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Recommendations Summary

Pediatric Weight Management (PWM) Assessing Family Climate Factors

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 Climate - Increased Risk of Overweight or Obesity

  Family climate factors that may be associated with an increase in the risk of pediatric obesity and should be included in Nutrition Assessment are: Parental dietary disinhibition and restraint, negative aspects of family functioning (such as lack of parental support or over-possessiveness) and parental concern about child’s weight status. ADA Evidence Analysis has shown that these factors are positively associated with childhood overweight or obesity.

  Rating: Fair
  Imperative

  PWM: Family Climate - Decreased Risk of Overweight or Obesity

  Family climate factors that may be associated with a decrease in the risk of pediatric obesity and should be included in Nutrition Assessment are: Positive aspects of family functioning (such as family cohesion, expressiveness, democratic style, parental support and cognitive stimulation at home). ADA Evidence Analysis has shown that these factors may be negatively associated with childhood overweight or obesity.

  Rating: Fair
  Imperative

  PWM: Family Climate - Relationship Unclear

  Dietitians should be aware of the research on the following family climate factor when carrying out their Nutrition Assessment: Household food insecurity. ADA Evidence Analysis has found that this factor 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 her 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 family climate factors associated with pediatric overweight or obesity
    • All factors are based only on observational (association) research and do not include research on interventions
    • The following family climate factors were associated with an increased risk of pediatric overweight or obesity:
      • Parental dietary disinhibition and restraint (Grade III)
      • Negative aspects of family functioning such as lack of parental support or over-possessiveness (Grade III)
      • Parental concern about child’s weight status (Grade II).
    • The following family climate factors were associated with a decreased risk of pediatric overweight or obesity:
      • Positive aspects of family functioning such as family cohesion, expressiveness, democratic style, parental support and cognitive stimulation at home (Grade III).
    • The following family climate factors may not be related to pediatric overweight or obesity. A relationship may or may not, in fact, exist, but research has not been able to determine this definitively.
      • Household food insecurity (Grade II).

  • 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 family climate factors associated with childhood overweight or 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).

  Are parental attitudes towards their own dietary intakes (Dietary restraint & disinhibition) associated with higher risk or prevalence of overweight among children?
  
  Is family functioning associated with higher risk or prevalence of overweight among children?
  
  Is parental concern about or criticism of their child's weight status associated with higher risk or prevalence of overweight among children?
  
  What is the relationship between household food insecurity and childhood overweight?

  • References

    Cutting TM, Fisher JO, Grimm-Thomas K, Birch LL. Like mother, like daughter: Familial patterns of overweight are mediated by mothers’ dietary disinhibition. Am J Clin Nutr 1999; 69: 608-613.
    
    Davison KK, Birch LL. Obesigenic families: Parents’ physical activity and dietary intake patterns predict girls’ risk of overweight. Int'l J Obes. 2002; 26: 1,186-1,193.
    
    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.
    
    Hood MY, Moore LL, Sundarajan-Ramamurti A, Singer M, Cupples LA, Ellison RC. Parental eating attitudes and the development of obesity in children. The Framingham Children’s Study. Int J Obes 2000; 24: 1,319-1,325.
    
    Johnson SL, Birch LL. Parents’ and children’s adiposity and eating style. Pediatrics 1994; 94: 653-661.
    
    Alaimo K, Olson CM, Frongillo EA Jr.  Low family income and food insufficiency in relation to overweight in US children.  Arch Pediatr Adolesc Med 2001; 155:1161-1167.
    
    Casey PH, Szeto K, Lensing S, Bogle M, Weber J.  Children in food insufficient, low-income families: Prevalence, health, and nutrition status.  Arch Pediatr Adolesc Med 2001;155:508-14.
    
    Cutts DB, Pheley AM, Geppert JS. Hunger in Midwestern inner-city young children.  Arch Pediatr Adolesc Med 1998;152:489-93.
    
    Kaiser LL, Melgar-Quiñonez HR, Lamp CL, Johns MC, Sutherlin JM, Harwood JO.  Food security and nutritional outcomes of preschool-age Mexican-American children. J Am Diet Assoc 2002; 102: 924-929.
    
    Matheson DM, Varady J, Varady A, Killen JD. Household food security and nutritional status of Hispanic children in the fifth grade.  Am J Clin Nutr 2002;76:210-7.
    
    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.
    
    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.
    
    Lissau I, Breum L, Sorensen TIA. Maternal attitude to sweet eating habits and risk of overweight in offspring: a ten-year prospective population study. Int J Obes 1993; 17: 125-129.
    
    Lissau I, Sorensen TIA. Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet 1994; 343: 324-328.
    
    Mendelson BK, White DR, Schliecker E. Adolescents’ weight, sex and family functioning. Int J Eat Disord 1995; 17: 73-79.
    
    Strauss RS, Knight J. Influence of the home environment on the development of obesity in children.
    Pediatrics. 1999 Jun;103(6):e85.  
    
    Trombini E, Baldaro B, Bertaccini R, Mattei C, Montebarocci O, Rossi N. Maternal attitudes and attachment styles in mothers of obese children. Percept Mot Skills. 2003 Oct;97(2):613-20.
    
    Valtolina GG, Marta E. Family relations and psychosocial risk in families with an obese adolescent. Psychological Reports 1998; 83: 251-260.
    
    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.
    
    Birch LL, Fisher JO, Davison KK. Learning to overeat: maternal use of restrictive feeding practices promotes girls' eating in the absence of hunger. Am J Clin Nutr. 2003 Aug;78(2):215-20.
    
    Brewis A. Biocultural aspects of obesity in young Mexican schoolchildren. Am J Hum Biol. 2003 May-Jun;15(3):446-60.
    
    Davison KK, Birch LL. Weight status, parent reaction, and self-concept in five-year-old girls. Pediatrics 2001; 107: 46-53.
    
    Davison KK, Birch LL. Processes linking weight status and self-concept among girls from ages 5 to 7 years. Developmental Psychology. 2002; 38: 735-748.
    
    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.
    
    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.

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

    None.