This article organizes research on how to get kids to eat healthy food. It is organized by strategies, so that one can weigh the usefulness of each.
We begin with the most powerful strategies: parental modeling and controlling the food environment. Other strategies follow, such as encouragement, education, and sleep considerations.
Strategies that don’t work are also shared. Surprisingly, food restriction leads to increased rates of obesity over time.
Food availability and parental modeling are the most effective strategies for improving diet (meta-analysis)
Seventy eight studies met the inclusion criteria for a systematic review, while thirty seven articles contained requisite statistical information for meta-analysis. Results: Results indicate that availability (Healthy: r = .24; Unhealthy: r = .34) and parental modeling effects (Healthy: r = .32; Unhealthy: r = .35) show the strongest associations with both healthy and unhealthy food consumption. Active guidance (r = .15), availability (r = .24), modeling (r = .32), and verbal praise (r = .15) were significantly and positively correlated with child healthy food consumption. Restrictive guidance (r = −.11), and verbal praise (r = −.04) had small but significant negative correlations with child unhealthy food consumption. On the other hand, availability (r = .34), modelling (r = .35), pressure to eat (r = .04), and using food as reward (r = .14) were positively correlated with child unhealthy food consumption. In addition, the efficacy of some parenting practices might be dependent on the food consumption context and the age of the child. For children 7 and older, restrictive guidance/rule-making could be more effective in preventing unhealthy eating (r = – .20). For children 6 and younger, rewarding with verbal praise can be more effective in promoting healthy eating (r = .26) and in preventing unhealthy eating (r = – .08).
When parents eat veggies, kids eat veggies (review)
Parental modeling and parental intake were consistently and positively associated with children’s fruit and fruit, juice and vegetable consumption. There were also positive associations between home availability, family rules and parental encouragement and children’s fruit and vegetable consumption. Parental intake was positively associated with adolescents’ fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents’ fruit, juice and vegetable consumption. Conclusions: Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviors.
Modeling a healthy diet works better than dietary control (review)
A recent paper describes two primary aspects of control: restriction, which involves restricting children’s access to junk foods and restricting the total amount of food, and pressure, which involves pressuring children to eat healthy foods (usually fruits and vegetables) and pressuring to eat more in general. The results showed significant correlations between parent and child for reported nutritional behavior like food intake, eating motivations, and body dis- and satisfaction. In conclusion positive parental role model may be a better method for improving a child’s diet than attempts at dietary control.
Modeling > Taking fruits/veggies to school > Encouragement > Availability at home (n=1255)
The children’s consumption of fruit and of vegetables was influenced by the fruit consumption and vegetable consumption of their parents (r=0·333 and r=0·273, respectively), parents encouraging their children to eat fruit and vegetable (r=0·259 and r=0·271), giving children fruits and vegetables to take to school (r=0·338 and r=0·321) and the availability of fruits and vegetables at home (r=0·200 and r=0·296). Conclusions: Factors within the family environment such as parents’ dietary habits and fruit and vegetable availability had the greatest influence on the fruit and vegetable consumption by children.
Modeling and covert control affect both healthy and unhealthy food intake; negotiating increases healthy food intake (n=609, longitudinal)
Mother’s fruit and vegetable score was a significant positive independent predictor for children’s fruit and vegetable score at baseline and follow-up, whereas availability of unhealthy foods was significantly negatively associated with both scores. Negotiation was positively associated with children’s follow-up score of fruit and vegetable, while permissiveness was positively associated with children’s follow-up excess score. Availability of unhealthy foods and mother’s excess score were positively related to children’s excess score at baseline and follow-up. Conclusions: Parental intake and restricting the availability of unhealthy foods not only appeared to have a consistent impact on children’s and adolescents’ diets, but also negotiating and less permissive food-related parenting practices may improve adolescents’ diets.
Modeling, but not pressure, improved BMI in teens over time (n=100, longitudinal)
Adolescents who perceived that their parents engaged in a healthy diet and frequent physical activity (T1) self-reported a healthier diet (T2 and T3), higher levels of physical activity (T2 and T3), and their combined index of healthy lifestyle was higher (T2 and T3). In turn, adolescents’ behaviors (T2 and T3) were related to lower BMI (T3). Perceived behaviors of parents had a significant, indirect effect on a BMI reduction. There were no effects of the perceived parental verbal pressure (T1) through adolescents’ behaviors (T2) on adolescents’ BMI (T3). Conclusion: Perceived parental modeling of healthy diet and frequent physical activity, but not verbal pressure, predicted adolescents’ behaviors (diet, physical activity, and a combined lifestyle index) and, in turn, a reduction in their BMI.
Parent’s own diet, rather than parental control practices, predict future diet of young adults (n=92, longitudinal)
Parents completed baseline measures of parental control practices (overt control, covert control and pressure to eat), their own diet (unhealthy snacks, unhealthy meals, healthy foods) and eating behaviours (emotional, uncontrolled and restrained eating). At one year follow up, once their child had left home, the child completed measures of their own diet and eating behaviours. The results showed a clear role for modelling with concordance between a child’s intake of unhealthy snacks and emotional eating and their parents’ own reports of these behaviors. Furthermore, the child’s intake of healthy foods was also predicted by their parent’s behaviour although there was both concordance and discordance between parents and their children. No role for parental control was found for any measure of diet or eating behaviour. It is concluded that a parent’s own behaviour rather than parental control has a stronger longer lasting influence once a child has left home and that although this mostly involves a child copying their parent’s behaviour (action) at times it also involves the opposite (reaction).
Modeling works best; praise works for veggies; food rewards and permissiveness lead to poor eating (n=316)
Multiple logistic regression analyses revealed that mothers’ consumption was an independent predictor for all four outcome variables; verbal praise was a significant predictor for children’s vegetable consumption, permissiveness for regular consumption of soft drinks and sweets, and, using food as a reward for regular sweet consumption.
Modeling and encouraging kids to eat veggies, while covertly restricting junk food best for improving diet
Only 21% of children in the UK consume the recommended 5 portions of fruit or vegetables a day. This review examines the role of parenting style, feeding style and feeding practices in fruit and vegetable consumption in early childhood. Overall the evidence suggests that the context of an authoritative parenting and feeding style is associated with better fruit and vegetable consumption in the childhood years. This context is typified by emotional warmth but high expectations for children’s dietary adequacy and behaviour, accompanied by specific feeding practices such as modeling consumption of fruit and vegetables, making fruit and vegetables available within the home, covertly restricting unhealthy alternative snack foods, and encouraging children to try fruit and vegetables.
Covert control superior to overt control on fruit intake and BMI over time (n=1275)
Instrumental Feeding (using food as a reward) and Emotional Feeding were negatively related to child fruit intake one year later and positively to (changes in) child energy-dense snack intake. Encouragement was negatively related to child energy-dense snacking and sugar sweetened beverage intake one year later. Overt Control was cross-sectionally and prospectively related to (changes in) child energy-dense snacking and sugar sweetened beverage intake in a negative direction. Covert Control showed similar associations with child energy-dense snacking and sugar sweetened beverage intake as Overt Control. Although Covert Control was also positively related to child fruit intake and (changes in) child BMI Z-score, bootstrapping analyses revealed only a differential effect of Overt Control and Covert Control on child BMI Z-score one year later, with Covert Control displaying a stronger, positive association.
More covert control and less restriction leads to healthier snack intake (n=611)
Participants were 611 mothers of children aged 2-7 years who completed an online questionnaire containing measures of general parenting domains and two particular feeding strategies, restriction and covert control. It was found that greater unhealthy snack intake was associated with higher restriction and lower covert control, while greater healthy snack intake was associated with lower restriction and higher covert control. Further, the feeding strategies mediated the association between parental demandingness and responsiveness and child snack intake. These findings provide evidence for the differential impact of controlling and positive parental feeding strategies on young children’s snack intake in the context of general parenting.
Covert strategies improve diet over 3 years; restrictive strategies backfire (n=252)
Participants were 252 mothers of children aged 3-11 years old who completed questionnaire measures of parent feeding strategies (Restriction and Covert Control) and reported on their child’s healthy and unhealthy snack intake at two time points separated by three years. Longitudinal regression models showed no prediction of healthy snack food intake. However, Time 1 parental restrictive feeding predicted greater unhealthy snack intake at Time 2, while Time 1 covert feeding strategies predicted lower unhealthy snack intake at Time 2. Structural equation modeling showed that these associations were independent of known covariates that influence children’s snack intake (child and parent weight, education level and SES). The results provide longitudinal evidence for the negative impact of restrictive parent feeding strategies on children’s snack intake and highlight the importance of dissuading parents from using this type of feeding control. Instead, parents should be encouraged to use more covert feeding strategies that are associated with less unhealthy snack intake over the longer term.
Increasing covert control leads to better diet quality over time (n=228)
Complete data at both time points were available for 228 mother-child pairs. Mothers who increased their use of overt control had children whose level of food neophobia also increased. Mothers who used more covert control had children with better quality diets at both time points and mothers who increased their use of covert control over the two year follow-up had children whose diet quality improved. These associations were independent of confounders such as mother’s level of education. Supporting parents to adopt more covert techniques to control their children’s eating habits may be an effective way of improving the quality of young children’s diets.
Food availability in the home influences child’s intake
The most consistent findings across studies include the following. Father’s BMI was positively correlated with child’s BMI, father’s dietary intake was predictive of child’s dietary intake, food availability in the home influenced child intake, father’s food parenting style predicted their children’s eating behaviors and congruent parenting by mothers and fathers produced the best child food choices.
Limiting purchases of snack foods and access to candy/cookies/chips (but not all snacks) leads to healthiest eating behavior
Profile analysis of maternal feeding practices showed 4 feeding profiles based on maternal use of limit-setting practices and keeping snacks out of girls’ physical reach, a restrictive practice: Unlimited Access to Snacks, Sets Limits+Does Not Restrict Snacks (limiting how often they purchased the snack foods, and once in the home, when access was given and how much was offered), Sets Limits+Restricts High Fat/Sugar Snacks (limits+keeping chocolate, fruit-flavored chewy candies, cookies, and chips out of reach), and Sets Limits+Restricts All Snacks (limits+keeping popcorn and pretzels out of reach). Girls whose mothers used Sets Limits+Restricts All Snacks had a higher approach and eating in the absence of hunger at 5 y. Low inhibitory control girls whose mothers used Sets Limits+Restricts All Snacks or Unlimited Access to Snacks had greater increases in eating in the absence of hunger and body mass index (BMI) from 5 to 7 y. Conclusions: Girls with low inhibitory control were more susceptible to the negative effects of low and high control.
Smaller portion sizes are associated with lower obesity rates (n=217)
For a range of main meals, parents estimated their child’s ‘ideal’ and ‘maximum tolerated’ portions. Children completed the same tasks. Results: An association was found between parents’ beliefs about their child’s ideal and maximum tolerated portions, and their child’s BMI. By contrast, children’s self-reported ideal and maximum tolerated portions did not predict their BMI. With increasing child BMI, parents’ estimations aligned more closely with their child’s own selected portions. Conclusions: Our findings suggest that when a parent selects a smaller portion for their child than their child self-selects, then the child is less likely to be obese.
Using food rewards leads to overeating; meal timing and covert restriction reduces overeating (n=207)
Mothers (N = 207) reported their own feeding practices and child eating behaviors using validated questionnaires at child ages 2, 3.7, and 5 years. Results: Maternal feeding practices (higher reward for behavior and lower covert restriction) were prospectively associated with tendency to overeat. Conversely, increased good self-regulation in eating was primarily prospectively associated with mothers’ feeding practices (increased structured meal timing, overt and covert restriction). The only exception was the child eating the same meal as the family, which was prospectively negatively associated with good self-regulation in eating.
Taste exposure and nutrition education helps kids eat healthy food (meta-analysis)
12 randomized trials were analyzed. Results: Nutrition education interventions resulted in a small but significant increase in fruit intake (Hedges’ g = 0.112). Taste exposure interventions led to a significant increase in vegetable intake, with a moderate effect (Hedges’ g = 0.438). Interventions involving daily or weekly sessions reported positive outcomes more frequently than those using monthly sessions.
Kids need up to 12 exposures to new foods; expecting kids to eat healthy foods but not coercing or bribing is best (review)
Laboratory studies using repeated exposure protocols indicate that the optimal number of required exposures is at least 5–6 exposures to a new food, and perhaps as many as 8–12 exposures. In general, parental feeding styles that are responsive to the child, use negotiation (but not coercion or bribery), make appropriate demands for mastery are associated with greater willingness to try vegetables, and greater intake of vegetables. Negative feeding practices that have been associated with lower vegetable intake include the use of contingencies [rewards of desired foods for eating less desired vegetables], pressure to eat, and catering to children’s demands for foods. The conditions that seem to promote child vegetable acceptance are consistency (in availability of vegetables with fewer unhealthful competing foods, structured mealtimes during which parents model vegetable consumption, and high expectations for consumption), flexibility (willingness to negotiate and provide choice), and responsiveness (warmth and encouragement, engagement, positive affect in the eating environment, and avoidance of pressuring or coercive strategies).
Repeat exposure, peer modeling, as well as serving a variety and large quantity of veggies boosts intake; pairing with dips and making fun shapes does not (review)
Repeated exposure is a well-supported method for increasing vegetable consumption in early childhood and may be enhanced with the inclusion of non-food rewards to incentivise tasting. Peer models appear particularly effective for increasing vegetable consumption. There is little evidence for the effectiveness of food adaptations (offering familiar and liked dips to children) for increasing general vegetable intake among this age group, although they show some promise with bitter vegetables. The authors found that presenting cucumber in a visually appealing way did not increase children’s consumption of the cucumber. Harnack et al. investigated whether serving vegetables 5 min before the rest of a meal could be an effective method for increasing vegetable consumption, but failed to find a significant effect of doing so. Serving a variety of vegetables was found to increase children’s consumption of vegetables. Choice was not a significant predictor of children’s consumption of vegetables. It was found that increasing the portion of soup served at the beginning of the meal increased children’s consumption of the soup, and so their intake of vegetables. Summary: This review suggests that practitioners may want to focus their advice to parents around strategies such as repeated exposure, as well as the potential benefits of modelling and incentivising tasting with non-food rewards.
Repeat exposure leads to more veggie intake; don’t try pairing veggies with dips (review)
30 articles and 44 intervention arms were identified for inclusion (n = 4017). The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. Conclusions: Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures.
Encouragement > modeling > fruit/vegetable accessibility > family meals for improving fruit and vegetable consumption (n=949)
Family meals, fruit/vegetable availability, fruit/vegetable accessibility, fruit/vegetable modeling, and encouragement to eat healthy foods were independently associated with higher fruit/vegetable intake. Of the 949 (34%) adolescents who reported infrequent family meals (≤2 days/wk), mean fruit/vegetable intake was 3.6 servings/day for those with high home fruit/vegetable availability vs 3.0 servings/day for those with low home fruit/vegetable availability. Similar differences in mean fruit/vegetable intake were found for high vs low fruit/vegetable accessibility (3.8), parental modeling (3.9), and parent encouragement for healthy eating (4.0). Adolescents who had high availability of fruit/vegetable but infrequent family meals consumed 3.6 mean servings of fruit/vegetable per day as compared to 3.0 mean servings of fruit/vegetable per day consumed by adolescents with frequent family meals but low availability of fruit/vegetable. Frequent family meals in addition to more favorable parenting practices were associated with the highest fruit/vegetable intakes.
10 year olds who were most encouraged to eat veggies ate the most veggies (n=8388)
Subjects: Grade 5 students (aged 10 and 11 years; n 8388) and their parent(s). Results: Most parents reported caring about healthy eating and encouraging their child to eat healthy foods at least quite a lot. Children whose parents who cared or encouraged ‘very much’ compared with ‘quite a lot’ were more likely have better diet quality and were less likely to be overweight. Children whose parents both cared and encouraged ‘very much’ compared with ‘quite a lot’ scored an average of 2·06 points higher on the diet quality index. Conclusions: Health promotion strategies that aim for a high level of parental interest and encouragement of their children to eat healthy foods may improve diet quality and prevent overweight among children.
Encouragement through negotiation works; pressure and permissiveness backfire
General parenting style did not show any significant impact on dietary habits. In contrast, the food-related parenting practice “encouragement through negotiation” showed a significant positive impact, whereas “pressure,” “catering on demand,” and “permissiveness” were practices with an unhealthy impact. Conclusion: Nutrition education programs that guide parents in firm but not coercive food parenting skills are likely to have a positive impact upon children’s dietary habits.
Modeling works; telling a kid to eat fruits and veggies backfires (n=702)
An exclusive focus on social determinants indicated that parental modeling and peer influence had significant and positive relationships with children’s fruit and vegetable intake, whereas verbal directives to eat fruit and vegetable exhibited a significant and negative relationship. In combination, the following personal and social determinants were demonstrated to be significant: knowledge of different types of fruits and vegetables and parental modeling, all of which had positive relationships, and verbal directives to eat fruits and vegetables, which had a negative impact. The results are shown by our analysis to be of equal importance.
When families begin to encourage veggie intake, kids eat more veggies (n=175)
Children (n = 175; BMI percentile ≥85th; ages 7-11) and a participating parent completed 4 months of family-based behavioral weight-loss treatment. Parents learned social support-related strategies (i.e., praise and modeling of healthy eating). Results: Family encouragement for healthy eating increased during weight-loss treatment, and this increase was related to increases in child healthy vegetable intake and overall diet quality, as well as decreases in refined grains consumed. Low pre-weight-loss treatment family encouragement predicted greater increases in healthy vegetable intake, greater weight reduction, and greater increases in family encouragement for healthy eating. Family discouragement for healthy eating did not change during treatment nor did it predict dietary or weight outcomes.
Tangible rewards increase vegetable intake more than praise (n=173, controlled)
In this randomized controlled trial, families with children aged 3-4 y (n = 173) were randomly assigned to exposure + tangible reward (sticker), exposure + social reward (praise), or no-treatment control conditions after a pretest assessment in which a target vegetable was selected for each child. In the intervention groups, parents offered their children 12 daily tastes of the vegetable, giving either praise or a sticker for tasting. No specific advice was given to the control group. Results: Children who received exposure + tangible rewards increased their intake and liking of their target vegetable significantly more than did children in the control group. Differences were maintained at the 3-mo follow-up. Increases in intake and liking in the exposure + social reward group were not significantly different from the control group.
Stickers and praise increase veggie intake (n=137, controlled)
Intervention groups were given 12 daily tastes of a target vegetable combined with no reward, a tangible reward, (sticker) or a verbal reward (praise). A no-treatment control group received no tastings. Liking and intake of a target vegetable were measured at baseline and post-intervention. Results: Children in all intervention groups increased liking compared to controls and both reward groups increased intake compared to controls. However, in the nonrewarded exposure group, only children with a limited experience with food rewards increased consumption. Conclusions: Experience of food rewards may limit the benefits of ‘mere exposure’. However, exposure with nonfood rewards can increase the acceptance of vegetables, regardless of previous experience.
Modeling superior to prompting; prompting works best for non-picky eaters (n=120, controlled)
A total of 120 caregiver-child dyads participated in this study. Dyads were allocated to one of the following three conditions: physical prompting but no modelling, physical prompting and modelling or a modeling only control condition. Dyads ate a standardized meal containing a portion of a fruit new to the child. Physical prompting but no modeling resulted in greater physical refusal of the new fruit. Food responsiveness interacted with condition such that children who were more food responsive had greater new fruit acceptance in the prompting and modeling conditions in comparison with the modeling only condition. In contrast, children with low food responsiveness had greater acceptance in the modelling control condition than in the prompting but no modelling condition. Physical prompting in the absence of modelling is likely to be detrimental to new fruit acceptance. Parental use of physical prompting strategies, in combination with modelling of new fruit intake, may facilitate acceptance of new fruit, but only in food-responsive children. Modelling consumption best promotes acceptance in children with low food responsiveness.
Modeling is better, but prompting works and reasoning prompts work best (n=60)
Parents made, on average, 48 prompts for their children to eat more during the main meals in a typical day, mostly of the neutral type. Authoritarian parents made the most prompts, and used pressure the most often. In the novel food situation, it took an average of 2.5 prompts before the child tasted the new food. The most immediately successful prompt for regular meals across food types was modeling. There was a trend for using another food as a reward to work less well than a neutral prompt for encouraging children to try a novel fruit or vegetable. More frequent prompts to eat fruits and vegetables during typical meals were associated with higher overall intake of these food groups. More prompts for children to try a novel vegetable was associated with higher overall vegetable intake, but this pattern was not seen for fruits, suggesting that vegetable variety may be more strongly associated with intake. Children who ate the most vegetables had parents who used more “reasoning” prompts, which may have become an internalized motivation to eat these foods, but this needs to be tested explicitly using longer-term longitudinal studies.
Encouragement backfires when it verges on controlling (n=60)
Sixty families with toddlers (12-36months-old) video recorded their children’s dinners at home as well as a separate meal in which they offered the child a novel fruit or vegetable. Parents completed questionnaires about their feeding practices and children’s picky eating and food neophobia. In regression models, more observed coercive-controlling prompts used by parents were associated with more food refusals by children. Parents of pickier eaters tended to use a lower proportion of autonomy-supportive prompts to eat, and these families also showed a stronger association between the use of controlling prompts and food refusals. These families may benefit the most from interventions aiming to reduce the use of controlling practices.
Restricting unhealthy foods increases children’s desire to obtain and consume them
Restricting children’s access to palatable foods may appeal to parents as a straightforward means of promoting moderate intakes of foods high in fat and sugar; however, restricting access to palatable foods may have unintended effects on children’s eating. Objective: Two experiments were conducted to test the hypothesis that restricting access to a palatable food enhances children’s subsequent behavioral responses to, selection of, and intake of that restricted food. Results: In both experiments, restricting access to a palatable food increased children’s behavioral response to that food. Experiment 2 showed that restricting access increased children’s subsequent selection and intake of that food within the restricted context. Conclusions: Restricting access focuses children’s attention on restricted foods, while increasing their desire to obtain and consume those foods. Restricting children’s access to palatable foods is not an effective means of promoting moderate intake of palatable foods and may encourage the intake of foods that should be limited in the diet.
Food restriction promotes future overeating (n=197, longitudinal)
Longitudinal data were used to create a study design featuring 2 maternal restriction factors (low and high), 2 weight-status factors (nonoverweight and overweight), and 3 time factors (ages 5, 7, and 9 y). Results: Mean eating in the absence of hunger increased significantly from 5 to 9 y of age. Higher levels of restriction at 5 y of age predicted higher eating in the absence of hunger at 7 y of age and at 9 y of age. Girls who were already overweight at 5 y of age and who received higher levels of restriction had the highest eating in the absence of hunger scores at 9 y of age and the greatest increases in eating in the absence of hunger from 5 to 9 y of age. Conclusions: These longitudinal data provide evidence that maternal restriction can promote overeating. Girls who are already overweight at 5 y of age may be genetically predisposed to be especially responsive to environmental cues.
Food restriction promotes future overeating, even after controlling for current BMI and eating behavior (n=192, longitudinal)
The participants were 192 girls and their parents, assessed when the girls were 5 and 7 y of age. The girls’ eating when exposed to palatable foods in the absence of hunger was measured after they consumed a standard lunch and indicated that they were no longer hungry. Results: The girls who ate large amounts of snack foods in the absence of hunger at 5 and 7 y of age were 4.6 times as likely to be overweight at both ages. Parents’ reports of restricting their daughter’s access to foods at age 5 y predicted girls’ eating in the absence of hunger at age 7 y, even when the girls’ weight status and eating in the absence of hunger at age 5 y were controlled for. Conclusions: These findings are consistent with previous work indicating that parents’ restrictive feeding practices may contribute to this behavior.
Food restriction is associated with higher child BMI (review)
Responsive feeding is characterized by caregiver guidance and recognition of the child’s cues of hunger and satiety. Nonresponsive feeding is dominated by a lack of reciprocity between the parent and child, with the caregiver taking excessive control of the feeding situation (forcing/pressuring or restricting food intake), the child completely controlling the feeding situation (indulgent feeding), or the caregiver being completely uninvolved during meals (uninvolved feeding). Although reports on the relationships between responsive feeding and child weight status in high-income counties have been inconsistent, the most consistent finding has been a positive association between nonresponsive feeding (i.e. restriction) and child weight status.
Food restriction and less praise leads to higher obesity in only children (n=274)
The objective of this study was to examine maternal feeding and child eating behaviors as underlying processes for increased weight status of only children and youngest siblings. Participants included 274 low-income 4-8 year old children and their mothers. The association between only child status and greater likelihood of overweight/obesity was fully mediated by higher maternal Verbal Discouragement to eat (forbidding, scolding, refusing, and making negative statements about, or verbally limiting the child from eating the food) and lower maternal Praise (saying something positive about the child or the food). The association between youngest sibling status and greater likelihood of overweight/obesity was partially mediated by lower maternal Praise and lower child Food Fussiness (willingness of the child to eat different types of foods and novel foods). Results provide support for our hypothesis that maternal control and support and child food acceptance are underlying pathways for the association between birth order and weight status.
Monitoring food intake leads to reduced BMI, food restriction leads to increased BMI (n=57, longitudinal)
Participants were 57 families enrolled in an Infant Growth Study of children born at high risk or low risk for obesity, on the basis of maternal prepregnancy overweight or leanness. Children were evaluated for weight and height at 3, 5, and 7 years of age. Results: With respect to feeding attitudes, perceived responsibility at age 5 predicted reduced child BMI at age 7 among low-risk families. With respect to feeding styles, monitoring predicted reduced child BMI at age 7 among low-risk children. In contrast, restriction predicted higher BMI and pressure to eat predicted reduced BMI among high-risk children. These associations remained significant after controlling for child weight status at age 3. Conclusions: Among children predisposed to obesity, elevated child weight appears to elicit restrictive feeding practices, which in turn may produce additional weight gain.
BMI is lower in children whose fathers pressure them to eat than those whose food is restricted (n=174)
We examined the associations between fathers’ feeding practices and child weight status, conditional on mothers’ feeding practices, within 174 Mexican American families with children aged 8-10 years. Parents completed the Parental Feeding Practices Questionnaire, which consists of four subscales: positive involvement in child eating, pressure to eat, use of food to control behavior, and restriction of amount of food. Fathers’ pressure to eat and use of food to control behavior were associated with lower child BMI, and restriction of amount of food was associated with higher child BMI, after accounting for mothers’ feeding practices. Fathers’ positive involvement in child eating was not associated with child BMI.
Parental restriction may only increase BMI in those with obesity gene (n=356)
Parental restriction was positively associated with child BMI-percentile only among children with two copies of the high-risk FTO allele, where each one-point increase in parental restriction was associated with a 14.7 increase in the child’s BMI-percentile. Conclusion: For only the children with two high-risk alleles, parental restriction was positively associated with child BMI-percentile.
Parental encouragement to diet predicts poorer weight outcomes (longitudinal)
Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children’s weight status did not predict child weight status 5 years later. Conclusions: Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet.
Kids with higher BMI’s are more discouraged from eating (n=109)
Regarding discouragement prompts, child body mass index (BMI) was significantly associated with a greater rate of total discouragements, nonverbal discouragements and temporary (delay) discouragements. Child percent body fat was associated with greater nonverbal discouragements. Conclusions: Heavier children received greater maternal discouragements to eat.
The preschool-aged children of authoritarian feeders eat the most fruits and veggies, least junk food
Most parents had feeding styles categorized as authoritarian (30.6%) or indulgent (33.3%). Compared to authoritarian feeders, those with uninvolved or with indulgent feeding styles had children who consumed evening foods with a higher energy density. Preschool children of indulgent or uninvolved parents had lower evening intakes of fruits and vegetables compared to those whose parents had authoritarian feeding styles as well as the lowest intakes of dairy foods, respectively. The average evening intakes of children of authoritative parents were between those of children with authoritarian and permissive (indulgent or uninvolved) feeding styles. Only for grains, did the children of authoritative parents have evening intakes lower than that of authoritarian parents.
Only in parents with high BMI does limit-setting reduce teen BMI (n=134)
This study examined the interaction between parental limit setting of sedentary behaviors and health factors on standardized body mass index in African American adolescents. RESULTS: The model for parent BMI and fruit and vegetable intake accounted for 31% of the variance in adolescent BMI. A significant interaction for parent BMI by limit setting showed that as parental BMI increased, higher limit setting was associated with lower adolescent BMI. Higher parent fruit and vegetable consumption was associated with lower adolescent BMI.
Teaching kids about healthy foods, improving nutritional quality of food supply, increasing physical activity, and reducing screen time effective strategies for obesity prevention (Cochrane review)
We found strong evidence to support beneficial effects of child obesity prevention programs on BMI, particularly for programs targeted to children aged six to 12 years. Our synthesis indicates the following to be promising policies and strategies: · school curriculum that includes healthy eating, physical activity and body image · increased sessions for physical activity and the development of fundamental movement skills throughout the school week · improvements in nutritional quality of the food supply in schools · environments and cultural practices that support children eating healthier foods and being active throughout each day · parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities.
Educating kids about health and nutrition leads to healthier BMI (meta-analysis)
The effect sizes were -0.19 and -0.28 kg/m2 for prevention and treatment interventions, with sustained effect sizes of -0.21 and -0.23 kg/m2, respectively. School-based or prevention interventions with active parental involvement did not yield better outcomes. Interventions targeting parents with parenting skill training and behavioral change strategies, and children with general health and nutrition education, resulted in greater effects.
Educating kids on health and growth, but not weight, helps prevent obesity (review)
This paper canvasses existing literature and intervention program data to make the following recommendations for effective childhood obesity prevention: Programs should be educative for both children and their parents, programs should be inclusive of the whole family, there should be a focus on health and growth, not weight, and parents, schools and children should all be involved.
Just looking at pictures of veggies in books may increase consumption (review)
Given that successful taste exposure programmes often enhance children’s familiarity with a food’s appearance, as well as its taste, this article reviews the potential for exposure interventions that do not require repeated tastings to bring about positive attitude changes towards healthy foods. Recent evidence from studies that expose toddlers to picture books about fruit and vegetables suggest that familiarity with the origins and appearance of unfamiliar foods might increase children’s willingness to accept these into their diets.
Preschoolers who recognize foods as healthy/unhealthy are more likely to make a healthy choice (n=235)
While controlling for child characteristics and cognitive functioning, preschoolers who were better at categorizing food as healthy or unhealthy were more likely to say they would choose the healthy food. Low-contrast food pairs in which food had to be classified based on multiple dimensions were outside the cognitive abilities of the preschoolers. Conclusions and implications: Nutrition interventions may be more effective in helping children make healthy food choices if developmental limitations in preschoolers’ abilities to categorize food is addressed in their curriculum.
Knowledge of negative food attributes reduces intake in adults (meta-analysis)
A total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6%, total fat by 10.6%, and other unhealthy dietary options by 13.0%, while increasing vegetable consumption by 13.5%. Evaluating industry responses, labeling decreased product contents of sodium by 8.9% and artificial trans fat by 64.3%. Evidence for publication bias was not identified. Conclusions: Food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.
Family meals improve diet quality and BMI (meta-analysis)
This systematic review and meta-analysis of 57 studies (203,706 participants) examines the relationship between family meal frequency and various nutritional health outcomes. Separate meta-analyses revealed significant associations between higher family meal frequency and better overall diet quality, more healthy diet, less unhealthy diet and lower body mass index, BMI. Child’s age, country, number of family members present at meals and meal type (i.e. breakfast, lunch or dinner) did not moderate the relationship of meal frequency with healthy diet, unhealthy diet or BMI. Socioeconomic status only moderated the relationship with BMI.
Family meals during adolescence have lasting positive influence on eating (n=1710, longitudinal)
Family meal frequency during adolescence predicted higher intakes of fruit, vegetables, dark-green and orange vegetables, and key nutrients and lower intakes of soft drinks during young adulthood. Frequency of family meals also predicted more breakfast meals in females and for both sexes predicted more frequent dinner meals, higher priority for meal structure, and higher priority for social eating. Conclusions: Family meals during adolescence may have a lasting positive influence on dietary quality and meal patterns in young adulthood.
Family dinners reduce the odds of future obesity (n=5014, longitudinal)
A sample of 5014 respondents between 12 and 15 years of age was used. Results: In 1997, the frequency of family dinner distribution was as follows: 0, 8.3%; 1 or 2, 7.3%; 3 or 4, 13.4%; 5 or 6, 28.1%; 7, 42%. Higher frequency of family dinner was associated with reduced odds of being overweight in 1997, reduced odds of becoming overweight, and increased odds of ceasing to be overweight by 2000.
Structured, family meals may help preschoolers self-regulate food intake (n=379)
Parents (n = 379) of preschool age children were mostly mothers (68.6%), Non-White (54.5%), and overweight/obese (50.1%). RESULTS: Results indicated that structure-related feeding practices (structured meal setting and family meal setting, but not structured meal timing) are associated with children’s heightened levels of self-regulation in eating. Models examining the relationship within children who were normal weight and overweight/obese indicated the following: a relationship between structured meal setting and heightened self-regulation in eating for normal-weight children and a relationship between family meal setting and heightened self-regulation in eating for overweight/obese children.
Involving kids in cooking meals
Kids who help cook dinner eat more veggies (review)
This literature review included 15 studies using a cross-sectional descriptive design, with two studies also including a longitudinal design. Data were self-reported (or parent-reported) using various surveys and/or interviews. Study findings supported positive associations between youth involvement in home meal preparation and improvement in overall dietary quality, increased consumption of fruits and vegetables, greater preference for vegetables, and higher self-efficacy for cooking and choosing healthy foods.
Kids who helped cook ate 76% more salad (n=47, controlled)
A between-subject experiment was conducted with 47 children aged 6 to 10 years. In condition 1 (n = 25), children prepared a lunch meal (pasta, breaded chicken, cauliflower, and salad) with the assistance of a parent. In condition 2 (n = 22), the meal was prepared by the parent alone. Independent samples t-tests were conducted to compare intake in the “child cooks” and “parent cooks” conditions. Children in the child cooks condition ate significantly more salad 41.7 g (76.1%), more chicken 21.8 g (27.0%), and more calories 84.6 kcal (24.4%) than children in the parent cooks condition. Between before cooking and directly after cooking the meal, children in the child cooks condition reported significantly increased feelings of valence (feeling positive) and dominance (feeling in control). This study confirms that involving children in meal preparation can increase vegetable intake.
Teens who help cook dinner have a healthier diet
Mothers (n = 1,875), stepmothers (n = 18), fathers (n = 977), stepfathers (n = 105), and adolescents (n = 2,108) participated in the study. Results: Adolescent involvement in food preparation for the family was significantly associated with several markers of better dietary quality and better eating patterns. In contrast, parent involvement in food preparation for the family was unrelated to adolescent dietary intake. Conclusions: Results suggest that involving adolescents in food preparation for the family is related to better adolescent dietary quality and eating patterns.
Gardening with kids
Gardening and cooking programs best for veggie intake; controlling strategies backfire (review)
A total of 120 experimental studies were identified and they are presented grouped within these 11 topics. In conclusion, controlling strategies for changing children’s eating behaviour in a positive direction appear to be counterproductive. Hands-on approaches such as gardening and cooking programs may encourage greater vegetable consumption and may have a larger effect compared to nutrition education. Providing children with free, accessible fruits and vegetables have been experimentally shown to positively affect long-term eating behaviour.
School gardens may not improve veggie intake (review)
Results from these trials provide little evidence that school gardening alone can improve children’s fruit and vegetable intake. In both trials, gardening levels increased across all groups from baseline to follow-up, with no statistically significant difference between groups in terms of improvement in gardening level. This lack of differentiation between groups is likely to have influenced the primary outcome. However, when the gardening intervention was implemented at the highest intensities there was a suggestion that it could improve children’s fruit and vegetable intake by a portion. Analysis of the baseline data showed that family support for fruit and vegetable intakes was associated with higher intakes of fruit and vegetables in children.
Sleep affects diet
Less sleep leads to unhealthy eating patterns (n=5777)
We found that shorter sleep duration, poorer sleep efficiency and later bedtimes were associated with unhealthy eating patterns in this sample of children. There is accumulating evidence showing that sleep has an influence on eating behaviors. Inadequate sleep habits have been reported to increase snacking, the number of meals eaten per day and the preference for energy-dense foods. Proposed mechanisms by which insufficient sleep may increase energy intake include: more time and opportunities for eating, psychological distress, greater sensitivity to food reward, disinhibited eating, more energy needed to sustain extended wakefulness and changes in appetite hormones.
Short sleep, irregular sleep and poor sleep habits all associated with poor diet (n=676)
Results: Sleep duration (hours per night) was negatively associated with energy density of the diet, added sugar and sugar-sweetened beverages. Furthermore, variability in sleep duration (10-min per night) was positively associated with sugar-sweetened beverages, independent of sleep duration, and sleep habits score was positively associated with energy density of the diet. All of these associations were independent of potential confounders (age, sex, pubertal status, height, weight, screen time, moderate-to-vigorous physical activity and parental education and ethnicity). Conclusion: Our study suggests that short sleep duration, high sleep duration variability and experiencing sleep problems are all associated with a poor, obesity-promoting diet in children.
Other factors to consider
Sitting around and watching TV leads to less veggies and more junk food (review)
Nineteen articles were included, all providing cross-sectional analysis. A significant relationship was found in all the studies, between television and/or total screen-time viewing and adverse dietary outcomes, including fewer fruits and vegetables, and greater consumption of unhealthy foods. In 15 studies, higher TV viewing and/or screen-time rates were associated with higher intake of cariogenic foods, like energy-dense snacks and sugar-sweetened beverages. Conclusions: There may be an association between sedentary behavior, particularly television viewing, and an unhealthy diet in young people involving increased intake of cariogenic foods.
Negotiating with kids to eat well and using praise linked to healthy BMI (review)
Associations between parenting style and child BMI were strongest and most consistent within the longitudinal studies. Uninvolved, indulgent or highly protective parenting was associated with higher child BMI, whereas authoritative parenting (parents negotiate with children to eat well using social praise) was associated with a healthy BMI. Similarly for feeding styles, indulgent feeding (parents permit their child freedom to eat when they wish and choose foods they prefer) was consistently associated with risk of obesity within cross-sectional studies. Where child traits were measured, the feeding practice appeared to be responsive to the child, therefore restriction was applied to children with a high BMI and pressure to eat applied to children with a lower BMI.
Focusing on healthy snack time leads to more healthy food intake in toddlers (n=201)
Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition, physical activity and behaviours, including guided active play and healthy snack time. Two hundred one parent-child dyads were randomized to intervention (n = 104) and control (n = 97). Baseline mean child age was 2.7 years. We found significant positive group effects for vegetable and snack food intake, and satiety responsiveness immediately post-intervention. At 12 months follow-up, intervention children exhibited less neophobia than controls.
Parenting style affects obesity risk
Parental inconsistency may be more important than other parenting traits in preventing childhood obesity (meta-analysis)
The objective of the meta-analysis is to integrate available results on associations of general parenting (not specific to feeding and activity promotion) and parent-child relations with child weight status, eating, and physical activity. METHODS: Searching in electronic databases and cross-referencing identified 156 empirical studies. Random-effects meta-analysis was computed. RESULTS: A positive parent-child relationship and higher levels of parental responsiveness were associated with lower weight, healthier eating, and more physical activity of the child. Parental demandingness, overprotection, psychological control, inconsistency, and parenting styles showed associations with some of the assessed outcome variables. Most effect sizes were small and varied by study characteristics. CONCLUSIONS: The small effects do not support making general parenting styles, parental demandingness, responsiveness, and the quality of the parent-child relationship a main target of preventing and treating obesity. Reducing parental inconsistency may be a better target if available results are replicated in future studies.
Adults with authoritarian parents are less likely to share their BMI or eating patterns (n=372)
A sample of young adults (N = 327) and their parents in the U.S. and in China were recruited and completed a series of questionnaires in two cycles RESULTS: Parents‘ BMIs and dietary behaviors were positively associated with those of their young adult children in the mixed-culture sample. At high levels of authoritarian and permissive parental authority, the relationships between young adults‘ and their parents‘ BMIs were negative for U.S. participants and positive for Chinese participants. Further, at high levels of authoritarian parenting, the relationship between young adults‘ and their parents‘ dietary consumption behaviors was negative for U.S. participants and positive for Chinese participants.
Demanding parenting style, rather than indulgent, associated with lower BMI in young children (n=124)
Latino parents of children between the ages of 2 and 8 (N = 124) completed a survey on parental feeding styles, acculturation, and demographics. RESULTS: Among respondents, 89% were mothers, 72% were overweight or obese, and 40% reported an indulgent feeding style. Children had a mean age of 59 months. A demanding parental feeding style was associated with lower child BMI.
Parental warmth increases odds of successfully lowering BMI by 28% (n=88)
Forty-four overweight parent-child dyads (child age 8 to 12 years) enrolled in a 16-week family-based behavioral weight control program. Children had a mean BMI change of -0.40; 75% of children had decreasing/stable BMI. In the multivariable model, only higher level of warmth was associated with increased odds of decreasing/stable child BMI (OR = 1.28). Conclusions: Baseline parental warmth may influence a child’s ability to lower/maintain BMI during a standard family-based behavioral weight control program. Efforts to increase parent displays of warmth and emotional support towards their overweight child may help to increase the likelihood of treatment success.
BMI may be mostly genetic
Parents’ BMI is strongly tied to childrens’ BMI, though less so as children age (longitudinal study)
Based on the China Health and Nutrition Survey longitudinal data from 1989 to 2009 and using BMI as the measure of adiposity, we estimate the intergenerational transmission of BMI in China. A one standard deviation increase in father’s or mother’s BMI is associated with an increase of around 20% in child’s BMI. These estimates decrease to around 14% when we control for family fixed effects. We also find this intergenerational correlation tends to be higher among children of higher BMI levels, though this tendency becomes weaker as children approach adulthood.
Can parents make a difference?
Child’s BMI has no relation to their parents’ food control strategy (n=518)
A cross-sectional survey of 518 parents with children aged 4-7 years was carried out. Measures included aspects of parental control practices and the child’s diet. Eating more unhealthy snacks was related to less covert control and more pressure to eat, eating fruit and vegetables was related to higher levels of both overt and covert control over meals and less pressure to eat and being neophobic was related to less covert control over meals and more pressure to eat. The children’s BMIs were unrelated to any variables measured in the study.
Veggie intake similar across 11 year olds regardless of parents’ feeding strategies (n=4,555)
Pupils and one of their parents completed questionnaires to measure fruit and vegetable intake, related social-environmental correlates and general parenting styles. The sample size was 4555. Parenting styles were divided into authoritative, authoritarian, indulgent and neglectful. RESULTS: No differences were found in fruit and vegetable intake intake across parenting styles and only very few significant differences in social-environmental correlates. The authoritarian (more parental encouragement and more demands to eat fruit) and the authoritative (more availability of fruit and vegetables) parenting styles resulted in more favourable correlates. CONCLUSION: Despite earlier studies suggesting that general parenting styles are associated with health behaviours in children, the present study suggests that this association is weak to non-existent for fruit and vegetable intake intakes in four different European countries.
Parent-based programs to reduce childhood obesity are as effective as those involving the children (n=300)
One hundred fifty children (mean BMI, 26.4; mean age, 10.4 years) and their parent were randomly assigned to either family-based weight loss treatment or parent-based treatment. Child weight loss after 6 months was -0.25 BMI z scores in both parent-based treatment and family-based weight loss treatment. Conclusions and relevance: Parent-based treatment was as effective on child weight loss and several secondary outcomes (parent weight loss, parent and child energy intake, and parent and child physical activity).
How many fruits and veggies are kids eating?
Kids in America eat .4 cups of fruit and .25 cups of veggies daily
Children in America age 2-18 consume, on average, 0.4 cups of fresh fruit daily and 0.25 cups of dark green, orange, red veggies and legumes, combined. The amount of whole fruit children ate increased 67% from 2003 to 2010 but remained low.
Kids in Germany eats around 2.5 servings of fruits and veggies daily, with younger kids consuming more than older (n=9950)
Via telephone interviews the average numbers of portions of fruits and vegetables consumed by 9,950 girls and boys aged 3-17 years were assessed. Results: Only 12.2 % of girls and 9.4 % of boys consume the recommended five portions of fruits and vegetables per day. 38.6 % of girls and 33.5 % of boys consume at least three portions per day. On average, girls consume 2.7 and boys 2.4 portions of fruits and vegetables per day. Younger participants consume significantly more portions of fruits than older participants. The percentage of persons consuming five or at least three portions per day increases significantly with higher socioeconomic status, higher parent’s educational level, and lower media consumption. Furthermore, children who conduct sport outside of school, those who are physically active every day consume significantly more portions of fruit and vegetables.
Fruit intake goes up during preschool years (n=500)
Intakes of total fruits, in particular fruit juice, increased with age. The contribution to total fruit intake was discrete fruits (47-56 % range across age), 100 % fruit juice, smoothies and pureés (32-45 %) as well as fruits in composite dishes (7-13 %). Total vegetable intake comprised of discrete vegetables (48-62 % range across age) and vegetables in composite dishes (38-52 %). Fruits and vegetables contributed on average 20 % (15 % fruit; 5 % vegetables) to the weight of the total diet and was <10 % in sixty-one children (12 %). Fruits and vegetables contributed 50 % of vitamin C, 53 % of carotene, 34 % of dietary fibre and 42 % of non-milk sugar intakes from the total diet.
Fruit intake declines after age 7, vegetable intake doesn’t change (n=2131)
The data consisted of 2131 observations of individuals aged 2-23 years. Fruit intake started to decrease from the age of 7 years for boys and girls, and reached its lowest level during adolescence. By 17 years, boys were consuming 0·93 less fruit portions compared with the age of 2 years. By 15 years, girls were consuming 0·8 fruit portions less. Vegetable intake changed little during childhood and adolescence. There was unclear evidence of recovery of fruit and vegetable intakes in early adulthood.
How genetic is BMI?
Body weight is 67% genetic
Data from the Virginia 30,000, including twins and their parents, siblings, spouses, and children, were analyzed using a structural equation model (Stealth) which estimates additive and dominance genetic variance, cultural transmission, assortative mating, nonparental shared environment, and special twin and MZ twin environmental variance. Genetic factors explained 67% of the variance in males and females, of which half is due to dominance. A small proportion of the genetic variance was attributed to the consequences of assortative mating. The remainder of the variance is accounted for by unique environmental factors, of which 7% is correlated across twins. These results are consistent with other studies in suggesting that genetic factors play a significant role in the causes of individual differences in relative body weight and human adiposity.