Parenting pre-schoolers with avid appetites: Understanding differential susceptibility to obesogenic environments for future intervention efficacy.

儿童肥胖症是21世纪最严重的公共卫生挑战之一，是社会关注的主要问题，使儿童在成年后面临糖尿病、心血管疾病和某些癌症等疾病的高风险。通常，儿童肥胖症始于婴儿期和幼儿期，90%在3岁时患有肥胖症的儿童在青春期继续超重或肥胖。了解可能有助于预防或降低儿童肥胖风险的因素，并将这种理解应用于制定有效的干预措施，对于解决这一复杂的政策和实践挑战至关重要。众所周知，健康的家庭环境可以防止肥胖的发展。然而，有些儿童比其他儿童更容易患肥胖症，因为他们的遗传易感性环境中，非常可口的食物是丰富和容易获得的。儿童的食欲和饮食行为将这种遗传风险与肥胖的发展联系起来。儿童的食欲贪婪表现在他们的“食物接近”行为中，这些行为具有相当大的遗传性。食物接近行为包括想要吃（或吃得更多）以回应可口食物的视觉，嗅觉或味道，更大的食物享受，快速进食，对“饱”的内部线索的敏感性较弱，以及情绪反应。父母的喂养习惯是儿童食物环境的关键组成部分，并有可能随着时间的推移加剧或减少这些食物行为。然而，对于高食物态度儿童的父母来说，有效地管理他们的饮食行为可能非常困难，父母报告说感到无能为力，沮丧和绝望的解决方案。因此，虽然喂养方法是改变儿童饮食行为和儿童体重结果的关键干预目标，但很少评估喂养方法如何与儿童的食物接近行为相互作用，以预测随着时间的推移的饮食行为和体重增加，或者如何最好地为具有高食物接近行为的儿童量身定制喂养方法，以防止肥胖的发展。在这个项目中，我们将进行纵向分析和实验研究，需要解开这些影响。我们将使用广泛的方法来回答本研究中的问题，包括行为遗传学，纵向研究，实验室研究，定性方法，问卷调查，并评估儿童的饮食行为和父母喂养的做法在不同的设置在真实的时间的措施。我们将结合现有的队列数据和从儿童和家庭中收集的新数据，这些儿童表现出高水平的食物方法。我们将与食物接近行为高的儿童的父母合作，然后利用我们在这些研究中获得的知识，共同制定未来干预设计的建议，重点关注食物接近行为高的儿童的父母喂养实践。我们不知道对于食欲旺盛的儿童的父母来说，关于喂养实践的最佳建议是什么。特别是，我们缺乏一个证据基础，证明喂养方法最能保护这些儿童免于超重。目前关于儿童饮食和体重的公共卫生建议是通用的，无效的，并且没有解决儿童食欲的变化，这使得行为改变对于那些努力管理孩子饮食行为的父母来说更具挑战性。利用当前的理论来指导复杂的干预措施的发展，我们的研究将研究父母如何与他们的学龄前儿童在食物环境中进行互动，评估这些互动如何预测对肥胖饮食行为的短期和长期影响，并制定干预建议。

Childhood obesity is one of the most serious public health challenges of the 21st century, of major societal concern, placing children at high risk of diseases such as diabetes, cardiovascular disease and some cancers in adulthood. Typically, childhood obesity begins in infancy and early childhood, with 90% of children who have obesity at 3 years continuing to have overweight or obesity in adolescence. Understanding the factors which may help to prevent or reduce the risk of childhood obesity, and applying this understanding to develop effective interventions, is of key importance to solving this complex policy and practice challenge. It is well established that a healthy home environment is protective against the development of obesity. However, some children are more vulnerable to the development of obesity than others, due to their genetic susceptibility to an environment where highly palatable food is plentiful and accessible. Children's appetite and eating behaviours link this genetic risk and the development of obesity. Children's appetite avidity is manifest in their 'food approach' behaviours, which have considerable heritability. Food approach behaviours include wanting to eat (or eating more) in response to the sight, smell or taste of palatable food, greater enjoyment of food, rapid eating, weaker sensitivity to internal cues of 'fullness', as well as eating in response to emotion. Parental feeding practices are a key component of the child's food environment and have the potential to exacerbate or minimise these food approach behaviours across time. However, it can be very difficult for parents of children with high food approach to manage their eating behaviour effectively, and parents report feeling powerless, frustrated and desperate for solutions. Therefore, whilst feeding practices are key intervention targets to change children's eating behaviour and child weight outcomes, there has been little evaluation of how feeding practices interact with children's food approach behaviours to predict eating behaviour and weight gain across time, or how feeding practices can be best tailored for children with high food approach behaviours to protect against the development of obesity. In this project, we will undertake the longitudinal analyses and experimental studies which are needed to disentangle these effects. We will use a wide range of methodologies to answer the questions in this study, including behaviour genetics, longitudinal studies, experimental laboratory studies, qualitative methods, questionnaire measures, and measures which assess children's eating behaviours and parental feeding practices in varied settings in real time. We will use a combination of existing cohort data and collection of novel data from children and families where children show high levels of food approach. Working with parents of children high in food approach behaviours, we will then use the knowledge we generate in those studies to co-develop recommendations for the future design of an intervention focused on parent feeding practices for children with high food approach behaviour.We do not know what the best advice regarding feeding practice is for parents of children with avid appetites. In particular, we are lacking an evidence base for which feeding practices work best to protect such children from the development of overweight. Current public health advice regarding children's eating and weight is generic, ineffective, and does not tackle variability in children's appetite avidity, which makes behaviour change even more challenging for parents who struggle to manage their child's eating behaviour. Using current theory to inform complex intervention development, our research will examine how parents interact with their pre-school children with avid appetites in the food context, evaluate how these interactions predict short and long-term effects on obesogenic eating behaviour and develop recommendations for intervention.