Parent Involvement in Diet or Physical Activity Interventions to Treat or Prevent Childhood Obesity: An Umbrella Review.

Parents substantially influence children's diet and physical activity behaviors, which consequently impact childhood obesity risk. Given this influence of parents, the objective of this umbrella review was to synthesize evidence on effects of parent involvement in diet and physical activity treatment and prevention interventions on obesity risk among children aged 3-12 years old. Ovid/MEDLINE, Elsevier/Embase, Wiley/Cochrane Library, Clarivate/Web of Science, EBSCO/CINAHL, EBSCO/PsycInfo, and Epistemonikos.org were searched from their inception through January 2020. Abstract screening, full-text review, quality assessment, and data extraction were conducted independently by at least two authors. Systematic reviews and meta-analyses of diet and physical activity interventions that described parent involvement, included a comparator/control, and measured child weight/weight status as a primary outcome among children aged 3-12 years old were included. Data were extracted at the level of the systematic review/meta-analysis, and findings were narratively synthesized. Of 4158 references identified, 14 systematic reviews and/or meta-analyses (eight treatment focused and six prevention focused) were included and ranged in quality from very low to very high. Our findings support the inclusion of a parent component in both treatment and prevention interventions to improve child weight/weight status outcomes. Of note, all prevention-focused reviews included a school-based component. Evidence to define optimal parent involvement type and duration and to define the best methods of involving parents across multiple environments (e.g., home, preschool, school) was inadequate and warrants further research. PROSPERO registration: CRD42018095360.

The Families and Schools for Health Project: A Longitudinal Cluster Randomized Controlled Trial Targeting Children with Overweight and Obesity.

This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity; Family Dynamics (FD) added parenting and healthy emotion management. A third Peer Group (PG) intervention taught social acceptance to children. Crossing interventions yielded four conditions: FL, FL + PG, FL + FD, and FL + FD + PG-compared with the control. Longitudinal BMI data were collected to determine if family- and peer-based psychosocial components enhanced the Family Lifestyle approach. Participants were 1st graders with BMI%ile >75 (n = 538: 278 boys, 260 girls). Schools were randomly assigned to condition after stratifying for community size and percent American Indian. Anthropometric data were collected pre- and post-intervention in 1st grade and annually through 4th grade. Using a two-level random intercept growth model, intervention status predicted differences in growth in BMI or BMI-M% over three years. Children with obesity who received the FL + FD + PG intervention had lower BMI gains compared to controls for both raw BMI (B = -0.05) and BMI-M% (B = -2.36). Interventions to simultaneously improve parent, child, and peer-group behaviors related to physical and socioemotional health offer promise for long-term positive impact on child obesity.

Bidirectional Associations between Restrained Eating and Body Mass Index in Middle Childhood.

The nature of the association between dietary restraint and weight has been examined in adult samples, but much less is known about this relationship among children. The current study examined the transactional associations among restrained eating behavior and weight among boys and girls during middle childhood. Data for this study came from 263 children participating in the Families and Schools for Health Project (FiSH), a longitudinal study of the psychosocial correlates of childhood obesity. Participants were interviewed by trained researchers in their third- and fourth-grade year when they completed questionnaires and anthropometric assessments. Dietary restraint was assessed using the restrained eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ), and weight was assessed using Body Mass Index z-scores (BMIz). Bidirectional associations between variables were examined using cross-lagged models controlling for children's sex, ethnicity, and weight in first grade. Results indicated that weight in grade 3 was related to greater dietary restraint in grade 4 (B = 0.20, p = 0.001), but dietary restraint in grade 3 was not associated with weight in grade 4 (B = 0.01, p = 0.64). Neither child sex nor race/ethnicity were associated with BMIz or dietary restraint at either time point. Findings from this study advance the existing limited understanding of eating behavior development among children and show that weight predicts increases in children's dietary restraint in middle childhood.

Family Eating Behavior and Child Eating Patterns Differences Between Children With and Without Siblings.

OBJECTIVE: To examine the differences in family eating behaviors and child eating patterns in children with siblings (nonsingletons) and without siblings (singletons). METHODS: Cross-sectional analysis of mother-child dyads of 5-7-year-old children, (nonsingletons with a 2-to-4-year-old sibling) was conducted. Anthropometrics were measured. Mothers completed questionnaires and a child dietary log. Healthy Eating Index 2010 (HEI) score was calculated. Linear regression models adjusting for child age, child sex, maternal body mass index, and hours-away-from-home were conducted, with a revised P < .021. RESULTS: Sixty-eight mother-child dyads (27 singletons, 41 nonsingletons) participated. Singletons exhibited less healthy family eating behaviors (ß = -4.98, SE = 1.88, P = .003), and lower total HEI scores than did nonsingletons (average: ß = -8.91, SE =2.40, P = .001). On average, singletons had lower scores in 3 HEI components compared with nonsingletons (P < .021 for all). CONCLUSION: In this sample, singleton children exhibited less healthy eating behaviors. Additional investigation into parent-level differences is warranted.

Difference in Objectively Measured Physical Activity and Obesity in Children With and Without Siblings.

Background/Context: Children without siblings (singletons) have higher rates of obesity than do children with siblings (nonsingletons). Higher moderate to vigorous physical activity (PA) and less sedentary behavior (SB) are associated with lower childhood obesity. PURPOSE: To examine the difference in PA and SB between singleton and nonsingleton children. METHODS: Mothers of children ages 5.0-7.9 years old who were singletons or nonsingletons with a sibling between the ages of 2.0 and 4.9 years old were recruited. Height, weight, and waist circumference of the 5.0- to 7.9-year-old children were measured, and age and sex percentiles were calculated. Accelerometry measured SB and PA, including light PA, moderate to vigorous PA, and counts per minute. RESULTS: Fifty-six mother-child dyads (23 singletons and 33 nonsingletons) with an average child age of 5.7 (0.7) years participated. More singletons were classified as overweight or obese than were nonsingletons (49% vs 17%, P = .04). In adjusted linear models, singletons had less light PA per day (ß = -38.1, SE = 19.2, P = .001) and more SB (ß = 38.0, SE = 16.5, P = .02) than did nonsingletons, with no difference in moderate to vigorous PA or counts per minute. CONCLUSION: In this sample, singletons had higher obesity and lower light PA than did nonsingleton children. Investigation into differences in singleton/nonsingleton families, including family health behaviors, may help assess sibling influence in early behavior development.

Psychosocial Factors in Children's Obesity: Examples from an Innovative Line of Inquiry.

In recent years, researchers and policymakers have recognized that obesity in childhood is not simply a medical problem, but is a complex social and psychological phenomenon. Our research team used an interpersonal and intrapersonal risk model to examine the psychosocial aspects of obesity among rural children. In this article, we describe how the global study of children's obesity has broadened over the last 10 to 15 years, and we present our model of interpersonal and intrapersonal risk factors, which includes complex pathways with many psychosocial variables. We then describe a large prospective longitudinal study of children in grades 1 through 4, and highlight findings from five studies guided by this model. This work illustrates opportunities for developmental scientists and practitioners to join transdisciplinary teams to develop more effective prevention and intervention programs for children.

African-American and Hispanic children's beverage intake: Differences in associations with desire to drink, fathers' feeding practices, and weight concerns.

Relationships of African-American and Hispanic fathers' feeding practices and weight concerns and preschoolers' desire to drink with children's beverage intake were examined, and associations between fathers' feeding practices and children's weight status were evaluated. Fathers' (Hispanic n = 61, African-American n = 49) difficulty in child feeding, use of food to calm, use of food as reward, and concern about the child being under and overweight as well as their child's desire to drink were assessed. Preschoolers' (ages 2 to 5) total sugar-sweetened beverage (SSB), fruit juice, and water intake were measured by a modified beverage intake questionnaire. Body Mass Index (BMI) and BMI percentile were calculated for fathers and children, respectively. Multiple regressions revealed that, in Hispanics, difficulty in feeding, concern about underweight, use of food to calm, and use of food as a reward were significantly associated with child intake of total SSB, whereas, in African-Americans, child desire to drink was associated with total SSB and fruit juice. Concern about the child being underweight was inversely associated with child BMI percentile in Hispanics. Significant differences in regression coefficients of child SSB intake to fathers' behaviors versus child desire to drink between the two racial-ethnic groups indicated that use of food to calm the child predicted increased intake of SSB by Hispanic but not by African-American children, while child desire to drink predicted increased intake of SSB by African-American but not by Hispanic children. Because of these significant differences, future research might profitably explore socio-cultural influences on associations of additional child feeding behaviors with fathers' attempts to control them. Furthermore, practitioners should consider developing and evaluating different child obesity interventions for these two racial-ethnic groups.

Preschoolers' influence on and help with beverage selection at the grocery store is linked to maternal responsiveness and child beverage intake: An exploratory study.

Children's involvement in beverage selection or purchase has seldom been investigated. The responsiveness dimension of parental feeding styles has been related to healthy maternal feeding practices. Assessing mothers' reports of responsiveness and demandingness in grocery stores may shed light on influences on purchases of sugar-sweetened beverages (SSB) and fruit juice (FJ). Study objectives were to explore whether (1) maternal responsiveness and demandingness were associated with preschoolers' a) help with selection of and b) influence on SSB and FJ purchases during grocery shopping and whether (2) preschoolers' a) help with selection of and b) influence on SSB and FJ purchases were associated with child intake of these beverages. Mothers of 3-to-5-year-old children (n=185) who co-shopped with the child completed the Caregiver Feeding Style Questionnaire, reported frequency of child help with selection and influence on beverage purchase via questionnaire, and provided a one-day weekend food recall for the child. In adjusted logistic regressions, responsiveness was associated with child help selecting FJ (OR=6.50, 95% CI[1.04, 40.75], p<0.05), but not SSB. In multiple regressions, children who frequently helped select or influenced SSB purchases had higher SSB intake, b(SE)=3.63(1.40), t(176)=2.59, and b(SE)=3.18(1.25), t(176)=2.53, p<0.05. Mothers with higher responsiveness were more likely to let their preschoolers select FJ but not SSB during shopping. Children who frequently helped select or influenced SSB purchases had higher SSB intake than children who did so infrequently. Additional parenting behaviors associated with grocery shopping should be explored.

The Social and Emotional Lives of Overweight, Obese, and Severely Obese Children.

This study examines inter- and intrapersonal problems associated with being overweight among one thousand one hundred sixty-four 6- to 7-year-olds (49% boys) in 29 rural schools. Socioemotional data include child self-reports, peer sociometrics, and teacher reports. Results support the hypothesis that children with weight problems struggle socially and emotionally, and extend current understanding of child obesity by demonstrating that problems appear early, are evident in a community sample, can be identified using standard sociometric methods, and are worse among children with severe obesity. Sociometric status difference between levels of obesity were also found. Although obese children were neglected by peers, severely obese children were rejected.

Child gender and weight status moderate the relation of maternal feeding practices to body esteem in 1st grade children.

Prevention of body dissatisfaction development is critical for minimizing adverse effects of poor body esteem on eating behaviors, self-esteem, and overall health. Research has examined body esteem and its correlates largely in pre-adolescents and adolescents; however, important questions remain about factors influencing body esteem of younger children. The main purpose of this study was to test moderation by children's gender and weight status of the relation of maternal controlling feeding practices to 1st graders' body esteem. The Body Esteem Scale (BES) and anthropometric measurements were completed during one-on-one child interviews at school. Mothers completed the Child Feeding Questionnaire (restriction, monitoring, concern, self-assessed maternal weight). A total of 410 mother/child dyads (202 girls) participated. Percent of children classified as overweight (BMI-for-age ≥85th) was: girls - 29%; boys - 27%. Gender moderated the relation between restriction and body esteem (ß = -.140, p = .05), with maternal restriction predicting body esteem in girls but not boys. The hypothesized three-way interaction among gender, child weight status, and monitoring was confirmed. Monitoring was significantly inversely related to body esteem only for overweight/obese girls (b = -1.630). The moderating influence of gender or gender and weight status on the link between maternal feeding practices and body esteem suggests the importance of body esteem interventions for girls as early as first grade.

Emotion regulation is related to children's emotional and external eating.

OBJECTIVE: The objective of this study was to examine the associations between 2 types of emotion regulation (reactivity and inhibition) and 2 types of non-hunger-based eating (emotional eating and external eating). Although emotion regulation and eating regulation problems have both been linked to obesity in previous studies, there is little research examining the link between the two, particularly among children. METHODS: A total of 782 rural second graders (49% girls, 20% American Indian) were followed longitudinally through third grade. During both data collection points, children participated in face-to-face interviews at school using the Children's Emotion Management Scales and the revised Dutch Eating Behavior Questionnaire. RESULTS: Correlational analyses revealed that children's emotion regulation was significantly related to both external and emotional eating within and across grades, with reactivity appearing to be more consistently related to eating regulation than was inhibition. Regression analyses showed that second to third grade increases in external and emotional eating were predicted by increases in reactivity to anger and reactivity to worry. CONCLUSIONS: Given the established link in previous research between poor behavioral regulation and obesity in children, findings from this study linking child emotional reactivity and emotional and external eating (both forms of behavior dysregulation) are important in informing prevention and treatment programs. Based on these findings, targeting child emotion regulation in addition to behavior regulation skills as part of prevention and intervention programs may improve program effectiveness.

Relation of parenting styles, feeding styles and feeding practices to child overweight and obesity. Direct and moderated effects.

The purpose of this study was to evaluate the direct and interacting relations of parenting styles, feeding styles, and feeding practices to child overweight and obesity. Participants were 144 mothers and children under 6 years of age. Mothers completed questionnaires about parenting and feeding styles and feeding practices. Researchers weighed and measured mothers and children or obtained measurements from a recent health report. Feeding practices were not directly related to child weight status. Compared to the uninvolved feeding style, authoritative and authoritarian feeding style categories were linked to lower odds of overweight. Feeding practices interacted with authoritative and authoritarian parenting styles to predict obesity: (1) healthful modeling was associated with 61% (OR = 0.39) reduced odds of obesity in children of authoritative mothers but with 55% (OR = 1.55) increased odds in children of non-authoritative mothers and (2) covert control was linked to 156% (OR = 2.56) increased odds of obesity in children of authoritarian mothers but with 51% (OR = 0.49) decreased odds in children of non-authoritarian mothers. Healthful modeling interacted with feeding style demandingness to predict overweight and with responsiveness to predict obesity. Findings suggest the need for research and interventions on mechanisms mediating between feeding practices and obesity in families characterized by non-authoritative parenting styles.

Infant responsiveness, alertness, haemoglobin and growth in rural Sidama, Ethiopia.

Several recent studies have supported relations between infant behaviour (alertness and responsiveness) and nutrition in addition to investigating infant behaviour within the context of changes in iron status over time. Existing research is typically limited to the investigation of the effects of a single vitamin or mineral, and no studies have been found that examined the influence that early alertness and responsiveness have on growth in early infancy, despite the fact that relations between behaviour and nutritional status may be bidirectional. The current study used a sample of Ethiopian infants and investigated anthropometrics, haemoglobin, the frequency of alertness and the frequency of responsiveness at 6 and 9 months of age. Six-month weight-for-age predicted 9-month frequency of alertness, while 6-month haemoglobin predicted 9-month frequency of responsiveness. Compared with responsive infants, non-responsive infants at 6 months remained more non-responsive at 9 months, although weight-for-age for both groups converged at 9 months. Results support relations between nutrition and behaviour (alertness and responsiveness) and provide evidence of a potentially useful tool (the Laboratory Temperament Assessment Battery) that was adapted to evaluate these relations in Ethiopia.

Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children.

Body satisfaction is important for the prevention of disordered eating and body image disturbances. Yet, little is known about body esteem and what influences it among younger children. The purpose of this study was to evaluate body esteem and the relationships between body esteem, weight, gender, and physical activity in elementary school children. A total of 214 third graders in a U.S. Midwestern state participated in this correlational study. The Body Mass Index-for-age, the Body Esteem Scale (BES), BE-Weight, BE-Appearance, and a Physical Activity Checklist were used to examine the relationships between the variables using bivariate correlations and analysis of variance. While children's body esteem did not differ by physical activity, important interactions were identified between weight status and gender in global body esteem and BE-Appearance. It is critical to examine attitudes about weight and appearance and the relationship between body esteem and self-esteem further among middle childhood-aged children.

Nutritional status and cognitive performance of mother-child pairs in Sidama, Southern Ethiopia.

The purpose of this study was to assess the nutritional status and cognitive performance of women and their 5-year-old children using a cross-sectional design. Cognitive performance of mothers and children was assessed with Raven's Colored Progressive Matrices (CPM) and Kaufman Assessment Battery for Children-II (KABC-II). Demographic characteristics, food consumption patterns and anthropometry were also measured. Four rural districts in Sidama, southern Ethiopia served as the setting for this study. Subjects were one hundred women and their 5-year-old children. Mean ± standard deviation age of the mothers was 29 ± 6 years and family size was 7.0 ± 2.6. Maternal body mass index (BMI) ranged from 15.3 to 29.0 with 14% of the mothers having BMI < 18.5. Anthropometric assessment of children revealed 29% to be stunted (height-for-age z-score < -2) and 12% to be underweight (weight-for-age z-score < -2). Mothers' education significantly contributed to prediction of both mothers' and children's cognitive test scores. There were significant differences in mean cognitive test scores between stunted and non-stunted, and between underweight and normal-weight children. Height-for-age z-scores were correlated with scores for short-term memory (r = 0.42, P < 0.001), and visual processing (r = 0.42, P < 0.001) indices and weight-for-age z-scores were also correlated with scores of short-term memory (r = 0.41, P < 0.001) and visual processing (r = 0.43, P < 0.001) indices. Malnutrition in the community likely contributed to the cognitive performance of the subjects. Performance on memory and visual processing tasks was significantly lower in children with growth deficits suggesting that efficient and cost effective methods to alleviate malnutrition and food insecurity would impact not only child health but also cognitive function.

Weight status, physical activity, and fitness among third-grade rural children.

BACKGROUND: Rural children are at a particular high risk for obesity. Given the importance of exercise in obesity and chronic disease prevention, this study evaluated the level and relationship between physical activity and fitness in a sample of rural third graders. The second purpose of the study was to determine potential differences in physical activity and fitness level by weight status in this sample. METHODS: Twelve schools participating in a multidisciplinary research project were randomly selected for the study. Body mass index-for-age percentile, the modified Self-administered Physical Activity Checklist, and the FITNESSGRAM battery tests were utilized to determine children's weight status, physical activity, and fitness level, respectively. RESULTS: Thirty-eight percent of the 237 participating children (9.2 ± 0.4 years) were overweight or obese. Nearly 15% were extremely obese. Children spent 91.8 ± 83.8 and 32.2 ± 47.7 minutes in moderate- and vigorous-intensity activities. Obese children spent less time in moderate-intensity activity (p < .01) and combined moderate- and vigorous-intensity activity more than other children (p < .05). Forty-three percent of all children failed to meet the fitness standard for muscular strength and 36% failed to meet it for flexibility. CONCLUSIONS: Rural children in this sample had higher rates of obesity compared to the national average; they had poor fitness and 30% failed to meet the minimum physical activity recommendations on the previous day. Future interventions should focus on increasing physical activity, especially of moderate-intensity, and improving physical fitness in order to reduce obesity and decrease the risk of future chronic diseases in this high-risk population.

Parenting styles, parental response to child emotion, and family emotional responsiveness are related to child emotional eating.

The aim of the present study was to examine the relations of parenting style, parent response to negative child emotion, and family emotional expressiveness and support to child emotional eating. Mothers (N=450) completed questionnaires and their 6-8-year-old children (N=450) were interviewed. Results showed that emotional eating was negatively predicted by authoritative parenting style and family open expression of affection and emotion, and positively predicted by parent minimizing response to child negative emotion. Results suggest the need for early prevention/intervention efforts directed to these parenting and family variables.

Maternal depression and socio-economic status moderate the parenting style/child obesity association.

OBJECTIVE: The purpose of the study was to test the moderating influence of two risk factors, maternal depression and socio-economic status (SES), on the association between authoritarian and permissive parenting styles and child obesity. DESIGN: Correlational, cross-sectional study. Parenting style was measured with the Parenting Styles and Dimensions Questionnaire (PSDQ). Maternal depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). BMI-for-age percentile was used to categorize children by weight status (children with BMI-for-age > or = 95th percentile were classified as obese). SES was computed from parent education and occupational status using the four-factor Hollingshead index. SETTING: Rural public schools in a mid-western state in the USA. SUBJECTS: One hundred and seventy-six mothers of first-grade children (ninety-one boys, eighty-five girls) enrolled in rural public schools. RESULTS: Both maternal depression and SES were found to moderate the permissive parenting style/child obesity association, but not the authoritarian/child obesity association. For depressed mothers, but not for non-depressed mothers, more permissive parenting was predictive of child obesity. Similarly more permissive parenting was predictive of child obesity among higher SES mothers, but not for lower SES mothers. CONCLUSIONS: Maternal depression and SES interact with permissive parenting style to predict child obesity. Future research should examine the relationship among these variables using a longitudinal design.

Main and interaction effects of iron, zinc, lead, and parenting on children's cognitive outcomes.

This study examined relations of blood lead < 10 microg/dL, iron, zinc, and parenting to Head Start children's (N = 112) scores on Peabody Picture Vocabulary Test-III (PPVT-III) and McCarthy Scales of Children's Abilities (MSCA). Venous whole blood and plasma samples were analyzed for lead and zinc by ICP-MS and iron status was assessed by serum transferrin receptors. Hierarchical regressions revealed significant effects of lead on MSCA perceptual scores and iron on PPVT-III and MSCA verbal scores. Children with lead > 2.5 microg/dL had significantly lower MSCA perceptual scores than children < 2.5 microg/dL. Permissive parenting significantly exacerbated negative effects of higher lead or lower iron on children's perceptual or verbal scores, respectively.