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Recommendations Summary

Pediatric Weight Management (PWM) Assessing Child and Family Diet Behaviors in Pediatric Obesity

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  PWM: Family Diet Behaviors - Increased Risk of Obesity

  Child and family diet behavior factors that may be associated with an increase in the risk of pediatric obesity and should be included in Nutrition Assessment are: Parental restriction of highly-palatable foods, consumption of food away from home, increased portion size of meals and breakfast-skipping. ADA Evidence Analysis has shown that these factors are positively associated with childhood overweight or obesity.

  Rating: Fair
  Imperative

  PWM: Family Diet Behaviors - Relationship Unclear

  Dietitians should be aware of the research on the following child and family diet behavior factors when carrying out their Nutrition Assessment: Parental encouragement or pressure to eat, parental control over child’s dietary intake, meal frequency, snacking frequency or snack food intake and using food as a reward. ADA Evidence Analysis has found that these factors may not be related to pediatric overweight or obesity or that the research is still unclear on the relationship.

  Rating: Fair
  Imperative

  • Risks/Harms of Implementing This Recommendation

    None.

  • Conditions of Application

    The above topics were selected for evidence analysis. However:

    • The practitioner should not limit their assessment to these factors
    • Modification of these factors should be considered when developing the nutrition prescription
    • Evidence analysis on other factors is currently underway and will be added to the guideline as they are finished.

  • Potential Costs Associated with Application

    None.

  • Recommendation Narrative

    • Evidence analysis was carried out on several child and family diet behaviors associated with pediatric obesity
    • All factors are based only on observational (association) research and do not include research on interventions
    • The following child and family diet behaviors were associated with an increased risk of pediatric obesity:
      • Parental restriction of highly palatable foods (Grade II)
      • Consumption of food away from home (Grade III)
      • Increased portion size of meals (Grade III)
      • Breakfast-skipping (Grade III).
    • The following child and family diet behaviors may not be related to pediatric obesity. A relationship may or may not, in fact, exist, but research has not been able to determine this definitively.
      • Parental encouragement or pressure to eat (Grade II)
      • Parental control over child’s dietary intake (Grade II)
      • Meal frequency (Grade III)
      • Snacking frequency or snack food intake (Grade III)
      • Using food as a reward (Grade III).

  • Recommendation Strength Rationale

    No direct research was analyzed regarding the benefits of knowledge-based assessment and intervention practices. However, the work group felt strongly that knowledge of relevant scientific research is indispensable for responsible dietetic practice.

    The majority of grades for the associations between child and family diet behaviors and pediatric obesity were a Grade III. However, while there is no risk to the patient or client, with respect to the practitioner's knowledge of these factors, the dietitian's ignorance of this research could result in substantial risk to the patient or client.

  • Minority Opinions

    None.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  Is eating out related to adiposity in children?
  
  Is portion size related to adiposity in children?
  
  Is breakfast skipping related to adiposity in children?
  
  Is eating frequency related to adiposity in children?
  
  Is snacking related to adiposity in children?
  
  Is parental encouragement/pressure to eat associated with higher risk or prevalence of overweight among children?
  
  Is parental restriction of highly palatable foods associated with higher risk or prevalence of overweight among children?
  
  Is parental control over child dietary intake associated with higher risk or prevalence of overweight among children?
  
  Is using food as a reward (Instrumental feeding) & emotional feeding associated with higher risk or prevalence of overweight among children?

  • References

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    Francis LA, Hofer SM, Birch LL. Predictors of maternal and child characteristics. Appetite 2001; 37: 231-243.
    
    Koivisto U, Fellenius J, Sjoden. Relations between parental mealtime practices and children’s food intake. Appetite 1994; 22: 245-258.
    
    Lee Y, Mitchell DC, Smickiklas-Wright H, Birch LL. Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding recommendations for total dietary fat of the American Academy of Pediatrics. Pediatrics 2001; 107: e95.
    
    Melgar-Quinonez HR, Kaiser LL. Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children. J Am Diet Assoc. 2004 Jul;104(7):1110-9.
    
    Robinson TN, Kiernan M, Matheson DM, Haydel KF. Is parental control over children’s eating associated with childhood obesity? Results from a population-based sample of third graders. Ob Res 2001; 9: 306-312.
    
    Spruijt-Metz D, Lindquist CH, et.al. Relation between mothers’ child-feeding practices and children’s adiposity. Am J Clin Nutr. 2002;75:581-586.
    
    Wardle J, Sanderson WS, Guthrie CA, Rapoport L, Plomin R. Parental feeding style and the intergenerational transmission of obesity risk. Obes Res 2002; 10: 453-462. Twins Early Development Study.
    
    Birch LL, Fisher JO. Mothers’ child-feeding practices influence daughters’ eating and weight. Am J Clin Nutr. 2000; 71: 1054-1061.
    
    Davison KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics 2001; 107: 46-53.
    
    Fisher JO, Birch LL. Restricting access to palatable foods affects children’s behavioral response, food selection and intake. Am J Clin Nutr 1999; 69: 1,264-1,272.
    
    Fisher JO, Birch LL. Restricting access to foods and children’s eating. Appetite 1999; 32: 405-419.
    
    Fisher JO, Birch LL. Eating in the absence of hunger and overweight in girls from 5 to 7 y of age. Am J Clin Nutr. 2002 Jul;76(1):226-31.
    
    Agras WS, Hammer LD, McNicholas F, Kraemer HC. Risk factors for childhood overweight: a prospective study from birth to 9.5 years. J Pediatr. 2004 Jul;145(1):20-5.
    
    Baughcum AE, Powers SW, Johnson SB, Chamberlin LA, Deeks CM, Jain A, Whitaker RC. Maternal feeding practices and beliefs and their relationships to overweight in early childhood. J Dev Behav Pediatr 2001; 22: 391-408.
    
    Johnson SL, Birch LL. Parents’ and children’s adiposity and eating style. Pediatrics 1994; 94: 653-661.
    
    Koivisto U, Fellenius J, Sjoden. Relations between parental mealtime practices and children’s food intake. Appetite 1994; 22: 245-258.
    
    Robinson TN, Kiernan M, Matheson DM, Haydel KF. Is parental control over children’s eating associated with childhood obesity? Results from a population-based sample of third graders. Ob Res 2001; 9: 306-312.
    
    Saelens BE, Ernst MM, Epstein LH. Maternal child feeding practices and obesity: a discordant sibling analysis. Int J Eat Disord 2000; 27:459-463.
    
    Sherman JB, Alexander MA, Dean AH, Kim M. Obesity in Mexican-American and Anglo children. Prog Cardiovasc Nurs. 1995 Winter;10(1):27-34.
    
    Ebbeling CB, Sinclair KB, Pereira MA, Garcia-Lago E, Feldman HA, Ludwig DS. Compensation for energy intake from fast food among overweight and lean adolescents. JAMA. 2004 Jun 16;291(23):2828-33.
    
    French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables. International Journal of Obesity. 2001:1823-1833.
    
    Gillis LJ, Bar-Or O. Food away from home, sugar-sweetened drink consumption and juvenile obesity. J Am Coll Nutr. 2003 Dec;22(6):539-45.
    
    Kelishadi R, Pour MH, Sarraf-Zadegan N, Sadry GH, Ansari R, Alikhassy H, Bashardoust N. Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program - Heart Health Promotion from Childhood. Pediatr Int. 2003 Aug;45(4):435-42.
    
    Lin BH, Huang CL, French SA. Factors associated with women's and children's body mass indices by income status. Int J Obes Relat Metab Disord. 2004 Apr;28(4):536-42.
    
    Mikkila V, Lahti-Koski M, Pietinen P, Virtanen SM, Rimpela M. Associates of obesity and weight dissatisfaction among Finnish adolescents. Publ Health Nutr 2002;6:49-56.
    
    Nicklas TA, Morales M, Linares A, Yang SJ, Baranowski T, De Moor C, Berenson G. Children's meal patterns have changed over a 21-year period: the Bogalusa Heart Study. J Am Diet Assoc. 2004; 104(5): 753-61
    
    Pastore DR, Fisher M, Friedman SB. Abnormalities in weight status, eating attitudes, and eating behaviors among urban high school students: correlations with self-esteem and anxiety. J Adolesc Health 1996;18:312-9.
    
    Sugimori H, Yoshida K, Izuno T, Miyakawa M, Suka M, Sekine M, Yamagami T, Kagamimori S. Analysis of factors that influence body mass index from ages 3 to 6 years: A study based on the Toyama cohort study. Pediatr Int. 2004 Jun;46(3):302-10.
    
    Thompson OM, Ballew C, Resnicow K, Must A, Bandini LG, Cyr H, Dietz WH. Food purchased away from home as a predictor of change in BMI z-score among girls. Int J Obes Relat Metab Disord. 2004 Feb;28(2):282-9.
    
    McConahy KL, Smiciklas-Wright H, Birch LL, Mitchell DC, Picciano MF. Food portions are positively related to energy intake and body weight in early childhood. J Pediatr 2002;140:340-347.
    
    Berkey CS, Rockett HR, Gillman MW, Field AE, Colditz GA. Longitudinal study of skipping breakfast and weight change in adolescents. Int J Obes Relat Metab Disord. 2003 Oct; 27(10): 1,258-1,266.
    
    Boutelle K, Neumark-Sztainer D, Story M, Resnick M. Weight control behaviors among obese, overweight, and nonoverweight adolescents.  J Pediatr Pscychol 2002;27:531-40.
    
    Dwyer JT, Evans M, Stone EJ, Feldman HA, Lytel L, Hoelscher D, Johnson C, Zive M, Yang M. CATCH Cooperative Research Group.  Adolescents’ eating patterns influence their nutrient intakes.  J Am Diet Assoc 2001;101:798-802.
    
    Lin BH, Huang CL, French SA. Factors associated with women's and children's body mass indices by income status. Int J Obes Relat Metab Disord. 2004 Apr;28(4):536-42.
    
    Nicklas TA, Yang SJ, Baranowski T, Zakeri I, Berenson G. Eating patterns and obesity in children. The Bogalusa Heart Study. Am J Prev Med. 2003 Jul;25(1):9-16.
    
    O'Dea JA, Caputi P. Association between socioeconomic status, weight, age and gender, and the body image and weight control practices of 6- to 19-year-old children and adolescents. Health Educ Res 2001;16:521-32.
    
    Ortega RM, Requejo AM, López-Sobaler AM, Quintas ME, Andrés P, Redondo MR, Navia B, López-Bonilla MD, Rivas T. Difference in the breakfast habits of overweight/obese and normal weight schoolchildren.  Int J Vitam Nutr Res 1998; 68:125-32.
    
    Sampson AE, Dixit S, Meyers AF, Houser R Jr. The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children.  J Natl Med Assoc 1995;87:195-202.
    
    Sekine M, Yamagami T, Hamanishi S, Handa K, Saito T, Nanri S, Kawaminami K, Tokui N, Yoshida K, Kagamimori S. Parental obesity, lifestyle factors and obesity in preschool children: results of the Toyama Birth Cohort study.  J Epidemiol 2002;12:33-9.
    
    Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. European Journal of Clinical Nutrition 1996;50:513-519.
    
    Wolfe WS, Campbell CC, Frongillo EA, Haas JD, Melnik TA. Overweight schoolchildren in New York State: Prevalence and characteristics. Am J Pub Health 1994;84:807-813.
    
    Crawley H, Summerbell C. Feeding frequency and BMI among teenagers aged 16-17 years. Int J Obes, 1997;21:159-161.
    
    Bandini LG, Vu D, Must A, Cyr H, Goldberg A, Dietz WH.  Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents.  Obes Res 1999;7:438-43.
    
    Brewis A. Biocultural aspects of obesity in young Mexican schoolchildren. Am J Hum Biol. 2003 May-Jun;15(3):446-60.
    
    Francis LA, Lee Y, Birch LL. Parental weight status and girls' television viewing, snacking, and body mass indexes.  Obes Res 2003;11:143-51.
    
    Locard E, Mamelle N, Billette A, Miginiac M, Munoz F, Rey S. Risk factors of obesity in a fiver year old population.  Parental versus environmental factors.  Int J Obes 1992;16:721-9.
    
    Maffeis C, Provera S, Filippi L, Sidoti G, Schena S, Pinelli L, Tatò L. Distribution of food intake as a risk factor for childhood obesity.  Int J Obes 2000;24:75-80.
    
    Phillips SM, Bandini LG, Naumova EN, Cyr H, Colclough S, Dietz WH, Must A. Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res. 2004;12:461-472.
    
    Rockett HR, Berkey CS, Field AE, Colditz GA. Cross-sectional measurement of nutrient intake among adolescents in 1996. Prev Med 2001; 33:27-37.
    
    Takahashi E, Yoshida K, Sugimori H, Miyakawa M, Izuno T, Yamagami T, Kagamimori S. Influence factors on the development of obesity in 3-year-old children based on the Toyama Study.  Prev Med 1999;28:203-6.
    
    Tanasescu M, Ferris AM, Himmelgreen DA, Rodriguez N, Pérez-Escamilla R. Biobehavioral factors are associated with obesity in Puerto Rican children. J Nutr 2000;130:1734-42.
    
    Wardle J, Sanderson WS, Guthrie CA, Rapoport L, Plomin R. Parental feeding style and the intergenerational transmission of obesity risk. Obes Res 2002; 10: 453-462. Twins Early Development Study.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    None.