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

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.