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.
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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
ImperativePWM: 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.
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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.
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Potential Costs Associated with Application
None.
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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).
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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.
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Minority Opinions
None.
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Risks/Harms of Implementing This Recommendation
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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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References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
None.
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References