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Controlling feeding practices and maternal migrant background: an analysis of a multicultural sample
- Maria Somaraki, Karin Eli, Anna Ek, Louise Lindberg, Jonna Nyman, Claude Marcus, Carl-Erik Flodmark, Angelo Pietrobelli, Myles S Faith, Kimmo Sorjonen, Paulina Nowicka
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- Journal:
- Public Health Nutrition / Volume 20 / Issue 5 / April 2017
- Published online by Cambridge University Press:
- 21 November 2016, pp. 848-858
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Objective
Parental feeding practices shape children’s relationships with food and eating. Feeding is embedded socioculturally in values and attitudes related to food and parenting. However, few studies have examined associations between parental feeding practices and migrant background.
DesignCross-sectional study. Parental feeding practices (restriction, pressure to eat, monitoring) were assessed using the Child Feeding Questionnaire. Differences were explored in four sub-samples grouped by maternal place of birth: Sweden, Nordic/Western Europe, Eastern/Southern Europe and countries outside Europe. Crude, partly and fully adjusted linear regression models were created. Potential confounding variables included child’s age, gender and weight status, and mother’s age, weight status, education and concern about child weight.
SettingMalmö and Stockholm, Sweden.
SubjectsMothers (n 1325, representing seventy-three countries; mean age 36·5 years; 28·1 % of non-Swedish background; 30·7 % with overweight/obesity; 62·8 % with university education) of pre-school children (mean age 4·8 years; 50·8 % boys; 18·6 % with overweight/obesity).
ResultsNon-Swedish-born mothers, whether European-born or non-European-born, were more likely to use restriction. Swedish-born mothers and Nordic/Western European-born mothers reported lower levels of pressure to eat compared with mothers born in Eastern/Southern Europe and mothers born outside Europe. Differences in monitoring were small. Among the potential confounding variables, child weight status and concern about child weight were highly influential. Concern about child weight accounted for some of the effect of maternal origin on restriction.
ConclusionsNon-European-born mothers were more concerned about children being overweight and more likely to report controlling feeding practices. Future research should examine acculturative and structural factors underlying differences in feeding.
Childhood obesity: from nutrition to behaviour: Symposium on ‘Behavioural nutrition and energy balance in the young’
- Carl-Erik Flodmark, Torsten Ohlsson
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- Journal:
- Proceedings of the Nutrition Society / Volume 67 / Issue 4 / November 2008
- Published online by Cambridge University Press:
- 20 August 2008, pp. 356-362
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Obesity in children is difficult to treat, but it seems to be easier to treat than adult obesity. The first step in treatment is to identify effective advice relating to nutrition and physical activity. In most treatment studies the macronutrient composition of the diet is not of major importance for treatment outcome. In relation to physical activity fat-utilisation strategies have been described. The second step includes appropriate approaches to lifestyle change. In Europe there are no drugs approved for children, and surgery for children is still limited to research projects. Thus, the major challenge is to develop effective ways of changing lifestyle. Family therapy may be an effective approach in preventing severe obesity from developing during puberty, and a therapeutic strategy based on treatment studies is described. The family-therapy techniques used here are intended to facilitate the family's own attempts to modify their lifestyle, and to increase their own sense of responsibility and readiness to change, i.e. these variables are the prime targets during therapy. Thus, the family, not the therapist, assumes responsibility for the changes achieved. This approach may be helpful in making the therapeutic process less cumbersome for the therapist. Instead of the therapist attempting to persuade the obese subjects to lose weight, it might be more effective to teach them to control their eating patterns through their own efforts. The treatment model includes structural family therapy and solution-focused-brief therapy. The use of such a model makes it possible to train therapists and health professionals to use an evidence-based intervention model.
8 - The obese adolescent
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- By Marie-Laure Frelut, Robert Debré University Hospital, Paris., Carl-Erik Flodmark, Department of Paediatrics, University Hospital in Malmö
- Edited by Walter Burniat, University of Brussels, Tim J. Cole, Institute of Child Health, University College London, Inge Lissau, National Institute of Public Health, Copenhagen, Elizabeth M. E. Poskitt, London School of Hygiene and Tropical Medicine
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- Book:
- Child and Adolescent Obesity
- Published online:
- 02 November 2009
- Print publication:
- 29 August 2002, pp 154-170
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Summary
Biophysical factors
Introduction
Adolescence is a key period in life for major physiological and psychological change. Obesity, perhaps dating from infancy, may peak in severity at adolescence. It is thus highly desirable to intervene with vigorous preventive or curative actions early in life.
However, adolescents' aspirations and their developing capacity to control their own lives can act as useful adjuncts to the management of obesity in those for whom earlier interventions have been unsuccessful. From the practical point of view, it is critically important that adolescents understand the biological processes affecting them. Stressing the advantages (e.g. growth spurt, increased fat-free mass (FFM) and, as a consequence, increased energy expenditure and requirements) as well as the disadvantages (e.g. increased fat mass in girls) of the pubertal changes in body composition can help adolescents feel more in control of weight management. The differences that develop between sexes should be discussed so that they are understood, accepted and not just seen as further disadvantages for subjects already suffering low self-esteem.
Adolescents also want better understanding of their own behaviour. A recent study from the United States found 24% of a nationally representative sample of adolescents were overweight, but 45% of the girls and 20% of the boys had been dieting, and 13% and 7% of girls and boys, respectively, reported disordered eating. The risk of disordered eating increased during adolescence and correlated with depressive patterns of behaviour (Kaltzman et al., 2000).
16 - Psychotherapy
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- By Carl-Erik Flodmark, Department of Paediatrics, University Hospital in Malmö, Inge Lissau, National Institute of Public Health, Copenhagen
- Edited by Walter Burniat, University of Brussels, Tim J. Cole, Institute of Child Health, University College London, Inge Lissau, National Institute of Public Health, Copenhagen, Elizabeth M. E. Poskitt, London School of Hygiene and Tropical Medicine
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- Book:
- Child and Adolescent Obesity
- Published online:
- 02 November 2009
- Print publication:
- 29 August 2002, pp 327-344
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Summary
Obesity – a disease put into perspective
Obesity itself is not usually regarded as an eating disorder, although sometimes obesity and eating disorders (commonly binge eating) coexist. The prevalence of eating disorders in association with obesity used to be thought as high as 20–50% of those seeking help for their obesity, but recent studies of adolescents enrolled into an obesity programme suggest a prevalence of around 7% of obese (Decaluwè et al., 2000). The reason for this difference is that diagnostic interviews do not confirm the findings of earlier questionnaires (Stunkard et al., 1996; Ricca et al., 2000). Further, amongst obese children in the general population and not seeking help for their obesity, the prevalence of eating disorders may be even lower. However, we do not propose to discuss the use of psychotherapy in the treatment of eating disorders here. This chapter is concerned with how psychotherapy can be used more generally for the understanding and treatment of obesity. Psychotherapy is one tool for achieving the lifestyle changes necessary to counteract strong genetic influences on the development of obesity.
The multifactorial causes of obesity demand lifestyle changes which can only be achieved through a combined approach using many different treatment components, for example combining advice on exercise and diet, training in social skills, even drug treatment in the most severe cases.
Psychosocial aspects of society
Psychosocial factors are certainly important in childhood obesity, although the extent to which they are relevant varies with the population selected and the differences in environmental support provided by family and peers.