Relation of social network support to child health behaviors among children in treatment for overweight/obesity.

PURPOSE: Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT). METHODS: Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT. RESULTS: Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time. CONCLUSION: The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention. LEVEL OF EVIDENCE: III. cohort study.

Child and family predictors of relative weight change in a low-income, school-based weight management intervention.

Introduction: Minority and low-income children are underrepresented in school-based weight management programs despite higher risk of obesity and the external contexts that influence their success are largely unknown. This study examines predictors of weight outcomes following the socioecological model in a school-based weight management intervention implemented in an elementary school serving primarily low-income, Black youth. Methods: Children (n = 145; ages 4-9) participated in an 8-month school-based weight management intervention that included components to increase physical activity, promote healthy eating, and engage parents. Children had height and weight measured at baseline and postprogram and parents completed questionnaires at baseline. Socioecological predictors (e.g., child demographic, parent beliefs and attitudes, family and home environment, and social contexts of the family) of zBMI change were assessed using linear regressions. Results: Weight change over the program differed by baseline weight status such that children with obesity lost weight, while children of healthy weight and with overweight gained weight. Children who were younger and had healthier family food choices at baseline were better able to maintain their weight, whereas children from food insecure families gained weight. Discussion: Children of different weight categories from low-income families vary in their response to universally delivered school-based weight management programs. Future work should consider how to address needs of children from different weight classes as well as to effectively target children with risk factors for excessive weight gain (e.g., older, food insecure, less healthful food choices), which may involve broader or more integrative approaches. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Family Encouragement of Healthy Eating Predicts Child Dietary Intake and Weight Loss in Family-Based Behavioral Weight-Loss Treatment.

Introduction: Social support for healthy eating can influence child eating behaviors; however, little is known about the impact of social support during family-based behavioral weight-loss treatment (FBT). This study aimed to determine the impacts of both baseline and change in family support on change in child diet and weight during FBT. Methods: Children (n = 175; BMI percentile ≥85th; ages 7-11; 61.1% female; 70.9% white) and a participating parent completed 4 months of FBT. Parents were active participants and learned social support-related strategies (i.e., praise and modeling of healthy eating). Child perceived family encouragement and discouragement for healthy eating, child diet quality (via 24-hour recalls), and child weight were assessed pre- and post-FBT. Results: Family encouragement for healthy eating increased during FBT, and this increase was related to increases in child healthy vegetable intake and overall diet quality, as well as decreases in refined grains consumed. Low pre-FBT family encouragement predicted greater increases in healthy vegetable intake, greater weight reduction, and greater increases in family encouragement for healthy eating. Family discouragement for healthy eating did not change during treatment nor did it predict dietary or weight outcomes. Conclusions: FBT successfully improves family encouragement, which is associated with improvements in child diet. Furthermore, even children who began treatment with low family encouragement for healthy eating show great improvements in dietary intake and weight during treatment. Results suggest that changes in child eating behavior during treatment is influenced by active, positive parenting techniques such as praise of healthy eating rather than negative family support.