ReviewParental involvement in interventions to improve child dietary intake: A systematic review
Introduction
Pediatric obesity continues to be a significant public health issue (Hedley et al., 2004, Ogden et al., 2008). Obesity during childhood is associated with increased disease risk and morbidities during young adulthood, and increased mortality later in life (Must and Strauss, 1999, Reilly et al., 2003). Dietary habits acquired in childhood track to adulthood (Kelder et al., 1994, Li and Wang, 2008, Lien et al., 2001), and changes in diet during childhood are significant predictors of diet quality in adults (Mikkila et al., 2004). Child dietary behavior is determined in part by individual factors (e.g. food preferences) (Capaldi, 1996), socio-cultural factors (e.g. peer norms and parent attitudes/beliefs) (Rozin, 1996) and environmental factors (e.g. availability of healthy food) (French et al., 2001). Parents are instrumental in influencing child diet by providing their child with the ability and opportunity to make healthy or unhealthy choices through the selective use of food parenting practices (i.e. behaviors that parents use to influence children on what and how much to eat) (Hoerr et al., 2009). Since food choices are related to energy intake and obesity risk, parent involvement in child dietary interventions seems crucial to mitigating risk (Rennie et al., 2005). The refractory nature of adult obesity suggests early establishment of healthy eating habits may be a key to prevention (Lobstein et al., 2004).
Reviews of childhood obesity prevention studies have largely focused on school-based programs, many of which did not include a parent component. (Baranowski et al., 2002, Brown and Summerbell, 2008, Sharma et al., 2004, Shaya et al., 2008, Summerbell et al., 2006, Thomas, 2006). A meta-analysis of pediatric obesity prevention programs that included an estimation of a “parent effect” found parental involvement (in 12 of the 46 studies) to be unrelated to larger effect sizes (Stice et al., 2006). A systematic review of studies that aimed to impact young children's weight status, physical activity, diet or sedentary behaviors (Campbell and Hesketh, 2007) concluded parents were “receptive to and capable of some behavioral changes that may promote healthy weight in their young children,” but due to the limited number of studies in this age group, the authors were unable to draw any conclusions as to the most effective strategies. As a result, we conducted a systematic review of randomized controlled intervention trials designed to prevent obesity, prevent disease, and/or promote health in children and adolescents through dietary behavior changes that involved parents. We summarized and evaluated the type of parent involvement that had been implemented in each study to answer two questions: 1) whether parent involvement enhanced program effectiveness, and 2) what type of parent involvement, if any, was most effective in achieving dietary change outcomes.
Section snippets
Methods
Following procedures for a systematic review (Lichtenstein et al., 2008), we searched Pub Med, Medline, Psych Info, and Cochrane Library electronic databases to identify individual and population-based obesity/disease prevention and health promotion programs designed to change child and adolescent dietary intake that involved parents. Key terms representing child and adolescent dietary behaviors that were associated with obesity in the literature were used in combination with key terms for
Results
The initial search yielded 1774 citations. After screening the titles and abstracts of candidate studies, 100 papers were retrieved and the full article reviewed. Of these 100 articles, twenty-four studies met all our criteria and were included in this review.
Discussion
There were not enough studies that compared dietary interventions for children with and without parental components to adequately answer whether parent involvement enhanced program effectiveness (Research Question 1). Despite variability in the quality of reporting of the RCTs reviewed to address Research Question 2 (What type of parent involvement was most effective in achieving dietary outcomes?), interesting patterns emerged. Studies that used direct methods to engage parents were more
Summary and conclusions
Currently, limited conclusions may be drawn regarding the best method to involve parents in changing child diet to prevent obesity and improve health. Indirect methods remain the most commonly used strategies to engage parents, however, direct methods of engagement show more promise and therefore, warrant further research.
Future research should specifically test a “parent effect” by designing methodologically rigorous studies with appropriate comparison groups. Different intensities of parental
Conflict of interest statement
The authors declare there is no conflict of interest.
Acknowledgments
This research was funded by a National Institute of Child Health and Human Development Training Grant 5T32HD007445, “Research Training in Maternal, Infant & Child Nutrition.” This work is also a publication of the United States Department of Agriculture (USDA/ARS) Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and has been funded in part with federal funds from the USDA/ARS under Cooperative Agreement no. 58-6250-6001. The contents of
References (68)
- et al.
Accuracy of material dietary recall for preschool children
J. Am. Diet Assoc.
(1991) - et al.
Theory as mediating variables: why aren't community interventions working as desired?
Ann. Epidemiol.
(1997) - et al.
Squire's quest! Dietary outcome evaluation of a multimedia game
Am. J. Prev. Med.
(2003) - et al.
Pathways: a school-based randomized controlled trial for the prevention of obesity in American Indian schoolchildren
Am. J. Clin. Nutr.
(2003) - et al.
Girl scouting: an effective channel for nutrition education
J. Nutr. Educ.
(1997) - et al.
Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial for overweight prevention in preschool minority children
J. Pediatr.
(2005) - et al.
High 5 for kids: the impact of a home visiting program on fruit and vegetable intake of parents and their preschool children
Prev. Med.
(2008) - et al.
The Parent Mealtime Action Scale (PMAS). Development and association with children's diet and weight
Appetite
(2009) - et al.
Revisiting a neglected construct: parenting styles in a child-feeding context
Appetite
(2005) - et al.
Tracking of dietary intake patterns is associated with baseline characteristics of urban low-income African-American adolescents
J. Nutr.
(2008)
Application of systematic review methodology to the field of nutrition
J. Nutr.
Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21
Prev. Med.
Parents are accurate reporters of their preschoolers' fruit and vegetable consumption under limited conditions
J. Nutr. Educ. Behav.
Influencing healthful food choices in school and home environments: results from the TEENS study
Prev. Med.
New moves: a school-based obesity prevention program for adolescent girls
Prev. Med.
Engaging parents to increase youth physical activity: a systematic review
Am. J. Prev. Med.
Gimme 5: an innovative, school-based nutrition intervention for high school students
J. Am. Diet Assoc.
Behavioural determinants of obesity
Best Pract Res. Clin. Endocrinol. Metab.
Increasing the fruit and vegetable consumption of fourth-graders: results from the high 5 project
Prev. Med.
Adherence to the food guide pyramid recommendations among African Americans and Latinos: results from the Multiethnic Cohort
J. Am. Diet Assoc.
A controlled evaluation of a fitness and nutrition intervention program on cardiovascular health in 10- to 12-year-old children
Prev. Med.
The revised CONSORT statement for reporting randomized trials: explanation and elaboration
Ann. Intern. Med.
Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation
Health Educ. Behav.
School-based obesity prevention: a blueprint for taming the epidemic
Am. J. Health Behav.
Are current health behavioral change models helpful in guiding prevention of weight gain efforts?
Obes. Res.
Improving the quality of reporting of randomized controlled trials: the CONSORT statement
JAMA
Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration
Ann. Intern. Med.
Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence
Obes. Rev.
Cardiovascular risk factor prevention in black schoolchildren: two-year results of the “Know Your Body” program
Am. J. Epidemiol.
Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature
Obes. Rev.
Why we eat what we eat: the psychology of eating
Am. Psychol.
The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes
Obes. Rev.
Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity
Obes. Res.
Hip-Hop to health Jr. for Latino preschool children
Obesity
Cited by (187)
Is it possible to improve healthy food habits in schoolchildren? A cross cultural study among Spain and Poland
2022, Food Quality and PreferenceCharacteristics of successful primary school-based experiential nutrition programmes: A systematic literature review
2021, Public Health NutritionManaging Screen Use in the Under-Fives: Recommendations for Parenting Intervention Development
2023, Clinical Child and Family Psychology Review