This study examined whether baseline and change in characteristics of the family food environment were associated with change in children’s diet, specifically saturated fat intake. The present study is one of the first to measure changes in the family food environment as simultaneous correlates of dietary change in children. Some measureable changes in these variables were observed, and change in parents’ knowledge, perceived responsibility and restriction were associated with positive dietary change in children. The key finding of this study was that factors associated with change in saturated fat intake differed depending on whether baseline or change in the family food environment was the exposure of interest.
A number of family food environment factors, measured at baseline, were associated with a change in children’s saturated fat intake. Higher parent reported perceived responsibility for food provision, greater perceived food availability, lower levels of restriction and pressure to eat were associated with greater decrease in saturated fat intake over the 12 week intervention period. Such findings support previous cross-sectional studies where child feeding practices, such as restriction and higher pressure to eat, have been associated with less healthy behaviours . Cross-sectional research has also shown that television interruptions to meals, parent’s role modelling and perceptions of adequacy of their child’s diet are important influences of children’s current dietary behaviour , and parents teaching their children about nutrition has been found to be associated with children’s current weight status . However, the present study found these variables were not associated with a change in diet. This may reflect limited variation in the data or a distinction between influences of current versus change in behaviour. Indentifying who is most likely to respond to an intervention based on demographic or other baseline characteristics, may increase the likelihood of successful behaviour change. Understanding and focusing on the determinants of change in the family food environment may also improve the effectiveness of intervention strategies to improve children’s diet and health outcomes.
The present study examined how changes in the family food environment were associated with changes in intake. Increases in nutrition knowledge, perceived responsibility and restriction were associated with a decrease in children’s saturated fat intake. The regression models suggest that parents’ knowledge and attitudes and shaping practices explain a greater proportion of variance in the change in children’s diet than role modelling aspects of the family environment. It has been shown that role modelling is an essential part of adopting new behaviour , and children tend to model their parents’ eating behaviours , which is evident from research showing parent and children’s intakes of nutrients and food groups are generally correlated [14, 15]. Longitudinal research with Australian adolescents has shown baseline levels of role modelling of healthy eating by mothers was associated with change in fruit consumption . However, to the best of our knowledge, the present study is the first to capture changes in parent reported perceived role modelling as a result of intervention. The lack of significant findings further support the idea that predictors of current and change in behaviour may be different. Other possible explanations may be that role modelling specific to dairy foods may not translate in a more general food related role modelling questionnaire, or despite using validated questionnaires, it is difficult for questionnaires to detect such small changes. Also, parents may not be very aware of their own behaviours and realise the extent to which their behaviours influence the behaviour of their children. To highlight the importance of role modelling as a predictor of dietary change, and support its inclusion in interventions, it is necessary that questionnaires are well developed to measure this complex domain.
Knowledge is the foundation of nutrition education. Many interventions include nutrition education as part of their content, however, there have been few explorations of whether change in knowledge is associated with change in dietary behaviour. An increase in parents’ nutrition knowledge was associated with a decrease in children’s saturated fat intake. However, we know that knowledge is “required but not sufficient” for changes in food behaviour . Improving knowledge is an attractive target of intervention because it is a relatively malleable characteristic, and at a population level knowledge of individuals is most amendable to policy intervention . The results of this study support the inclusion of nutrition knowledge as an intervention target, in combination with other known determinants of behaviour change.
The multivariable regression analysis in the present study found differing results for baseline levels of restriction and change in restriction as a predictor of dietary change. Lower levels of parent reported restriction at baseline but an increase in restriction over the intervention period were associated with a decrease in saturated fat, or healthier behaviour. Previous parent-child feeding research has focussed on parental restriction and subsequent impacts on children’s energy intake and risk of obesity [9, 43]. Higher levels of restriction and excessive control by parents can result in a reduction in children’s ability to self-regulate their own intake, resulting in higher energy intake [9, 43]. In terms of energy balance, it appears higher levels of restriction are associated with negative eating behaviours in children. But in terms of food intake, one study to examine feeding practices and children’s consumption of certain food groups found no relationship between parental restriction and intake of healthy or unhealthy foods . Therefore, there is still uncertainty as to the role of parental restriction on children’s eating behaviours. A review of parent-child feeding practices suggests the short and longer-term effect of shaping practices on children’s eating behaviours may be different . From the results of this study, it is difficult to make inferences about the effects of restriction in promoting healthy dietary intake. The CFQ asks about restriction related to consumption of sweet and snack foods, junk foods and children’s favourite foods . While the intervention focussed on decreasing the availability of regular fat milk at home, it is possible that parents perceived this behaviour to be a form of restrictive practice, thereby recording an increase in their response to these questions. Nonetheless, there appears to be a fine line between positive and negative impacts of restrictive practices and children’s eating behaviours , particularly in terms of healthy behaviours, and further research is required to decipher how parents’ shaping practices are best included into future interventions.
The family food environment factors showed acceptable validity. It is difficult to capture the complexity of the family environment through a questionnaire, however, using a comprehensive measure of known validity, may give greater confidence in these findings. Generally relatively small effect sizes were observed for changes in any one food environment factor. There may be a number of possible explanations for this. While the intervention aimed to change the food environment through food choices, support from parents and role modelling, it is possible that it was not successful in changing these domains, or that scores at baseline were high and therefore results showed evidence of a ceiling effect. But it is also possible that the intervention was successful in changing these, however, the tools used did not capture this change because these tools have generally been developed within obesity literature. Regardless, we were still able to capture a range of changes in the family food environment. Because understanding change in family food environments is vital to intervention success, further effort is needed to examine the sensitivity of existing tools to detect change or develop new tools if required.
In considering these findings, it is important to acknowledge some of the limitations of this study. While parent and children’s sociodemographic characteristics and weight status largely represents that of broader Australian community [36, 46, 47], this sample was relatively small and was comprised of volunteers who may show greater motivation than the general population. As a result, baseline and change in the family food environment and dietary intake of children may be more positive than what could be expected generally. All predictor variables of the family food environment were theoretically derived but were self-reported, and are subject to social desirability bias. A strength of this study is the rigorous dietary assessment method used. Three 24-hour recalls is considered a robust measure of diet in children . Parent report is recommended for younger children, but because this sample contained children aged 4-13 years, the primary source of reporting was not consistent between the younger and older children. Another strength was that the family food environment was measured pre and post intervention, allowing change to be calculated. Other multifaceted studies have had limited scope to capture the complexity of the family environment. So a further strength of this study is the detail to which the food environment was measured, and the broad range of family characteristics that were measured. While we attempted to capture the complexity of the family food environment, it is acknowledge that there are numerous other factors that can influence behaviour change which should also be considered in future research. For example children’s personal characteristics such as self-esteem or factors from within the community or wider environment. The influences of behaviour may vary with children’s age. Future research may examine the change in the relative importance of the family and other environments as young children transition through to adolescents.