In the past 40 years, there has been a dramatic increase in dual-income families. More women are
working outside the home, with homemaking responsibilities being shared by all family members
or outside caretakers. This new dynamic can affect family meal and snack patterns, resulting in
more outside dining, prepared convenience foods, or shared meal preparation responsibilities.
Children may receive less supervision with after-school food and activity selections. Older siblings
may be responsible for child care of younger siblings and for food preparation for the family.
Extended family members such as grandparents or other relatives may assume the roles of caretaker
and food preparer. Child care may be provided in a commercial daycare or after-school care setting
in which younger children consume two meals and daily snacks up to 5 days per week and schoolage
children receive afternoon snacks. Therefore, understanding which family member or caretaker
plays significant roles in food selection and preparation is key to helping the family develop nutrition
strategies to foster healthful eating. Specific queries as to who is responsible for purchasing,
preparing, and serving food must be included in a comprehensive nutrition assessment.
As family schedules become more hectic, family meals occur less frequently in households.
Often, families rely on outside dining or frozen convenience meals between or after activities.
Meals may be consumed in cars in transit to or from an activity. Eating may be rushed or hurried
to conform to the family schedule. Data from the U.S. Department of Agriculture indicates that
from 1977 to 1996, energy consumed outside the home increased from 17% to almost 35% of the
daily energy intake, with the percentage of energy contributed from fast food almost tripling [3].
In addition, several studies have shown the relationship between fast food consumption and total
energy intake and body weight in adolescents [4,5]. Children have been shown to consume more
energy when dining outside the home than when eating in the home [6]. Conversely, in-home,
family meals have been shown to increase nutrient quality of the meal by decreasing nutrient-sparse
foods and increasing fruit and vegetable consumption [7]. Assessing the frequency of outside or
“on the run” dining verses in-home family meals may provide the practitioner with an insight into
problematic family eating behaviors.
Family composition can be an important influence on dietary intake and feeding practices in
families. Children of divorced parents with various custody arrangements and visitation rights can
live in separate households, consuming significantly different foods and beverages in each setting.
The divorced spouses’ awareness and priority in addressing the issue of overweight may be similar
or markedly different. The children may use family discord to manipulate family dining practices
causing inconsistencies in applying nutrition interventions between households. Inquiring about
these issues in divorced families can aid the practitioner in identifying supportive family members,
in communicating with the different households, and in assessing the educational needs of each
household to support recommended lifestyle changes. The relationship between the parents may
dictate scheduling joint or separate consultation sessions with the parents, child, and practitioner.
An inventory of the variety and amounts of foods and beverages available to the child or
adolescent and his or her family in the home may reveal the degree to which the home food
environment is nutritious or toxic. A pantry full of high-calorie, nutrient-sparse foods and beverages
provides stiff competition to the bowl of fruits and a bottle of water on the kitchen table. Grimm
et al. demonstrated that parental soda consumption was correlated with increased soda consumption
of children, especially when the beverage was stocked in the home [8]. Inquiring about the food
habits and preferences of individual family members may identify barriers to the successful weight
management of the child or adolescent. Some examples may be parental concerns about weight
gain for thin siblings conflicting with concerns about weight loss for overweight siblings. Parental
ambivalence about eating habits and their effect on weight management may lead to the presence
of nonnutritious family food selections in the home. It is important to address the presence of
calorically dense but nutrient-sparse foods and beverages in the home, their role in family eating
patterns, and the effect these items have on the nutritional status of the family. This focus will
enable the family to modify their home feeding environment to foster healthy food choices for the
entire family.
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