'You just eyeball it': Parent and nursery staff perceptions and influences on child portion size: A reflexive thematic analysis.

Background: Childhood obesity is one of the most serious public health epidemics of the 21st century. Observational studies report that increases in portion size (PS) have occurred in parallel with levels of obesity. Increased PSs of high-energy-dense foods can promote overeating, and without compensatory behaviours, can contribute to childhood obesity. Caregivers make decisions about PSs for children in the home and nursery environment, thus are gatekeepers to child food intake. Understanding caregiver PS decisions can aid in the best practice of PS provision to young children. The aim of this study was to explore parent and nursery staff influences on child PS selection and their suggestions for useful tools/strategies in PS decisions. Methods: A qualitative design was employed using focus group discussions (FGDs) with parents and nursery staff of children aged 3-5 years. FGDs were employed given their ability to generate rich data, as well as permit the exploration of collective perceptions, attitudes, behaviours and experiences. Data were analysed using an inductive, semantic approach to reflexive thematic analysis. Results: Four FGDs were conducted: two with parents (n = 13), two with nursery staff (n = 17). Four overarching themes were derived: (i) awareness of PS guidelines; (ii) control over PS; (iii) social influences on children's eating behaviours; (iv) child-specific, social and external factors influencing parent and nursery staff PS decisions. Additionally, participants discussed tools/strategies they believe would be useful in PS decisions. Conclusion: Data from the themes suggest that caregiver control, social, child-specific and external factors are more influential than PS guidelines in both parent and nursery staff PS decisions for young children aged 3-5 years. These findings can inform future childhood obesity prevention initiatives focussed on improving parent and nursery staff provision/use of age-appropriate PSs.

A qualitative study of young peoples' thoughts and attitudes to follow a more plant-based diet.

Plant-based diets (PBDs) refer to dietary habits that reduce the consumption of animal-based products and increase the consumption of nutritionally rich plant foods. PBD's have been shown to provide significant health benefits, such as reducing obesity and improving psychological wellbeing, and are environmentally friendly. However, few studies have investigated factors that influence young people's thoughts and attitudes toward following a PBD in western societies, particularly in the United Kingdom. Understanding these factors may benefit public health interventions that encourage the consumption of more fruit and vegetables. The aim of this study was to explore the factors that affect young people's intentions toward following a PBD. Twenty-one young people (18-24 years) participated in this qualitative study. Participants were asked about their views of PBDs in a semi-structured interview. Thematic analysis was utilized to explore views and the barriers and facilitators to following a PBD. The Theory of Planned Behavior (TPB) was used as a framework to organise the findings. Within attitudes, the sub-themes identified were an awareness of a healthy diet, environmental concerns, health concerns and distrust, perceptions of PBDs and associated stereotypes, perceived restriction and lack of enjoyment, and need for education. Within subjective norms, the sub-themes identified were cultural and familial norms, peer influence, and exposure through social media. Within perceived behavioral control (PBC), the sub-themes identified were a lack of independence and parental control, lack of knowledge and perceived difficulty, lack of inclusiveness and accessibility, and inconvenience. Overall, the findings suggest that increased provision of education and knowledge about PBDs to young people, and widening access to PBDs, could encourage and help improve their understanding and intention to follow this dietary style. Tailored health promotion strategies, which also consider additional barriers and facilitators found within this study, could motivate young people to consume a more PBD.

The influence of supraliminal priming on energy density of food selection: a randomised control trial.

BACKGROUND: Many people exercise because they know it is good for their health. Although this is true, it can make us feel deserving of a reward and lead us to eat more indulgent, less healthy food than if we had not done any exercise. Generally, lower energy-dense (LED) foods are recognised as healthier choices than higher energy-dense (HED) options. Despite our intention to make healthy choices, seeing tempting higher-calorie foods on offer often side-tracks us. Priming is a psychological tool that makes specific changes to our environment that remind us of our motivation to be healthy. This makes it easier to choose a healthier option, by nudging us towards it without us even realising. However, it is currently unclear which method of priming achieves the best results. AIMS: Our study explores whether priming people to expect they will receive LED food leads them to make this healthier choice after exercise, even when also offered tempting less healthy HED foods at the moment of selection. METHODS: Our study observed the foods selected by university athletes after their sports matches. Before the match, half of the participants were primed by asking them to choose a LED snack from the options we offered, which they would receive after the match. The remaining half of participants were not asked this same question. To distract the athletes from our observation of their food choices, participants completed a task prior to choosing their snack, which was disguised as a 'thank you' for taking part. RESULTS: Overall, we found the priming group did not choose LED foods significantly more than the control group, hence priming did not increase LED food selection. CONCLUSION: Importantly, our results indicate that priming must be more noticeable to achieve its goal. Additionally, we demonstrated that priming may be less successful for young athletic individuals, compared to older and more overweight adults recruited in other studies. This highlights the importance of studying a broader demographic range of individuals from the general population. We support future research into this area, which will help us to tweak priming to achieve the best outcomes. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN74601698. Date registered: 02/10/2020 (retrospectively registered).

Methods of connecting primary care patients with community-based physical activity opportunities: A realist scoping review.

Deemed a global public health problem by the World Health Organization, physical inactivity is estimated to be responsible for one in six deaths in the United Kingdom (UK) and to cost the nation's economy £7.4 billion per year. A response to the problem receiving increasing attention is connecting primary care patients with community-based physical activity opportunities. We aimed to explore what is known about the effectiveness of different methods of connecting primary care patients with community-based physical activity opportunities in the United Kingdom by answering three research questions: 1) What methods of connection from primary care to community-based physical activity opportunities have been evaluated?; 2) What processes of physical activity promotion incorporating such methods of connection are (or are not) effective or acceptable, for whom, to what extent and under what circumstances; 3) How and why are (or are not) those processes effective or acceptable? We conducted a realist scoping review in which we searched Cochrane, Medline, PsycNET, Google Advanced Search, National Health Service (NHS) Evidence and NHS Health Scotland from inception until August 2020. We identified that five methods of connection from primary care to community-based physical activity opportunities had been evaluated. These were embedded in 15 processes of physical activity promotion, involving patient identification and behaviour change strategy delivery, as well as connection. In the contexts in which they were implemented, four of those processes had strong positive findings, three had moderately positive findings and eight had negative findings. The underlying theories of change were highly supported for three processes, supported to an extent for four and refuted for eight processes. Comparisons of the processes and their theories of change revealed several indications helpful for future development of effective processes. Our review also highlighted the limited evidence base in the area and the resulting need for well-designed theory-based evaluations.

Snack Portion Sizes for Preschool Children Are Predicted by Caregiver Portion Size, Caregiver Feeding Practices and Children's Eating Traits.

Caregivers are mostly responsible for the foods young children consume; however, it is unknown how caregivers determine what portion sizes to serve. This study examined factors which predict smaller or larger than recommended snack portion sizes in an online survey. Caregivers of children aged 2 to 4 years were presented with 10 snack images, each photographed in six portion sizes. Caregivers (n = 659) selected the portion they would usually serve themselves and their child for an afternoon snack. Information on child eating traits, parental feeding practices and demographics were provided by caregivers. Most caregivers selected portions in line with recommended amounts for preschool children, demonstrating their ability to match portion sizes to their child's energy requirements. However, 16% of caregivers selected smaller than recommended low energy-dense (LED, e.g., fruits and vegetables) snacks for their child which was associated with smaller caregiver's own portion size, reduced child food liking and increased satiety responsiveness. In contrast, 28% of caregivers selected larger than recommended amounts of high energy-dense (HED, e.g., cookies, crisps) snacks for their child which were associated with larger caregiver's own portion size, greater frequency of consumption, higher child body mass index (BMI), greater pressure to eat and lower child food liking. These findings suggest that most caregivers in this study select portions adjusted to suit their child's age and stage of development. Future interventions could provide support to caregivers regarding the energy and nutrient density of foods given the relatively small portion sizes of LED and large portions of HED snacks offered to some children.

Can Reduced Intake Associated with Downsizing a High Energy Dense Meal Item be Offset by Increased Vegetable Variety in 3⁻5-year-old Children?

Large portions of energy dense foods promote overconsumption but offering small portions might lead to compensatory intake of other foods. Offering a variety of vegetables could help promote vegetable intake and offset the effect of reducing the portion size (PS) of a high energy dense (HED) food. Therefore, we tested the effect on intake of reducing the PS of a HED unit lunch item while varying the variety of the accompanying low energy dense (LED) vegetables. In a within-subjects design, 43 3⁻5-year-old pre-schoolers were served a lunch meal in their nursery on 8 occasions. Children were served a standard (100%) or downsized (60%) portion of a HED sandwich with a side of LED vegetables offered as a single (carrot, cherry tomato, cucumber) or variety (all 3 types) item. Reducing the PS of a HED sandwich reduced sandwich (g) (p < 0.001) and total meal intake (kcal) consumption (p = 0.001) without an increased intake of other foods in the meal (LED vegetables (p = 0.169); dessert (p = 0.835)). Offering a variety of vegetables, compared with a single vegetable, increased vegetable intake (g) (p = 0.003) across PS conditions. Downsizing and variety were effective strategies individually for altering pre-schoolers' intakes of HED and LED meal items, however, using variety to offset HED downsizing was not supported in the present study.

The Feasibility and Acceptability of Two Methods of Snack Portion Control in United Kingdom (UK) Preschool Children: Reduction and Replacement.

Large portions of high energy dense (HED) snacks are offered to children from a young age and are pervasive in our food environment. This study aimed to explore the feasibility, acceptability, and preliminary efficacy of two strategies of snack portion control: reduction and replacement. Forty-six mother-child dyads aged 22⁻56 months (36.6 ± 9.5 m, 48% female) completed a three-week intervention. In week 1 (baseline) no changes were made to the child's diet; week 2 (acclimation) children received a standardised selection of HED snacks, and in week 3 (intervention) participants were randomly assigned to snack replacement (n = 24) or snack reduction (n = 22). Snack replacement involved swapping HED snacks for fruits and vegetables, whilst snack reduction involved reducing the size of HED snacks by 50%. Food and energy intake were measured using a weighed food diary for four consecutive days. Snack replacement resulted in more positive changes to children's diets; vegetable intake increased (p < 0.01), and total daily energy intake decreased when compared to snack reduction (p < 0.05). Mothers expressed a more favourable attitude to snack replacement, although snack reduction was also well received by mothers. Despite increased preliminary efficacy of snack replacement on dietary intake, both strategies were feasible and acceptable. The current pilot study provides the necessary information to inform the design of future interventions.

How important are the influencing factors to the decision on whether to provide seafood in infant and young child feeding?

Seafood is recommended as part of a healthy, balanced introductory diet however, consumption rates are low in young children. Research has previously investigated the influences to seafood consumption in consumers and non-consumers however the importance of these factors in mothers' decisions on whether to provide seafood for their child during the early years is unknown. This study aimed to measure the importance of factors that influence mothers' decisions on providing seafood for their child during infant and young child feeding (six months to four years). A mixed method Q methodology and cognitive interview approach was used with 32 mothers in Scotland. Despite a large consensus of opinion between mothers (n = 20) on the importance of factors on their decision-making, two viewpoints emerged highlighting an importance placed on food attributes and the infant, and convenience and family-centred. This study is the first to quantify the influences on the decision to provide seafood during early years' feeding and could be used to inform and tailor seafood-based dietary promotions and interventions for parents.

Factors influencing mothers' decisions on whether to provide seafood during early years' feeding: A qualitative study.

The first year of a child's life is a key period of transition from an exclusive milk diet to solid foods to meet growing nutritional demands. An increased requirement for nutrients includes the introduction of protein-rich solid foods, such as seafood, which additionally provides valuable omega-3 fatty acids. However, consumption of seafood is low in the British child population. The aim of this study was to identify maternal perceptions of the factors that can influence the decision on whether to provide seafood during early years' feeding using a multi-method qualitative study design. A total of 26 discussions posted by mothers on parenting websites; Mumknowsbest, Mumsnet and Netmums, accessed July 2013, together with discussions from six focus groups (February-July 2014) in the North East of Scotland were included for thematic qualitative analysis. Discussions on the inclusion of seafood during the early years were centred across four interrelating themes; - food-related attributes, mother-centred aspects, family-centred aspects, and external information sources. Concerns regarding safety and mothers' limited knowledge and skills on seafood were apparent from discussions; however, the practicalities of providing a cost effective family meal were also issues raised by mothers. An understanding of the numerous and sometimes contradictory influences on mothers' decisions to include seafood during early years' period could be used to develop strategies to help increase regular seafood consumption. In particular, ensuring formal information and guidance clearly addresses the safety concerns of mothers and the development of practical education schemes to encourage and teach cooking skills should be considered.

A comparison of preprepared commercial infant feeding meals with home-cooked recipes.

OBJECTIVES: To compare the cost, nutritional and food variety contents of commercial meals and published infant and young child feeding (IYCF) home-cooked recipes, and to compare nutritional contents to age-specific recommendations. DESIGN: Cross-sectional study. SETTING: Full range of preprepared main meals available within the UK market. Main-meal recipes identified from a survey of Amazon's top 20 best-sellers and IYCF cookbooks available from local libraries. SAMPLES: 278 commercial IYCF savoury meals from UK market and 408 home-cooked recipes from best-selling IYCF published cookbooks. MAIN OUTCOME MEASURES: Cost and nutritional content per 100 g and food variety per meal for both commercial meals and home-cooked recipes. RESULTS: Commercial products provided more 'vegetable' variety per meal (median=3.0; r=-0.33) than home-cooked recipes (2.0). Home-cooked recipes provided 26% more energy and 44% more protein and total fat than commercial products (r=-0.40, -0.31, -0.40, respectively) while costing less (£0.33/100 g and £0.68/100 g, respectively). The majority of commercial products (65%) met energy density recommendations but 50% of home-cooked recipes exceeded the maximum range. CONCLUSIONS: The majority of commercial meals provided an energy-dense meal with greater vegetable variety per meal to their home-cooked counterparts. Home-cooked recipes provided a cheaper meal option, however the majority exceeded recommendations for energy and fats.

Something fishy about home-cooked infant feeding recipes.

There is no evidence available indicating whether popular infant and young child feeding (IYCF) cookbooks provide nutritious options for home-cooking, what the most common food types are within the recipes, and what accompanying dietary advice is provided to parents. This study surveyed available IYCF cookbooks from local libraries and Amazon UK's top 20 bestsellers (May to July 2013 to examine the prevalence and nutritional content of cookbook recipes comparing these to recommendations whilst investigating the messages portrayed towards parents on giving different foods to their child during IYCF. Vegetable-based recipes (median=29) predominated main-meal options while a proportional number of red meat, poultry and seafood-based recipes were included providing parents with options of protein-rich recipes for their young child. These home-cooked recipes adequately met or exceeded age-specific dietary recommendations. Mixed messages were apparent on the inclusion of foods during IYCF within and across these cookbooks, in particular for seafood, highlighting a lack of consistent advice portrayed to parents during the early years. Community-based health professionals should advise parents of the inconsistent and incorrect messages on food inclusion portrayed in some IYCF cookbooks and guide them towards formal recommendations.

Seafood inclusion in commercial main meal early years' food products.

Seafood consumption is recommended as part of a healthy, balanced diet. Under-exposure to seafood during early years feeding, when taste and food acceptance is developed, may impact on the future development of a varied diet. This study aimed to investigate the availability and nutritional content of seafood in commercial infant meals compared to the other food types. A survey was conducted of all commercial infant main meal products available for purchase in supermarkets, high street retailers and online stores within the United Kingdom. The primary food type (seafood, poultry, meat and vegetables) within each product, nutritional composition per 100 g, and ingredient contribution were assessed. Of the original 341 main meal products seafood (n = 13; 3.8%) was underrepresented compared to poultry (103; 30.2%), meat (121; 35.5%) and vegetables (104; 30.5%). The number of the seafood meals increased three years later (n = 20; 6.3%) vegetable meals remained the largest contributor to the market (115; 36.4%) with meat (99; 31.3%) and poultry (82; 26.0%) both contributing slightly less than previously. Seafood-based meals provided significantly higher energy (83.0 kcal), protein (4.6 g), and total fat (3.2 g) than vegetable (68 kcal, 2.7 g, 1.9 g), meat (66 kcal, 3.0 g, 2.1 g) and poultry-based meals (66 kcal, 3.0 g, 2.1 g) and higher saturated fat (1.3 g) than poultry (0.4 g) and vegetable-based (0.6 g) meals (all per 100 g) which may be attributed to additional dairy ingredients. Parents who predominantly use commercial products to wean their infant may face challenges in sourcing a range of seafood products to enable the introduction of this food into the diet of their infant.