Plate waste increases with the number of foods proposed: An exploratory experimental study in adolescents' school canteens.

The objective of this exploratory study was to examine whether the number of foods offered has an impact on plate waste and meal satisfaction in adolescents' school canteens. The plate waste of 247 French students was estimated during two school lunches, the only variation being the number of starters offered (3 versus 6). Plate waste was assessed by the weight of food left on the tray. Students had to complete a short questionnaire regarding their general satisfaction with the meal. The results indicated that limiting the number of starters provided from 6 to 3 choices led to a decrease of Plate waste (-28.1 g) (p < .0001), and a modest increase in Meal satisfaction (p = .02). They suggest that limiting the number of food choices in school canteens reduces plate waste, while not diminishing satisfaction with the meal.

Development of a new questionnaire to assess the links between children's self-regulation of eating and related parental feeding practices.

Young children have an innate ability to self-regulate food intake, driven primarily by hunger and satiety cues, but this ability tends to decrease during early childhood. The study aimed to first examine the development and initial validation of a self-report questionnaire suitable for French samples that assess two dimensions of children's self-regulation of eating (eating in the absence of hunger, poor eating compensation abilities) and potential related parental feeding practices. The second aim was to assess the links between children's self-regulation of eating and parental feeding practices as well as the links between children's self-regulation and children's body mass index. An initial 28-item questionnaire was developed. It included items related to the child's eating in the absence of hunger and eating compensation, which were selected mainly from interviews conducted with 45 mothers, and items related to parental feeding practices selected from existing tools. This questionnaire was then completed by 793 parents. A 21-item questionnaire was validated using a confirmatory factor analysis that showed satisfying fit indices. The structural equation modeling indicated that the use of food as reward was positively associated with eating in the absence of hunger, whereas parental awareness of children's cues was negatively associated with both children's eating in the absence of hunger and poor eating compensation ability. Interestingly, positive associations between eating in the absence of hunger and child's BMI, and between poor eating compensation ability and child's BMI were reported. The current study offered an initial validation of a new questionnaire that combines parental feeding practices and constructs involved in children's self-regulation of eating. Further studies are needed to disentangle these links and their directionality as well as the associations with children's body mass index.

Disentangling the effects of parental food restriction on child's risk of overweight.

The links between parental restriction of food intake, child's eating behaviour and child's adiposity are still unclear. Our aim was to validate a model suggesting an underlying mechanism for the impact of parental restriction on child's adiposity through a broad dimension of child's eating temperament entitled the appetite reactivity (including both appetite arousal and appetite persistence). Using an online questionnaire administered at home to children aged between 8 and 11 years (N = 414) with one or both of their parents, we measured: based on child's reports, the perceived maternal restriction of child's food intake, the appetite reactivity and both the desired and the eaten mean food portion sizes; based on parental reports, the mean food portion size given to the child and the child's BMI. Structural equation modelling was used to test a model linking measured variables. A well-fitting structural model (AGFI = 0.91; RMSEA = 0.07; SRMR = 0.08) was identified, showing that: (i) perceived maternal restriction of child's food intake negatively impacts child's appetite arousal and food portion size but positively influences child's appetite persistence; (ii) the two components of appetite reactivity have a positive effect on child's adiposity which is partly mediated by child's actual food portion size. Results suggest an explanation for the controversy surrounding the links between parental food restriction and child's adiposity: through its negative impact on child's appetite arousal and food portion size, parental control may protect against overweight, but because of its positive effect on appetite persistence, it can also be detrimental.

Behavioural measures of child's eating temperament and their link with BMI.

Rothbart's model of temperament, defined as individual differences in reactivity and self-regulation, has a strong heuristic value with applications in a wide variety of children's outcomes. Our objective was to test Rothbart's model applied to children's food behaviours and BMI outcome through behavioural measures. Our hypotheses, according to Rothbart's model, were as follows: (i) self-regulation in eating modulates appetite reactivity; (ii) appetite reactivity increases the risk of excess BMI, whereas self-regulation in eating limits this risk. One hundred and four children aged between 7 and 12 years completed four behavioural tasks to assess scores for two components of appetite reactivity (i.e. appetite arousal and appetite persistence) and two components of self-regulation in eating (i.e. self-regulation in eating without hunger and self-regulation in eating speed). Their heights and weights were measured in order to calculate their BMI-for-age. T-tests and regression analysis were used to verify our hypotheses. None of the scores of self-regulation in eating was directly associated with BMI but we observed a significant impact of self-regulation in eating without hunger on appetite arousal (p-value = 0.04), together with a modest but significant association between appetite persistence and BMI (p-value = 0.02). We can thus conclude that our behavioural measures could be used for the determination of the child's eating temperament. Further studies are needed to investigate how to use these measures to improve the treatment of overweight in children.

Early determinants of food liking among 5y-old children: a longitudinal study from the EDEN mother-child cohort.

BACKGROUND: Identifying the determinants of child's liking for different foods may help to prevent future choices of unhealthy food. OBJECTIVE: To study early-life food-related characteristics associated with child's liking for different foods at 5y with a longitudinal study. DESIGN: 1142 5y- old children completed a liking test for "fruit and vegetables", "meat, fish and eggs", desserts and cheese. Data related to maternal food intake before pregnancy, infant feeding during the first year of life, maternal feeding practices at 2y, child's food intake at 3y, and child's food neophobia from 1 to 4y were collected prospectively from the mother. The associations between these factors and child's liking for each category of foods were analyzed using structural equation modelling. RESULTS: High food neophobia at 4 y was related to lower child's liking for all food groups. Maternal feeding practices at 2y were associated with liking for dessert: negatively for the practices allowing child to control his/her own food intake, positively for restriction of child's food intake for weight reasons. Moreover, child's food intake at 3y was positively associated with child's liking for "fruit and vegetables" as well as for cheese. Finally, adherence to the infant feeding pattern "long breastfeeding, later introduction of main meal components and use of home-made products" was positively associated with child's liking for meat/fish/eggs. CONCLUSIONS: For all food groups, food neophobia was a common determinant of child's liking for food at 5y, whereas other factors were associated with food liking for specific food groups.

Smell differential reactivity, but not taste differential reactivity, is related to food neophobia in toddlers.

Previous research has identified relationships between chemosensory reactivity and food neophobia in children. However, most studies have investigated this relationship using declarative data and without separately analysing smell and taste reactivity. Our first objective was to assess the relationships between smell and taste differential reactivity in toddlers (i.e. reactivity towards several stimuli), using experimental behavioural measurements. The second objective was to determine the relationships between smell (or taste) differential reactivity and food neophobia in toddlers, with the hypothesis that the more responsive a toddler was across food odours or tastes, the more neophobic s/he would be. An additional objective was to determine whether the potential relationships between smell (or taste) differential reactivity and food neophobia differ according to gender. One hundred and twenty-three toddlers aged from 20 to 22 months from the Opaline birth cohort (Observatory of Food Preferences in Infants and Children) were involved. A questionnaire was used to assess child's food neophobia. Toddlers' differential reactivity for smell (and for taste) was defined as the variability of behavioural responses over 8 odorants, and over the five basic tastes. Smell and taste differential reactivities were not correlated. Food neophobia scores were modestly but significantly positively correlated with smell differential reactivity but not with taste differential reactivity. When gender was considered, smell reactivity and neophobia were correlated only among boys. This indicates the need to study smell and taste reactivity separately to determine their associations with eating behaviours. This suggests that the rejection of novel foods in neophobic boys could be partly due to food odour. This finding is new and clearly requires further investigation.

Links between maternal feeding practices and children's eating difficulties. Validation of French tools.

The main objectives of the present study were to validate measures of young children's eating difficulties and maternal feeding practices in a French sample, as well as to assess the links between these practices and children's eating difficulties. Mothers (n=502) of French children aged 20-36 months completed four questionnaires that were validated using a Structural Equation Modelling approach. Links between children and maternal components were investigated using a PLS regression. The Children's Eating Difficulties Questionnaire yielded a 4-dimension solution: Neophobia, Pickiness, Low Appetite and Low Enjoyment in food. The Feeding Style Questionnaire assessed three dimensions: Authoritarian, Authoritative and Permissive Styles. The Feeding Strategy Questionnaire, designed to evaluate strategies used by mothers to make their child taste rejected foods, resulted in four factors: Coercion, Explanation, Contingency and Preference. The Questionnaire relating to Parental Motivations when buying food for children presented a 6-dimension solution: Convenience, Weight-control, Natural, Health-concern, Preference and Price. The factors associated positively with the four dimensions of the Children's Eating Difficulties Questionnaire were on the one hand Permissive Style and Practices to fulfil child's desires, and on the other hand Authoritarian Style, Contingent and Coercive Practices aimed at forcing children to taste rejected foods.

Parental practices perceived by children using a French version of the Kids' Child Feeding Questionnaire.

About 18% of 6-11-year-old French children are overweight, of whom 3.3% are obese. Parental feeding practices, especially restriction and pressure-to-eat, seem to promote overeating in children. Since no tool was available for the perception of parental feeding practices of French children, our aim was to validate a French version of the Kids'Child Feeding Questionnaire (KCFQ, Carper, Orlet Fischer, & Birch, 2000), and to determine the relationship between KCFQ's dimensions and children's standardised body mass index (BMI z-scores). The questionnaire was completed by 240 normal-weighted or overweight children between the age of 9 and 11. The validation was based on a confirmatory factor analysis. The internal consistency of factors was confirmed using Cronbach's coefficients. After deleting some items (3 for the pressure-to-eat subscale and 3 for the restriction subscale), the two-factor model (pressure-to-eat, restriction) provided an acceptable fit (χ² (34)=64; RMSEA=.06; CFI=0.93; NNFI=.90), and satisfactory internal consistency. Children's perception of restriction was significantly and positively correlated with BMI z-scores (r=36, p<.001), whereas their perception of pressure-to-eat was not significantly associated with BMI z-scores (r=-.09, p=.24). This scale appears to be a sound tool for highlighting children's perceptions of parental feeding practices, and their links to weight status.

Mental health of adolescents after bariatric surgery: A textual analysis.

Mental health after bariatric surgery during adolescence has been little explored. This is a sensitive period in terms of self-image on which bariatric surgery could have negative effects because of the rapid and significant changes in morphology it induces. Previous studies have explored mental effects using questionnaires and only related to psychopathological disorders. The objective of our study was to complement these studies by exploring, via in-depth interviews, the adolescents' views on changes after bariatric surgery at psychological as well as socio-emotional levels. Fourteen adolescents with obesity were recruited in a French hospital 6-43 months after surgery. They participated in one-on-one interviews lasting an average of 45 minutes. A lexical analysis (using ALCESTE software© ) of their speech highlighted the most positive effects, particularly in terms of social relationships, physical activities, self-esteem and reduced stigma, along with less positive effects in terms of eating behaviour and skin. In terms of clinical implications, this study confirmed the value of bariatric surgery for adolescents at psychological and social levels and its contribution to their mental health. However, it also highlighted the importance of pre- and post-operative support.

Patients and Parents' Experience of Multi-Family Therapy for Anorexia Nervosa: A Pilot Study.

BACKGROUND: Family therapy is considered as the gold standard in treatment of adolescents with anorexia nervosa (AN). Among the different types of family therapy, multi-family therapy (MFT) is increasingly used for treating AN, and shows promising results. In this article, our focus relied on the patients' and their parents' perceptions of the effectiveness and the underlying mechanisms of the MFT. METHODS: The present pilot exploratory qualitative study included two focus groups conducted using a semi-structured approach: one with the adolescents (n = 3), and another with one or two of their parents (n = 4 mothers; n = 2 fathers). The subjects discussed were the changes observed in both AN symptoms and family interactions following therapy, and the mechanisms underlying these changes. We crossed the perspectives of the adolescents and of the parents on these two points. RESULTS: Qualitative analysis revealed that while both adolescents and parents had difficulties relating the changes they observed in the last year to MFT, they were able to say that the group cohesion had several positive effects and that their family dynamics had improved. In the light of analysis the adolescents perceived more improvements related eating disorders symptoms than their parents did, while parents were concerned about a negative effect of MFT on their children. DISCUSSION: While both patients and parents perceived improvements in both AN symptoms and family interactions in the past year, it was not clear if they considered MFT to have led to these improvements. FG also explored the MFT mechanisms underlying changes. Both adolescents and their parents stressed the beneficial effects of identification to others members of the group and shared experience to overcome social isolation. Parents also mentioned the sympathy they felt for each other. The idea that they give a central place to families in the therapy was also described by the families.

Do children with a high level of eating motivation consume less when foods are partitioned?

Eating behaviors, especially the control of intake, are modulated by both internal and external factors. The objective of our study was to examine the effect of the interaction between eating motivation (as an internal factor) and food partition (as an external factor) on chocolate intake in children, with the hypothesis, based on the paradigm of motivated perception, that the effect of partition, i.e. reduced intake, is higher for children with a high level of eating motivation than for other children. A mixed model design was used in which 80 children aged 8-11 yrs. were offered, in their natural setting, two standardized afternoon snacks that included, among other things, 100 g of chocolate presented once as a whole (one bar) and once segmented (six pieces). The amount of chocolate eaten was weighed and compared between conditions (Bar vs Pieces). Children completed questionnaires in order to assess two of their eating motivational features (appetite arousal, chocolate specific appetite). Results indicated no effect of Partition: children ate the same quantity of chocolate in the two conditions (Bar or Pieces). Only chocolate specific appetite was associated with the amount of chocolate eaten, with children with a higher level eating more than other children (+13 g). Contrary to adults, children are not influenced by the "many is more effect". Methodological and developmental interpretations were suggested, linked to the size of the portion, the network of attention and the sensibility to the external cues underlying the control of intake.

Food portion at ages 8-11 and obesogeny: The amount of food given to children varies with the mother's education and the child's appetite arousal.

During childhood, the amount of food consumed, associated with adiposity and overweight risk, depends mainly on the amount of food that is served, especially by parents. This study focuses on the food amount served by parents ("Portion"), with two objectives: 1/to confirm (or not) its link with the food amount eaten ("Intake") by their child; 2/to identify some of its correlates, i.e., maternal education, and child's appetite arousal. Five hundred and three French children aged between 8 and 11 years and one of their parents completed different self-administrated questionnaires online. Results indicated that Portion and Intake were highly correlated, and that mothers with lower levels of education gave larger portions to their child, especially if he/she had a high appetite arousal. Moreover, these mothers, compared to others, were more concerned by taste preferences and less by health with regard to their child's diet. Such differences in taste and health considerations may contribute to underlie the educational inequality in food portion size.

Parental concerns and attributions of food pickiness and its consequences for the parent-child relationship: A qualitative analysis.

A qualitative study was conducted to identify how parents describe and attribute their toddler's food pickiness, a common pediatric problem during childhood. Parental strategies to respond to picky behaviors were also explored in this study. Focus groups were used with 38 parents of children aged 18-38 months. Results highlighted several consequences of child pickiness such as parental concerns about child's growth and health, conflicts at mealtime, and feelings of guilt. Parents attributed food pickiness mainly as a manifestation of opposition and assertiveness by their child. Some strategies known to be effective were applied by parents (such as repeated exposure, modeling, co-preparing meals, and using a flavor-based approach) but some strategies that are counterproductive were also highlighted (such as rewards for eating). Parents need to be better informed about food pickiness and the strategies that help to overcome it. Understanding parental beliefs may help pediatricians to offer appropriate guidance adapted to parental experiences and feelings.

Is harsh caregiving effective in toddlers with low inhibitory control? An experimental study in the food domain.

The aim of our study is to evaluate the validity of the "Caregiving×Temperament Paradigm" in the food domain. In this study, two prototypes of caregiving control have been contrasted: Harsh (forceful measures to curve the child's behavior) versus Gentle control (supportive measures to direct the child's behavior). In food domain, the most effective control to help a child to overcome initial dislike is repeated exposure. Our first objective was to test whether the repeated exposure displayed in a gentle context has a more benefical effect on dislike shifting than the one displayed in a harsh context. Our second objective was to assess whether this effect was moderated by a temperamental characteristic (child's inhibitory control). A randomized experimental protocol was used in day care-centers, involving 98 children aged 21-41 months. Children were asked to consume an initially rejected target food on five occasions either with a Gentle or a Harsh instruction. Children's dislike for the target food was assessed via intake before and after the familiarization phase. Inhibitory control level was measured in 78 of these children using validated questionnaire. Four groups were created: Instructions (Gentle vs Harsh)×Inhibitory control (Lower vs Higher). After the familiarization phase, the consumption of the target food increased in all groups, but with a higher increase in children with high Inhibitory control with Gentle instruction, than for children with low Inhibitory control with Harsh instruction, the two other groups being in between. Our data fit a model of cumulative effects, and show that both gentle control strategies and high inhibitory control in children contribute to regulate disgusts experienced in some feeding contexts.

A review of methods to assess parental feeding practices and preschool children's eating behavior: the need for further development of tools.

We reviewed tools developed to measure parental feeding practices and eating behavior and food intake or preferences of children aged 0 to 5 years. Two electronic literature databases (Medline and Psycinfo) were used to search for both observational and experimental studies in human beings. The articles selected for review were those presenting tools with data on internal consistency and/or test-retest reliability and/or construct validity. A total of 3,445 articles were retrieved, and further searching of reference lists and contact with experts produced an additional 18 articles. We identified three tools on the qualitative dimension of children's eating behavior, two tools on food intake or preferences, and one tool on parental feeding practices with rigorous testing of internal consistency, construct validity, and test-retest reliability. All other tools presented in this review need further evaluation of their validity or reliability. Because major gaps exist, we highlight the need for more tools on parental attention to children's hunger and satiety cues, and the need to evaluate the degree of control allowed to children younger than age 2 years in feeding events. Food avoidance (ie, behaviors or strategies to take away and to reject food) and food approach (ie, attractiveness for food stimuli) have not been assessed in children aged 12 to 24 months. Food preference tests based on sensory aspects rather than nutritional quality may be worth investigating. We identified a need for further evaluation of quality, especially test-retest reliability and construct validity, for most tools developed for use in studying children aged 0 to 5 years.

Measuring willingness to try new foods: a self-report questionnaire for French-speaking children.

The study was designed to develop and validate a self-report questionnaire on food neophobia in French children. We evaluated food neophobia in a specific cultural context, examining an age group that has hardly been studied (5- to 8-year-olds). The questionnaire items were based on methods known for changing neophobic behavior (imitation, information, flavor principle and external stimulation) in order to diversify food presentation situations. In addition, we used colored pictures of food for seven items. Thirteen items that referred to acceptance of unfamiliar food were selected out of 25 items tested in an earlier stage. Six hundred and three children filled out the food neophobia questionnaire and a food task used to check its predictive validity was given to 503 of them. A factor analysis emphasized the one-dimensional structure of the questionnaire. Results showed satisfactory internal consistency and good test-retest reliability. The children's choices and their willingness to try new types of food were significantly correlated with the questionnaire scores. Food neophobia conceived as a personality trait was discussed.

Taste acuity of obese adolescents and changes in food neophobia and food preferences during a weight reduction session.

The relationship between taste acuity and food neophobia, food familiarity and liking has been studied in the context of a residential weight reduction session (WRS; mean duration: 10 months) in 39 obese adolescents. Taste acuity was assessed using recognition thresholds for sucrose, citric acid, sodium chloride and 6-n propylthiouracil (PROP) and supra-threshold perceived intensities for sucrose, sodium chloride and PROP. Food neophobia was assessed by using the food neophobia scale at the beginning and at the end of the WRS. At these time points we used also a food familiarity and liking questionnaire to assess changes in food familiarity and likes or dislikes for different food categories. Taste acuity appeared to mediate behavioural food-related changes during the WRS. High taste acuity was associated with limited reductions in food neophobia; less sensitive subjects showed greater increases in the acceptability of healthy foods, especially fruits and vegetables. Therefore, taste perception (and particularly PROP perception) appears to be a predictor of the magnitude of food-related behavioural change achieved during a WRS.

Food neophobia in the context of a varied diet induced by a weight reduction program in massively obese adolescents.

Previous studies in humans have shown that short to middle-term pre-exposure to multiple foods can reduce the negative response to novel foods (neophobia). In order to explore the effects of a long-term exposure to varied foods on food neophobia, we studied a population of obese adolescents observed in a longitudinal protocol in which the multiple food experiences are induced by a residential weight reduction program (WRP) that encourages the consumption of a wide variety of foods. Seventy-two massively obese adolescents (22 boys) filled the food neophobia scale (FNS, [Pliner, P., & Hobden, K. (1992). Development of a scale to measure the trait of food neophobia in humans. Appetite 19, 105-120]) and an ad hoc food familiarity and liking questionnaire at the beginning and at the end of the program (mean duration: 8.9 months). Their scores were compared to those of a control group of 51 adolescents (14 boys) tested within a similar period. FNS results show a decrease of food neophobia, without significant difference between the control group and the WRP subjects, although only WRP have encountered new foods experiences as attested by the familiarity and liking results. Methodological considerations, concerning the characteristics of the participants, the nature of the multiple food exposure and the food neophobia measurements, will be proposed to explain differences among studies.