Reduction in Food Away from Home Is Associated with Improved Child Relative Weight and Body Composition Outcomes and This Relation Is Mediated by Changes in Diet Quality

Abstract

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.

An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3–8

“…7 It has been shown that an intervention reducing the intake of food consumed away from home improved diet quality and body composition in overweight children. 32 Higher diet quality scores are independently associated with improved weight status in elementary schoolchildren, 33 and a recent meta-analysis showed that dietary patterns high in energy and fat and low in fiber are predictive of later obesity. 3 These studies suggest that it is reasonable to hypothesize that educational interventions that improve vegetable liking and intakeand lead to improved diet quality-may help students achieve a healthy BMI over time.…”

Decreasing food fussiness in children with obesity leads to greater weight loss in family‐based treatment

“…Finally, the mediation analysis in this study utilized nonexperimental data (i.e., mediators were not preselected and tested against a control), which may increase bias of the results . However, similar approaches are commonly used within the literature and serve to provide an initial test of causal models that can be confirmed with a follow‐up study designed specifically to address the challenges of mediation analysis.…”

“…In addition, this study examined baseline FF as a predictor of FBT response and, consequently, how changes in FF may contribute to child weight and diet change following treatment. Finally, given the link between dietary and weight change our data have previously indicated , an exploratory mediation analysis assessed changes in food group consumption and diet quality as a mediator of the relation between children's FF change and weight change.…”

Multidisciplinary care management has a positive effect on paediatric obesity and social and individual factors are associated with better outcomes

“…They also emphasise the need to raise parental awareness about the health risks associated with childhood overweight and obesity. Indeed, parents who are aware of these issues might be significantly more likely to get their children screened early, to improve their diet and to increase their physical activity than parents who are not aware .…”