Could 'family-style meals' beat childhood obesity?

“Families who serve dinner at the table have slimmer children,” is the entirely unsupported claim from the Mail Online today.

The website appears to have taken a leap of imagination by pinning this headline on research which didn't look at families or measure children’s weight.

The research mentioned in the Mail’s coverage actually looked at how far different US childcare programmes follow guidance on healthy feeding practices.

The guidelines, from the US Academy of Nutrition and Dietetics, recommend childcare organisations offer regular “family-style” feeding patterns carried out in a social setting. They also recommend not pressuring children into eating.

Overall, the research found that most childcare programmes were following the recommendations. But it should be noted that the researchers used questionnaires that the childcare organisations filled in themselves (which could be open to bias). The study also did not look at any outcomes for the children.

The question of whether regular mealtimes do produce “slimmer children” remains unanswered – at least by this research.

Where did the story come from?

The study was carried out by researchers from the University of Illinois and was funded by the US Department of Health and Human Services, the Illinois Trans-Disciplinary Obesity Prevention Program, the Illinois Council for Food and Agricultural Research, the University of Illinois and the US Department of Agriculture.

The study was published in the peer-reviewed Journal of the Academy of Nutrition and Dietetics.

The Mail’s report was both confusing and misleading. In fact, it was not at all clear which study the paper was reporting. Its article appears to mix the results of the study described with quotes taken from press releases about entirely separate studies.

The research actually looked at whether recommendations on childhood feeding practices were being followed by US daycare institutions. However, the Mail’s report may have led readers to believe the study looked at feeding practices within families, and how these related to the risk of children becoming overweight or obese.

The Mail also mentioned another study of the issue which is not examined here. The website said this other study found that people who eat as a family around a table instead of in front of a TV, are less likely to be overweight. As no details of the study were reported we are unable analyse and comment on it.

What kind of research was this?

This was a cross-sectional survey of how 118 childcare facilities in the US fed children in their care.

The facilities were run by a mix of different organisations:

• Head Start (a US government programme for children and their families on a low income)
• the Child and Adult Care Food Program (CACFP), a US federal initiative which provides subsidised food services for children in daycare
• other non-government daycare programmes (called non-CACFP)

The researchers looked at whether childcare providers in these programmes meet the recommendations for healthy feeding practices, developed by the Academy of Nutrition and Dietetics in 2011. They point out that, in the US more than 12 million preschool children attend childcare, and consume up to three-quarters of their daily energy intake while there. This, they say, is an ideal setting to promote healthy eating behaviours and prevent obesity. Achieving these benchmarks is a public health priority in the US, where over a quarter of preschoolers are overweight or obese.

What did the research involve?

In 2011 and 2012, the researchers collected data from 123 childcare providers, who had taken part in self-administered surveys on their feeding practices for two- to five-year-old children. Five of these participants were excluded from the analyses because they reported only caring for children younger than two years.

The survey was intended to examine how far the childcare centres were following the US guidance on healthy feeding practices for preschool children, to help them develop long-term positive eating behaviours and help prevent obesity.

The guidance says for example, that childcare providers should:

• sit with the children during meals
• eat meals together with the children
• serve meals “family-style” (rather than delivered pre-plated or in bulk)
• help children recognise internal hunger and fullness signals with verbal cues
• not use controlling practices such as restrictions on food or pressure to eat
• provide a model of healthy eating
• teach children about nutrition
• encourage balance and variety of foods
• train staff in nutrition
• educate children and parents about nutrition

Once the results were in, they analysed the data using standard statistical methods.

What were the basic results?

The final analysis consisted of 118 providers from 24 childcare programmes, from Head Start, CACFP and non-CACFP. It found that:

• Head Start providers sat more frequently with children during meals, ate the same foods as children and served meals family-style more often, compared with CACFP and non-CACFP providers.
• Head Start provided parents and children with more nutrition-education opportunities compared with CACFP and non-CACFP programmes.
• Head Start providers encouraged more balance and variety of foods and offered healthier foods compared with CACFP and non-CACFP providers.
• Head Start providers had greater compliance with the Academy’s benchmarks compared with CACFP and non-CACFP providers.

How did researchers interpret the results?

The researchers say that childcare providers are in a “unique position” to prevent childhood obesity by instilling positive eating behaviours in preschool-aged children.

Conclusion

Although this is a survey of US childcare providers, it does raise some interesting issues for both parents and childcare institutions here.

For example, it advises that children be supported in recognising both feelings of hunger and fullness by the right verbal cues (“Are you full?” rather than, for example, “Would you like some more?”). It also argues that adults should not override children’s “internal cues” of hunger by using “controlling” feeding practices, such as restrictions on food or by getting children to eat up everything on their plate.

Serving food “family-style” – where children select their own portions and serve themselves – is another interesting area. The researchers say this allows children control over the type and amount of food on their plates and helps them to self-regulate energy intake. Similarly sitting at meals together, with the adults as models for healthy eating, are linked to healthier eating practices.

But as the researchers say, more research is needed as to whether such measures have an impact on children's eating behaviour, and ultimately on their health throughout their lives.