TY - JOUR A1 - Warschburger, Petra A1 - Kröller, Katja A1 - Haerting, Johannes A1 - Unverzagt, Susanne A1 - van Egmond-Fröhlich, Andreas T1 - Empowering Parents of Obese Children (EPOC): A randomized controlled trial on additional long-term weight effects of parent training JF - Appetite : multidisciplinary research on eating and drinking N2 - Although inpatient lifestyle treatment for obese children and adolescents can be highly effective in the short term, long-term results are unconvincing. One possible explanation might be that the treatment takes place far from parents' homes, limiting the possibility to incorporate the parents, who play a major role in establishing and maintaining a healthy lifestyle in childhood and adolescence. The main goal was to develop a brief behaviorally oriented parent training program that enhances ‘obesity-specific’ parenting skills in order to prevent relapse. We hypothesized that the inclusion of additional parent training would lead to an improved long-term weight course of obese children. Parents of obese children (n = 686; 7–13 years old) either participated in complementary cognitive-behavioral group sessions (n = 336) or received written information only (n = 350) during the inpatient stay. Children of both groups attended multidisciplinary inpatient rehabilitation. BMI-SDS as a primary outcome was evaluated at baseline, post-intervention and at 6- and 12-month follow-up. Intention-to-treat (ITT) as well as per-protocol analyses (PPA) were performed. A significant within-group decrease of 0.24 (95% CI 0.18 to 0.30) BMI-SDS points from the beginning of the inpatient stay through the first year was found, but no group difference at the one-year follow-up (mean difference 0.02; 95% CI -0.04 to 0.07). We also observed an increase in quality of life scores, intake of healthy food and exercise for both groups, without differences between groups (ITT and PPA). Thus, while the inpatient treatment proved highly effective, additional parent training did not lead to better results in long-term weight maintenance or to better psychosocial well-being compared to written psycho-educational material. Further research should focus on subgroups to answer the question of differential treatment effects. KW - Obesity KW - Children KW - Randomized controlled trial KW - Weight KW - Parent training KW - Quality of life Y1 - 2016 U6 - https://doi.org/10.1016/j.appet.2016.04.007 SN - 0195-6663 SN - 1095-8304 VL - 103 SP - 148 EP - 156 PB - Elsevier CY - London ER - TY - JOUR A1 - Warschburger, Petra A1 - Kröller, Katja T1 - Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC) JF - BMC PEDIATRICS N2 - Background: Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. Methods: Five hundred twenty-three parents and their 7-13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. Conclusions: The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background. KW - Attrition KW - Obesity KW - Child KW - Predictors KW - Weight management trial Y1 - 2016 U6 - https://doi.org/10.1186/s12887-016-0727-2 SN - 1471-2431 VL - 16 PB - BioMed Central CY - London ER - TY - GEN A1 - Warschburger, Petra A1 - Kröller, Katja T1 - Childhood overweight and obesity BT - maternal perceptions of the time for engaging in child weight management N2 - Background: There is an increasing awareness of the impact of parental risk perception on the weight course of the child and the parent's readiness to engage in preventive efforts, but only less is known about factors related to the parental perception of the right time for the implementation of preventive activities. The aim of this study was to examine parental perceptions of the appropriate time to engage in child weight management strategies, and the factors associated with different weight points at which mothers recognize the need for preventive actions. Methods: 352 mothers with children aged 2-10 years took part in the study. We assessed mothers' perceptions of the actual and preferred weight status of their child, their ability to identify overweight and knowledge of its associated health risks, as well as perceptions of the right time for action to prevent overweight in their child. A regression analysis was conducted to examine whether demographic and weight related factors as well as the maternal general risk perception were associated with recognizing the need to implement prevention strategies. Results: Although most of the parents considered a BMI in the 75th to 90th percentile a valid reason to engage in the prevention of overweight, 19% of the mothers were not willing to engage in prevention until their child reached the 97th percentile. Whereas the child's sex and the identification of an elevated BMI were significant predictors for parents' recognition of the 75th percentile as right point to engage in prevention efforts, an inability to recognize physical health risks associated with overweight silhouettes emerged as a significant factor predicting which parents would delay prevention efforts until a child's BMI reached the 97th percentile. Conclusion: Parental misperceptions of overweight and associated health risks constitute unfavorable conditions for preventive actions. Feedback on the health risks associated with overweight could help increase maternal readiness for change. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 340 KW - maternal perception KW - need for action KW - prevention KW - obesity KW - overweight KW - children Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-400954 ER - TY - JOUR A1 - Warschburger, Petra A1 - Kröller, Katja T1 - "Childhood overweight and obesity maternal perceptions of the time for engaging in child weight management" JF - BMC public health N2 - Background: There is an increasing awareness of the impact of parental risk perception on the weight course of the child and the parent's readiness to engage in preventive efforts, but only less is known about factors related to the parental perception of the right time for the implementation of preventive activities. The aim of this study was to examine parental perceptions of the appropriate time to engage in child weight management strategies, and the factors associated with different weight points at which mothers recognize the need for preventive actions. Methods: 352 mothers with children aged 2-10 years took part in the study. We assessed mothers' perceptions of the actual and preferred weight status of their child, their ability to identify overweight and knowledge of its associated health risks, as well as perceptions of the right time for action to prevent overweight in their child. A regression analysis was conducted to examine whether demographic and weight related factors as well as the maternal general risk perception were associated with recognizing the need to implement prevention strategies. Results: Although most of the parents considered a BMI in the 75th to 90th percentile a valid reason to engage in the prevention of overweight, 19% of the mothers were not willing to engage in prevention until their child reached the 97th percentile. Whereas the child's sex and the identification of an elevated BMI were significant predictors for parents' recognition of the 75th percentile as right point to engage in prevention efforts, an inability to recognize physical health risks associated with overweight silhouettes emerged as a significant factor predicting which parents would delay prevention efforts until a child's BMI reached the 97th percentile. Conclusion: Parental misperceptions of overweight and associated health risks constitute unfavorable conditions for preventive actions. Feedback on the health risks associated with overweight could help increase maternal readiness for change. KW - Maternal perception KW - Need for action KW - Prevention KW - Obesity KW - Overweight KW - Children Y1 - 2012 U6 - https://doi.org/10.1186/1471-2458-12-295 SN - 1471-2458 VL - 12 IS - 12 PB - BioMed Central CY - London ER - TY - JOUR A1 - Kröller, Katja A1 - Kröller, Alexander A1 - Warschburger, Petra T1 - What do you like to eat? Correlation between food familiarity and actual preference JF - Zeitschrift für Gesundheitspsychologie N2 - The preference for fruits and vegetables is the main predictor for the longtime healthy eating behavior. There are many factors which affect the development of food preferences. The familiarity with different foods seems to be a special aspect associated with the corresponding preference. To establish a preference for fruits and vegetables during early childhood, we need to know more about the factors that affect this preference development. So far, research has mostly concentrated on the food intake and less on the corresponding preference. Additionally, it is often based on studies of the mere-exposure effect or on older children and their ability to label fruits and vegetables correctly. Findings about the level of food familiarity in young children and its relation to the actual food preference are still missing. Our study focuses on different aspects of food familiarity as well as on their relationship to the child's preference and presents results from 213 children aged 2 to 10 years. Using standardized photos, the food preference was measured with a computer-based method that ran automatically without influence from parents or interviewer. The children knew fewer of the presented vegetables (66 %) than fruits or sweets (78 % each). About the same number of vegetables (63 %) had already been tasted by the children and were considered tasty. Only 48 % of the presented vegetables were named correctly - an ability that increases in older children. Concerning the relationship between the familiarity with vegetables and their preference, the different familiarity aspects showed that vegetables of lower preference were less often recognized, tasted, considered tasty, or named correctly. KW - food preference KW - familiarity KW - fruits and vegetables KW - children Y1 - 2013 U6 - https://doi.org/10.1026/0943-8149/a000089 SN - 0943-8149 VL - 21 IS - 2 SP - 53 EP - 61 PB - Hogrefe CY - Göttingen ER - TY - JOUR A1 - Kröller, Katja A1 - Jahnke, Dörte A1 - Warschburger, Petra T1 - Are maternal weight, eating and feeding practices associated with emotional eating in childhood? JF - Appetite : multidisciplinary research on eating and drinking N2 - Background: Research concerning children's emotional eating behavior has shown its negative impact on weight-related problems. Taking the model of Birch and Davison (2001) into account, we focus on the role of maternal feeding behavior on the association between emotional eating of the mother and the child. Methods: 482 mothers and their children participated in this cross-sectional study. The mothers were asked about their feeding strategies, their children's and their own emotional eating and weight. We tested a structural equation model for different feeding strategies. Results: In addition to an expected direct association between the mother's and child's emotional eating, the maternal feeding strategies are related to the child's eating behavior. A higher maternal restriction of food or its monitoring was associated with a higher level of children's emotional eating, while allowing the child more control about their eating was linked to less pronounced emotional eating behavior. Conclusions: The results highlight the relevance of maternal feeding behavior on emotional eating in childhood. In terms of preventing weight-related problems, the findings indicate the necessity of training parents in allowing their children more control and avoiding the restriction of food. KW - Maternal weight KW - Eating KW - Feeding practices KW - Child's emotional eating Y1 - 2013 U6 - https://doi.org/10.1016/j.appet.2012.11.032 SN - 0195-6663 VL - 65 IS - 4 SP - 25 EP - 30 PB - Elsevier CY - London ER - TY - JOUR A1 - Warschburger, Petra A1 - Kröller, Katja T1 - Childhood overweight and obesity: maternal perceptions of the time for engaging in child weight management Y1 - 2012 UR - http://www.biomedcentral.com/content/pdf/1471-2458-12-295.pdf U6 - https://doi.org/10.1186/1471-2458-12-295 ER - TY - JOUR A1 - Kröller, Katja A1 - Warschburger, Petra T1 - Maternal feeding strategies and child's food intake : considering weight and demographic influences using structural equation modeling N2 - Background: Research concerning child's food intake have considered various influencing factors, for example parental feeding strategies, demographic and weight factors. At this time, however, there are few findings that explore these factors simultaneously. Accordingly, the aim of this study was to test a structural equation model regarding the associations between maternal feeding strategies and child's food intake. Methods: 556 mothers and their children between 1 and 10 years of age participated in this cross-sectional study. Besides socio-demographic and weight data, the mothers were asked about their feeding strategies as well as their child's food intake. Results: The well-fitting model explained 73% of the variance in the child's consumption of healthy and 34% of unhealthy food. In addition to the effect of the mother's social status and the child's age, a rewarding and modeling feeding behavior significantly influenced the child's food intake. Conclusion: The results highlight the relevance of maternal feeding behavior on the child's food intake. In terms of preventing eating- or weight-related problems, the findings indicate the usefulness of training parents in explicit modeling behavior and avoiding food as a reward. Y1 - 2009 UR - http://www.ijbnpa.org/home/ U6 - https://doi.org/10.1186/1479-5868-6-78 SN - 1479-5868 ER - TY - JOUR A1 - Kröller, Katja A1 - Warschburger, Petra T1 - ISS : ein Instrument zur Erfassung elterlicher Steuerungsstrategien in der Essenssituation N2 - Vorgestellt wird ein Instrument zur Erhebung muetterlicher Steuerungsstrategien in der Essenssituation (ISS), fuer deren Erfassung bislang kein deutschsprachiges, ueberprueftes Instrument vorliegt. Dazu wurde an 163 Muettern mit Vorschulkindern ein auf Grundlage bereits existierender englischsprachiger Instrumente (CFQ, CFSQ) sowie Fokusinterviews mit Experten und Muettern entstandener Itempool ueberprueft. Die Studie berichtet ueber die faktoren- und itemanalytischen Ergebnisse, nach denen sich 21 Items als trennscharf und verstaendlich erwiesen. Eine explorative Faktorenanalyse ergab sechs Faktoren, die zusammen 68% der Varianz aufklaerten. Sie umfassen aktive Strategien, wie Restriktion, Draengen und Belohnung, aber auch passive Steuerung durch Vorbild, Monitoring und die Staerkung der Eigenverantwortung des Kindes. Analysen zu Unterschieden im Steuerungsverhalten der Mutter bestaetigten die Faehigkeit des Instrumentes zur Differenzierung zwischen Muettern mit verschiedenem soziooekonomischen Status und Kindern unterschiedlichen Gewichts. Y1 - 2009 UR - http://psycontent.metapress.com/content/0012-1924/ U6 - https://doi.org/10.1026/0012-1924.55.3.135 SN - 0012-1924 ER - TY - JOUR A1 - Warschburger, Petra A1 - Kröller, Katja T1 - Adipositas im Kindes- und Jugendalter : was sind Risikofaktoren für die Entstehung einer Binge Eating Disorder? Y1 - 2005 ER - TY - GEN A1 - Warschburger, Petra A1 - Kröller, Katja T1 - Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC) N2 - Background Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. Methods Five hundred twenty-three parents and their 7–13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. Results Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child’s quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant. Conclusions The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 307 KW - Attrition KW - Child KW - Obesity KW - Predictors KW - Weight management trial Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-100359 ER - TY - JOUR A1 - Warschburger, Petra A1 - Kröller, Katja T1 - Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC) JF - BMC pediatrics N2 - Background Attrition is a serious problem in intervention studies. The current study analyzed the attrition rate during follow-up in a randomized controlled pediatric weight management program (EPOC study) within a tertiary care setting. Methods Five hundred twenty-three parents and their 7–13-year-old children with obesity participated in the randomized controlled intervention trial. Follow-up data were assessed 6 and 12 months after the end of treatment. Attrition was defined as providing no objective weight data. Demographic and psychological baseline characteristics were used to predict attrition at 6- and 12-month follow-up using multivariate logistic regression analyses. Results Objective weight data were available for 49.6 (67.0) % of the children 6 (12) months after the end of treatment. Completers and non-completers at the 6- and 12-month follow-up differed in the amount of weight loss during their inpatient stay, their initial BMI-SDS, educational level of the parents, and child’s quality of life and well-being. Additionally, completers supported their child more than non-completers, and at the 12-month follow-up, families with a more structured eating environment were less likely to drop out. On a multivariate level, only educational background and structure of the eating environment remained significant. Conclusions The minor differences between the completers and the non-completers suggest that our retention strategies were successful. Further research should focus on prevention of attrition in families with a lower educational background. KW - Attrition KW - Obesity KW - Child KW - Predictors KW - Weight management trial Y1 - 2016 U6 - https://doi.org/10.1186/s12887-016-0727-2 SN - 1471-2431 VL - 16 PB - BioMed Central CY - London ER - TY - GEN A1 - Kröller, Katja A1 - Warschburger, Petra T1 - Maternal feeding strategies and child's food intake : considering weight and demographic influences using structural equation modeling N2 - Background: Research concerning child's food intake have considered various influencing factors, for example parental feeding strategies, demographic and weight factors. At this time, however, there are few findings that explore these factors simultaneously. Accordingly, the aim of this study was to test a structural equation model regarding the associations between maternal feeding strategies and child's food intake. Methods: 556 mothers and their children between 1 and 10 years of age participated in this crosssectional study. Besides socio-demographic and weight data, the mothers were asked about their feeding strategies as well as their child's food intake. Results: The well-fitting model explained 73% of the variance in the child's consumption of healthy and 34% of unhealthy food. In addition to the effect of the mother's social status and the child's age, a rewarding and modeling feeding behavior significantly influenced the child's food intake. Conclusion: The results highlight the relevance of maternal feeding behavior on the child's food intake. In terms of preventing eating- or weight-related problems, the findings indicate the usefulness of training parents in explicit modeling behavior and avoiding food as a reward. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - paper 181 KW - Parenting practices KW - Obesity risk KW - Consumption KW - Overweight KW - Adolescents Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus-45023 ER - TY - THES A1 - Kröller, Katja T1 - Mütterliche Steuerung in der Essenssituation T1 - Maternal feeding strategies N2 - Die Etablierung eines gesunden Ernährungsverhaltens unserer Kinder ist die wichtigste Voraussetzung für ihre körperliche, kognitive und emotionale Entwicklung. Dabei sind neben einer genetischen Disposition und kulturellen Gegebenheiten vor allem die Einflüsse der jeweiligen Betreuungspersonen ausschlaggebend. Die Eltern steuern sowohl direkt (durch Aufforderungen, Verbote u.ä.) als auch indirekt (durch die Förderung eigenverantwortlicher Entscheidungen u.ä.) das Ernährungsverhalten ihres Kindes. Untersuchungen zum mütterlichen Steuerungsverhalten konzentrierten sich bisher vorwiegend auf die Betrachtung direkter Strategien sowie auf altershomogene und sozial besser gestellte Gruppen. Aufgrund möglicher Verzerrungen durch die Betrachtung einzelner Ausschnitte des Zusammenhangs zwischen Steuerung und Ernährung wurde in der vorliegenden Arbeit ein Gesamtmodell spezifiziert, welches den Zusammenhang zwischen elterlicher Steuerung und kindlicher Ernährung unter Berücksichtigung von Sozial- und Gewichtsfaktoren abbildet. Dazu wurden drei Erhebungen mit insgesamt über 900 Müttern 1 – 10-jähriger Kinder durchgeführt. Innerhalb dieser Untersuchungen ist es gelungen, erstmalig ein deutschsprachiges Instrument zur Messung elterlicher Steuerungsstrategien in der Essenssituation (ISS) zu entwickeln. Die Analysen zeigten, dass bisher nur selten untersuchte Strategien, wie das explizite Bemühen um Vorbildwirkung und das Erlauben von eigenverantwortlichen Entscheidungen des Kindes, von den Müttern häufig angewandt werden. Die Analyse des komplexen Wirkungsgefüge von Steuerung, kindlicher Ernährung sowie sozialer und gewichtsbezogener Faktoren zeigte weiterhin, dass neben stabilen Faktoren, wie dem mütterlichen Status und dem Alter des Kindes, ein entscheidender Anteil der mütterlichen Steuerungsstrategien für die kindliche Ernährung verantwortlich ist. Die berichteten Ergebnisse zeigen auf, wie relevant die gemeinsame Betrachtung von gesunden und problematischen Nahrungsmitteln sowie die den Zusammenhang zwischen Steuerung und Ernährung beeinflussenden Faktoren innerhalb eines Modells ist. Zusammengefasst scheint vor allem die Steuerung durch Belohnung von und mit bestimmten Nahrungsmitteln eine für das kindliche Ernährungsverhalten und das Übergewichtsrisiko besonders kritische Strategie zu sein. Dies ist umso bedeutender, als bisherige Untersuchungen dieses Verhalten häufig in restriktive Strategien integriert betrachteten. Die separate Analyse wies jedoch darauf hin, dass vor allem die belohnenden Verhaltensanteile relevant sind. Dies zeigt, dass es für die Entwicklung einer gesunden kindlichen Ernährung tatsächlich veränderbare Verhaltensweisen gibt, die Eltern in Präventionsprogrammen oder anderen mit Kursen zum kindlichen Wohl assoziierten Einrichtungen vermittelt werden können. N2 - The establishment of healthy eating for our children is an important precondition for their physical, cognitive, and emotional development. Besides genetic and cultural effects that influence children’s food preferences and eating behavior, parents play a pivotal role. Both direct (e.g., demands and restrictions) and indirect strategies (e.g., modeling and monitoring) are used to influence the child’s eating. Previous research about maternal feeding strategies has concentrated mostly on either direct feeding strategies or age-homogenous samples with high social status. To avoid bias by ignoring interdependencies I have explored the association of maternal feeding strategies and the child’s food intake in a complex model, which includes socio-demographic and weight aspects. I undertook three investigations with a total of over 900 mothers of 1- to 10-year-old children. I achieved to develop a German instrument for measuring the parental feeding strategies (ISS). Further analyses showed that rarely examined strategies, such as an explicit modeling or allowing the child to control his food, were often used. We examined a multi-factorial model of the relationship between maternal feeding practices and child’s food intake, taking into account the influences of age, socioeconomic and weight factors. This underlines the relevance of some feeding strategies (namely rewarding and modeling) besides the influence of the child’s age and the mother’s social status. The described results demonstrate the need for considering a model including healthy and unhealthy foods as well as demographic, age and weight variables, to detect relevant strategies in the complex association between parental feeding and child’s food intake. Rewarding turned out to be a critical feeding strategy for the child’s unhealthy food intake and obesity risk, whereas modeling seems to have a protective effect. This is important given that previous research mostly considers this behavior as part of restrictive strategies. The separate analysis shows that the rewarding behavior is especially relevant for the child’s eating. In summary, the results point out the existence of modifiable behavior for the development of healthy eating in a child, which could be conveyed to parents during prevention programs and other facilities. KW - elterliche Steuerungsstrategien KW - kindliche Ernährung KW - gesunde und ungesunde Nahrung KW - parental feeding strategies KW - child's food intake KW - healthy and unhealthy food Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus-33682 ER -