Parent-related mechanisms underlying the social gradient of childhood overweight and obesity: a systematic review.

BACKGROUND: Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts. OBJECTIVE: A systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects. METHOD: Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors. RESULTS: High parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors. CONCLUSIONS: Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.

Associations between child temperament, maternal feeding practices and child body mass index during the preschool years: a systematic review of the literature.

It is a research priority to identify modifiable risk factors to improve the effectiveness of childhood obesity prevention strategies. Research, however, has largely overlooked the role of child temperament and personality implicated in obesogenic risk factors such as maternal feeding and body mass index (BMI) of preschoolers. A systematic review of relevant literature was conducted to investigate the associations between child temperament, child personality, maternal feeding and BMI and/or weight gain in infants and preschoolers; 18 papers were included in the review. The findings revealed an association between the temperament traits of poor self-regulation, distress to limitations, low and high soothability, low negative affectivity and higher BMI in infants and preschool-aged children. Temperament traits difficult, distress to limitations, surgency/extraversion and emotionality were significantly associated with weight gain rates in infants. The results also suggested that child temperament was associated with maternal feeding behaviours that have been shown to influence childhood overweight and obesity, such as using restrictive feeding practices with children perceived as having poor self-regulation and feeding potentially obesogenic food and drinks to infants who are more externalizing. Interestingly, no studies to date have evaluated the association between child personality and BMI/weight gain in infants and preschoolers. There is a clear need for further research into the association of child temperament and obesogenic risk factors in preschool-aged children.

The relationship between childhood weight, dental caries and eating practices in children aged 4-8 years in Australia, 2004-2008.

OBJECTIVES: The association between overweight/obesity and dental caries in children is contentious with studies variously reporting positive or negative associations between the two conditions. Since 1995, Australia has experienced a rise in the prevalence of both conditions in its children. This study investigated the association between child weight, diet and dental problems in a nationally representative sample. METHOD: Data from 4149 children (51.5% male) participating in the Longitudinal Study of Australian Children (LSAC) were used. The LSAC is a longitudinal study collecting data from a large representative cohort of Australian children; data from the first three waves were included with children aged 4-5 years, 6-7 years, and 8-9 years. Multivariate cross-sectional and prospective analyses were conducted to determine the relationships between child weight, diet and dental problems. RESULTS: Overweight/obesity was associated with sweet drink consumption and dental problems associated with consumption of fatty foods and sweet drinks. Underweight was associated with dental problems cross-sectionally, but both underweight and overweight at age 6-7 years predicted dental problems at age 8-9 years. CONCLUSIONS: Dental caries and body weight are influenced by diet. Overweight children may be consuming less fatty food but appear to be consuming more sweet drinks than normal-weight children, which can lead to both increased weight and dental caries. Dietary interventions designed to reduce the development of dental caries may also reduce the development and maintenance of overweight.