The candidate for this K23 career development award is committed to a career as an independently funded clinical and translational researcher and leader in the field of pediatric obesity prevention. This K23 Career Development Award will allow the Candidate to complete her educational goals of gaining experience in structural equation modeling, longitudinal study design and analysis, diet assessment, observed standardized feedings, and measures of stress. In all these activities, she will be mentored by a highly accomplished, multidisciplinary team of mentors and advisors. Her mentors have complementary expertise in nutrition and longitudinal assessment (Dr. Mara Vitolins), biostatistics (Dr. Edward Ip), and childhood obesity (Dr. Joseph Skelton). The Candidate will also utilize an outstanding advisory committee with expertise in observational feeding studies (Dr. Julie Lumeng), weight perception (Dr. Eliana Perrin), physiologic measures of stress (Dr. Patricia Nixon), and anxiety (Dr. Gretchen Brenes). In her clinical work as a general pediatrician, the candidate noted that many parents express concerns about their young child?s picky eating, whether their child is eating enough, or whether their child is underweight. The candidate?s preliminary work has demonstrated that such concerns affect how parents feed their children, leading to behaviors such as pressuring to eat or overfeeding. These approaches could ultimately lead to increased child stress at mealtimes and decreased self-regulation of eating, which in turn can increase long-term risk of obesity and diabetes. However, the predictive relationships between child and parent factors, feeding practices, and obesity remain unclear. Additionally, the relationship between parent feeding practices and child stress has not been previously investigated. To address these gaps in knowledge, the following Specific Aims are proposed: 1) to assess the effects of parental concerns about their child?s weight and eating behaviors on pressure to eat, feeding frequency and amount, and dietary variety; 2) to assess the effects of parent feeding practices on child stress, child self- regulation of eating, and energy intake; and 3) assess the effect of parent concerns and parent feeding practices on child body weight (BMIz). The central hypotheses are that parental concerns about their child?s eating and weight are associated with children?s subsequent greater: 1) feeding frequency and amount; 2) pressure to eat; 3) stress at mealtimes; and 4) body weight status (body mass index z-score [BMIz]). To investigate these aims the Candidate will recruit a cohort of 300 parents of 3- to 6-year-old children to complete questionnaires and a subsample of 50 parent-child dyads to participate in standardized directly observed feedings (observing pressure to eat and stress) and dietary recalls to follow over 2 years. The preliminary data from this research proposal and the skills achieved throughout the career development plan will directly support future R01 applications to expand this work to conduct randomized controlled trials to determine effective interventions to improve feeding practices and reduce obesity.
Many parents express concerns about their young child?s picky eating, whether their child is eating enough, or whether their child is underweight, and these concerns may lead to parental feeding practices that increase a child?s stress and long-term risk of obesity and diabetes. The proposed project will demonstrate the predictive relationship between parental concerns about their child?s eating and weight, parental feeding practices such as pressure to eat, child stress, and later obesity risk. This is the first necessary step to developing interventions for these obesity risk factors and promoting an evidence-based approach to anticipatory counseling in primary care.
