Background Reducing consumption of food away from home (FAFH) is often targeted during pediatric obesity treatment given associations with weight status and gain. However, the effects of this dietary change on weight loss are unknown. Objective Evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment. It is hypothesized that reduced consumption of FAFH will be associated with improved dietary intake and greater reductions in anthropometric outcomes (standardized body mass index [zBMI] and percent body fat), and the relationship between FAFH and anthropometric outcomes will be mediated by improved child dietary intake. Design Longitudinal evaluation of associations between dietary changes and child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric data were collected at baseline and 16-weeks. Participants/setting 170 overweight and obese children ages 7–11 who completed 16-week family-based behavioral weight loss treatment (FBT) as part of a larger multi-site (MO and WA) randomized controlled trial (RCT) conducted in two cohorts between 2010–2011. Clinical research trial. Intervention Dietary treatment targets during FBT included improving diet quality and reducing FAFH. Main Outcome Measures Child relative weight (zBMI) and body composition (percent body fat) Statistical Analyses Performed T-tests, bootstrapped single mediation analyses adjusting for relevant covariates. Results As hypothesized, decreased FAFH was associated with improved diet quality and greater reductions in zBMI (Ps<0.05) and percent body fat (Ps<0.01). Associations between FAFH and anthropometric outcomes were mediated by changes in diet quality. Specifically, change in total energy intake and added sugars mediated the association between change in FAFH and zBMI, and change in overall diet quality, fiber, added sugars, and added fats mediated the association between change in FAFH and percent body fat. Including physical activity as a covariate did not significantly impact these findings. Conclusions These results suggest that reducing FAFH may be an important behavioral target for affecting positive changes in both diet quality and anthropometric outcomes during treatment.
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