Reduction in Food Away from Home Is Associated with Improved Child Relative Weight and Body Composition Outcomes and This Relation Is Mediated by Changes in Diet Quality



      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.


      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.


      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 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).


      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.


      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.


      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.


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      M. Altman is a graduate student, Department of Psychology, Washington University in St Louis, St Louis, MO.


      R. P. Kolko is a graduate student, Department of Psychology, Washington University in St Louis, St Louis, MO.


      At the time of the study, J. Cahill Holland was a postdoctoral fellow, Department of Psychiatry, Washington University School of Medicine, St Louis, MO.


      D. Lundeen is a graduate student, Department of Nutrition and Dietetics, Saint Louis University, St Louis, MO.


      R. I. Stein is a research assistant professor of medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO.


      R. R. Welch is an assistant professor of psychiatry, Department of Psychiatry, Washington University School of Medicine, St Louis, MO.


      D. E. Wilfley is Scott Rudolph Professor of Psychiatry, Medicine, Pediatrics, and Psychology, Department of Psychiatry, Washington University School of Medicine, St Louis, MO.


      K. B. Schechtman is an associate professor, Division of Biostatistics, Washington University School of Medicine, St Louis, MO.


      B. E. Saelens is a professor of pediatrics and psychiatry and behavioral sciences, Seattle Children’s Research Institute, University of Washington, Seattle.


      M. G. Perri is Robert G. Frank Professor of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville.


      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.