Family Encouragement of Healthy Eating Predicts Child Dietary Intake and Weight Loss in Family-Based Behavioral Weight-Loss Treatment

Abstract

Introduction: Social support for healthy eating can influence child eating behaviors; however, little is known about the impact of social support during family-based behavioral weight-loss treatment (FBT). This study aimed to determine the impacts of both baseline and change in family support on change in child diet and weight during FBT. Methods: Children (n = 175; BMI percentile ≥85th; ages 7-11; 61.1% female; 70.9% white) and a participating parent completed 4 months of FBT. Parents were active participants and learned social support-related strategies (i.e., praise and modeling of healthy eating). Child perceived family encouragement and discouragement for healthy eating, child diet quality (via 24-hour recalls), and child weight were assessed pre- and post-FBT. Results: Family encouragement for healthy eating increased during FBT, and this increase was related to increases in child healthy vegetable intake and overall diet quality, as well as decreases in refined grains consumed. Low pre-FBT family encouragement predicted greater increases in healthy vegetable intake, greater weight reduction, and greater increases in family encouragement for healthy eating. Family discouragement for healthy eating did not change during treatment nor did it predict dietary or weight outcomes. Conclusions: FBT successfully improves family encouragement, which is associated with improvements in child diet. Furthermore, even children who began treatment with low family encouragement for healthy eating show great improvements in dietary intake and weight during treatment. Results suggest that changes in child eating behavior during treatment is influenced by active, positive parenting techniques such as praise of healthy eating rather than negative family support.

Trial registration: ClinicalTrials.gov NCT00759746.

Keywords: child; diet; obesity; social support; treatment.

Conflict of interest statement

No competing financial interests exist.

Figures

Figure 1.

Children with low and high pre-FBT family encouragement (median-split) and change in (a) healthy vegetable servings and (b) weight. *p < 0.05; † = p < 0.05 for the difference in change in healthy vegetable servings and weight between children with low or high levels of family encouragement pre-FBT. The following covariates were tested in both (a) and (b) but not significant: child age, sex, race, and ethnicity; parent marital status and education; and the family's annual household income category. Child percent overweight was not a significant covariate in the model shown in (a). FBT, family-based behavioral treatment.

Figure 2.

Change in (a) HEI score, (b) healthy vegetable intake, and (c) refined grain intake for children with low and high increases in family encouragement for healthy eating from pre- to post-FBT (median split). *p < 0.05; †p < 0.05 for the difference in change in HEI score, healthy vegetable intake, and refined grain intake between children with low or high increases in family encouragement from pre- to post-FBT. The following covariates were tested but not significant: child age, sex, race, ethnicity, and percent overweight; parent marital status and education; and the family's annual household income category. HEI, Healthy Eating Index-2015.