Associations of preschoolers’ dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = −0.39, 95% CI −0.63, −0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity

Parenting and childhood obesity : validation of a new questionnaire and evaluation of treatment effects during the preschool years

Objectives Parenting is an integral component of obesity treatment in early childhood. However, the link between specific parenting practices and treatment effectiveness remains unclear. This paper introduces and validates a new parenting questionnaire and evaluates mothers’ and fathers’ parenting practices in relation to child weight status during a 12-month childhood obesity treatment trial. Methods First, a merged school/clinical sample (n = 558, 82% mothers) was used for the factorial and construct validation of the new parenting questionnaire. Second, changes in parenting were evaluated using clinical data from the More and Less Study, a randomized controlled trial (RCT) with 174 children (mean age = 5 years, mean Body Mass Index Standard Deviation Score (BMI SDS) = 3.0) comparing a parent support program (with and without booster sessions) and standard treatment. Data were collected at four time points over 12 months. We used linear mixed models and mediation models to investigate associations between changes in parenting practices and treatment effects. Findings The validation of the questionnaire (9 items; responses on a 5-point Likert scale) revealed two dimensions of parenting (Cronbach’s alpha ≥0.7): setting limits to the child and regulating one’s own emotions when interacting with the child, both of which correlated with feeding practices and parental self-efficacy. We administered the questionnaire to the RCT participants. Fathers in standard treatment increased their emotional regulation compared to fathers in the parenting program (p = 0.03). Mothers increased their limit-setting regardless of treatment allocation (p = 0.01). No treatment effect was found on child weight status through changes in parenting practices. Conclusion Taken together, the findings demonstrate that the new questionnaire assessing parenting practices proved valid in a 12-month childhood obesity trial. During treatment, paternal and maternal parenting practices followed different trajectories, though they did not mediate treatment effects on child weight status. Future research should address the pathways whereby maternal and paternal parenting practices affect treatment outcomes, such as child eating behaviors and weight status

Parent-child feeding dynamics and childhood obesity : The importance of foreign background and effects of early obesity treatment

Childhood obesity is often characterised as a global epidemic. Yet, little progress has been made in addressing its increasing levels, especially among certain populations. The present thesis includes five studies and offers an examination of parenting practices and child behaviours, in relation to foreign background in Sweden and in the context of obesity treatment among pre-schoolers. In Studies I and II, parental feeding practices and perceived child eating behaviours, respectively, were compared between Swedish-born mothers and mothers of foreign background. Data were merged from a population-based sample in Malmö and two samples (school and clinical) in Stockholm. Studies III through V offer an evaluation of secondary outcomes (parenting practices and child behaviours) of the More and Less study (ML study), a randomised controlled trial for obesity treatment in Sweden. The ML study includes two treatment approaches, namely a parent support programme (enhancing evidence-based parenting practices)–with and without boosters–and standard treatment (focusing on lifestyle modifications). Compared to Swedish-born mothers, mothers with a foreign background exerted higher levels of unfavourable and controlling feeding practices by restricting access to and intake of energy-dense foods and pressuring their children to eat. Accordingly, mothers with a foreign background perceived their children to overeat in response to external cues (whether food or emotion related), but also to eat according to their internal cues for satiety and hunger to a larger degree than Swedish-born mothers. Maternal concerns about child weight status influenced the observed associations. In the context of early obesity treatment, controlling feeding practices of both mothers and fathers overall remained stable, while the parent support programme particularly affected fathers’ evidence-based parenting practices when compared to standard treatment. While child food intake did not change during treatment, children showed a trend for decreasing certain behaviours, which relate to excess eating. In conclusion, the thesis highlights the importance of foreign background in obesity-related parenting practices and child behaviours, and also provides insights into some of the mechanisms that may be at play to facilitate reductions in child weight status

Dynamique alimentaire parent-enfant et obésité infantile : l'importance de l'origine étrangère et les effets du traitement précoce de l'obésité

PhD dissertation published in paper by Acta Universitatis Upsaliensis (ISBN : 978-91-513-1050-3) available at this address : http://uu.diva-portal.org/smash/record.jsf?pid=diva2%3A1478560&dswid=2311Childhood obesity is often characterised as a global epidemic. Yet, little progress has been made in addressing its increasing levels, especially among certain populations. The present thesis includes five studies and offers an examination of parenting practices and child behaviours, in relation to foreign background in Sweden and in the context of obesity treatment among pre-schoolers. In Studies I and II, parental feeding practices and perceived child eating behaviours, respectively, were compared between Swedish-born mothers and mothers of foreign background. Data were merged from a population-based sample in Malmö and two samples (school and clinical) in Stockholm. Studies III through V offer an evaluation of secondary outcomes (parenting practices and child behaviours) of the More and Less study (ML study), a randomised controlled trial for obesity treatment in Sweden. The ML study includes two treatment approaches, namely a parent support programme (enhancing evidence-based parenting practices)–with and without boosters–and standard treatment (focusing on lifestyle modifications).Compared to Swedish-born mothers, mothers with a foreign background exerted higher levels of unfavourable and controlling feeding practices by restricting access to and intake of energy-dense foods and pressuring their children to eat. Accordingly, mothers with a foreign background perceived their children to overeat in response to external cues (whether food or emotion related), but also to eat according to their internal cues for satiety and hunger to a larger degree than Swedish-born mothers. Maternal concerns about child weight status influenced the observed associations. In the context of early obesity treatment, controlling feeding practices of both mothers and fathers overall remained stable, while the parent support programme particularly affected fathers’ evidence-based parenting practices when compared to standard treatment. While child food intake did not change during treatment, children showed a trend for decreasing certain behaviours, which relate to excess eating.In conclusion, the thesis highlights the importance of foreign background in obesity-related parenting practices and child behaviours, and also provides insights into some of the mechanisms that may be at play to facilitate reductions in child weight status.La thèse met en évidence l'importance de l'origine étrangère dans les pratiques parentales liées à l'obésité et les comportements des enfants, et fournit également un aperçu de certains des mécanismes qui peuvent être en jeu pour faciliter la réduction du statut pondéral des enfants

Parent-child feeding dynamics and childhood obesity : The importance of foreign background and effects of early obesity treatment

Childhood obesity is often characterised as a global epidemic. Yet, little progress has been made in addressing its increasing levels, especially among certain populations. The present thesis includes five studies and offers an examination of parenting practices and child behaviours, in relation to foreign background in Sweden and in the context of obesity treatment among pre-schoolers. In Studies I and II, parental feeding practices and perceived child eating behaviours, respectively, were compared between Swedish-born mothers and mothers of foreign background. Data were merged from a population-based sample in Malmö and two samples (school and clinical) in Stockholm. Studies III through V offer an evaluation of secondary outcomes (parenting practices and child behaviours) of the More and Less study (ML study), a randomised controlled trial for obesity treatment in Sweden. The ML study includes two treatment approaches, namely a parent support programme (enhancing evidence-based parenting practices)–with and without boosters–and standard treatment (focusing on lifestyle modifications). Compared to Swedish-born mothers, mothers with a foreign background exerted higher levels of unfavourable and controlling feeding practices by restricting access to and intake of energy-dense foods and pressuring their children to eat. Accordingly, mothers with a foreign background perceived their children to overeat in response to external cues (whether food or emotion related), but also to eat according to their internal cues for satiety and hunger to a larger degree than Swedish-born mothers. Maternal concerns about child weight status influenced the observed associations. In the context of early obesity treatment, controlling feeding practices of both mothers and fathers overall remained stable, while the parent support programme particularly affected fathers’ evidence-based parenting practices when compared to standard treatment. While child food intake did not change during treatment, children showed a trend for decreasing certain behaviours, which relate to excess eating. In conclusion, the thesis highlights the importance of foreign background in obesity-related parenting practices and child behaviours, and also provides insights into some of the mechanisms that may be at play to facilitate reductions in child weight status

Hydrolysed proteins in infant formula and child neurodevelopment: The French ELFE study

International audienc

Hydrolysed proteins in infant formula and child neurodevelopment: The French ELFE study

International audienc

How do young children eat after an obesity intervention? Validation of the Child Eating Behaviour Questionnaire using the Rasch Model in diverse samples from Australia and Sweden

Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4–6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5–1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours

Associations between retail food environment and organic food purchases in French households: the Mont'Panier cross-sectional study

International audienc