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.

ObjectiveTo examine associations between modifications in parent feeding practices, child diet, and child weight status after treatment and to evaluate dietary mediators.Design and MethodsChildren classified as overweight or obese and 7-11 years old (N=170) completed a 16-session family-based behavioral treatment program (FBT). Anthropometrics (standardized body mass index (zBMI)), Child Feeding Questionnaire, and 24-hr dietary recalls were collected at baseline and post-FBT. Linear regression predicted child zBMI change. Single and multiple mediation tested child dietary modifications as mediators between change in parent feeding practices and child zBMI.ResultsRestrictive parent feeding practices significantly decreased during FBT. Reductions in parent restriction, child weight concern, child total energy intake, and percent energy from fat, and increases in parent perceived responsibility, and child percent energy from protein, predicted reductions in child zBMI. Change in child total energy intake mediated the relation between parent restriction and child zBMI change after accounting for covariates and additional dietary mediators.ConclusionsFBT is associated with a decrease in parental restriction, which is associated with reductions in child relative weight, which was mediated by a decrease in child energy intake. Teaching parents to reduce children's energy intake without being overly restrictive may improve child weight.

Objectives Food fussiness (FF), or the frequent rejection of both familiar and unfamiliar foods, is common among children and given its link to poor diet quality, may contribute to the onset and/or maintenance of childhood obesity. The current study examined child FF in association with anthropometric variables and diet in children with overweight/obesity participating in family-based behavioral weight loss treatment (FBT). Change in FF was assessed in relation to FBT outcome, including whether change in diet quality mediated the relation between change in FF and change in child weight. Methods Child (N=170; age=9.41 ± 1.23) height and weight were measured and parents completed FF questionnaires and three 24-hour recalls of child diet at baseline and post-treatment. Healthy Eating Index-2005 (HEI) scores were calculated. Results At baseline, child FF was related to lower vegetable intake. Average child FF decreased from start to end of FBT. Greater decreases in FF were associated with greater reductions in child zBMI and improved overall diet quality. Overall diet quality change through FBT mediated the relation between child FF change and zBMI change. Conclusions Children with high FF can benefit from FBT and addressing FF may be important in childhood obesity treatment to maximize weight outcomes.

Purpose Discussions about weight between medical professionals and young adults may increase risk of eating disorders (EDs). Clarifying the relation between screening for overweight and ED risk is needed. Methods 548 college-age women were classified as at-risk (n=441) or with an ED (n=107), and were assessed for disordered eating attitudes, behaviors, and relevant history, including, “Has a doctor, nurse, or other medical professional ever told you that you were overweight?” Regression analyses were used to evaluate the relations between being identified as overweight and current disordered eating behaviors, attitudes, and ED diagnosis, without and with covariates (history of weight-related teasing, history of an ED, family history of being identified as overweight, and current body mass index). Results 146 (26.6%) women reported being previously identified as overweight by a medical professional. There was no relation between being previously identified as overweight and having an ED. Those identified as overweight were more likely to have weight/shape concerns above a high-risk cutoff, but showed no difference in dietary restraint, binge eating, purging behaviors, or excessive exercise compared to those not identified. Conclusions Being previously identified as overweight by a medical professional was associated with increased weight/shape concerns but not with current disordered eating behaviors or ED status. Minimizing the potential negative effects of overweight screening on weight and shape concerns by providing patients with strategies to increase healthy lifestyle behaviors and long-term support for healthy weight loss goals may have a positive impact on reducing the public health problem of overweight and obesity.

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