Restrictive And/or Coercive Food Environments Increase Risk Of Child Obesity Via Malformed Eating

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Preventing childhood obesity: what works?
Preventing childhood obesity: what works?

Current school-based intervention efforts have not proven to be effective in reversing the rising rates of childhood obesity; additional approaches to the problem are needed. We propose an expansion of these efforts to include a focus on the period before school entry and the development of interventions that include parents and families in home and childcare settings. The existing research on the factors influencing the developing controls of food intake in infancy and early childhood suggests a number of possible targets for interventions with young children, parents or caregivers. As young omnivores, children are prepared to learn to eat a diet of whatever foods are available in their environment, and their innate ability to learn to like or to reject foods provides the needed flexibility. Children's predisposition to learn can be used to advantage if parents understand how their practices affect children's eating and weight, and that the impact of their feeding practices may either promote or undermine the development of eating behaviors consistent with higher quality diets and healthy weight status. If a feeding environment is created that supports children's opportunities to choose and try new foods in positive contexts and to make choices among healthy alternatives, without coercion, children can learn to like and eat those foods. When the child-feeding environment is restrictive or coercive, or when children are offered the wrong kinds and portions of foods, they develop preferences and eating styles that may increase their risk for obesity. These findings provide the evidence base needed for the development of behavioral interventions for the early prevention of childhood obesity, and we propose the use of a phased strategy to create optimized, potent intervention strategies for preventing obesity during the first years of life. However, in our the current obesogenic environment, it must be acknowledged that early prevention of obesity is only one essential step in developing effective prevention and treatment approaches to combat the obesity epidemic across the lifespan.

A universal goal of parents across all cultures is to raise healthy children who are growing well. Historically, one of the main environmental threats to this goal has been food scarcity: food supplies were unpredictable, available food was unpalatable and lacking in variety, energy-dense, nutrient-rich foods were limited and conditions were unsanitary. Faced with this environmental threat, traditional feeding practices evolved that include (1) feeding children frequently; (2) offering large portions; (3) offering preferred foods; (4) offering food as a first response to crying or distress; and (5) coercing children to eat when food is available, even if they are not hungry. Additionally, in a context where food is scarce, ‘bigger is better’; a plump, large for age child is a sign of child health and successful parenting.

In contrast to the food scarcity that has persisted through most of human history, the current threat faced by families in developed countries is an obesogenic environment. This type of environment encourages habitual energy intakes that are greater than habitual energy expenditures, an imbalance created by a combination of easy access to large portions of energy-dense and highly palatable foods, discouragement of free-living physical activity through the presence of labor-saving devices and normative participation in sedentary behaviors during leisure time. When traditional child-feeding practices that promoted child health when food was scarce are applied in obesogenic environments, they may result in overeating and accelerated weight gain by promoting children's (1) lack of responsiveness to satiety cues; (2) overeating in response to large portions; (3) learned preference for unhealthy, palatable foods as they are used as rewards and treats; (4) learning to eat in response to distress rather than hunger; and (5) learned dislike for ‘healthy foods’ if there is pressure to eat them. When a ‘bigger is better’ attitude about child growth persist as a traditional parenting attitude, parents may not realize the problematic nature of children's eating, activity and weight gain patterns. A growing body of evidence has confirmed the use of traditional feeding practices in the current obesogenic environments and that these practices are indeed associated with accelerated weight gain and higher weight status in children.

With respect to the effects of one traditional practice, coercing children to eat, when children are pressured by parents to ‘clean their plate’ or offered a reward for finishing certain foods, children eat more within that meal setting, but appear to do so with a loss of responsiveness to caloric density cues in foods suggesting that external pressure to eat from parents creates children who attended to external, rather than internal, hunger and satiety cues. Additionally, the use of coercion for eating ‘healthy’ foods leads to the development of dislikes for those foods; this practice has been associated with a lower preference or even learned dislike for foods that children are either rewarded for eating or are pressured to eat. Retrospective studies have shown that the learned dislikes that result when children are coerced to eat a food persist in adulthood; young adults report dislike for foods that they had reportedly been coerced to eat as children.