Parenting Pre-Schoolers With Avid Appetites: Understanding Differential Susceptibility to Obesogenic Environments for Future Intervention Efficacy, 2021-2024

The APPETItE data comprises a multiple mixed methods approach, including an online survey of feeding practices and perceptions of child food approach behaviours, a qualitative study of parents’ experiences of feeding children with avid appetites, an ecological momentary assessment study to capture emotion and feeding practice across time and context, as well as a randomized controlled experiment to examine effects of feeding practice on child food intake. Types of data: Data generated were both quantitative and qualitative. New data were generated by a survey, interviews, ecological momentary analysis, experimental laboratory methods, and co-creation methods. All pre-registrations, data, data dictionaries and analysis code are openly available as soon as study papers are published at https://osf.io/r6789/<p>Childhood obesity is one of the most serious public health challenges of the 21st century, of major societal concern, placing children at high risk of diseases such as diabetes, cardiovascular disease and some cancers in adulthood. Typically, childhood obesity begins in infancy and early childhood, with 90% of children who have obesity at 3 years continuing to have overweight or obesity in adolescence. Understanding the factors which may help to prevent or reduce the risk of childhood obesity, and applying this understanding to develop effective interventions, is of key importance to solving this complex policy and practice challenge. It is well established that a healthy home environment is protective against the development of obesity. However, some children are more vulnerable to the development of obesity than others, due to their genetic susceptibility to an environment where highly palatable food is plentiful and accessible. Children's appetite and eating behaviours link this genetic risk and the development of obesity. Children's appetite avidity is manifest in their 'food approach' behaviours, which have considerable heritability. Food approach behaviours include wanting to eat (or eating more) in response to the sight, smell or taste of palatable food, greater enjoyment of food, rapid eating, weaker sensitivity to internal cues of 'fullness', as well as eating in response to emotion. Parental feeding practices are a key component of the child's food environment and have the potential to exacerbate or minimise these food approach behaviours across time. However, it can be very difficult for parents of children with high food approach to manage their eating behaviour effectively, and parents report feeling powerless, frustrated and desperate for solutions. Therefore, whilst feeding practices are key intervention targets to change children's eating behaviour and child weight outcomes, there has been little evaluation of how feeding practices interact with children's food approach behaviours to predict eating behaviour and weight gain across time, or how feeding practices can be best tailored for children with high food approach behaviours to protect against the development of obesity. In this project, we will undertake the longitudinal analyses and experimental studies which are needed to disentangle these effects. We will use a wide range of methodologies to answer the questions in this study, including behaviour genetics, longitudinal studies, experimental laboratory studies, qualitative methods, questionnaire measures, and measures which assess children's eating behaviours and parental feeding practices in varied settings in real time. We will use a combination of existing cohort data and collection of novel data from children and families where children show high levels of food approach. Working with parents of children high in food approach behaviours, we will then use the knowledge we generate in those studies to co-develop recommendations for the future design of an intervention focused on parent feeding practices for children with high food approach behaviour. We do not know what the best advice regarding feeding practice is for parents of children with avid appetites. In particular, we are lacking an evidence base for which feeding practices work best to protect such children from the development of overweight. Current public health advice regarding children's eating and weight is generic, ineffective, and does not tackle variability in children's appetite avidity, which makes behaviour change even more challenging for parents who struggle to manage their child's eating behaviour. Using current theory to inform complex intervention development, our research will examine how parents interact with their pre-school children with avid appetites in the food context, evaluate how these interactions predict short and long-term effects on obesogenic eating behaviour and develop recommendations for intervention.</p>APPETItE数据集采用多类混合研究方法，涵盖针对儿童食物趋近行为（food approach behaviours）的喂养行为与认知的在线调查、针对父母喂养食欲旺盛儿童的经历开展的质性研究、用于捕捉不同时间与情境下情绪及喂养行为的生态瞬时评估（ecological momentary assessment）研究，以及用于探究喂养策略对儿童食物摄入量影响的随机对照实验（randomized controlled experiment）。 数据类型：本项目生成的数据涵盖定量与定性两类。全新数据通过问卷调查、访谈、生态瞬时分析、实验室实验方法及协同创作方法（co-creation methods）采集得到。所有预注册信息、数据、数据字典及分析代码，均在研究论文发表后于https://osf.io/r6789/ 公开获取。 儿童肥胖是21世纪最严峻的公共卫生挑战之一，引发社会广泛关注，会使儿童在成年后罹患糖尿病、心血管疾病及部分癌症等疾病的风险显著升高。儿童肥胖通常始于婴儿期与幼儿早期，3岁时确诊肥胖的儿童中，有90%在青春期仍会存在超重或肥胖问题。厘清有助于预防或降低儿童肥胖风险的影响因素，并将相关认知转化为有效干预手段，是应对这一复杂政策与实践难题的核心要务。 现有研究已证实，健康的家庭环境可预防肥胖发生。但部分儿童因在高适口性食物充足易得的环境中存在遗传易感性，其肥胖发生风险高于其他儿童。儿童的食欲与进食行为是连接遗传风险与肥胖发生的关键纽带。儿童的食欲旺盛性体现在其食物趋近行为中，这类行为具有较高的遗传力。食物趋近行为包括：看到、闻到或尝到适口性食物时产生进食（或过量进食）欲望、对食物的愉悦感更强、进食速度更快、对内部饱腹感信号的敏感度更低，以及因情绪驱动进食。父母的喂养行为是儿童食物环境的核心组成部分，可能会随时间推移加剧或缓解儿童的这类食物趋近行为。然而，对于食物趋近行为水平较高的儿童的父母而言，有效管控孩子的进食行为往往极具挑战，家长常表示感到无力、沮丧且迫切寻求解决方案。因此，尽管喂养策略是改变儿童进食行为与体重结局的关键干预靶点，但目前针对“喂养策略如何与儿童食物趋近行为交互作用，以预测长期进食行为与体重增长”，以及“如何针对食物趋近行为水平较高的儿童优化喂养策略以预防肥胖发生”的相关研究仍较为匮乏。本项目将开展纵向分析与实验研究，以厘清上述关联。本研究将采用多类研究方法解答相关问题，包括行为遗传学（behaviour genetics）、纵向研究、实验室实验研究、质性研究方法、问卷调查量表，以及用于实时评估不同场景下儿童进食行为与父母喂养行为的测评工具。研究将结合现有队列数据与针对食物趋近行为水平较高的儿童及其家庭的全新数据采集工作。本研究将与食物趋近行为水平较高的儿童的父母合作，基于上述研究中获得的认知，协同开发针对食物趋近行为水平较高儿童的父母喂养行为干预方案的未来设计建议。 目前我们尚不明确，针对食欲旺盛儿童的父母而言，最佳的喂养建议是什么。尤为关键的是，目前缺乏能够证明哪些喂养策略可有效保护这类儿童免于超重的证据基础。当前针对儿童饮食与体重的公共卫生建议均为通用型建议，效果不佳，且未考虑儿童食欲旺盛性的个体差异，这使得那些难以管控孩子进食行为的父母更难实现行为改变。本研究将以现有理论为指导开展复杂干预方案的开发，探究父母与学龄前食欲旺盛儿童在食物场景中的互动模式，评估这些互动如何预测致胖性进食行为（obesogenic eating behaviour）的短期与长期影响，并据此开发干预建议。