Abstract
Background
Reducing consumption of food away from home is often targeted during pediatric obesity
treatment, given the associations with weight status and gain. However, the effects
of this dietary change on weight loss are unknown.
Objective
Our aim was to evaluate associations between changes in dietary factors and child
anthropometric outcomes after treatment. It is hypothesized that reduced consumption
of food away from home will be associated with improved dietary intake and greater
reductions in anthropometric outcomes (standardized body mass index [BMI] and percent
body fat), and the relationship between food away from home and anthropometric outcomes
will be mediated by improved child dietary intake.
Design
We conducted a longitudinal evaluation of associations between dietary changes and
child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric
data were collected at baseline and 16 weeks.
Participants/setting
Participants were 170 overweight and obese children ages 7 to 11 years who completed
a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site
randomized controlled trial conducted in two cohorts between 2010 and 2011 (clinical
research trial).
Intervention
Dietary treatment targets during family-based behavioral weight-loss treatment included
improving diet quality and reducing food away from home.
Main outcome measures
The main outcome measures in this study were child relative weight (standardized BMI)
and body composition (percent body fat).
Statistical analyses
We performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates.
Results
As hypothesized, decreased food away from home was associated with improved diet quality
and greater reductions in standardized BMI (P<0.05) and percent body fat (P<0.01). Associations between food away from home and anthropometric outcomes were
mediated by changes in diet quality. Specifically, change in total energy intake and
added sugars mediated the association between change in food away from home and standardized
BMI, and change in overall diet quality, fiber, added sugars, and added fats mediated
the association between change in food away from home and percent body fat. Including
physical activity as a covariate did not significantly impact these findings.
Conclusions
These results suggest that reducing food away from home can be an important behavioral
target for affecting positive changes in both diet quality and anthropometric outcomes
during treatment.
Keywords
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Biography
M. Altman is a graduate student, Department of Psychology, Washington University in St Louis, St Louis, MO.
Biography
R. P. Kolko is a graduate student, Department of Psychology, Washington University in St Louis, St Louis, MO.
Biography
At the time of the study, J. Cahill Holland was a postdoctoral fellow, Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
Biography
D. Lundeen is a graduate student, Department of Nutrition and Dietetics, Saint Louis University, St Louis, MO.
Biography
R. I. Stein is a research assistant professor of medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO.
Biography
R. R. Welch is an assistant professor of psychiatry, Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
Biography
D. E. Wilfley is Scott Rudolph Professor of Psychiatry, Medicine, Pediatrics, and Psychology, Department of Psychiatry, Washington University School of Medicine, St Louis, MO.
Biography
K. B. Schechtman is an associate professor, Division of Biostatistics, Washington University School of Medicine, St Louis, MO.
Biography
B. E. Saelens is a professor of pediatrics and psychiatry and behavioral sciences, Seattle Children’s Research Institute, University of Washington, Seattle.
Biography
M. G. Perri is Robert G. Frank Professor of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville.
Biography
L. H. Epstein is SUNY Distinguished Professor and chief, Behavioral Medicine, Department of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
Article info
Publication history
Published online: May 08, 2015
Accepted:
March 5,
2015
Received:
November 12,
2014
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This work was supported by several National Institutes of Health (NIH) Grants: 5-RO1HD036904 (National Institute of Child Health and Human Development), 5K24MH070446 (National Institute of Mental Health), and 5T32HL007456 (National Heart, Lung, and Blood Institute [NHLBI]). M. Altman, J. Cahill Holland, and R. P. Kolko were supported by NIH Grant 5T32HL007456 (NHLBI), and KL2RR024994 (National Center for Research Resources). This work was also made possible by NIH Grant UL1 RR024992 (National Center for Research Resources).
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
