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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.
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.
Loss to follow-up in a randomized controlled trial study for pediatric weight management (EPOC)
(2016)
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.
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.