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Research Project: Eating Patterns and Obesity Prevention in Children

Location: Children's Nutrition Research Center

2021 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
We are conducting mixed-methods research to understand factors that influence the obesity risk of rural adolescents and the ways in which technology may be used to help them make healthy choices. We planned to partner with the Cooperative Extension Service (CES) network in our target counties, augmented by more traditional methods (e.g., flyers, postings on volunteer websites and newsletters, etc.) as our primary recruitment methods. To this end, to facilitate recruitment efforts in our initial Texas region (Gulf Coastal Plains), we reached out to extension county agents affiliated with Prairie View A&M University. They have shared the study with the listserv for extension county agents throughout the state of Texas and another agent encouraged her team of extension county agents in the department of Family and Community Health to share the study with families. Their efforts and ability to assist with recruitment efforts were hampered by the limitations imposed by the pandemic. Other more traditional recruitment efforts have included posting flyers and the recruitment notice to volunteer websites, newsletters (e.g., Hunger Free Texans), and a Baylor College of Medicine social media page. In addition, we expanded our recruitment efforts to include mailings to medical practices and YMCA's serving rural counties throughout the state and emailing flyers to food banks and pantries. We have also reached out to community organizations (e.g., Baker Ripley, Sam Houston State University Center for Community Engagement, Strikeforce Counties, Texas A&M Rural and Community Health Institute, Girls Scouts, JD Walker Community Center-Baytown, Gift of Life-Beaumont, Black Nurses Rock East Texas, and Triangle AIDS Network [TAN] Healthcare) and the Center for Community Health Development at Texas A&M University. We recently met with a colleague at MD Anderson Comprehensive Cancer Center who conducts research in rural Texas. She agreed to share her network with us, connect us with others conducting research in rural Texas, and to disseminate recruitment flyers. To date, our most successful recruitment approach has been through the Cooperative Extension Agents. For Objective 2, we aim to gain a better understanding of how parental feeding and child eating behaviors interact in the development of childhood obesity. We conducted analyses using our long-term data which was collected previously during three time points: Time 1: child ages 4 to 5; Time 2: child ages 5.5 to 6.5; and Time 3: child ages 7 to 9). The specific aim of these analyses was to test whether there is a reciprocal relationship (or what was the direction of effects/influences) between maternal feeding styles and children's eating behaviors informing us how feeding styles and eating behaviors influence each other over time. The method of statistical analysis we used is a cross-lagged regression model. We only used data from the first and third time points in our analyses, when the children were in preschool (4 to 5 y) and later in elementary school (7 to 9 y), because the data between Time 1 and Time 2 were found to be highly related. Additionally, we focused on six variables at each of the two time points. Using data from the Caregiver's Feeding Styles Questionnaire, we used three out of the four maternal feeding styles (the uninvolved feeding style was used as the reference group). We chose the authoritative, authoritarian, and indulgent feeding styles for the analyses because of their consistent relationships with child weight status in previous studies. Using data from the Children's Eating Behavior Questionnaire, we used three child eating behaviors: the satiety responsiveness, emotional overeating, and food responsiveness. We also conducted a second set of analyses to examine the direction of effects/influences between maternal feeding styles and child weight status over time, using the same method, a cross-lagged regression model. Similar to the previous analyses, we focused on four variables at each of two time points (child ages 4 to 5 and child ages 7 to 9): authoritative, authoritarian, and indulgent feeding styles along with child body mass index. For Objective 3, researchers are currently assessing 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. As indicated in our research plan, this study leverages existing data on Hispanic fathers on their use of food and PA parenting practices 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 and 100 fathers in year 3 (total of 400 fathers) to complement the planned 200 Hispanic fathers. We have completed data collection, with 228 Hispanic fathers recruited and 378 non-Hispanic fathers recruited. The USDA/ARS study component included 55.0% white, 27.5% black, 10.1% Asian, 7.4% other (American Indian, Hawaiian/Pacific Islander, mixed and self-identified as other) fathers. We were 22 fathers shy of meeting our goal of 400 non-Hispanic fathers, but the current sample is more than sufficient to complete Objectives 3 and 4. Data analyses is almost complete to assess if the questionnaires capture fathers' use of food and PA parenting practices in reliable ways among the diverse sample of fathers and whether the same questionnaire can be used to assess food and PA parenting practices among fathers of different race or ethnicity. For Objective 6, which proposes to examine the role of child temperament on infant feeding behavior and adiposity, we have collected electronic recordings for 68 infants at ages 4 month, from which we will be able to directly observe and assess three aspects of infant temperament: surgency, negative affectivity, and affiliation/orienting by direct observation. We have additionally collected infant eating behaviors as measured by several sucking parameters during bottle feeding, and infant adiposity by dual-energy x-ray absorptiometry (DXA). Three team members have been trained on how to code the electronic recordings to form an assessment of infant temperament, and we have also made several adaptations to the coding scheme. For example, instead of coding the type of smile an infant is observed to make every 10 seconds (as per the original protocol) we now code every smile for its type, and also code what (or who) the infant was looking at when they smiled. This will yield richer information and a more nuanced assessment of temperament. Coding sheets and operations manuals have been written for the measure of infant temperament. In the next phase of the study we will conduct data analysis to identify those behaviors which (1) can be reliably assessed (or counted) by the staff members; and (2) are stable across several of the tasks forming the temperament observation. This will ultimately allow us to measure infant temperament in an accurate way for the first time in children as young as four months of age.

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 seem to 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. 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. These findings are important as they provide 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 will help promote better feeding behaviors among Hispanic mothers of young children and hopefully reduce weight problems as children age.