Nutritional surveillance in the United States suggests that many children may be eating a less-than-healthy diet that fails to meet nutritional recommendations (Taylor, Evers, & Mc Kenna, 2005). They are eating too much sugar and saturated fat and too little fruit, vegetables, and milk products Lino, Basiotis, Gerrior, & Carlson, 2002; Enns, Mickle, & Goldman, 2003). Furthermore, the availability of processed foods has skyrocketed, portion sizes have increased, and children eat fewer meals at home with their families – all compounding children’s difficulty in eating healthful diets (Variyam & Smith, 2010). Unhealthful eating habits during childhood may interfere with optimal growth and development and set the stage for poor eating habits in later life (Taylor, Evers, & Mc Kenna, 2005). Unhealthful eating habits are inextricably linked to the current childhood overweight and obesity problem.
Childhood overweight and obesity prevalence rates have nearly doubled during the past three decades (Faith, Scanlon, Birch, & Sherry, 2004). According to the 2007-08 National Health and Nutrition Examination Survey, approximately 17% of children ages 2 to 19 years are obese (Centers for Disease Control and Prevention, 2010a). Overweight and obese children are at elevated risk for physical and psychological health problems including Type 2 diabetes, dyslipidemia, and hypertension, as well as negative self-esteem, stress, depression, and social discrimination (Centers for Disease Control and Prevention, 2010c; Dehghan, Akhtar-Danesh, & Merchant, 2005; Faith, et al., 2004; National Research Council Committee on Diet and Health, 1998; U.S. Department of Health and Human Services, 1988). These elevated risks are costly both for the individual and for society (Centers for Disease Control and Prevention, 2009; Lobstein, Baur, & Uauy, 2004).
Although the mechanisms of childhood overweight and obesity are not fully understood, researchers agree that they have multiple causes, including genetic and behavioral factors. Recent increases in prevalence, however, suggest that children’s environments play a larger role than thought in the past. Therefore, it is critical to identify environmental factors that can be positively modified for prevention or treatment. Some of the environmental factors implicated in overweight and obesity are the lack of safe outdoor spaces for physical activity, restricted access to affordable and healthful foods, poor institutional child care and school policies about food and physical activity, an unhealthful food environment at home, and inappropriate caregiver behavior and feeding practices (Centers for Disease Control and Prevention, 2010b). Given that children’s dietary practices evolve within the context of the family and home, the food environment at home and caregiver feeding practices are important and particularly mutable environmental factors (Faith, et al., 2004).
Studies suggest that interventions aimed at preventing childhood overweight and obesity should involve caregivers as forces for change in their childrens health (Barlow & Dietz, 1998; Lindsay, Sussner, Kim, & Gortmaker, 2006). The Expert Committee for Obesity Evaluation and Treatment identified caregivers’ food-related skills and behaviors as key components of successful interventions (Barlow & Dietz, 1998). Caregivers’ feeding attitudes and practices determine which foods children are offered and control the timing, size, and context of eating (Birch & Fisher, 1995; Birch, Fisher, Grimm-Thomas, Sawyer, & Johnson, 2001). Caregivers’ food preferences, eating behavior, and attitudes about food, along with the quantity and variety of foods in the home establish a food environment (Golan, Weizman, Apter, & Fainaru, 1998; Lindsay, et al., 2006). Additionally, caregivers’ feeding practices are related to children’s food preferences, consumption patterns and habits, and ability to self-regulate food intake – all of which may influence overweight or obesity (Birch & Fisher, 1995). Caregivers need to become educated so they can promote healthful nutrition for the family; making a lifestyle change in eating is a solid step toward improved lifelong health. Although much research has been done on how caregivers shape their children’s eating habits, far less research has examined the effectiveness of programs aimed at changing children’s behavior by improving caregivers’ behavior (Lindsay, et al., 2006). In one such study, Golan et al. (1998) found that children ages 6 to 11 achieved greater weight reduction when caregivers were the agents of change, compared with when children themselves were the agents of change (Golan, et al., 1998). This finding suggests that programs that target caregiver practices could be effective in improving children’s dietary practices in the short run and combating childhood overweight and obesity in the long run (Golan & Crow, 2004; Golan, et al., 1998). Feeding Your Kids is an example of such a program. It provides information and suggestions for feasible, simple ways caregivers can model healthful eating habits while nudging children toward more healthful nutrition. Studying the effectiveness of low-cost population-based strategies to prevent and reduce childhood obesity, such as Feeding Your Kids, should be a public health priority.
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