood. Among them, sensory education programs have shown their effectiveness. On the other hand, various nutritional programs that include garden and food preparation activities are used for the same purpose. However, the heterogeneity of programs and their evaluations, make it difficult to reach firm conclusions about its effectiveness. Several experimental studies have been conducted to determine the effect of each of the stages of preparing food separately: the selection of the recipe, the purchase of food, cooking and the presentation of the plate. While the results are promising, it is necessary to realize studies in real environments to validate such experiments. An example is the EgizuSUK project, carried out at schools and that encompasses different sessions that involve children in the different stages of the preparation of new foodstuffs, and whose results, compared with a control group, seem to be in line with the experimental studies. Finally, in order to promote healthy eating in children, it is considered that programs should include elements of nutrition education, sensory education, as well as culinary skills. In addition, school setting as well as the family context should be taken into consideration as key elements in the development of such programs.

La neofobia alimentaria infantil se asocia normalmente a un menor consumo de frutas y verduras, y esto último se relaciona con una dieta menos saludable. Se han llevado a cabo diferentes tipos de programas con el objetivo de reducir la neofobia alimentaria y aumentar así la ingesta de frutas y verduras en la infancia. Entre ellos, los de educación sensorial han mostrado su eficacia. Por otro lado, los diversos programas nutricionales que incluyen actividades de huerto y preparación de alimentos se utilizan con el mismo fin. No obstante, la heterogeneidad de los programas y de sus evaluaciones dificultan llegar a conclusiones sólidas sobre su efectividad.Se han llevado a cabo diversos estudios experimentales para determinar el efecto de cada una de las etapas de la preparación de alimentos por separado: la elección de la receta, la compra de los alimentos, su cocinado y su emplatado. Si bien los resultados son prometedores, es necesario realizar estudios en entornos reales para validar dichos experimentos. Un ejemplo es el proyecto EgizuSUK, llevado a cabo en el ámbito escolar y que engloba diferentes sesiones que trabajan las etapas del proceso de alimentación y cuyos resultados, comparados con un grupo control, parecen estar en línea con los estudios experimentales.Finalmente, y con el objetivo de promover una alimentación saludable en la población infantil, se considera necesario que los programas incluyan elementos de educación nutricional y educación sensorial, así como de habilidades culinarias. Además, tener en cuenta el entorno escolar y el contexto familiar es clave para el adecuado desarrollo de dichos programas.

Prevention of diabetes in overweight/obese children through a family based intervention program including supervised exercise (PREDIKID project): study protocol for a randomized controlled trial.

BACKGROUND: The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. METHODS: A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). DISCUSSION: Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03027726 . Registered on 16 January 2017.