Rationale and design of the Feeding Dynamic Intervention (FDI) study for self-regulation of energy intake in preschoolers

Abstract

In 2011, the Institute of Medicine Early Childhood Prevention Policies Report identified feeding dynamics as an important focus area for childhood obesity prevention and treatment. Feeding dynamics include two central components: (1) caregiver feeding practices (i.e., determining how, when, where, and what they feed their children) and (2) child eating behaviors (i.e., determining how much and what to eat from what food caregivers have provided). Although there has been great interest in overweight and obesity prevention and treatment in young children, they have not focused comprehensively on feeding dynamics. Interventions on feeding dynamics that reduce caregivers’ excessive controlling and restrictive feeding practices and encourage the development of children’s self-regulation of energy intake may hold promise for tackling childhood obesity especially in the young child but currently lack an evidence base. This manuscript describes the rationale and design for a randomized controlled trial designed to compare a group of mothers and their 3-to 5-year old children who received an intervention focused primarily on feeding dynamics called the Feeding Dynamic Intervention (FDI) with a Wait-list Control Group (WLC). The primary aim of the study will be to investigate the efficacy of the FDI for decreasing Eating in the Absence of Hunger (EAH) and improving energy compensation (COMPX). The secondary aim will be to examine the effect of the FDI in comparison to the WLC on maternal self-reported feeding practices and child satiety responsiveness.

An examination of children's eating behaviours as mediators of the relationship between parents' feeding practices and early childhood body mass index z‐scores

“…This study provides support for the differing roles of overt restriction and covert restriction in childhood obesity and uniquely indicates the presence of a mediator relation between parent's use of overt restriction, child food responsiveness and child BMIz, controlling for parent BMI, child age, child gender and income. The results of this study add to the recommendation that parents should avoid the use of overt restrictive feeding practices in young children, whilst the use of covert restriction may be more appropriate (10,11).…”

“…Overt restriction, as defined as ‘controlling a child's food intake in a way that can be detected by the child’, is theorized to have a detrimental impact on children's eating by undermining a child's ability to self‐regulate food intake through increased preoccupation with food , whilst covert restriction, as defined as ‘controlling a child's food intake in a way that cannot be detected by the child’, is theorized to have a beneficial impact on child eating by providing structure and limits to appropriately guide a child . Whilst there is limited data examining the impact of these differing restrictive feeding practices on child weight, the evidence for impact on children's eating behaviours appears largely consistent with the theorized impact in cross‐sectional, longitudinal and experimental studies .…”

Family Ecologies and Child Risk for Obesity: Focus on Regulatory Processes

“…This includes the child's response to negative emotions and response to satiety cues as well as parents' response to child negativity, in particular during meals. Innovative interventions designed to promote children's attention to satiety cues and reduce parental controlling and restrictive feeding dynamics are now underway (Eneli et al, 2015). Similar approaches have been proposed for child care settings (Dev, McBride, Speirs, Donovan, & Cho, 2014).…”

Targeting Feeding and Eating Behaviors: Development of the Feeding Dynamic Intervention for Caregivers of 2- to 5-Year-Old Children

“…The addition of evidence-based lifestyle recommendations beyond feeding behaviors further strengthened the FDI, increasing its potential to be a promising and practical program for obesity prevention or treatment in young children. There are many next steps in this area of research [ 33 ]. They include researchers (a) investigating the outcome of the FDI with a larger and diverse population, (b) studying the degree to which children can be taught to recognize hunger and satiety cues via parent-directed intervention versus a child-targeted intervention, (c) videotaping within the home to assess the feeding environment rather than relying on caregiver self-report, (d) using objective assessments of self-regulation such as the energy compensation and eating in the absence of hunger tests, (e) validating the acceptability and feasibility of the physical activity component, and (f) exploring short- and long-term effects of the FDI on the child's anthropometrics and eating behaviors.…”