eating habits strongly influence nutrients intake of young children. The food
environment the parents provide shapes children’s preference and food acceptance
patterns which in turn are linked to children’s adiposity [43–45].
Parents shape their children’s eating environment in a variety of ways besides
the choice of infant feeding method, the foods they make available and accessible
and the extent of media exposure at home, they also interact with children in
the eating context. Parents’ practices may be especially controlling and may
have particularly negative effects on children: for instance [46], parents’ feedback
to children about eating vegetables. Moreover, contrary to parental beliefs
restricting children’s access to foods does not produce dislike for the restricted
foods [47] whereas limiting over-availability of a preferred food could enhance
children’s desire to obtain this food.
In addition, maternal feeding practices can influence infant and child intake
and particularly his ability to regulate energy intake and the amount of food
consumed [48]. This could explain the higher growth rate of formula-fed infants
whom mothers can encourage to finish the bottle. Increasing maternal impact
on child food intake tends to decrease the child’s responsiveness to internal
signals of hunger and satiety as a basis for adjusting energy intake. This has also
been proven for the responsiveness to food energy density and the way children
adjust their intake. Besides this innate behavior children’s intake is strongly
modified by feeding practices. Parental prompts to eat were positively associated
with time spent eating and degree of overweight in children [49]. Parents
impose behavioral control (1) when they have problems regarding their own
behavior; (2) when they perceive a risk for the child, and (3) when the child lacks
self-regulation. In obesity, this parental control impedes children’s ability to
develop self-regulatory behavior thereby promoting the problem they attempt to
avoid [50]. A high degree of parental control is associated with low self-control
in children. For girls energy regulation was related to their adiposity with
thinner girls doing better than heavier girls. In addition, in girls and not in boys,
parental control is linked to the girl’s adiposity. Parental control is linked to the
parents’ dieting and weight history the most striking story being a thin high jogger
mother with an obese daughter. These findings are limited to middle class
populations as data remains poor in others.
Moreover, early dieting in girls as young as 9 years of age (44% of high
school were dieting) may constitute a risk for the development of obesity and
overeating in adolescence and adults [51–54]. Adolescents’ restraint scores were
positively associated with depression, body dissatisfaction, social anxiety and
weight status [55].
A recent study [48] using a self-report child feeding questionnaire in 120
patients (obese and non-obese) reports that total fat mass measured by dual
absorptiometry (DEXA) is correlated with weight concern and restriction whereas
pressure to eat, responsibility for feeding and monitoring were unrelated to total
fat mass. Although the cross-sectional nature of this study does not allow
conclusions to be drawn concerning cause and effect these data clearly show
that child-feeding practices are key variables that explain more of the variance
in body fat than dietary fat intake does [48].
Child Eating Style
Child eating style is also a factor eliciting parental concern. The obese eat at
a faster rate than non-obese children [56], this is true for preschoolers as well as
school children [57, 58]. Moreover obese children do not decrease the rate of eating
towards the end of the meal. Such patterns could be explained by an impaired
satiety signal or a lack of response to this signal. This pattern appeared early as
infants with more rapid sucking at 2 and 4 weeks have greater BMI at 1 and
2 years of age. Data are lacking on the subsequent evolution of these children.
Food Choices
Among the nutritional factors involved in the increase of prevalence of
childhood obesity, the role of high-fat or high-energy food seems to be the
strongest. There is no evidence of an innate preference for these foods in children.
Although limited, the findings from research with young children [59, 60] are
consistent with conditioned preferences for energy foods as it has been extensively
reported in animals [61]. Regarding obesity, there has been no research
into whether children’s ability to learn preferences for high-fat food differs
between children in obese and normal weight families. Among adults there are
differences between obese and non-obese individuals in their preferences for fat
and for mixtures of sugar and fat [62, 63]. The social context in which children’s
eating patterns develop become important as a model for establishing food
preferences. For children eating is a social occasion and other eaters besides
parents, other adults, peers and siblings as well as children’s observations of
other eating behaviors influence the development of their own preferences and
eating behaviors. Findings have suggested that daycare could provide opportunities
for expanding the availability and accessibility of foods and for fostering
preferences for food modeling effects. Daycare could give the opportunity to
test and like some disliked vegetable. Interestingly the same phenomenon
occurred to model the preference of chili-flavored foods in young children
among Mexican families [64].
Fast Food Restaurant Use among Adolescents
Eating away from home now accounts for almost half of the total food
spending in families. Fast food restaurant use (FFRU) has increased strongly and
rapidly particularly in adolescents. Data available in the USA showed that the
average adolescent visits a fast food restaurant (FFR) twice a week (it is once a
week in France: unpublished data) and this represents one third of the away-fromhome
meals at this age. Nutrient profiles of these away-from-home foods are
higher in fat and energy compared with foods eaten at home. A recent study [65]
involving 4,746 students reports that 75% of them ate at a FFR at least once
during the week preceding the study. This study described the nutrient intake,
personal food choices, behavioral and environmental variables associated with
FFRU among adolescents. A greater proportion of females (27%) than males
(22%) reported never having visited a FFRU during the past week. Older adolescents
visit FFRs more frequently. Social economic status (SES) is associated with
FFRU among females but not in males, the lower SES visit FFRs more frequently.
FFRU was associated with significantly lower fruit and vegetable grains
intake and less milk servings and with significantly higher intake of soft drinks,
cheeseburgers, pizza and French fries suggesting that dietary intakes of adolescents
who frequently consumed fast food are of poorer nutritional quality.
Interestingly, in this study no association was observed between FFRU and
obesity. In boys, BMI was even lower in males who frequently visit FFRs. This
finding could be due to a lack of prospective data as a 3-year study period showed
in young women that an excessive weight gain was associated with frequent consumption
of fast food. Another explanation could also be that these boys practiced
more team sports than the poor FFR users. Environmental variables are also
important in this issue showing that female adolescents in single parent families
and adolescents working more 10h/day reported more FFRU. TV viewing is also
associated with FFRU in males and females. Moreover, FFRU is associated with
less concern about healthy eating, more perceived barriers to healthy eating and
lower perceptions of maternal concern for their child’s healthy eating. Interestingly
dietary behavior and weight concern were not associated with FFRU.
As poor eating habits are associated with FFRU, these adolescents could
be at risk of developing obesity. FFR are highly used for different reasons. They
should be encouraged to provide healthy food lower in fat and energy, fruit and
vegetables and restricting portion size.
In conclusion, research attempting to increase the knowledge of how environmental
factors interact with genetic background need to be extensively encouraged and developed.
Pediatricians really want to optimize prevention and
care of obesity in children and adolescents. More studies should focus on
preschool children (before 6 years) in order to develop concepts for prevention
as well as on adolescents in order to optimize the management which is difficult
at this age. We decided to add this cartoon drawn by IOTF (International
Obesity Task Force) showing the complex network of environmental factors
involved in obesity, from the Causal web available at http://wwwiotf.ung/groups/
phapalcausalweb.htm (fig. 1).
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