Child Weight Status: The Role of Feeding Styles and Highly Motivated Eating in Children.

Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children's food motivation interacted with mothers' feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4-5 years (Time 1) and 7-9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children's eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations.

Maternal Feeding Styles and Child Appetitive Traits: Direction of Effects in Hispanic Families With Low Incomes.

Feeding styles of parents have been associated with dietary quality/intake and weight outcomes; however, much of the research to date has been cross sectional and the direction of influence unclear. This prospective longitudinal study evaluated the direction of effects between feeding styles and child appetitive traits over time in a sample of 129 Hispanic parent/child dyads that participated in a larger study. Data analyzed for the current study were collected when the children were 4-5 years old and again at ages 7-9 years. Parents (all mothers) reported on their feeding styles and children's appetitive traits using well-established questionnaires. Cross-lagged panel analyses were used to examine the direction of effects. Fully adjusted models revealed that a number of children's appetitive traits at baseline predicted later feeding styles. A bi-directional relationship was found between authoritarian feeding and satiety responsiveness such that higher satiety responsiveness was associated with authoritarian feeding and vice versa. Lower satiety responsiveness was associated with indulgent feeding, whereas higher food responsiveness was associated with authoritarian feeding. Results show preliminary evidence that children's appetitive traits may shape mothers' approach to child feeding. There is also preliminary support for the protective role of an authoritarian feeding style in the self-regulatory processes around child appetitive traits among this population of Hispanic families with low-income levels. These results warrant continued research given that other studies have shown beneficial outcomes for authoritarian feeding among ethnically diverse families with low incomes.

Food Parenting Practices and Feeding Styles and Their Relations with Weight Status in Children in Latin America and the Caribbean.

While a growing body of literature looks at the associations between food parenting practices, and feeding styles, and child's weight status in developed countries, little is known for less developed countries, in general, and the Latin America and the Caribbean (LAC) region, in particular. This study systemically reviews and synthesizes existing evidence on the associations between child caregivers' food parenting practices and feeding styles and 2 to 12-year-old child weight status. Keywords were used to search in PubMed, Web of Science, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature. Among the ten eligible articles, all of them reported significant associations between food parenting practices and feeding styles and child weight status. Existing studies have limitations, mainly related to cross-sectional convenience samples, which limit the generalization of the results. Additionally, small sample, heterogeneous feeding measures and weight related outcomes were other limitations. Future research is needed to understand caregiver-child interactions in the food situation and its link to child weight status in 2 to 12-year-old children in areas of LAC with diverse forms of malnutrition and contextual factors of countries.

Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender.

Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.

Twelve-Month Efficacy of an Obesity Prevention Program Targeting Hispanic Families With Preschoolers From Low-Income Backgrounds.

OBJECTIVE: Assess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children. DESIGN: Randomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks. SETTING: Families recruited from Head Start across 2 sites. PARTICIPANTS: Two hundred fifty-five families randomized into prevention (n = 136) or control (n = 119). INTERVENTION: Prevention received curriculum; control received no curriculum. MAIN OUTCOME MEASURE(S): Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child). ANALYSIS: Multilevel analyses for nested data (time points within families; families within waves) and multinomial regression. RESULTS: Program increased mothers' repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Program effects emphasize the importance of feeding approaches in reducing childhood obesity.

Rationale and design of the Baylor Infant Twin Study-A study assessing obesity-related risk factors from infancy.

BACKGROUND: Early childhood (0-3 years) is a critical period for obesity prevention, when tendencies in eating behaviors and physical activity are established. Yet, little is understood about how the environment shapes children's genetic predisposition for these behaviors during this time. The Baylor Infant Twin Study (BITS) is a two phase study, initiated to study obesity risk factors from infancy. Data collection has been completed for Phase 1 in which three sub-studies pilot central measures for Phase 2. A novel infant temperament assessment, based on observations made by trained researchers was piloted in Behavior Observation Pilot Protocol (BOPP) study, a new device for measuring infant feeding parameters (the "orometer") in the Baylor Infant Orometer (BIO), and methods for analyzing DNA methylation in twins of unknown chorionicity in EpiTwin. METHODS: EpiTwin was a cross-sectional study of neonatal twins, while up to three study visits occurred for the other studies, at 4- (BOPP, BIO), 6- (BOPP), and 12- (BOPP, BIO) of age. Measurements for BOPP and BIO included temperament observations, feeding observations, and body composition assessments while EpiTwin focused on collecting samples of hair, urine, nails, and blood for quantifying methylation levels at 10 metastable epialleles. Additional data collected include demographic information, zygosity, chorionicity, and questionnaire-based measures of infant behaviors. RESULTS: Recruitment for all three studies was completed in early 2020. EpiTwin recruited 80 twin pairs (50% monochorionic), 31 twin pairs completed the BOPP protocol, and 68 singleton infants participated in BIO. CONCLUSIONS: The psychometric properties of the data from all three studies are being analyzed currently. The resulting findings will inform the development of the full BITS protocol, with the goal of completing assessments at 4-, 6-, 12-, and 14-month of age for 400 twin pairs.

Maternal feeding style and child weight status among Hispanic families with low-income levels: a longitudinal study of the direction of effects.

BACKGROUND: The home environment is a central and modifiable influence on the development of childhood obesity. Evidence supports the central role of parents in shaping problematic child eating behaviors and excess weight. Most studies of feeding emphasize parent-driven influences without taking into account the child's role in eating interactions. Few studies have addressed the bi-directional nature of feeding dynamics in studies of young children. METHODS: The goals of this study were: 1) to examine if parental feeding styles during preschool (4-5 years) predict child weight status at 7-9 years, and 2) to examine the direction of effects between parental feeding styles and child weight status over time. Participants were part of a larger longitudinal study of Hispanic Head Start families living in the West South Central United States. Data from mother/child dyads were collected at three time points: Time 1 (ages 4-5), Time 2 (ages 5 ½-6 ½), and at Time 3 (ages 7-9). Only data from the Times 1 and 3 were used in the current analyses. A total of 128 mothers and their children had data on all variables needed for the analyses. Assessments included parent-reported feeding styles, feeding practices, acculturation, child eating behaviors, and child height and weight. Hierarchical regression was used to examine the first aim; a cross-lagged panel analysis examined the second aim. RESULTS: An indulgent parental feeding style at ages 4-5 was associated with increased child BMI z-score at ages 7-9. Indulgent feeding significantly contributed to child BMI z-score beyond demographics, baseline child BMI z-score, parental acculturation, and child eating behaviors. Regarding the direction of effects in parental feeding interactions, the cross-lagged analyses showed that both indulgent feeding style and authoritative feeding style at Time 1 positively predicted child BMI z-scores at Time 3. Child effects were significant as well. Child BMI z-score at Time 1 positively predicted indulgent feeding and negatively predicted authoritarian feeding at Time 3. CONCLUSIONS: Indulgent feeding should be addressed in future family-focused childhood obesity initiatives focused on young children and their parents.

General Parenting and Hispanic Mothers' Feeding Practices and Styles.

Previous research has shown that general parenting styles, general parenting dimensions, maternal feeding styles, and maternal feeding practices all show specific relationships with the weight status of young children. This study examined the relationships between general parenting and maternal feeding styles/practices in a sample of 187 Hispanic mothers with low incomes. As part of a larger study, mothers of preschool children were recruited through Head Start programs and completed validated questionnaires assessing their general parenting, feeding styles, and feeding practices. Results identified numerous associations between general parenting dimensions and specific feeding practices: i.e., maternal nurturance was positively associated with healthy eating guidance and feeding responsiveness; inconsistency was positively associated with restriction for weight and promotion of overconsumption; follow through on discipline was positively associated with monitoring, healthy eating guidance, and feeding responsiveness; and family organization was positively associated with monitoring and healthy eating guidance. General parenting styles were associated with feeding practices as well, with authoritative mothers showing the highest levels of healthy eating guidance and authoritarian mothers showing the lowest levels of monitoring. There were no significant associations between mothers' general parenting styles and mothers' feeding styles. Implications of these findings for the prevention of childhood obesity are considered.

Associations Between Independent Assessments of Child Appetite Self-Regulation: A Narrative Review.

A variety of eating behaviors among children have been associated with obesity risk and are thought to broadly reflect child appetite self-regulation (ASR). While ASR is thought to occur on cognitive, emotional, motivational, biological, and behavioral levels, the inter-relatedness of ASR constructs as assessed by different methods/measures is not well-characterized. This narrative review describes the correspondence between different methods/measures of child ASR constructs as assessed by self-report questionnaires and/or observational tasks and their relationship to child standardized body mass index (BMIz). Research involving at least two different methods/measures is presented including observational tasks such as the Eating in the Absence of Hunger task, compensation trials, and eating rate, as well as various child eating behavior self-report questionnaires. Keyword searches in the PubMed and PsycINFO databases for articles published between 2000 and July 2021 identified 21,042 articles. Eighteen articles met the inclusion criteria and examined at least two of the targeted measures. Studies comparing questionnaire data with other questionnaire data showed the most evidence of significant associations (r values ranging from -0.45 to 0.49), whereas studies comparing questionnaires with observational tasks mostly showed weak (r values ranging from -0.17 to 0.19) or not significant associations, with only few studies finding moderate associations (r values ranging from -0.38 to 0.33). Studies comparing different observational tasks showed no significant associations. Overall, studies comparing self-report questionnaires showed the most correspondence, whereas those comparing observational tasks showed no correspondence. Studies across methods (questionnaires with tasks) showed less correspondence. Significant associations were found between ASR constructs and child BMIz across five studies using self-report questionnaires and two studies using observational tasks. Future research is needed to clearly define the various ASR constructs, their expected correspondence, and the strength of that correspondence, as well as the relations between ASR constructs and child weight among youth with and without overweight/obesity.

Maternal Predictors of Child Dietary Behaviors and Weight Status.

PURPOSE OF REVIEW: To provide scientific evidence showing links between parenting/feeding, child eating, and weight status and recommend best practices for creating a feeding environment protective against childhood obesity. RECENT FINDINGS: Current research shows that authoritative styles in both feeding and general parenting contexts has been consistently associated with better child health outcomes. Authoritative feeding styles have been associated with better child dietary quality and weight. Indulgent feeding styles have been associated with problematic child eating behaviors and higher weight. Authoritative general parenting styles have predicted healthier child weight status overtime. Highly controlling feeding behaviors in the form of parental styles or practices hinder development of healthy eating in children. It is more productive to study styles of feeding as opposed to practices as feeding styles show less variability in predicting child health outcomes. Areas that warrant further research are identified and recommendations of beneficial feeding behaviors are provided.

Observations of Toddlers' sensory-based exploratory behaviors with a novel food.

BACKGROUND: Food neophobia hinders the acceptance of healthy foods in young children, and may be overcome by repeated food exposure. Prevalent literature states that children exhibit five sensory-based exploratory behaviors (SBEBs): smelling, licking, spitting, manipulating and/or swallowing as they progress towards accepting a novel food, yet there is a paucity of research on these behaviors. This study aimed to use direct observations of SBEBs across first-time exposures to hummus to (1) determine the prevalence of five SBEBs (smelling, licking, spitting, manipulating and swallowing) in 12-35 month olds, (2) quantify the psychometric properties of the SBEB assessment; and (3) examine the association of SBEBs with parent-assessed food fussiness, and consumption of the novel food. METHODS: Direct observations of SBEBs during a 15-20 min snack time were conducted by trained staff members for 55 hummus-naïve toddlers ages 12-35 months, across 16 exposures to a novel food (hummus). Parents completed the child eating behavior questionnaire. Hummus consumption was measured using digital plate waste method. RESULTS: Very low base rates of spitting (0.06%), smelling (0.97%) and licking (1.95%) were observed but manipulation (26.36%) and swallowing (62.15%) were more prevalent. Observation data on two behaviors over 16 occasions gave rise to a reliability coefficient from our G study portion of our generalizability analyses of Eρ2 = 0.65. SBEBs did not significantly associate with parent-assessed food fussiness, nor hummus consumption. CONCLUSIONS: Although literature refers to the prevalence of SBEBs, we did not observe this for three proposed behaviors. We did observe manipulation, but more research is needed to determine if there are additional SBEBs not noted in the literature, and to better delineate the process that leads to acceptance/rejection of novel food.

Depressive Symptoms and Perceptions of Child Difficulty Are Associated with Less Responsive Feeding Behaviors in an Observational Study of Low-Income Mothers.

BACKGROUND: Maternal depressive symptoms and perceptions of child difficulty are associated with negative effects on general development and cognitive functioning in children. The study examined associations between maternal depressive symptoms, perceptions of child difficulty, and maternal feeding behaviors in a population at elevated risk for childhood obesity. METHODS: Participants were 138 low-income black and Hispanic mothers and their children (ages 3-5) participating in an observational study of mealtimes among Head Start families. Three dinnertime observations were conducted over 2 weeks on each family and audio/videotaped for coding. Coding included eating influence attempts and other food- and nonfood-related interactions exhibited by the mother during dinner. Mothers completed questionnaires on depressive symptoms and perceptions of child difficulty. Linear regressions were conducted, examining associations between maternal depressive symptoms, perceptions of child difficulty, and coded parent feeding behaviors. RESULTS: Mothers reporting higher levels of depressive symptoms used more verbal pressure to get their child to eat during meals, were more likely to discourage child independence, and less likely to enforce table manners. Mothers reporting higher perceptions of child difficulty were less likely to have nonfood-related discussions during meals and to try to get the child to eat a different food. CONCLUSIONS: This study is one of the first to investigate associations between maternal depression, perceptions of child difficulty, and mother's feeding behaviors during meals using observational methodology. These results may help researchers identify specific parental characteristics and feeding practices on which to intervene when developing tailored intervention programs for reducing childhood obesity.

Peanut consumption in adolescents is associated with improved weight status.

Studies have shown an association between nut consumption and health benefits in adults such as lower lipid levels, lower body mass indices, and reduced risk of coronary artery disease. Few studies have demonstrated these health benefits in children. To determine the association between peanut consumption and weight, intake of nutrients of concern, high-density lipoprotein, low-density lipoprotein, and cholesterol in Mexican American children, baseline data from 262 sixth-grade students (48% female) in a school-based weight management program were analyzed to compare differences between peanut and non-peanut eaters. It was hypothesized that Mexican American children who consume peanuts will be less overweight and have a better nutrient and lipid profile when compared to those who do not eat peanuts. Participants completed a food frequency questionnaire as a baseline dietary assessment before beginning the program. Children were identified as either a peanut consumer (n = 100) or non-peanut consumer (n = 162). Body mass index measurements were taken on all participants. A smaller sample of participants submitted blood for lipid analysis. Analyses revealed that children in the peanut consumer group were less likely to be overweight or obese than children in the non-peanut consumer group (χ(2) = 13.9, P = .001), had significantly higher intakes of several vitamins and micronutrients (i.e., magnesium, vitamin E), and had lower low-density lipoprotein and total cholesterol levels. These results illustrate that consumption of peanuts and/or peanut butter is associated with lower weight status, improved diet, and lipid levels among Mexican American children. Future research is needed to clarify the role of peanut consumption in children's overall health.

Feeding style differences in food parenting practices associated with fruit and vegetable intake in children from low-income families.

OBJECTIVE: To examine the moderating effects of feeding styles on the relationship between food parenting practices and fruit and vegetable (F & V) intake in low-income families with preschool-aged children. DESIGN: Focus group meetings with Head Start parents were conducted by using the nominal group technique. Parents completed information on food parenting practices and feeding styles. Three dietary recalls were collected on each child. SETTING: Parents completed measures in Head Start centers and/or over the telephone. PARTICIPANTS: 667 parents of preschool-aged children participated. OUTCOMES: Food parenting practices and F & V intake. ANALYSIS: Mean differences in the food parenting practices across the 4 feeding styles were established through multivariate general linear modeling using MANOVA. Moderated multiple regression analysis was conducted to examine the moderating role of feeding style on food parenting practices and child F & V intake. RESULTS: The indulgent feeding style moderated the relationship between food parenting practices and child F & V intake. CONCLUSIONS AND IMPLICATIONS: This study indicates that parents' feeding styles have a moderating effect on the relationship between the food parenting practices and children's F & V intake. This finding can facilitate the development of interventions aimed at reducing childhood overweight.

Achieving long-term weight maintenance in Mexican-American adolescents with a school-based intervention.

PURPOSE: This study evaluated 24-month outcomes of a school-based intensive lifestyle weight management program targeting overweight Mexican-American adolescents. METHODS: We recruited a total of 71 adolescents (32 males; 45.1%) between the ages of 10 and 14 years, at or above the 85th percentile for body mass index (BMI). Participants were randomized to a 6-month instructor-led intervention (ILI) or a self-help (SH) program. Both interventions were aimed at modifying eating and physical activity behaviors using behavior modification strategies. We assessed changes in participants' standardized BMI and BMI percentile at baseline, 1, and 2 years. RESULTS: Repeated-measures analyses showed that ILI participants showed significantly greater decreases in standardized BMI at 1 and 2 years (F = 8.58, p < .01; and F = 9.27, p < .01, respectively) compared with SH controls. Similar results were found for changes in BMI and BMI percentile. At 2 years, the ILI condition decreased their average BMI percentile by 3.9 percentile points, compared to an increase of 1.6 percentile points in the SH condition. CONCLUSIONS: A school-based intervention resulted in improved weight outcomes in overweight Mexican-American adolescents and results were maintained over 2 years.

Emotional climate, feeding practices, and feeding styles: an observational analysis of the dinner meal in Head Start families.

BACKGROUND: A number of studies conducted with ethnically diverse, low-income samples have found that parents with indulgent feeding styles had children with a higher weight status. Indulgent parents are those who are responsive to their child's emotional states but have problems setting appropriate boundaries with their child. Because the processes through which styles impact child weight are poorly understood, the aim of this study was to observe differences in the emotional climate created by parents (including affect, tone of voice, and gestures) and behavioral feeding practices among those reporting different feeding styles on the Caregiver's Feeding Styles Questionnaire. A secondary aim was to examine differences on child weight status across the feeding styles. METHODS: Participants were 177 Head Start families from Houston, Texas (45% African-American; 55% Hispanic). Using an observational approach, the relationship between the observed emotional climate of the meal, behavioral feeding practices, and self-reported parent feeding styles were examined. Mean age of the children was 4.4 years (SD = 0.7) equally distributed across gender. Families were observed on 3 separate dinner occasions. Heights and weight were measured on the parents and children. RESULTS: Parents with self-reported indulgent feeding styles made fewer demands on their children to eat during dinner and showed lower levels of negative affect and intrusiveness. Surprisingly, these parents also showed higher levels of emotional detachment with their children during dinner. Hispanic boys with indulgent parents had significantly higher BMI z scores compared to Hispanic boys in the other three feeding style groups. No other differences were found on child weight status. CONCLUSIONS: Results suggest that the emotional climate created by indulgent parents during dinner and their lack of demands on their children to eat may play an important role in how young children become overweight. Numerous observed emotional climate and behavioral differences were found between the other self-reported feeding styles as well. Results suggest that parents' self-reported feeding styles may be a proxy for the emotional climate of the dinner meal, which may in turn influence the child's eating behaviors and weight status.