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Research Project: Preventing the Development of Childhood Obesity

Location: Children's Nutrition Research Center

2021 Annual Report

Objectives
Today, an estimated 16% of US children and adolescents are overweight and 17% are obese, and the prevalence continues to rise. Most child obesity prevention interventions have not been effective and additional research is necessary to address broader eating patterns, rural/urban differences and how parents influence their children’s behaviors. Researchers will conduct studies on: 1) characterize the food & activity environments in which teens in rural areas live, work, and play and their perceptions regarding obesity, challenges to eating healthfully and being physically active (PA), and ways in which technology might be useful in helping them engage in healthy behaviors; 2) in low-income Hispanic families with children, examine the following parent feeding and child eating behaviors based on data from an existing data set: the direction of effects between parent feeding styles and child eating behaviors; how parent feeding styles and child eating behaviors at baseline predict individual growth curve trajectories for child BMI across 3 time points; and how child eating behaviors interact with parent feeding styles in predicting child BMI over time; 3) assess the psychometrics of sub-scales of food and PA parenting and whether there is differential item functioning among a sample of ethnically and racially diverse fathers; 4) describe fathers' use of parenting practices that support healthful nutrition and PA for their children and how this varies by demographic factors, household responsibilities, and co-parenting alliance; 5) develop and assess the feasibility of child obesity prevention videos for mothers to better engage them during a father targeted obesity prevention program; 6) assess 3 aspects of infant temperament: a) surgency, negative affectivity, and affiliation/orienting by direct observation; b) infant eating behaviors as measured by several sucking parameters, for example maximal suck pressure, burst rate and reductions in pressure during bottle feeding, and c) infant adiposity by dual-energy x-ray absorptiometry, and characterize the associations between these traits; 7) the NHANES will be used to identify diet-related risk factors for obesity, and other health outcomes in children, adolescents, and adults specifically: identify eating patterns in children, adolescents and adults by gender and ethnicity; examine the association between eating patterns and obesity and related health risk factors; examine the impact of individual foods, nutrients, and food-specific patterns on obesity and health outcomes in children, adolescents, and adults; and identify the impact of eating patterns on dietary intake, nutrient adequacy, and diet quality; 8) examine the rural-urban differences in and associations between food security status, food availability, participation in federal nutrition assistance programs, dietary intake, and obesity among children across different age groups; and 9) determine the relationship between children's physical activity, diet, sedentary behavior, and sleep, on summer weight gain in children and the impact of parenting on these behaviors.

Approach
A multidimensional approach will be undertaken to address the obesity research conducted at the Children's Nutrition Research Center. A mixed methods research using a sequential explanatory design will be used to address the goals of understanding why rural adolescents have a higher prevalence of obesity than their urban counterparts. A secondary data analysis will be performed on data collected from a previous study to gain an insight on the direction of effects between parent feeding styles and child eating behaviors. A cross-sectional study of a racially/ethnically, income and educational diverse sample of fathers will be conducted to be able to better design food or physical activity parenting practice survey instruments for use amongst fathers. A cohort of infants from late preterm or full term births (>=36 weeks gestation) will be recruited and various observational studies will be conducted to monitor the infants’ temperament and correlation amongst the observations. Researchers will also perform secondary analysis using the 2011-2014 NHANES to compare weight and health risk outcome measures and nutrient intake with eating patterns in children, adolescents, and adults; using the 4 years of data will ensure an adequate sample size for the analyses. NHANES data from child as well as adult datasets on food security status will be used for the analyses to assess child as well as household food security status. And to better understand summer weight gain in children, researchers will review demographics, sleep, screen media use, meal patterns, physical activity, childcare arrangements and medication usage during summer via a structured parent interview.

Progress Report
To review the progress made during the year, please refer to the following projects: 3092-51000-063-01S (Project #1), 3092-51000-063-02S (Project #2), and 3092-51000-063-03S (Project #3).

Accomplishments
1. Maternal feeding styles and child eating behaviors. Limitations exist in the literature on maternal feeding behaviors, especially around the conceptualization that mothers are seen as directing eating interactions with their children and the children's eating patterns are in response to those directions. Some researchers are currently considering a different concept – that child eating patterns actually elicit feeding responses from parents, i.e., mothers adjust their feeding directives depending on child eating characteristics. Current pediatric recommendations support a 'one size fits all' approach to providing guidance for feeding children and does not consider the role of the child. To address this problem, scientists in Houston, Texas, conducted analyses on Hispanic mothers and their children and showed that children's individual eating patterns (e.g., picky eating or highly food motivated eating) elicited feeding responses from mothers as opposed to the other way around. Understanding why some children eat sparingly, while others have seemingly insatiable appetites is an important step in understanding how child eating behaviors develop and what we can teach parents to do about it. Understanding that these child eating characteristics elicit a feeding response from mothers allows us to better tailor feeding guidance to parents from pediatricians and healthcare professionals.

2. Perceptions about health, nutrition knowledge and the Dietary Guidelines food groups. Adolescents tend to have poor dietary practices and for this reason they have been a common target for the 2015 Dietary Guidelines for Americans (DGA) recommendations to enhance their diet and overall health. The words used by the DGA to describe aspects of the diet and the food categories may be unclear to adolescents. To assess this, researchers from Houston, Texas, surveyed adolescents to define terms commonly used in the dietary guidelines and to categorize 20 of the foods most consumed by adolescents using the most recent DGA food categories. Researchers found that adolescents defined "healthy" in terms of behaviors performed (e.g. diet and physical activity) but had difficulty in defining other commonly used guideline terms (e.g. energy-dense, processed foods). Adolescents were able to accurately classify 72% of the commonly consumed foods but had difficulty with complex foods (e.g. pizza, chicken soup) which required the use of multiple categories, and foods that had both desirable and undesirable characteristics (e.g. potato chips and chocolate chip cookies). More research is needed on clarifying the terms and categories used in the Dietary Guidelines to enhance adolescents understanding, compliance, and health.

3. Feeding styles and child weight status. Few studies have examined the reciprocal relationship between parent feeding behaviors and their child's weight status over time to better understand childhood obesity development. Most prevention programs designed for preschool aged children have not been effective in preventing weight gain as children progress through elementary school. Researchers in Houston, Texas, examined the relationships among Hispanic mothers and their preschool children and found that an indulgent feeding style (mothers who set few boundaries but are sensitive to their child's individual needs) was associated with an increased child body mass index over time. This finding is important as it provides information on the reciprocal effects between indulgent feeding and child weight that have not been well studied. Educating parents about how their responses to their children's weight may impact their feeding directives and will help promote better feeding behaviors among Hispanic mothers of young children, and hopefully reduce weight problems as children age.

4. Orange juice consumption improves diet quality. Americans are under-consuming vitamins A, D, E, and C, folate, calcium, magnesium, potassium, and fiber relative to the current Dietary Guidelines for Americans recommendations. 100% orange juice (OJ) is the most commonly consumed fruit juice and contributes a variety of vitamins A, D, E, and C, folate, calcium, magnesium, potassium, and fiber to the diet. Researchers in Houston, Texas, found that the consumption of 100% OJ was associated with higher intakes of dietary fiber, folate, calcium, magnesium, potassium and vitamin C without an associated increase in weight. Decreasing consumption of 100% OJ has reduced intakes and adequacy of key nutrients; thus, affecting the individuals' overall diet quality. Consumption of OJ should be encouraged for children and adults as part of a healthy diet in an effort to move Americans to meeting current dietary recommendations.

U.S. DEPARTMENT OF AGRICULTURE

Children's Nutrition Research Center: Houston, TX