Preschoolers whose parents have rules about what their children can and cannot eat have healthier eating habits than those raised without such rules, according to a new study by pediatrics researchers at the University at Buffalo.
The study also provides new information on how toddlers’ ability to self-regulate, or control, their emotional and behavioral impulses influences their eating habits two years later, depending on the presence or absence of parental food rules.
The new findings were presented last week at ObesityWeek 2014 in Boston. ObesityWeek runs concurrently with the annual meetings of The Obesity Society and the American Society for Metabolic and Bariatric Surgery.
“Parents can make a difference here by training young children to self-regulate and also by setting food rules in the home,” says Dr. Xiaozhong Wen, PhD, assistant professor in the Department of Pediatrics in the UB School of Medicine and Biomedical Sciences and senior author on the research. “We found that the combination of parental rules and young children’s ability to self-regulate their behaviors works best in teaching young children to eat healthy.”
With good reason, the Institute of Medicine identifies childhood obesity as an urgent public health problem. The prevalence of obesity in young children more than tripled from 1970 to 2010; today, about one in three young children are overweight or obese. Although childhood overweight and obesity rates may have plateaued in some US population subgroups, such as non-Hispanic whites and those of higher socioeconomic status, overall rates remain high and racial/ethnic and socioeconomic disparities appear to be widening.
Once established, childhood obesity typically persists and can lead to serious health problems including cardiovascular disease and diabetes. Developing effective prevention and intervention programs for young children, particularly during the preschool years, is seen as an essential step in combating the obesity epidemic across the lifespan. The preschool years have been identified as a critical period in childhood for the development of childhood obesity because the eating and physical activity habits that contribute to later obesity become established during these formative years and thus are still malleable.
Self-regulation and obesity risk factors
Despite the need, few obesity prevention and intervention programs for young children have been rigorously tested, and effects are modest at best. There is growing consensus, however, that improving behavioral self-regulation (i.e., inhibiting impulses, calming down when upset) may be important for preventing childhood obesity. Past studies indicate that stress can lead to increased appetite and a shift in preference to foods high in added sugar and fats. Additionally, obesity is more prevalent among children who engage in emotional eating, disinhibited eating, or eating in the absence of hunger.
It is thought that children who cannot effectively cope with stress may engage in such stress-eating habits as a way to self-regulate emotion and behavior; over time, this leads to obesity. However, little is known about the long-term impact of self-regulation during early childhood on later risk of obesity. “In adults and adolescents, self-regulation, emotional eating and obesity have been well-studied, but there is very little information about the role that self-regulation plays in young childhood obesity,” says Wen.
The UB study explores the researchers’ hypothesis that the ability of children to self-regulate their emotions and behavior at 2 years of age would translate into healthier eating habits at 4 years of age. They used a widely accepted definition of self-regulation: the child’s ability to override his or her natural and automatic tendencies or desires in order to pursue long-term goals.
The study was based on data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a federally funded, nationally representative sample conducted by the U.S. Department of Education of approximately 10,700 children born in the U.S. in 2001. Data was gathered from parents and teachers who completed surveys and phone interviews about children at various ages. It was designed to provide detailed information about children’s early life experiences, including health, development, care and education. The UB study focused on a subsample of 8,850 children.
Without parental rules, self-regulation does not predict healthy eating
To determine how much the child could self-regulate, parents were asked to rate how frequently the child exhibited emotional/behavioral responses, including irritability and fussiness, whimpering and their ability to wait for something. The researchers then examined associations between self-regulation in children at 2 years and their consumption at 4 years of age of the following foods: fruit juices, soda, fresh fruit, fresh vegetables, fast food, salty snacks, and sweets.
“We found that children who were able to self-regulate at 2 years old had healthy eating habits by the time they were 4 years old, so long as their parents also set rules about the right types of foods to eat,” he says. However, “self-regulation by itself, without parental food rules, made little difference in children’s later eating habits.”
That finding is key, as it demonstrates the strong influence of environmental factors on eating behaviors and preferences, explains Neha Sharma, a co-author and recent UB graduate from the Department of Psychology who presented the research at ObesityWeek. “It is amazing to see that a parental rule about which types of food a child can and cannot eat could have such a great impact on child eating habits,” says Sharma.
Among the unhealthy food items, soda was the one that children consumed most if their parents had no food rules. Compared to preschoolers whose parents set food rules, preschoolers without parental food rules drank about 25% m ore soda. Research indicates that rising consumption of sugary drinks has been a major contributor to the obesity epidemic. From 1989 to 2008, calories from sugary beverages increased by 60% in children ages 6 to 11 — from 130 to 209 calories per day — and the percentage of children consuming them rose from 79% to 91%.
The problem is that people who drink this ‘liquid candy’ do not feel as full as if they had eaten the same calories from solid food and do not compensate by eating less. As Wen observed among the children in the study, “[S]oda is pretty attractive to preschoolers, but it cannot kill their hunger. It doesn’t fill them up.” Over time, these extra calories lead to significant weight gain. In a landmark study that was the first of its kind, Harvard researchers tracked both the weights and the soft drink consumption of 548 grade school children for two years, finding that each additional 12-ounce soda children consumed each day increased their risk of becoming obese by 60% during 1½ years of follow-up. Importantly, children whose parents drink soda or other sugary beverages are far more likely to consume soda themselves.
These findings provide important insight into how young children with limited or no parental food rules begin early consumption of unhealthy foods. “Without these boundaries set by caregivers, the benefits of high self-regulation on weight gain and childhood obesity could be diminished. This illustrates just how important parental involvement is in influencing child eating habits.”
The researchers are already moving forward with further investigation on the links between self-regulation, parental influences, and eating behaviors among young children. Next, they hope to design a new study to see whether improvements in toddlers’ ability to self-regulate their behaviors results in subsequent improvements in eating habits.