Title: Parenting pre-schoolers with avid appetites: Understanding differential susceptibility to obesogenic environments for future intervention efficacy.
Funder: Economic and Social Research Council

Abstract: Childhood obesity presents a major, complex policy and practice challenge for the UK. Lack of understanding of individual responses to obesogenic environments and a lack of targeted, theoretically informed, co-designed interventions have resulted in poor outcomes for changing children's eating behaviour. One important aspect of differential susceptibility to obesogenic environments is children's food approach behaviour, which links genetic risk to the development of obesity in food abundant environments. How parents feed their children who show high levels of food approach behaviour is a key intervention target, but we lack longitudinal and experimental evidence to unravel cause and effect relationships in this context, and have yet to identify the key levers for behaviour change in children with these characteristics. Therefore, across four interlinked research work packages, the objectives of this project are: Objective 1: To establish the directional and longitudinal relationships between food approach behaviour and parent feeding practice. To achieve objective 1, we will determine i) the extent to which parental feeding practices differentially affect the development of children's food approach, depending on children's individual baseline susceptibility to food approach ii) the direction of the relationship between children's food approach and parental feeding practices iii) whether the relationship between children's food approach and parental feeding practices varies across early development iv) the extent to which genetic factors influencing children's food approach can explain parental feeding practices and v) the degree to which genetic influences on children's food approach behaviour can explain parental feeding practice changes across the preschool period. Objective 2: To document the views and perspectives of parents of children with high food approach behaviours. To achieve objective 2, we will i) establish how families with children who show high levels of food approach behaviours parent their children in the food context; ii) examine, in detail, the emotional, contextual and child food approach behavioural predictors of parental feeding practices in real time and real-life contexts. Objective 3: To test whether specific feeding practices can change eating behaviour in children high in food approach behaviour. To achieve objective 3, we will establish the efficacy of specific feeding practices (which are feasible and acceptable to parents) in reducing palatable food consumption in a short-term, experimental setting, within the laboratory, for children high in food approach behaviours. The specific practices that we will evaluate will be determined by the outcomes of the first two work packages (Objectives 1 & 2). Objective 4: To use the knowledge generated by work packages 1-3 to develop guidelines for future evidence-based intervention design, tailored to children with high food approach behaviours. To achieve objective 4, we will i) establish the views of parents and other stakeholders regarding the content and delivery of targeted intervention to improve outcomes for children with high food approach ii) determine which intervention format, focusing on digital delivery, stakeholders would find most helpful iii) determine other behaviour change strategies which could support implementation of feeding strategies and iv) establish the feasibility of further development of such an intervention in the future. Together, achievement of these objectives, combining discovery research, existing data, innovative methods, interdisciplinary approaches, and co-design, will extend the frontiers of our understanding of differential susceptibility to obesogenic environments and inform the development of trusted and efficacious interventions tailored to protect children with avid appetites from the development or maintenance of obesity.

Lay abstract: Childhood obesity is one of the most serious public health challenges of the 21st century, of major societal concern, placing children at high risk of diseases such as diabetes, cardiovascular disease and some cancers in adulthood. Typically, childhood obesity begins in infancy and early childhood, with 90% of children who have obesity at 3 years continuing to have overweight or obesity in adolescence. Understanding the factors which may help to prevent or reduce the risk of childhood obesity, and applying this understanding to develop effective interventions, is of key importance to solving this complex policy and practice challenge. It is well established that a healthy home environment is protective against the development of obesity. However, some children are more vulnerable to the development of obesity than others, due to their genetic susceptibility to an environment where highly palatable food is plentiful and accessible. Children's appetite and eating behaviours link this genetic risk and the development of obesity. Children's appetite avidity is manifest in their 'food approach' behaviours, which have considerable heritability. Food approach behaviours include wanting to eat (or eating more) in response to the sight, smell or taste of palatable food, greater enjoyment of food, rapid eating, weaker sensitivity to internal cues of 'fullness', as well as eating in response to emotion. Parental feeding practices are a key component of the child's food environment and have the potential to exacerbate or minimise these food approach behaviours across time. However, it can be very difficult for parents of children with high food approach to manage their eating behaviour effectively, and parents report feeling powerless, frustrated and desperate for solutions. Therefore, whilst feeding practices are key intervention targets to change children's eating behaviour and child weight outcomes, there has been little evaluation of how feeding practices interact with children's food approach behaviours to predict eating behaviour and weight gain across time, or how feeding practices can be best tailored for children with high food approach behaviours to protect against the development of obesity. In this project, we will undertake the longitudinal analyses and experimental studies which are needed to disentangle these effects. We will use a wide range of methodologies to answer the questions in this study, including behaviour genetics, longitudinal studies, experimental laboratory studies, qualitative methods, questionnaire measures, and measures which assess children's eating behaviours and parental feeding practices in varied settings in real time. We will use a combination of existing cohort data and collection of novel data from children and families where children show high levels of food approach. Working with parents of children high in food approach behaviours, we will then use the knowledge we generate in those studies to co-develop recommendations for the future design of an intervention focused on parent feeding practices for children with high food approach behaviour. We do not know what the best advice regarding feeding practice is for parents of children with avid appetites. In particular, we are lacking an evidence base for which feeding practices work best to protect such children from the development of overweight. Current public health advice regarding children's eating and weight is generic, ineffective, and does not tackle variability in children's appetite avidity, which makes behaviour change even more challenging for parents who struggle to manage their child's eating behaviour. Using current theory to inform complex intervention development, our research will examine how parents interact with their pre-school children with avid appetites in the food context, evaluate how these interactions predict short and long-term effects on obesogenic eating behaviour and develop recommendations for intervention.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE