Modifications in parent feeding practices and child diet during family-based behavioral treatment improve child zBMI

Jodi Cahill Holland, Rachel P Kolko, Richard I Stein, R Robinson Welch, Michael G Perri, Kenneth B Schechtman, Brian E Saelens, Leonard H Epstein, Denise E Wilfley, Jodi Cahill Holland, Rachel P Kolko, Richard I Stein, R Robinson Welch, Michael G Perri, Kenneth B Schechtman, Brian E Saelens, Leonard H Epstein, Denise E Wilfley

Abstract

Objective: To examine associations between modifications in parent feeding practices, child diet, and child weight status after treatment and to evaluate dietary mediators.

Methods: Children classified as overweight or obese and 7-11 years old (N = 170) completed a 16-session family-based behavioral weight loss treatment (FBT) program. Anthropometrics (standardized body mass index (zBMI)), Child Feeding Questionnaire, and 24-hr dietary recalls were collected at baseline and post-FBT. Linear regression predicted child zBMI change. Single and multiple mediation tested child dietary modifications as mediators between change in parent feeding practices and child zBMI.

Results: Restrictive parent feeding practices significantly decreased during FBT. Reductions in parent restriction, child weight concern, child's total energy intake, and percent energy from fat, and increases in parent perceived responsibility, and child percent energy from protein, predicted reductions in child zBMI. Change in child total energy intake mediated the relation between parent restriction and child zBMI change after accounting for covariates and additional dietary mediators.

Conclusions: FBT is associated with a decrease in parental restriction, which is associated with reductions in child relative weight, which was mediated by a decrease in child energy intake. Teaching parents to reduce children's energy intake without being overly restrictive may improve child weight.

Conflict of interest statement

Conflict of Interest: The authors declared no conflict of interest.

Copyright © 2014 The Obesity Society.

Figures

Figure 1
Figure 1
Multiple mediation model for plausible reporters only (n=128, which tests the mediating effects of changes in dietary intake on the relationship between change in parent restriction and change in child zBMI, adjusting for child age, child gender, child race/ethnicity, household income, child baseline weight status, baseline restriction score, and baseline eating behavior. Unstandardized regression coefficients for each path are presented. The indirect effects and the bias corrected bootstrapping confidence intervals of change in energy are 0.012 (0.0002, 0.0356)*. Model R-square was 0.472.
Figure 2
Figure 2
Multiple mediation model for ALL CHILDREN (n=170), which tests the mediating effects of changes in dietary intake on the relationship between change in parent restriction and change in child zBMI, adjusting for child age, child gender, child race/ethnicity, household income, child baseline weight status, baseline restriction score, and baseline eating behavior. Unstandardized regression coefficients for each path are presented. The indirect effects and the bias corrected bootstrapping confidence intervals of change in energy and change in percent energy from protein are 0.015 (0.0003, 0.0448)* and 0.012 (0.0008, 0.0361)*, respectively. Model R-square was 0.499. *P<0.05, **P<0.01

References

    1. Davison KK, Markey CN, Birch LL. A longitudinal examination of patterns in girls' weight concerns and body dissatisfaction from ages 5 to 9 years. Int J Eat Disord. 2003;33:320–332.
    1. Latner JD, Stunkard AJ. Getting worse: the stigmatization of obese children. Obes Res. 2003;11:452–456.
    1. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175–1182.
    1. Dockray S, Susman EJ, Dorn LD. Depression, cortisol reactivity, and obesity in childhood and adolescence. J Adolesc Health. 2009;45:344–350.
    1. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120(Suppl 4):S164–192.
    1. Fisher JO, Birch LL. Restricting access to palatable foods affects children's behavioral response, food selection, and intake. Am J Clin Nutr. 1999;69:1264–1272.
    1. Faith MS, Berkowitz RI, Stallings VA, Kerns J, Storey M, Stunkard AJ. Parental feeding attitudes and styles and child body mass index: prospective analysis of a gene-environment interaction. Pediatrics. 2004;114:e429–436.
    1. Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL. Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite. 2001;36:201–210.
    1. Jansen E, Mulkens S, Jansen A. Do not eat the red food!: prohibition of snacks leads to their relatively higher consumption in children. Appetite. 2007;49:572–577.
    1. Epstein LH, Truesdale R, Wojcik A, Paluch RA, Raynor HA. Effects of deprivation on hedonics and reinforcing value of food. Physiol Behav. 2003;78:221–227.
    1. Raynor HA, Epstein LH. The relative-reinforcing value of food under differing levels of food deprivation and restriction. Appetite. 2003;40:15–24.
    1. Hill C, Saxton J, Webber L, Blundell J, Wardle J. The relative reinforcing value of food predicts weight gain in a longitudinal study of 7--10-y-old children. Am J Clin Nutr. 2009;90:276–281.
    1. Best JR, Theim KR, Gredysa DM, et al. Behavioral economic predictors of overweight children's weight loss. J Consult Clin Psychol. 2012;80:1086–1096.
    1. Epstein LH, Paluch RA, Beecher MD, Roemmich JN. Increasing healthy eating vs. reducing high energy-dense foods to treat pediatric obesity. Obesity (Silver Spring) 2008;16:318–326.
    1. Klesges RC, Stein RJ, Eck LH, Isbell TR, Klesges LM. Parental influence on food selection in young children and its relationships to childhood obesity. Am J Clin Nutr. 1991;53:859–864.
    1. Birch LL, Fisher JO. Mothers' child-feeding practices influence daughters' eating and weight. Am J Clin Nutr. 2000;71:1054–1061.
    1. Valoski A, Epstein LH. Nutrient intake of obese children in a family-based behavioral weight control program. Int J Obes. 1990;14:667–677.
    1. Hollingshead AB. Four-factor Index of social status. New Haven, CT: Yale University; 1975.
    1. Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11. 2002:1–190.
    1. Burrows TL, Martin RJ, Collins CE. A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. Journal of the American Dietetic Association. 2010;110:1501–1510.
    1. Huang TT, Roberts SB, Howarth NC, McCrory MA. Effect of screening out implausible energy intake reports on relationships between diet and BMI. Obes Res. 2005;13:1205–1217.
    1. Institute of Medicine. Food and Nutrition Board. Washington, DC: National Academy press; 2002. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids.
    1. Garcia-Dominic O, Wray LA, Ledikwe JH, et al. Accuracy of self-reported energy intakes in low-income urban 4th grade minority children. Obesity (Silver Spring) 2010;18:2220–2226.
    1. Dorsey KB, Herrin J, Krumholz HM. Patterns of moderate and vigorous physical activity in obese and overweight compared with non-overweight children. Int J Pediatr Obes. 2011;6:e547–555.
    1. Ventura AK, Loken E, Mitchell DC, Smiciklas-Wright H, Birch LL. Understanding reporting bias in the dietary recall data of 11-year-old girls. Obesity (Silver Spring) 2006;14:1073–1084.
    1. Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord. 2000;24:1119–1130.
    1. Kranz S, Mitchell DC, Smiciklas-Wright H, Huang SH, Kumanyika SK, Stettler N. Consumption of recommended food groups among children from medically underserved communities. J Am Diet Assoc. 2009;109:702–707.
    1. Bailey RL, Mitchell DC, Miller C, Smiciklas-Wright H. Assessing the effect of underreporting energy intake on dietary patterns and weight status. J Am Diet Assoc. 2007;107:64–71.
    1. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40:879–891.
    1. Nielsen SJ, Adair L. An alternative to dietary data exclusions. J Am Diet Assoc. 2007;107:792–799.
    1. Goldfield GS, Epstein LH. Can fruits and vegetables and activities substitute for snack foods? Health Psychol. 2002;21:299–303.
    1. Ogden J, Reynolds R, Smith A. Expanding the concept of parental control: a role for overt and covert control in children's snacking behaviour? Appetite. 2006;47:100–106.
    1. Brown KA, Ogden J, Vogele C, Gibson EL. The role of parental control practices in explaining children's diet and BMI. Appetite. 2008;50:252–259.
    1. Webber L, Hill C, Cooke L, Carnell S, Wardle J. Associations between child weight and maternal feeding styles are mediated by maternal perceptions and concerns. European journal of clinical nutrition. 2010;64:259–265.
    1. Seagle HM, Strain GW, Makris A, Reeves RS. Position of the American Dietetic Association: weight management. J Am Diet Assoc. 2009;109:330–346.
    1. Kirk S, Brehm B, Saelens BE, et al. Role of carbohydrate modification in weight management among obese children: a randomized clinical trial. J Pediatr. 2012;161:320–327 e321.

Source: PubMed

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