Reducing pressure on children to eat may help prevent obesity

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An adult's hand points into the shot at a bowl. The boy sits in front of the bowl looking sullen, holding his chin in his hands.
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An educational program for parents helps to reduce pressure on children to eat—which may reduce the child’s risk of obesity, reports a study in the September Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Parents educated in an approach based on “division of responsibility” (DOR) for eating put less pressure on their children to eat certain foods, according to the new research, led by Dr. W. Stewart Agras of Stanford University. The study adds to the evidence that the DOR approach can promote healthy development of appetite and eating behaviors in young children.

The study included 62 families with a toddler (aged two to four) considered at high risk of obesity—with at least one parent who was obese or overweight. One group of parents was educated in the DOR concept, which takes a child-development approach to “parent/child feeding interactions.” Dr Agras explains, “At the family level parent feeding practices, such as taking control over their child’s eating, appear to contribute to childhood overweight.”

In the DOR approach, parents take responsibility for providing and serving food, while children are responsible for deciding whether or not to eat and how much to eat. “The primary principle is that crossing parent or child boundaries leads to feeding problems,” according to the authors. The other group of parents was assigned to the National Institutes of Health’s “We Can” program, which seeks to promote healthy eating and increased physical activity.

At follow-up, parents educated in the DOR approach were putting less pressure on their child to eat, compared to those taught about the “We Can” program. Two parental factors affected the pressure to eat: “disinhibition,” reflecting the parents’ tendency to overeat, and hunger or food cravings in the parents. Parents who learned about DOR put less pressure on their children to eat, regardless of their own disinhibition or hunger scores.

In contrast, for the “We Can” group, parents with low disinhibition and low hunger scores (that is, less control over eating and lower hunger/cravings) put more pressure on their children. Thus an approach that teaches parents to promote consumption of healthy foods may have actually led to a decrease in positive feeding practices

Parents in the DOR group were less likely to restrict food choices in girls, although not in boys. It may be that parents are more focused on girls’ eating patterns, “in line with the greater concern about female weight and shape,” the researchers write.

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Children whose parents are obese or overweight are at risk of becoming obese themselves, possibly because the family environment reinforces “maladaptive” eating behaviors. There’s evidence that parents becoming over-involved in their child’s eating behavior—such as taking excessive control over their child’s eating—contributes to childhood overweight. Excessive parental control over eating may interfere with the child’s perceptions of hunger and feeling full (satiety).

Although the new study is only preliminary, it adds to the evidence that parents taught the DOR approach put less pressure on their child at mealtimes. A larger study with longer follow-up will be needed to determine whether the changes lead to a lower risk of childhood overweight or obesity. Dr Agras and colleagues add, “Efforts to increase consumption of healthy foods in toddlers should include counseling parents to model eating such foods and not to pressure children to eat them.”

Source: Lippincott, Williams and Wilkins

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Date Created: September 12, 2012