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Research Project: Eating Patterns and Obesity Prevention in Children

Location: Children's Nutrition Research Center

2020 Annual Report

Objective 1: Characterize the food and 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, and ways in which technology might be useful in helping them engage in healthy behaviors. Objective 2: In low-income Hispanic families with children ages 4 to 5 at baseline, examine the following parent feeding and child eating behaviors based on data from an existing data set: Objective 2A: the direction of effects between parent feeding styles and child eating behaviors; Objective 2B: how parent feeding styles and child eating behaviors at baseline predict individual growth curve trajectories for child body mass index (BMI) across three time points 18 months apart (ages 4 to 5 at baseline; ages 5 1/2 to 6 1/2 at Time 2; ages 7 to 8 at Time 3); Objective 2C: how child eating behaviors interact with parent feeding styles in predicting child BMI overtime. Objective 3: Assess the psychometrics of sub-scales of food and physical activity parenting and whether there is differential item functioning among a sample of ethnically and racially diverse fathers. Objective 4: Describe fathers' use of parenting practices that support healthful nutrition and physical activity for their children and how this varies by demographic factors (race/ethnicity, education, income), household responsibilities, and co-parenting alliance. Objective 5: Develop and assess the feasibility of child obesity prevention videos for mothers to better engage them during a father targeted obesity prevention program. Objective 6: Assess three aspects of infant temperament: 1) surgency, negative affectivity, and affiliation/orienting by direct observation; 2) infant eating behaviors as measured by several sucking parameters, for example maximal suck pressure, burst rate and reductions in pressure during bottle feeding, and 3) infant adiposity by dual-energy x-ray absorptiometry, and characterize the associations between these traits.

Obesity is the most prevalent nutrition-related pediatric problem in the US and most child obesity prevention interventions have not been effective. Although there has been disagreement regarding the reasons for this lack of documented success, likely reasons include not understanding or adequately addressing: a) the role of place of residence on obesity risk; b) how parents influence child behaviors; c) how to accurately assess intervention effects; d) cultural influences; and/or e) the role of child characteristics, such as temperament, on obesity risk. Using an approach informed by the Socio-Ecological Model, four independent research projects will address these knowledge gaps. We will conduct mixed methods research to understand factors that influence obesity risk of rural adolescents and the ways in which technology may be used to help them make healthy choices. Additionally, we will take an intensive look at the family by assessing how feeding styles and practices influence child eating behaviors, and assess how to independently engage both fathers and mothers in obesity prevention interventions and accurately assess father's food and physical activity parenting behaviors. Researchers will also examine the role of child temperament on infant feeding behavior and adiposity.

Progress Report
For Objective 1, this year was primarily devoted to project start up activities. A bilingual recruitment coordinator was hired and trained. Online parent and adolescent surveys were programmed and beta tested; however, REDCap is available at no charge to the Children's Nutrition Research Center researchers. Therefore, we researched REDCap, determined it met our needs, and are in the process of programming and beta testing the surveys in this system. English language adolescent surveys are programmed, beta tested, and ready for deployment. Programming for English language parent surveys and Spanish language adolescent and parent surveys is currently underway. We have completed the training for the payment system which will be utilized, enabling us to electronically transfer incentives to research participants. Interview scripts were written and institutional review board (IRB) approval was obtained. Data collection procedures have been written and distributed to project staff. All research staff associated with the project are current on required certifications, enabling them to work with protected human data (i.e., personally identifiable information). For Objective 2, data analysis was conducted on our longitudinal dataset examining parental feeding, child eating behaviors, and child standardized body mass index (BMI) on children seen at Time 1 (ages 4-5), Time 2 (ages 5.5-6.5), and Time 3 (ages 7-9). The first set of analyses we conducted included parent-report measures of child satiety responsiveness, food responsiveness, and effortful control. Observed measures included eating in the absence of hunger, executive functioning, delay of gratification, and emotional regulation. Standardized BMI was calculated by objectively measuring heights and weights of the children. Given recent evidence showing that boys and girls may be different in their self-regulatory skills, data on boys and girls were analyzed in different regression analyses. A second set of analyses were conducted on parent feeding styles and child standardized BMI. Measures included parent-reported feeding styles, feeding practices, acculturation, and child eating behaviors (food responsiveness, emotional overeating, and satiety responsiveness). For Objective 3, researchers plan to assess the psychometrics of sub-scales of food and physical activity (PA) parenting and whether questionnaires work as well among fathers of diverse ethnicity and race. This study leverages existing data on Hispanic fathers on their use of food and PA parenting practices funded by the National Heart, Lung and Blood Institute (NHLBI), by adding data collection on an ethnically and racially diverse sample of fathers. The goal was to collect data on 150 non-Hispanic fathers each in years one and two (total of 300 fathers) to complement the planned 200 Hispanic fathers from the NHLBI funded study. We have completed data collection, with 227 Hispanic fathers and 379 non-Hispanic fathers (55.1% white, 27.4% black, 9.8% Asian, 7.7% other). Data analysis is currently under way to assess whether the questionnaires capture father's use of food and PA parenting in reliable ways among the diverse sample of fathers and whether the questionnaire works differently among fathers of different race or ethnicity. For Objective 5, we developed and assessed the feasibility of child obesity prevention videos for Hispanic mothers to better engage them during a father-targeted, culturally adapted obesity prevention program. The videos were delivered to mothers whose family took part in the feasibility study of Papas Saludables, Ninos Saludables (PSNS). A total of 36 families enrolled in the feasibility trial and participated in the program as part of the intervention group (19 families) or a wait-listed group (17 families). Twenty-eight families attended at least one PSNS session. Links to videos were sent to participating mothers weekly and a follow-up survey was sent later in the week to assess whether mothers received the link, viewed the video and whether the video was helpful. Exit interviews with 26 mothers after their family completed PSNS were completed. Objective 6 was also primarily devoted to project set up. Specifically, we have trained three study staff on how to conduct the infant temperament assessment protocol, and how to code (record) all the behaviors recorded as part of the temperament assessment. Preliminary analyses suggest that the concordance between the three staff is high at over 70% agreement. Thus, we conclude that our training was rigorous and comprehensive. This achievement is a critical step necessary for being able to assess the infants' temperaments accurately, which will enable the team to associate temperament assessments with infant bottle-feeding behaviors.

1. Outreach to parents and practitioners on healthy eating behaviors in young children. Researchers know that how a child eats may be as important as what they eat from the point of view of preventing childhood obesity. Further, we know that the first five years of life are a critical period for helping children learn how to regulate their food intake to match their energy expenditure, and so reduce their obesity risk. To help parents (and other caregivers) understand how they can best foster healthy behavior tendencies in their children, and help clinicians relay this information to patients and clients, researchers in Houston, Texas, partnered with the American Heart Association to release their first ever scientific statement giving advice on how to foster heathy eating behaviors in children ages 0-5 years. This is important as this guidance will broadly reach parents across the country providing strategies for healthy eating behaviors with the goal of reducing childhood obesity.

2. Feeding styles, eating behaviors, and child weight status. Parent feeding and child eating behaviors have been implicated in the development of childhood obesity. Researchers in Houston, Texas, examined how parental feeding during preschool impacted child weight status. We found that parents who were indulgent feeders (no eating boundaries) had children with a higher weight status over a three-year period. This was found over and above child eating characteristics such as food responsiveness (responding to food cues such as smell and color), emotional overeating (eating when bored or unhappy), and satiety responsiveness (stopping eating when full). These results are important as they provide insight for the development of prevention programs targeting parental feeding behaviors.

3. Feeding styles and child weight status overtime. Typical parent-directed analyses only look at the influence of parents' behaviors on their child's weight status. These analyses do not take into account the part that children play in the parent/child feeding dynamic. Researchers in Houston, Texas, examined the impact of a child's weight status on parental feeding and vice versa. We examined how a child's weight status influenced parental feeding of their child by looking at the direction of influence. We found that the weight status of the child impacted how indulgent parents (those who set no eating boundaries) fed their child. This is important as it is takes into consideration a neglected aspect of the parent/child feeding relationship – aiding parents to better understand that child characteristics may play a role in how they feed their children.

4. Gender impacts self-regulated eating behavior. Eating self-regulation (eating when hungry and stop eating when full) has been linked to the development of obesity in children. Researchers in Houston, Texas, conducted a study with Hispanic families which showed that, for girls only, lower levels of eating self-regulation during preschool predicted weight gain over a three year period. Girls' inability to wait for a larger pile of chocolate candies and immediately consuming the smaller pile was also related to weight gain over time. No such relationships were found for boys. These research findings support a focus on self-regulatory skills in prevention programs targeting young preschool aged girls. More research is needed on young boys to determine possible characteristics that may play a part in early obesity prevention.