Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 8
itself is unlikely to result in healthy food and nutrition
choices, and associations between nutrition knowledge
and dietary behavior have been found to be
weak.
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It is also possible that parents from lower socio -
economic status groups have different parenting styles
or parenting practices, which results in less healthy
behaviors in their offspring. Vereecken et al (2004)
explored whether differences in children ’ s food consumption
by mothers ’ educational level could be
explained by mother ’ s consumption and other eating -
related parenting practices. 19 They revealed that SES
differences in children ’ s fruit and vegetable consumption
were completely mediated by differences in the
mothers ’ food consumption and parenting practices.
This was, however, not the case for SES differences
in soft - drink consumption. In addition, a recent
Australian study showed that adolescents living in
lower SES households reported greater availability of
unhealthy foods at home and were more likely to be
allowed to watch TV during mealtimes, while adolescents
from higher SES households reported greater
availability and accessibility of fruits. 34
Neighborhood SES and h ealthy f oods
and PA
It may also be that families from lower socio -
economic positions live in neighborhoods where
healthy foods and physical activity opportunities are
less available.
While neighborhood inequalities in food availability
have been reported, the evidence on the directions
of effects is inconsistent. Some studies showed that
there are fewer healthy choices available in stores in
more deprived areas, 35 – 37 but other studies did not find
such differences, 38,39 or found evidence that healthier
options were better available in the more deprived
neighborhoods. 40,41 It appears that the lower availability
of healthy foods in the more deprived neighborhoods
is especially apparent in US cities, 42 but the
majority of individuals in many Western countries —
including those with less healthy diets — may have
sufficient access to healthy foods.
Regarding physical activity, the review by Feirreira
and others showed that neighborhood crime rates are
associated with lower levels of physical activity among
adolescents, 5 but to date, very few studies have
explored the relationship between the built environment
and physical activity in youngsters. In contrast
to the expectations and the studies in adults, Haerens
et al found that participation in moderate to vigorous
physical activity ( MVPA ) measured with accelerometers,
was higher among students living further away
from facilities that are attractive to adolescents. 8 In
line with the findings from Jago et al, no other environmental
factors (environmental safety, environmental
density, sedentary equipment) were found to
be associated with participation in MVPA in
adolescents. 43
Discussion and c onclusions
The home and family environment is of key importance
for behavioral nutrition and physical activity
among children and adolescents. Evidence points out
that the home and family physical (what is available),
social - cultural (what is appropriate and acceptable),
and economic (what is affordable) environments are
associated with important nutrition, physical activity
and sedentary behaviors that define energy balance.
It should be noticed, however, that the available
evidence is mostly based on studies using rather weak
research designs. Most studies on potential home and
family environmental influences on eating and the
physical activities of young people are cross - sectional,
and such studies may tell us about associations, but
provide no proof of causal relations. An association
between, for example, parenting and children ’ s eating
habits may indicate that parenting influences eating
habits, but it may also mean that a child ’ s eating habits
influences parenting practices. If children eat too
much, too little, or the wrong things, parents are likely
to adjust their parenting practices accordingly.
Ventura and Birch presented a conceptual model
in which they proposed that parenting, child eating
and child weight status all influence each other
bidirectionally.
4
Nevertheless, the associations found in recent
studies indicate that obesity prevention for children
and adolescents should focus on promoting home and
family environments that endorse healthy energy -
balance - related behaviors. However, by far the most
initiatives for obesity prevention among young people
have used school - based approaches, and interventions
aiming at home and family environments are scarcer
and, thus, less well researched. Results from the
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