November Journal Club

Childhood obesity has been a major health concern for many years, and prevention is a key part of combating this problem. Most school-based childhood obesity prevention programs have focused on school-age children and adolescents and have shown little success in preventing obesity (Birch & Ventura, 2009). By the time children reach school age, 20% are at risk of overweight or are already overweight, which suggests a need for obesity prevention interventions in early childhood (Birch & Ventura, 2009). It is suggested that these early interventions should consider an ecological framework that focuses heavily on parents, family members in the home, and childcare providers (Birch & Ventura, 2009). Parents and other caregivers, including childcare providers, have immense influence on forming and developing children’s relationship with food and their eating behaviors. For these reasons, education for these key influencers of young children is needed. The types of foods offered to children are as important as the mealtime practices that accompany the foods.

The use of controlling feeding practices (CFP) and their effects on children have been studied in many different ways. CFP may include pressuring children to eat, using food as a reward, or praising children for cleaning their plates. Research has indicated that the use of CFP on young children may have negative effects on eating behaviors that may be long-lasting, and thus are not recommended for use by parents or childcare providers. One particular study of the effects of restricting children’s access to palatable foods indicated that restriction focuses children’s attention on the restricted foods and increases their desire to obtain and consume those foods (Fisher & Birch, 1999). Further, this study supports the notion that food restriction can sensitize children to external eating cues (in this case, focus on the restricted food), instead of learning to pay attention to internal hunger/satiety cues. Other specific CFP have been shown to have different negative outcomes. 

Evidence indicates that childcare providers often use CFP despite recommendations to avoid it (Dev, McBride, Speirs, Blitch, Williams, 2016). To better understand the determinants of childcare providers’ use of CFP, a qualitative study consisting of individual, face-to-face, semi-structured interviews was conducted on 18 full-time childcare providers from numerous care contexts (Dev, McBride, Speirs, Blitch, Williams, 2016). The study participants were interviewed about their feeding practices and beliefs about their feeding practices they use with the children ages 2-5 that they are responsible for feeding meals and snacks to during the day. The researchers analyzed the content from the interviews and determined trends in responses. Barriers to avoiding using CFP, motivators to avoiding using CFP, and facilitators that promoted ability to avoid CFP were identified. Primary barriers identified were that providers’ believed that CFP work to get children to eat, providers held misconceptions about CFP, and providers felt a fear of negative parental response if their children did not eat while at childcare. Motivators identified were that CFP are ineffective in getting children to eat, the belief that children can regulate their own energy intake, and beliefs that CFP are associated with negative outcomes for children’s eating habits and weight. The main facilitators identified were providers using healthful feeding practices instead of CFP, providers adhering to policies that restrict use of CFP, and training providers received about CFP. Identification and developing an understanding of the determinants behind CFP use by childcare providers led to the researchers concluding with recommendations of topics to emphasize in future education for childcare providers.

Overall, the results from these studies show that childhood obesity is a health concern, early childhood obesity prevention interventions are needed, and interventions need to focus on education for parents and childcare providers. Further, in terms of childcare provider training and education, understanding the determinants of CFP use by providers will shape upcoming training strategies. The study indicated that understanding what CFP is, how it may affect children’s eating behaviors and weights, and learning how to overcome pressure to use CFP should be the focus of future childcare provider education. Future research studies should then focus on exploring the impacts these improved training strategies have on children’s eating behaviors and food intake.

AND Continuing Education Article:

Dev, D.A., McBride, B.A., Speirs, K.E., Blitch, K.A., Williams, N.A. (2016). “Great job cleaning your plate Today!” Determinants of child-care providers’ use of controlling feeding practices: an exploratory examination. Journal of the Academy of Nutrition and Dietetics, 116(11), 1803-09.

Supplemental Article 1 (reference #1 in CEU article):

Birch, L.L., & Ventura, A.K. (2009). Preventing childhood obesity: What works? International Journal of Obesity, 33, S74-S81.

Supplement 1 web link: https://www.researchgate.net/publication/24353626_Preventing_childhood_obesity_What_works

Supplemental Article 2 (reference #27 in CEU article, reference #25 in supplemental article 1):

Fisher, J.O., & Birch, L.L. (1999). Restricting access to palatable foods affects children’s behavioral response, food selection, and intake. American Journal of Clinical Nutrition, 69, 1264-1272.

Supplement 2 web link: http://ajcn.nutrition.org/content/69/6/1264.full.pdf+html