The Early Food Environment

• The early environment, why the attention?

• The environment – what it is and how we define and categorise it
• 2 settings Home and childcare
• Availability
• Exposure
• Social environment
• Models

• First 5 years
• Considered to be a critical period in the development of children eating and food preferences (e.g.
Birch & Fischer, 1998; Mannino et al., 2004; Harris, 2008; Cosmi et al., 2017)

• Further research suggests end of primary school eating behaviours are relatively stable and less
susceptible to change (Matton et al., 2013)

• Diet quality – tracks and declines through childhood and adolescence

• Why are children's developing diets important?

• Supporting development – physical, cognitive (Social & Emotional)
• Associated short and long term health related outcomes – such as diabetes, obesity

• Poor nutrition
• Dense energy intake (sugar & fat), higher salt intake, low vitamin, and mineral intake
• Sugar tax has been developed and people have started to put less salt in food
• B12 is important for pregnant women – connected to foetus’s development.
• Fruit and veg intake
• around 3 portions on average
• 16-20% eat the recommended portion of fruit
• Should really aim for 12 portions of fruit and veg rather than 5
• Weight levels
• 1/3 of UK child (2-15yrs) over weight/obese
• Higher rates in deprived areas

Just because someone is obese, doesn’t mean they are getting enough nutrients
(National Diet & Nutritional Survey, 2017; Public Health England, 2018-19)

• Earlier the intervention the better

• First 5yrs, most effective – but with changes i.e. peers entering the picture, exposure to different
environments i.e. schools - later interventions or on-going interventions are still required

• Early interventions are also more easier to enact

• Access - pathways to parents/children
• Before the age of 5, it is unlikely children are in schools.
 • Some children go to pre-school and nursey which could help with implementing
intervention
• There will be a certain demographic of children who aren’t going to preschool/nursery
• Working with their parents allows for changes to be made at home
• Dads are hard to work with – they potentially play a major role on children’s eating
habits.
• Grandparents can be influential on children’s eating habits.
• Control – 2/3 of meals/foods consumed in the home environment.
• As the child ages their environment becomes more complex
• Early years and developing eating
• First 5 years – significant development and changes in eating
1) Breast/bottle feeding.
2) Weaning
3) Solid diet (adult like)

• Difficult periods/phases faced by parents (Food neophobia (around 18 months) they reject food they
had already been eating, Food refusal/food fussiness, Variety and balanced intake)

• Entering new environments – nurseries, preschools and then schools)

• Influence of others
• How to break down the environment/ different ways to define it
• The environment has not been consistently defined or measured (Lytle, 2009)
• Different researchers can mean different things when they use the term environment
• May use terms like physical, social, direct, indirect, structural, home, urban settings, rural settings etc
etc.

• Important we know what they mean when they talk about the environment
• Potential for interactions
• Physical and Social
Physical – the resources to enable food prep and social interaction.
Social – inclusion of children into the activity makes it a social activity – children can help with food prep
Individual differences:
- Parent, time, income
- Child (active participant) sensory sensitivity
- Bidirectionality
Cultural differences: social norms, cultural diets and food

Issues – there are basic assumptions that all families have access to resources

Bronfenbrenner's Bioecological model

•

• Can help conceptualisations of the environment

• Also how potential factors interact and routes for interventions to take
• 2 Main settings of interest – Home and Childcare
• Home and family
• Availability of food (Access)
• Food prep – cooking
• Family meals
• Food knowledge

Parents and immediate family in the home AKA family based interventions
• Providers
• Models
• Regulators
• Childcare and others
• Availability of food
• Eating with others
• Pack lunch or school meals
• Teaching about food and food related activities

Childcare staff and peers AKA childcar/school based interventions

- Providers
- Models
- Regulators
• Experiences with food within the home (and outside)

• 2/3 of meals/ food consumption within the home environment

• Mealtimes, snacks, food prep and food activities

• Exposure to foods, exposure to others (models), food knowledge etc
1
• Important to remember the other
3
• Mealtimes with others (Family, friends), eating out, snacks outside of the home etc

• Exposure to foods, exposure to others (models), food knowledge etc

• Advertising, availability i.e. child menus (wider environment)

Feeding strategies and overall characteristics of the home food environment

- Food availability and modelling are regulated as overall characteristics of the home food
environment, whereas specific availability and modelling practices have also been
distinguished as food parenting practices
• Availability (exposure) and Access
• What's in the home and what is accessible to the child
• Influences food preferences & consumption patterns (Ventura & Brich, 2008)

• Restriction through availability (Covert & Overt) (Ogden et al., 2006)

• Restriction found to lead to greater desirability and greater consumption when no longer
supervised (Fisher & Birch, 2002)

• Active child and food marketing/advertising (Boyland & Halford, 2013)

• Mediation of exposure by parents (Newman & Oates, 2014)
• Repeated Exposure (Strategy to increase food acceptance and intake)
• Type of exposure – Tasting, seeing, feeling & smelling?

• Taste/flavour exposure important during weaning in terms of variety and acceptance (Heatherington
et al, 2014)

• Repeated taste exposure to food has been found to increase acceptance and intake
• Between 6-16 times– age dependent younger children requiring less than older children
(Fisher & Birch, 2011)

• Other forms of exposure

• Incorporation of finger foods at mealtimes (complimentary feeding) – texture exposure

• Cooking/food prep – increases food enjoyment and reduces food fussiness (van der Horst, 2012)

• Exposure through food activities such as play (Coulthard & Ahmed, 2017)

• Visual exposure – story books (Health et al., 2014)

• Parents create the social eating environment for children
Mealtimes Structure - Eating with others at table
• Enables modelling, sharing of knowledge, exposure (opportunities to try foods/share foods),
forms of parental feeding practices etc
• Frequently eating meals as a family linked with better nutritional health (e.g., Dallacker,
Hertwig, & Mata, 2019), better diet quality (e.g., Mou, Jansen, Raat, Nguyen, & Voortman,
2021), and lower levels of obesity (e.g., Anderson & Whitaker, 2010) in children
• Frequency young children eat meals with their family is often low (e.g., Anderson &
Whitaker, 2010)
• Can be a relaxed or stressful for both parents and children
Mealtime Structure - Eating in front of the TV
• Over-eating/ greater amounts of foods consumed (Francis & Birch, 2006)
• Poor response to internal cues

• Social eating environment

• Parental feeding practices are defined as specific behaviours or strategies that parents use to
maintain or modify children's dietary intake (Hughes et al., 2013)
• Restriction, pressure, modelling, monitoring, encouragement etc
• Rules, verbal instructions, exposure, choice etc
• Associations to weight levels, children’s eating behaviours & food intake
• Adaptive, maladaptive, both?

• Bidirectional
• Parental response to perceived threat to child’s development or health (Birch et al., 2007)
• Numerous influences – own eating behaviours (Sleddens et al, 2010), weight levels of parents and
children (Crouch & Battisti, 2007), parental mental health (Haycraft, 2020)

• Parental food parenting practices - controlling strategies

• Restriction
• Pressure
• Permission
• Body mass/weight levels
• Conflicting findings
• Restriction – HW levels HW= higher weight
• Pressure – LW levels LW = lower weight
• Permission – HW levels
• Food acceptance & preferences
• Increase in desirability of restricted foods (Fisher & Birch, 2002)
• Pressure more likely to reduce desirability of food (Galloway et al., 2005)

• Developmental perspective of goodness of fit approach (Brat & Prins, 2008)

• Maybe adaptive in children prone to over eat and under-eat (Moens et al., 2007)

• Maybe maladaptive negatively effects child’s self-regulation and response to satiety cues (Birch
& Fisher, 2000, fisher & Birch 2002)

• Bidirectionality – Reaction rather than proactive strategy (Brann & Skinner, 2005, Derks, et al.,
2017)

• Instrumental and Emotional feeding

Food parenting practices in which food is used as a reward to control children's behaviours (instrumental
feeding) or emotions (emotional feeding) also do not seem to be effective in stimulating healthy
children's intake
 • instrumental and emotional feeding characterised by the use of unhealthy food products
(Raaijmakers, et al., 2014)
• Parental Food Parenting Practices – adaptive forms?
• Variety of health foods provided
• Portion size – larger for healthy and smaller for unhealthy
(e.g. Savage et al., 2012, Nicklaus, 2009)
• Parental modelling
• Children observe and mimic parents eating behaviours and attitudes (Scaglioni, et al., 2010)
• Good and bad outcomes
• Greater consumption of Healthy food intake (Palfreyman, et al., 2012) and lower levels of
food fussiness (Gregory et al., 2010)
• Unhealthy snack intake (Brown & Ogden, 2004), elevated levels dietary restraint (Cuttings et
al., 2000)
• Dependent on what is being modelled

• Intentional and unintentional (intentional modelling considered as a feeding practice or strategy)

• Food and dietary knowledge

• A lot of interventions have taken this route

• Parents (Typical approach)

• Tip sheet (Sharma et al., 2011)
• Newsletters (Tabak, et al., 2012)

• Children – Fun games and activities

• Story books both exposure and food knowledge, cooking activities both exposure and
knowledge (e.g. Witt et al., 2012)
• Childcare settings
• Public health policies – requirement to include some nutritional education into curriculum
(Department for Education, 2017)
• Nutritional education training programmes for staff

• Activities (exposure, reduces tactile sensitivity, food knowledge) (e.g. Witt et al., 2012)
• Encouragement to eat together (children and staff) - Models

• Public health Interventions – snacks milk/water and a piece of fruit at break

• Healthy food environment in early years interventions and promotions
• Availability
• Exposure
• Encouraging food engagement and eating together
• Food and dietary knowledge
• Modelling
• Parental feeding strategies

• Reading
• Birch, L., Savage, J. S., & Ventura, A. (2007). Influences on the development of children's eating
behaviours: from infancy to adolescence. Canadian journal of dietetic practice and research: a
 publication of Dietitians of Canada= Revue canadienne de la pratique et de la recherche en
dietetique: une publication des Dietetistes du Canada, 68(1), s1.
• Liszewska, N., Scholz, U., Radtke, T., Horodyska, K., & Luszczynska, A. (2018). Bi-directional
associations between parental feeding practices and children's body mass in parent-child
dyads. Appetite, 129, 192-197.
• Newman, N., & Oates, C. J. (2014). Parental mediation of food marketing communications aimed at
children. International Journal of Advertising, 33(3), 579-598.
• Nekitsing, C., Hetherington, M. M., & Blundell-Birtill, P. (2018). Developing healthy food preferences
in preschool children through taste exposure, sensory learning, and nutrition education. Current
obesity reports, 7(1), 60-67.
• Ventura, A. K., & Worobey, J. (2013). Early influences on the development of food
preferences. Current biology, 23(9), R401-R408.