A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Abstract

Summary Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

Parental Child-Feeding in the Context of Child Temperament and Appetitive Traits: Evidence for a Biopsychosocial Process Model of Appetite Self-Regulation and Weight Status

“…The primary purpose of the present study was to examine the pathways between early life child factors involved in appetite self-regulation (temperament and appetitive traits), controlling parental child-feeding practices (pressure to eat and restrictive feeding) and child body composition (Body Mass Index or BMI, percent body fat, and parental perception of child weight) in economically and ethnically diverse families. Study results are consistent with a biopsychosocial perspective on the development of children's eating and weight [7] that links child biology and behavior with parenting practices, psychosocial processes, and environment such as poverty status and culture.…”

“…Importantly, despite the temperamental basis for emotional self-regulation and emotional or impulsive eating, the behaviors associated with such traits and parents' responses to such traits and behaviors are modifiable through intervention [6]. According to a biopsychosocial model of the development of children's overweight and obesity [7], child biological foundations (e.g., child temperament and child appetitive traits) are assumed to influence parents' cognitions, expectations, and interpretations in addition to parents' reactions or behaviors (e.g., parents feeding styles and practices). Guided by a biopsychosocial framework, the present study examines the contributions of child temperament (negative affectivity and effortful control), child appetitive traits (food approach and food avoidance), and parental controlling child-feeding behaviors (restrictive feeding and pressure to eat) to child body composition (Body Mass Index or BMI, percent body fat, and parental perception of child weight) in an economically and ethnically diverse sample of 4-6-year-old children.…”

A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence

“…Importantly, the DC model of paediatric obesity identifies child intrapersonal constructs (eg, temperament, self‐regulation, inhibitory control and self‐esteem) as processes that may amplify obesity risk from one stage to the next. A recently proposed biopsychosocial model of the development of paediatric overweight and obesity overlaps with the DC model in that it highlights the contributions of child‐level characteristics such as temperament and self‐regulation of energy intake as influencing parent behaviours and practices . Because these intrapersonal constructs have been previously shown to mediate associations between general positive parenting and other adverse child outcomes (eg, externalizing behaviour), it is important to target both general and domain‐specific parenting within paediatric obesity prevention interventions across development.…”

The Feeding Practices and Structure Questionnaire: development and validation of age appropriate versions for infants and toddlers

“…In summary, although parental feeding practices have been identi ed as a risk factor for childhood overweight and obesity (15), the mechanisms and processes underlying such relationships are still uncertain. Mechanistic research is hindered by the lack of suitable tools to measure feeding practices across infancy and childhood.…”

“…Consequently, many questions remain unanswered in relation to bidirectional and transactional in uence processes occurring between parents and infants/children in relation to eating and growth outcomes across various ages and stages of childhood. Studies utilising longitudinal designs that begin in infancy and extend into middle childhood and beyond would provide knowledge about the developmental trajectories and processes that are causally linked to eating and weight outcomes that could inform prevention efforts (15).…”