Research
Review
Family Environment and Pediatric Overweight: What Is a Parent to Do?

https://doi.org/10.1016/j.jada.2005.02.017Get rights and content

Abstract

Although the causes of pediatric overweight are many and the levels of intervention required to prevent overweight in children extend from the child’s immediate environment to the larger societal level, one critical intervention target is the parent. Scientific evidence points to specific dietary and physical activity/inactivity behaviors that families can adopt to encourage healthful weight status. Dietary recommendations include providing children with ample access to nutrient-dense foods and beverages and high-fiber foods, both at meals and snack times, reducing children’s access to high-calorie, nutrient-poor beverages and foods both when eating at home and at restaurants, avoiding excessive food restriction or use of food as a reward, and encouraging children to eat breakfast on a daily basis. Physical activity recommendations include providing opportunities and encouragement for children to be physically active while reducing children’s television and video game time. Parental modeling of healthful eating and physical activity practices is recommended to reinforce these patterns in youth. Dietetics professionals, physicians, and other health care professionals can assist parents in their efforts to prevent pediatric overweight by providing information and supporting these key behaviors, while working to create environments that support healthful lifestyle changes.

Section snippets

Focus of current research

Inherent problems of research design have sometimes made it difficult to determine the modifiable risk factors that predispose youth to overweight. Cross-sectional studies are limited by their inability to determine causal direction. For example, because excess body fat presents physical, social, and behavioral barriers that may limit participation in physical activities, children may become inactive as a result of their weight. Similarly, children who are overweight may make dietary

WHat is a parent to do? Parental reinforcement and restriction

Environmental conditions that promote energy intake and minimize energy expenditure have been major factors contributing to the increasing obesity epidemic (65). Because parents are responsible for the physical and social environments of young children, they are indisputably the first line of prevention for youth overweight. Research about parental reinforcement and restriction of food and physical activity has revealed that parents must walk a “fine line” when trying to promote healthful

Recommendations

The nature of society has changed considerably in the past 20 years, and these changes have dramatically influenced the ways in which people live, eat, and play. Children are now more likely to have single parents or two working parents, either or both of whom may have multiple jobs (75). Time constraints make it harder for parents to provide healthful snacks and meals at home. Studies have demonstrated that over the past 20 to 30 years, the percentage of meals and snacks eaten away from home

Role of health care professionals

Health care professionals have regular interactions with parents and children and, therefore, are in an ideal position to discuss measures that may decrease the likelihood of the development of obesity. Recent recommendations from the Institute of Medicine report on preventing pediatric obesity include specific health care recommendations, which are incorporated into the list that follows (86). It is important to note that even without evidence-based proof of efficacy, recommendations that have

Future directions

Families represent a crucial environmental influence in the development and maintenance of healthful eating and physical activity habits among children. Health care professionals should inform, encourage, and support parental efforts to promote healthful habits among all children and thereby prevent pediatric overweight. To this end, providers who work with families need to be aware of the key dietary, activity, and parenting behaviors that are most likely to be successful in preventing weight

L. D. Ritchie is an associate researcher, Center for Weight and Health, College of Natural Resources, University of California, Berkeley.

References (95)

  • D.C. Cusatis et al.

    Influences on adolescent eating behavior

    J Adolesc Health

    (1996)
  • S.W. McNutt et al.

    A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollmentThe NHLBI Growth and Health Study

    Adolesc Health

    (1997)
  • N. Butte et al.

    The start healthy feeding guidelines for infants and toddlers

    J Am Diet Assoc

    (2004)
  • A.M. Siega-Riz et al.

    Trends in breakfast consumption for children in the United States from 1965–1991

    Am J Clin Nutr

    (1998)
  • S. Kumanyika et al.

    Eating patterns of community-dwelling older adultsThe Cardiovascular Health Study

    Ann Epidemiol

    (1994)
  • P. Gordon-Larsen et al.

    Adolescent physical activity and inactivity vary by ethnicityThe National Longitudinal Study of Adolescent Health

    J Pediatr

    (1999)
  • E. Obarzanek et al.

    Energy intake and physical activity in relation to indexes of body fatThe National Heart, Lung, and Blood Institute Growth and Health Study

    Am J Clin Nutr

    (1994)
  • M.S. Treuth et al.

    Effects of familial predisposition to obesity on energy expenditure in multiethnic prepubertal girls

    Am J Clin Nutr

    (2000)
  • D.L.G. Borzekowski et al.

    The 30-second effectAn experiment revealing the impact of television commercials on food preferences of preschoolers

    J Am Diet Assoc

    (2001)
  • J. Stang et al.

    Parental feeding practices and risk of childhood overweight in girlsImplications for dietetics practice

    J Am Diet Assoc

    (2004)
  • J.O. Fisher et al.

    Eating in the absence of hunger and overweight in girls from 5 to 7 y of age

    Am J Clin Nutr

    (2002)
  • D. Spruijt-Metz et al.

    Relation between mothers’ child-feeding practices and children’s adiposity

    Am J Clin Nutr

    (2002)
  • L. Harnack et al.

    Temporal trends in energy intake in the United StatesAn ecologic perspective

    Am J Clin Nutr

    (2000)
  • J.F. Guthrie et al.

    Role of food prepared away from home in the American diet, 1977–78 versus 1994–96Changes and consequences

    J Nutr Educ Behav

    (2002)
  • P.B. Crawford et al.

    Counseling Latina mothers of preschool children about weight issuesSuggestions for a new framework

    J Am Diet Assoc

    (2004)
  • B.R. Carruth et al.

    The role of dietary calcium and other nutrients in moderating body fat in preschool children

    Int J Obes Relat Metab Disord

    (2001)
  • B.H. Lin et al.

    Higher fruit consumption linked with lower body mass index

    Food Rev

    (2002)
  • R.A. Forshee et al.

    Total beverage consumption and beverage choices among children and adolescents

    Int J Food Sci Nutr

    (2003)
  • M.B. Zemel et al.

    Regulation of adiposity by dietary calcium

    FASEB J

    (2000)
  • S. Arenz et al.

    Breast-feeding and childhood obesity—A systematic review

    Int J Obes

    (2004)
  • R. von Kries et al.

    Does breast-feeding protect against childhood obesity?

    Adv Exp Med Biol

    (2000)
  • D.S. Ludwig et al.

    Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults

    JAMA

    (1999)
  • D. Kromhout et al.

    Physical activity and dietary fiber determine population body fat levelsThe Seven Countries Study

    Int J Obes Relat Metab Disord

    (2001)
  • C.S. Berkey et al.

    Activity, dietary intake and weight changes in a longitudinal study of preadolescent and adolescent boys and girls

    Pediatrics

    (2000)
  • F. Rodriguez-Artalejo et al.

    Dietary patterns among children aged 6–7 y in four Spanish cities with widely differing cardiovascular mortality

    Eur J Clin Nutr

    (2002)
  • Obesity and Overweight

    (2003)
  • S. Gerrior et al.

    Milk and milk productsTheir importance in the American diet

    Food Review

    (1998)
  • C.S. Berkey et al.

    Sugar-added beverages and adolescent weight change

    Obes Res

    (2004)
  • R.P. Troiano et al.

    Energy and fat intakes of children and adolescents in the United StatesData from the national health and nutrition examination surveys

    Am J Clin Nutr

    (2000)
  • J. James et al.

    Preventing childhood obesity by reducing consumption of carbonated drinksCluster randomised controlled trial

    BMJ

    (2004)
  • O.M. Thompson et al.

    Food purchased away from home as a predictor of change in BMI z-score among girls

    Int J Obes Relat Metab Disord

    (2004)
  • C.B. Ebbeling et al.

    Compensation for energy intake from fast food among overweight and lean adolescents

    JAMA

    (2004)
  • J.G. Dausch et al.

    Correlates of high-fat/low-nutrient-dense snack consumption among adolescentsResults from two national health surveys

    Am J Health Promot

    (1995)
  • C.L. Rock Zoumas-Morse et al.

    Children’s patterns of macronutrient intake and associations with restaurant and home eating

    J Am Diet Assoc

    (2001)
  • S.A. Bowman et al.

    Effects of fast-food consumption on energy intake and diet quality among children in a national household survey

    Pediatrics

    (2004)
  • M.A. McCrory et al.

    Dietary variety within food groupsAssociation with energy intake and body fatness in men and women

    Am J Clin Nutr

    (1998)
  • M.A. McCrory et al.

    Dietary determinants of energy intake and weight regulation in healthy adults

    J Nutr

    (2000)
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    L. D. Ritchie is an associate researcher, Center for Weight and Health, College of Natural Resources, University of California, Berkeley.

    D. E. Gerstein is an associate specialist, Center for Weight and Health, College of Natural Resources, University of California, Berkeley.

    P. B. Crawford is codirector, Center for Weight and Health, College of Natural Resources, University of California, Berkeley. P. B. Crawford is also Cooperative Extension Nutrition Specialist and Lecturer, Department of Nutritional Sciences and Toxicology, University of California, Berkeley.

    G. Welk is an assistant professor, Department of Health and Human Performance, Iowa State University, Ames.

    D. Styne is Rumsey Chair of Pediatric Endocrinology, professor of Pediatrics, University of California, Davis, Sacramento.

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