Network Social Support for Healthy and Obesogenic Behavior Influences Children's Dietary Intake and Weight Change during Family‐Based Behavioral Obesity Treatment
Authors: Balantekin Katherine Naime , Hayes Jacqueline F , Kolko Rachel P , Stein Richard I , Saelens Brian E , Welch R. Robinson , Perri Michael G , Schechtman Kenneth B , Epstein Leonard H , Wilfley Denise E. 
Published: November 2023

Parent support is a key influence on children's eating behaviors. However, less is known about how broader social network support (e.g., extended family, friends) for eating behaviors predicts dietary intake in children with overweight and obesity. Further, as networks can support healthy and/or obesogenic eating behaviors, characterizing the patterns of healthy or obesogenic support may identify factors that impact obesity treatment response. This study aimed to examine the influence of network support for healthy and obesogenic behaviors on weight change across treatment and food group intake at pre‐ and post‐treatment in children with overweight and obesity attending family‐based behavioral obesity treatment (FBT). Parent‐child dyads (n=174) completed 4‐months of FBT. Children with a body mass index (BMI) ≥85th percentile and ≥1 parent with a BMI ≥25 were enrolled. All measures were assessed both pre‐ and post‐FBT. Child height and weight were measured and used to calculate zBMI. Parents completed interviews on children's network social support, yielding summary scores of network support for healthy and obesogenic behaviors. Parents completed three 24‐hour recalls of their child's diet to assess intake of vegetables, fruit, whole grains, low‐fat dairy, lean meat, and sweet foods. The Healthy Eating Index‐2005 (HEI) total score, measuring diet quality in conformance with federal guidelines, was calculated. T‐tests examined differences in food group intake pre‐ and post‐FBT. Linear regression models evaluated how pre‐FBT network support predicted pre‐ and post‐FBT intake, and how change in healthy and obesogenic support across FBT predicted change in zBMI. Models were adjusted for child age, sex, socioeconomic status, study site; intake models were adjusted for pre‐FBT BMI, and post‐FBT intake models were also adjusted for pre‐FBT intake to examine change in intake. Overall, from pre‐ to post‐FBT, improvements were reported in vegetable, fruit, lean meat, and sweet intake, and HEI scores (ps<.01), but not low‐fat dairy or whole grain intake. Pre‐FBT, higher support for healthy behaviors was associated with increased vegetable and fruit intake (ps<.05), and higher support for obesogenic behaviors was associated with lower total HEI scores (p<.05). No other pre‐FBT relations emerged. Additionally, higher pre‐FBT network support for healthy behaviors predicted increased low‐fat dairy intake post‐ FBT (p<.05). Higher pre‐FBT support for obesogenic behaviors predicted lower vegetable intake and lower HEI score post‐FBT (ps<.05). Greater decrease in support for obesogenic behaviors predicted greater decreases in zBMI across treatment (p<.01); no relations were observed for support for healthy behaviors. Network support for healthy versus obesogenic behaviors demonstrated different impacts on children's dietary intake and weight change across treatment. Higher pre‐FBT support for healthy behaviors predicts fruit and vegetable intake, whereas higher support for obesogenic behavior may impede diet and weight improvements. Effective childhood obesity treatments typically target increasing support for healthy behavior, and these results indicate it is also important to address support for obesogenic behaviors to improve weight outcomes and diet quality. Future work is warranted on identifying optimal and efficient strategies for targeting social support for healthy and obesogenic behaviors to enhance children's obesity treatment response.Support or Funding InformationThis work was supported by 2R01HD036904 and T32 HL007456.