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Parenting pre-schoolers with avid appetites: Understanding differential susceptibility to obesogenic environments for future intervention efficacy.

Lead Research Organisation: Aston University
Department Name: Sch of Life and Health Sciences

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.

Publications

10 25 50

 
Title APPETItE project: animation for parents 
Description We translated the key recommendations of our project into an animation for parents that promotes the use of delay, distraction and portioning for handling repeated snack food requests from children. 
Type Of Art Film/Video/Animation 
Year Produced 2025 
Impact None yet as this is just released. 
URL https://www.appetite-research.com/animation-for-parents
 
Description The APPETItE project has established the directional and longitudinal relationships between food approach behaviour and parent feeding practice. We have shown that there are reciprocal associations between parent feeding practices and child appetite traits: We have Highlighted that emotional and instrumental feeding and pressure to eat are exacerbators of food responsiveness and emotional eating - two key traits that confer risk for avid eating. We have also shown that these relationships vary based on children's early appetite: children with a more avid appetite in toddlerhood are differentially affected by parental feeding practices; caregivers of toddlers will benefit from feeding advice that is tailored to their child's appetite traits.
We identified that at 3-5 years of age, there are 4 distinct identifiable eating profiles. 22% of children fall into the 'avid eating behaviour' profile which is distinguished by food responsiveness and emotional overeating. These children are more temperamentally surgent and more likely to live in families experiencing food insecurity. We also showed that parents of children with avid eating behaviour find managing repeated requests for food outside of mealtimes challenging. We showed that snacking is typically initiated by the child rather than the parent, and that when the child initiates the eating occasion, the most common goal reported by parents in that moment is to reduce stress or conflict.
In the laboratory we tested how effective distraction and portioning were at reducing children's intake of snack foods when they were not hungry. We showed that distraction has a powerful effect on reducing children's eating in the absence of hunger. The strategy works as well for children with avid and typical eating profiles. Importantly, there was no 'rebound effect' - those who had been in the distraction condition did not go on to eat more when they had free access to snacks 10 minutes later.
We integrated these findings with parent interviews and focus groups to develop guidelines for future evidence-based intervention design, tailored to children with high food approach behaviours. Parents wanted guidelines to help them i) put a structure in place for meals and snack times, ii) manage the home food environment, iii) manage unplanned snack food requests in the moment.
Parents also needed significant support to avoid giving food to regulate children's emotion. This would need to be a more in-depth extension of the intervention and may need to be delivered in a different way to the digital, self-guided resource planned for the next steps of the current intervention. This opens up new research questions and paths to develop resources specifically for parents who use this practice.
Exploitation Route The next steps for this research area will be to develop and evaluate tailored intervention materials to support parents of children with avid eating with their feeding practices. Development of resources for parents who use food for emotion regulation will be useful next steps for academics and practitioners. We have produced guidelines for intervention development and an animation for parents (available via appetite-research.com, and childfeedingguide.com). This will enable maximal exposure to our findings for practitioners and professionals working in relevant areas (e.g. dietetics, paediatrics, general practice, clinical psychology, health visitors, local authorities, schools and nurseries). Parents will also be able to access the animation and guidelines directly.

In addition, there is further opportunity for expansion of this work by academics, in particular regarding:
1. The demonstrated value of using person-centred statistical approaches, to better understand how behaviours cluster together.
2. The use of experience sampling methodology to capture what is happening 'in the moment': we demonstrated that ecological momentary assessment was feasible and acceptable for busy parents of preschoolers, and demonstrated changing motivations for behaviour across time and context.
3. The potential for design of tailored interventions for other appetite trait profiles.
Sectors Agriculture

Food and Drink

Communities and Social Services/Policy

Healthcare

URL http://appetite-research.com
 
Title APPETItE study all data 
Description The APPETItE data comprises a multiple mixed methods approach, including an online survey of feeding practices and perceptions of child food approach behaviours, a qualitative study of parents' experiences of feeding children with avid appetites, an ecological momentary assessment study to capture emotion and feeding practice across time and context, as well as a randomized controlled experiment to examine effects of feeding practice on child food intake. Types of data: Data generated were both quantitative and qualitative. New data were generated by a survey, interviews, ecological momentary analysis, experimental laboratory methods, and co-creation methods. Because of the scale and complexity of data within this project, there is not one overall dataset. The project datasets are organised by project and published within project files. A data dictionary is available which describes all available data generated by the project. As publications are related from the original study, the resource will be updated directly at https://osf.io/r6789/ and can also be accessed via https://beta.ukdataservice.ac.uk/datacatalogue/studies/study?id=857642 
Type Of Material Database/Collection of data 
Year Produced 2024 
Provided To Others? Yes  
Impact These data have already generated publications beyond that planned for the original grant. 
URL https://beta.ukdataservice.ac.uk/datacatalogue/studies/study?id=857642
 
Description APPETItE website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Our website contains all outputs and end of project pre-recorded talks, as well as an animation for parents. We have had over 2000 visitors to our site.
Year(s) Of Engagement Activity 2023,2024,2025
URL https://www.appetite-research.com
 
Description BBSRC LIDO lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact approx 50 students from London Interdisciplinary Biosciences Consortium (LIDo), the largest BBSRC funded Doctoral Training Partnership in the UK. http://lido-dtp.ac.uk/

Blissett contributed a lecture to a week of cross UKRI remit talks and workshops, designed to broaden our BBSRC students understanding of the science that frameworks their own funding body.

The event occurred on Friday 24th February 2025 at 12:30

The audience was a mix of students from a broad range of UKRI funded doctoral training programmes, although the core attendees were from a biological background.

Students asked great questions and some followed up by email afterwards.
Year(s) Of Engagement Activity 2023
 
Description BFDG 2022: Poster presentation of APPETItE project 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Poster of APPETItE protocol and published abstract
Year(s) Of Engagement Activity 2022
 
Description CBCD Workshop on Naturalistic Experimentation of Child Development, University of Birkbeck (London) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Poster presentation 'Latent Profile Analysis of Children's eating behaviour: identifying avid eaters'
Year(s) Of Engagement Activity 2022
 
Description Conference presentation at UK Congress on Obesity 2022. Lancaster, UK. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Presentation entitled Latent Profile Analysis of Children's eating behaviour: identifying avid eaters. Discussed the findings of the Latent Profile Analysis of children's eating behaviour.
Year(s) Of Engagement Activity 2022
 
Description Conference presentation, 31st Annual European Childhood Obesity Group Congress, (Vichy, France) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Presentation 'Latent Profile Analysis of Children's eating behaviour: identifying avid eaters.'
Year(s) Of Engagement Activity 2022
 
Description Dr Pickard: Symposium at Society for Research in Child Development 2023 Biennial Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Dr Abigail Pickard presented 'Latent Profiles of Children's Eating Behaviour: Identifying Avid Eaters' for the symposium 'Towards a Holistic Developmental Investigation of Children's Eating Behaviors' at the Symposium at Society for Research in Child Development 2023 Biennial Meeting
Year(s) Of Engagement Activity 2023
 
Description Durham University Psychology Seminar: The APPETItE Project 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Blissett Gave a seminar at Durham University to academics and students. It summarised the following:

Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively (APPETItE)

The causes of obesity are multifactorial but a key predictor of individual BMI is the interaction between our genetic predisposition towards obesity and our environmental context. The obesogenic environment does not pose the same risk of overweight and obesity to all individuals. The Behavioural Susceptibility Theory of obesity posits that inherited variation in appetitive traits influence individual differences in responsiveness to the 'obesogenic' environment. The "APPETItE" study examines how this variation in appetitive traits manifests and how it may be moderated by parental feeding practices, with a view to developing interventions that are specifically tailored for those individuals at greatest risk. In this talk I will describe work completed so far in our project, including: person centred conceptualisation of appetite traits, longitudinal assessment of the causal relationships between feeding practices and children's eating behaviour outcomes, and qualitative work with parents of children with very avid appetite. I will finish by discussing the implications of our findings so far for the development of interventions.
Year(s) Of Engagement Activity 2024
 
Description End of Project conference for professionals 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 50 practitioners, clinicians, local government employees as well as some academics including PhD students attended an end of project conference to hear about our findings and implications for intervention development.
Year(s) Of Engagement Activity 2024
URL https://www.appetite-research.com/end-of-project-talks
 
Description Energy Balance presentation, Department of Behavioural Science and Health, University College London 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Dr Kininmonth gave a presentation on Parental feeding practices and appetite in toddlerhood and early childhood: a discordant twin analysis of the Gemini cohort as part of the Energy Balance presentation hosted by the Department of Behavioural Science and Health at University College London.
Year(s) Of Engagement Activity 2023
 
Description Interview for BBC Radio Bristol 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Abigail Pickard was interviewed by Dohn Darvall (presenter of BBC Radio Bristol) about Eating Profiles in Young Children following the publication of 'Identifying an avid eating profile in childhood and the association with temperament, feeding practices and food insecurity'.
Year(s) Of Engagement Activity 2023
 
Description Invited seminar talk at the University of Leeds 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Dr Pickard and Dr Edwards were invited to give a seminar for the psychology department at the University of Leeds. The talk was titled 'Appetite in pre-schoolers: Appetite in Pre-schoolers: Producing Evidence for Tailoring Interventions Effectively (APPETItE)' and detailed the research findings of the ongoing APPETItE project.
Year(s) Of Engagement Activity 2023
 
Description Invited talk - St George's Hospital - Population Health Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact An invited talk to discuss my work on eating behaviours and parental feeding behaviours.
Year(s) Of Engagement Activity 2024
 
Description Invited to discuss ongoing research plans at the Real-Time Eating Activity and Children's Health (REACH) Lab at the University of Southern California 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Dr Pickard was invited by Dr. Genevieve Dunton to attend a lab meeting of the Real-Time Eating Activity and Children's Health (REACH) Lab at the University of Southern California. Dr Pickard presented the research plans for WP2 Ecological Momentary Assessment study to the research group and was provided feedback on the study protocol.
Year(s) Of Engagement Activity 2023
 
Description Oral presentation at Aston Univeristy's Institute of Health and Neurodevelopment Postgraduate and Postdoctoral Research Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Oral presentation by Dr Pickard at Aston Univeristy's Institute of Health and Neurodevelopment Postgraduate and Postdoctoral Research Conference. Talk entitled 'Latent profiles of eating behaviours in childhood and their association with temperament, parenting and food insecurity'.
Year(s) Of Engagement Activity 2023
 
Description Oral presentation at research seminar. Institute of Health and Neurodevelopment, Aston University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact An oral presentation at Aston's Institute of Health and Neurodevelopment. The presentation outlined the findings of a Latent Profile Analysis of Children's Eating Behaviour.
Year(s) Of Engagement Activity 2022
 
Description Oral presentation at research seminar. Institute of Health and Neurodevelopment, Aston University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact An oral presentation at Aston's Institute of Health and Neurodevelopment. The presentation outlined plans for our study using ecological momentary assessment, which led to insightful discussion about our research plans.
Year(s) Of Engagement Activity 2022
 
Description Poster presentation at International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Poster presentation by Dr Edwards at International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2023. Talk entitled Examining Parents' Experiences and Challenges of Feeding Preschool Children with Avid Eating Behaviour.
Year(s) Of Engagement Activity 2023
 
Description Poster presentation at Novo Nordisk Foundation Science Cluster Conference: Prevention of Childhood Obesity 2023. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Poster presentation by Dr Edwards titled 'Examining Parents' Experiences and Challenges of Feeding Preschool Children with Avid Eating Behaviour'.
Year(s) Of Engagement Activity 2023
 
Description Poster presentation at the Annual Meeting of the British Feeding and Drinking Group (BFDG) 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Dr Kininmonth presented a poster on Parental feeding practices and appetite in toddlerhood and early childhood: a discordant twin analysis of the Gemini cohort at the Annual Meeting of the British Feeding and Drinking Group (BFDG) 2023
Year(s) Of Engagement Activity 2023
 
Description Poster presentation at the Annual Meeting of the British Feeding and Drinking Group (BFDG) 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Poster presentation at the Annual Meeting of the British Feeding and Drinking Group (BFDG) 2023 by Dr Edwards, titled 'A million snacks: Examining caregivers' experiences of feeding preschool children with avid eating behaviour'.
Year(s) Of Engagement Activity 2023
 
Description Presentation at Aston Univeristy's Institute of Health and Neurodevelopment Postgraduate and Postdoctoral Research Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Oral presentation by Dr Edwards at Aston Univeristy's Institute of Health and Neurodevelopment Postgraduate and Postdoctoral Research Conference, titled 'Examining Parents' Experiences and Challenges of Feeding Preschool Children with Avid Eating Behaviour'.
Year(s) Of Engagement Activity 2023
 
Description Presentation at International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Dr Kininmonth gave a presentation on Parental feeding practices and appetite in toddlerhood and early childhood: a discordant twin analysis of the Gemini cohort at the International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2023
Year(s) Of Engagement Activity 2023
 
Description Presentation at International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation on Latent profiles of eating behaviours in childhood and their association with temperament, parenting and food insecurity given by Dr Pickard at the International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2023.
Year(s) Of Engagement Activity 2023
 
Description Presentation at Novo Nordisk Foundation Science Cluster Conference: Prevention of Childhood Obesity 2023. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation by Dr Pickard titled 'Identifying an avid eating profile in childhood: associations with temperament, feeding practices and food insecurity' at the Novo Nordisk Foundation Science Cluster Conference: Prevention of Childhood Obesity 2023.
Year(s) Of Engagement Activity 2023
 
Description Presentation at the Annual Meeting of the British Feeding and Drinking Group (BFDG) 2023 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Oral presentation by Dr Pickard at the Annual Meeting of the British Feeding and Drinking Group (BFDG) 2023. Titled 'Identifying an avid eating profile in childhood and the association with temperament, feeding practices and food insecurity'.
Year(s) Of Engagement Activity 2023
 
Description Presentation at the King's Health Partners Women and Children's Health Research Seminar series - Current Approaches in Childhood Obesity 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Industry/Business
Results and Impact Presentation of APPETITE project and Behavioural Susceptibility theory of childhood obesity
Year(s) Of Engagement Activity 2023
 
Description Prof Blissett: Symposium at Society for Research in Child Development 2023 Biennial Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Prof Blissett gave a talk entitled 'Understanding Differential Susceptibility to Obesogenic Environments: early findings of the APPETItE project' at the symposium entitled 'Influences on child obesity and obesity-related health behaviors from infancy through adolescence'
Year(s) Of Engagement Activity 2023
 
Description Public lecture presenting APPETItE project for Aston Originals YouTube channel 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact The Aston Institute for Health and Neurodevelopment host a public lecture in their series Molecules to Minds. Professor Jackie Blissett will be discussing how one size does not fit all when it comes to children's healthy eating behaviour. Jackie and her team from the Psychology of Eating in Adults and Children (PEACh) research group will explore how we can better understand and support children's healthy eating habits.

Molecules to Minds is presented by members of the Aston PEACh Team: Professor Jackie Blissett, Dr Abigail Pickard and Dr Megan Jarman.
Year(s) Of Engagement Activity 2022
URL https://www.youtube.com/watch?v=vB-3roIPsuA&t=2711s&ab_channel=AstonOriginals
 
Description Symposium at UK Society for Behavioural Medicine 18th Annual Scientific Meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Symposium on Appetite in Preschoolers: Understanding differential susceptibility to obesogenic environments for future intervention efficacy, presented by Prof Blissett, Prof Farrow, Dr Edwards, Dr Kininmonth, Dr Pickard
Year(s) Of Engagement Activity 2023