AHA: Promotion of good eating behavior in children multifaceted
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A scientific statement from the American Heart Association addressed the role of caregivers in the development of healthy eating behaviors in children, actions that can be taken by caregivers to improve these outcomes and challenges that may inhibit these changes.
“This statement was written to share with the public that the early years are, for some children, a period in which caregiver can play a critical period in mitigating obesity risk. The mission of the AHA is “To be a relentless force for a world of longer, healthier lives”, and as such they provide education on a broad range of health matters,” Alexis C. Wood, PhD, assistant professor at the U.S. Department of Agriculture/Agriculture Research Services Children’s Nutrition Research Center and the department of pediatrics at Baylor College of Medicine and chair of the writing committee, told Healio.
“In brief, caregivers should not focus on the child and their eating per se, but rather on, for example, limiting the availability of unhealthy food, and letting children see them eat a healthy diet themselves,” Wood said in an interview. “However, it is very, very important that readers understand that childhood obesity is a complex condition with a myriad of causes; while caregivers can be important people in childhood obesity prevention, their influence is limited by other factors beyond their control — therefore just like any medical condition, caregivers should not feel undue responsibility for preventing childhood obesity.”
Caregiver characteristics and behavior
The committee suggested that prenatal influences, such as prepregnancy obesity, maternal diet and excess weight gain during pregnancy may be associated with increased risk for obesity in children, but few human studies exist on the topic.
Factors such as protein and fat consumption at age 10 years may correlate with the maternal intake of these macronutrients during pregnancy. However, children of individuals who experienced caloric restriction during pregnancy at the time of the Dutch famine from 1944 to 1945 experienced increased rates of obesity up to 30 years later, according to the statement.
“Under the assumption that eating self-regulation is present from birth (even in preterm infants), caregivers are thought to either support children’s innate eating self-regulation tendency or promote a deviation from this tendency,” the committee wrote. “Thus, early feeding research has focused on a didactic relationship between children and caregivers, examining the interrelationship between children’s appetite cues, caregiver responsivity to these and the effect this has on child eating self-regulation.”
According to the statement, with increased dietary variety and reduction in food “fussiness” as a child reaches preschool age, this period is critical in the establishment of food boundaries.
Applying pressure to eat certain foods or restrict them with the goal of improving improve dietary quality has been associated with impaired ability to self-regulate in preschool and poorer energy compensation throughout childhood.
Moreover, restrictive feeding practices of caretakers, such as limiting intake of snack foods, have also been associated with greater food intake when the child is not hungry, energy intake, adiposity, failing to stop eating when full and poorer compensation for the energy density of food, according to the statement.
“When considered alongside decades of developmental science demonstrating that sociocultural context can have a powerful role in shaping a wide range of outcomes for children, including general self-regulatory skills, these findings highlight a core concept underlying this scientific statement, which is that although strong heritability estimates suggest inherent individual differences in child eating self-regulation, they do not negate the potential for caregivers to shape or moderate the expression of children’s eating tendencies,” the committee wrote.
What caregivers can do
The committee posed that caregivers may improve childhood obesity and CV health outcomes when the following five actions are supported:
- When pregnancies are initiated at a healthy maternal weight; guidelines for caloric intake and consumption of fats and sugars are maintained during pregnancy; and weight gain during pregnancy is within guideline-recommended levels.
- When caregivers have knowledge of infant hunger and satiety cues and can distinguish from non-appetite-related signals.
- When caregivers are responsive to children’s hunger and fullness cues, pay close attention to both verbal and nonverbal signals and do not pressure the child to eat beyond satiety. To promote dietary and CV health among underweight children, caregivers should allow for the choice of when to stop eating during a meal and perhaps remove the choice for the child to not eat anything.
- When a varied diet is encouraged via environmental structure, which may include consistent and repeated offering of healthy foods to children, the use of “preferred” foods such as dips and enthusiastic consumption of the food by the caregivers themselves.
- When there is an appropriate structure around food that provides rules and limitations regarding the children’s meals. These actions may include the implementation of steadfast snack routines and meals times in addition to selective availability of foods at home.
Socioeconomics and other factors
“At a broader level, caregivers who are living in poverty or in under-resourced circumstances may face unique challenges to implementing recommended feeding practices,” the committee wrote. “Income and socioeconomic status can influence feeding practices through many interrelated and complex pathways, including the relatively limited access to relatively more expensive healthy foods for many poor families, especially when such foods require time, expertise, and facilities to prepare and store.”
Moreover, feeding behaviors may be behest to the child’s temperament in addition to the caregiver’s mental health. When fear of judgment based on ideal child eating behaviors is addressed, caregivers may foster a better feeding relationship between themselves and the offspring, according to the statement.
“Recognizing the difficulties inherent with implementing change in the feeding environment, we encourage policies that address barriers within the wider socioeconomic context, including the social determinants of health, alongside individual caregiver efforts in child obesity prevention,” the committee wrote. “Although efforts that encourage caregivers to provide a responsive, structured feeding environment could be an important component of reducing obesity and cardiometabolic risk across the life span, it is likely they will be most effective as part of a multilevel, multicomponent prevention strategy.” – by Scott Buzby
Disclosures: Wood reports she received grant support from the American Academy of Pediatrics, Baylor College of Medicine, the NIH, the Sabra Dipping Company, Unilever and the USDA. Please see the study for all other authors’ relevant financial disclosures.
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