Critically discus the idea that the development of child overweight is attributable to parental feeding practices. PDF

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3 Critically discus the idea that the development of child overweight is attributable to parental feeding practices. Word Count: 1980

Oxford Dictionaries (2016) describe being overweight as “being above a weight considered normal or desirable”. This is often measured using to the Body Mass Index (BMI) scale, where 25+ is identified as overweight, and 30+ for obesity. Worldwide obesity has nearly doubled since 1980, with more than 40 million children under the age of five being overweight or obese in 2011 (European Association for the Study of Obesity [EASO], 2013), and over 42 million children in 2013 (World Health Organisation [WHO], 2016). Figures from the National Child Measurement Programme for 2014/15 show that over a third of children in Year 6 (aged 10-11) were obese (19.1%), or overweight (14.2%), and over a fifth of children in Reception (aged 4-5) were obese (9.1%) or overweight (12.8%). Data from the Health Survey for England in 2014 further endorse these figures, showing that 31.2% of children aged 2 to 15 were classed as either overweight or obese (Public Health England, 2016). Moreover, recent reports from Ogden, Carroll, Curtin, Lamb and Flegal (2010) indicate an increase in both the degree and severity of childhood obesity, as well as an increased likelihood of obese children becoming obese adults, which may result in long-term health issues (Magarey, Daniels, Boulton, & Cockington, 2003). Generally, parents control what and when their children eat, as well as the quantities of food being consumed, often right the way from birth onwards (Mitchell, Farrow, Haycraft & Meyer, 2013). Parental feeding practices are central in shaping children’s eating environments and their developing preferences (Birch & Fisher, 1998), and it has been suggested that parental feeding strategies may play a role in the development of childhood overweight (Birch & Fisher, 1998; Faith, Scanlon, Birch, Francis

4 & Sherry, 2004; Johnson & Birch, 1994). The focus of this essay therefore, will be to identify parental feeding practices currently being deployed by parents, and to decipher whether they can be identified as attributable factors for child overweight.

There is an expectation that a relationship exists between low familial income and an increased risk of child overweight (Gibbs & Forste, 2013) and the reasons for why this might be are to be explored here. Firstly, families with a low income are likely to live in neighbourhoods which lack full-service grocery stores, and alongside a lack of reliable transportation, residents may be restricted to shopping in convenience stores and corner shops, where fresh produce and low-fat products are limited (Bell, Mora, Hagan, Rubin & Karpyn, 2013). Further to this, low income families are often priced out of buying healthy foods — such as fruits and vegetables, and hence have to buy higher fat, cheaper food products. Even when these healthy foods are available they're often of a reduced quality, diminishing their appeal (Andreyeva, Blumenthal, Schwartz, Long & Brownell, 2008; Evans et al., 2015). As a result, parents are left with little choice but to feed their children with foods which are likely to have poorer nutritional value, in addition to a high fat or high sugar content, increasing the risk to child overweight as a result of parental feeding. In addition, the prevalence of child overweight with regard to low socioeconomic status has been found to be higher amongst developed countries (Bhargava, Jolliffe & Howard 2008; Chia, 2013; El-Sayed, Scarborough & Galea 2012; Stamatakis, Wardle & Cole 2010; Walsh & Cullinan 2015), but reversed in developing countries (Mushtaq Gull, Abdullah, Shahid, Shad & Akram, 2011; Nguyen, Beresford & Drewnowski 2007; Zere, Kirigia, Duale & Akazili, 2012). A potential explanation for this could be due to an increased availability of high sugar fast food at a relatively low cost in developed countries (Drewnowski, Mennella, Johnson & Bellisle, 2012), making these options seemingly more

5 appealing to parents, as well as being a quick and easy alternative to sourcing fresh food and investing time into preparing a meal for the family. With the readiness and availability of fast food being reduced in developing countries, this could explain the findings that child overweight is higher amongst developed countries. Therefore, in developed countries, socioeconomic status could arguably impact upon parental feeding practices, but not in developing countries, so as there is still an issue with child overweight in developing countries, where there is research in to suggest low socioeconomic status does not correlate with child overweight (Shackleton, 2015), other factors also need to be considered when assessing the issues surrounding child overweight.

Parental control in relation to parental feeding practices is another potential factor which has been researched to assess the affect it has upon child overweight. Parents have control over what and when their children eat, and they can often be overly controlling, pressuring their children to finish the food on their plate or to eat foods they don't want to eat (Francis, Hofer & Birch, 2001). This is presented in varying forms, including verbal and physical prompts as well as incentives in the form of food and nonfood rewards (Mitchell, Farrow, Haycraft & Meyer, 2013). Research has found this to be counter-productive, increasing neophobia (Fisher, Mitchell, Smiciklas-Wright & Birch, 2002), food avoidance (Powell, Farrow & Meyer, 2011) and decreased liking and wanting of that food in particular (Galloway, Fiorito, Francis & Birch, 2006). Pressuring children to eat has been associated with increased food consumption (Orrell-Valente et al., 2007). By pressuring the child to finish their food, you undermine their ability to acknowledge feelings of satiety, which introduces problems for future regulation of food intake (Carper, Fisher & Birch, 2000). This is likely to cause excess calories to be consumed, resulting in weight gain which not only is of immediate concern with regard to child overweight, but the risk of the child remaining overweight into adolescence and adulthood is also increased. If

6 parents can be made aware of this, they can adapt their feeding practices to give the child more control over what they eat and the amount they eat, potentially reducing the number of overweight children. Parents act as role-models to their children, and when they themselves have a narrow or restrictive diet, many foods do not appear on the table, and consequently, children will not receive sufficient exposure to those types of foods (Carruth & Skinner, 2000), reducing the likelihood of acceptance. Research has shown parents consumption of fruit is the most important predictor of children’s fruit consumption (Vereecken, Rovner & Maes, 2010). It is often healthy food products which parents with a narrow diet avoid, meaning their children are not being introduced to such foods, and are instead fed the high sugar, high fat food alternatives that their parents are eating. This in turn, as a result of the parents feeding practices, could increase the likelihood of their child becoming overweight as their diet is inappropriately balanced, with calorie intake being to heavily weighted in favour of high fat foods, containing 9 kcal/g, significantly more than both carbohydrates and protein which contain 4 kcal/g. Consequently, their caloric intake is likely to be superior to their caloric expenditure, resulting in weight gain and an increased likelihood of being overweight. It may be beneficial to provide more specific nutrition related advice to parents so they are aware of the consequences a poor nutritional diet can have on the health and weight of both themselves and their children.

Parental lifestyle is another factor which must be considered when addressing whether parental feeding practices can result in child overweight. Parents who engage in a healthy, active lifestyle will often increase their calorie intake to account for the extra calories they burn while engaging in physical activity. Research has shown a 420 kJ/day increase in energy intake at age 4 months is associated with an increased risk for

7 overweight at 3 years of age and 5 years of age (Ong, Emmett, Noble, Ness & Dunger, 2006). Other studies have also shown that rapid weight gain during infancy, from 4-24 months of age, predicts an obesity risk in children (Ong, Ahmed, Emmett, Preece & Dunger, 2000; Stettler, Kumanyika, Katz, Zemel & Stallings, 2003; Stettler, Zemel, Kumanyika & Stallings, 2002). It is possible that these children are eating healthy foods, but the quantity of food being consumed could be too high. This will therefore result in weight gain because the amount of calories being consumed is greater than the amount of energy being expended. Interventions for parents to be educated on portion size, as well as allowing the child to control the quantities of food they eat could be of significant benefit in an attempt to reduce the amount of overweight children. As childhood overweight is a predictor for overweight in adulthood (Llewellyn, Simmonds, Owen & Woolacott, 2016; Simmonds et al., 2015), it is vital that this sort of education is provided to parents to try and reduce the obesity epidemic. !

Parental feeding styles and practices, including pressure to eat, restriction, reward, availability and providing nutritional knowledge have been shown to be associated with child eating, physical activity habits and child weight status (Faith et al., 2004; Faith & Kerns, 2005; Farrow & Blissett, 2008; Rhee, 2008; Pugliese & Tinsley, 2007). As identified by Sherry, Mei, Scanlon, Mokdad and Grummer-Strawn (2004), an increase in the prevalence of overweight among low-income children 2 to 5 years old between 1989 to 1994 and 1995 to 2000 has occurred, suggesting a need for identification of intervention strategies to prevent child overweight. These interventions are not only necessary for lowincome population, but across children of all backgrounds in an attempt to reduce the growing issue of child overweight. Food preferences and eating patterns that develop in early childhood remain relatively stable through adolescence (Northstone & Emmett, 2008)

8 and adulthood (Mikkila, Rasanen, Raitakari, Pietinen & Viikari, 2005), hence establishing healthy eating practices, which have the potential to impact on lifelong health, is vital. Research has demonstrated that parental modelling of healthy eating correlates with lower rates of fussy eating in children (Gregory, Paxton & Brozovic, 2010), meaning children are increasingly likely to accept healthy foods, such as fruits and vegetables, into their diets, as well as try new foods they have not yet been exposed to.

Although parental practices have a clear role in child overweight, it is evident that they are not the sole factor responsible. Other factors have been shown to have a significant role in child overweight, such as growing portion sizes. When compared to previous generations, children are being exposed to greater quantities of food (Young & Nestle, 2002), be it at home, school or in a restaurant. Not only this, but the availability of high sugar fast food has grown dramatically, surrounding us with inexpensive, caloriedense food, usually served in an oversized portion. Reedy and Krebs-Smith (2010) showed the average daily intake of energy from added sugars among all 2-18 year-olds was 365 kcal as well as finding an overlap between the major energy sources and empty calories (including soda, grain deserts, pizza and whole milk). In addition, home-cooking is also becoming less prevalent, potentially due to the availability of these fast-foods, but also because of longer average working hours for both parents. Moreover, sedentary lifestyles are becoming all to common nowadays, with children becoming more dependant on TV and video games in place of engaging in physical activity outdoors with their peers than their parents were, however this can be unavoidable in some cases due to the unsafe nature of the neighbourhoods they're living in (Clements, 2004), but encouraging physical activity could be very beneficial when trying to reduce the obesity epidemic.

9 It is vital that all these factors, amongst others are considered when assessing the reasons for child overweight, as it is likely that an interaction of a variety of these factors are responsible for child overweight. These factors must be further researched in order to gain a fuller understanding so better interventions and strategies can be provided to reduce the issues of child overweight as there is very little evidence currently published which provides a definitive answer to the factors which are attributable to child overweight.

10 Reference List Andreyeva, T., Blumenthal, D. M., Schwartz, M. B., Long, M. W., & Brownell, K. D. (2008). Availability and prices of foods across stores and neighborhoods: The case of new haven, Connecticut. Health Affairs, 27(5), 1381-1388.

Bell, J., Mora, G., Hagan, E., Rubin, V., & Karpyn, A. (2013). Access to healthy food and why it matters: A review of the research. Philadelphia, PA: The Food Trust.

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Carper, J. L., Fisher, J. O., & Birch, L. L. (2000). Young girls’ emerging dietary restraint and disinhibition are related to parental control in child feeding. Appetite, 35(2), 121– 129. Carruth, B. R., & Skinner, J. D. (2000). Revisiting the picky eater phenomenon. neophobic behaviors of young children. Journal of the American College of Nutrition, 19(6), 771–780. Chia, Y. (2013). Dollars and Pounds: The impact of family income on childhood weight. Applied Economics 45: 1931–1941. doi:10.1080/00036846.2011.641929. Clements, R. (2004). An investigation of the status of outdoor play. Contemporary Issues in Early Childhood, 5(1), 68-80.

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Drewnowski, A., Mennella, J. A., Johnson, S. L., & Bellisle, F. (2012). Sweetness and food preference. The Journal of nutrition, 142(6), 1142S-1148S.

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Faith, M. S., Berkowitz, R. I., Stallings, V. A., Kerns, J., Storey, M., & Stunkard, A. J. (2004). Parental feeding attitudes and styles and child body mass index: Prospective analysis of a gene–environment interaction. Pediatrics, 114(4), e429– e436. Faith, M. S., & Kerns, J. (2005). Infant and child feeding practices and childhood overweight. The role of restriction. Maternal and Child Nutrition, 1, 164–168. Faith, M. S., Scanlon, K. S., Birch, L. L., Francis, L. A., & Sherry, B. (2004). Parent–child feeding strategies and their relationships to child eating and weight status. Obesity Research, 12, 1711–1722.

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Farrow, C. V., & Blissett, J. (2008). Controlling Feeding Practices. Cause or consequence of early child weight? Pediatrics, 121, e164–e169. Fisher, J. O., Mitchell, D. C., Smiciklas-Wright, H., & Birch, L. L. (2002). Parental influences on young girls’ fruit and vegetable, micronutrient, and fat intakes. Journal of the American Dietetic Association, 102(1), 58–64. Francis, L. A., Hofer, S. M., & Birch, L. L. (2001). Predictors of maternal child-feeding style: maternal and child characteristics. Appetite, 37, 231–243. Galloway, A. T., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). ‘Finish your soup’. Counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46, 318–323. http://dx.doi.org/10.1016/j.appet.2006.01.019. Gibbs, B. G., & Forste, R. (2014). Socioeconomic status, infant feeding practices and early childhood obesity. Pediatric Obesity, 9(2), 135-146. doi:10.1111/j. 2047-6310.2013.00155.x

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13 Llewellyn, A., Simmonds, M., Owen, C. G., & Woolacott, N. (2016). Childhood obesity as a predictor of morbidity in adulthood: A Systematic Review and Meta-Analysis doi: 10.1111/obr.12316

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14 Ogden, C. L., Carroll, M. D., Curtin, L. R., Lamb, M. M., & Flegal, K. M. (2010). Prevalence of high body mass index in US children and adolescents, 2007– 2008. The Journal of the American Medical Association, 303, 242–249. Ong, K. K., Ahmed, M. L., Emmett, P. M., Preece, M. A., & Dunger, D. B. (2000). Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. Bmj, 320(7240), 967-971.

Ong, K. K., Emmett, P. M., Noble, S., Ness, A., & Dunger, D. B. (2006). Dietary energy intake at the age of 4 months predicts postnatal weight gain and childhood body mass index. Pediatrics, 117, e503–e508. Orrell-Valente, J. K., Hill, L. G., Brechwald, W. A., Dodge, K. A., Pettit, G. S., & Bates, J. E. (2007). ‘‘Just three more bites’’. An observational analysis of parents’ socialization of children’s eating at mealtime. Appetite, 48, 37–45. Oxforddictionaries.com,. (2016). perception psychology - definition of overweight in English from the Oxford dictionary. Retrieved 22 November 2016, from https:// en.oxforddictionaries.com/definition/overweight Powell, F. C., Farrow, C. V., & Meyer, C. (2011). Food avoidance in children. The influence of maternal feeding practices and behaviours. Appetite, 57(3), 683-692. doi: 10.1016...