Programs to reduce childhood obesity must include all family members, suggests study

Many mothers have to navigate a sea of advice from family and experts when it comes to feeding their babies. Nonetheless, nutrition educators typically focus only on the mother, even in Latino communities where grandmothers and other older female relatives often play major roles in caring for children.

A new study shows programs to reduce childhood obesity and other nutrition programs should incorporate all family members who regularly take care of children, not just their mothers.

Ann Cheney, an assistant professor in the Center for Healthy Communities at the UC Riverside School of Medicine, co-led the study with Tanya Nieri, an associate professor in the UCR Department of Sociology. The study focused on food and feeding in low-income Latino families and sought to generate ideas for the development of early childhood obesity prevention programs based on mothers' experiences.

"Mothers are busy. We can't assume that only the mother feeds her baby," Cheney said. "In many cultures, senior women in family and community help with childcare and instruct new mothers on how, when, and what to feed their baby."

The researchers talked about feeding babies with 19 women who had a child under 2 years old enrolled in Early Head Start programs in Riverside and San Bernardino counties. The participants were Latina, mostly of Mexican descent. Many lived in extended family households, which included in-laws or other members of their families of origin. A little over half spoke English as their dominant language, with the rest speaking predominantly Spanish.

Through Early Head Start nutritional education, the mothers knew a lot about healthy diets for babies but faced conflicting ideas from older female relatives. They knew, for example, that doctors do not recommend giving solid food to babies under six months old because it increases the risk of obesity. But many of them were told by their own mothers, mothers-in-law, or grandmothers to give their babies oatmeal, mashed rice and beans, or other soft foods to help their babies feel fuller and gain weight, even though the mothers did not think their babies were too thin.

The mothers also knew not to give their babies sugar but were often told by older female relatives to add sugar to milk or other foods so the baby would consume more of it. These relatives also often fed the children, making it harder for the mother to stick to the healthy feeding recommendations she learned through Early Head Start.

Some of the older relatives had experienced food insecurity growing up and did not want their grandchildren to experience it too. To the older generation, chubby babies with full stomachs were healthy babies. Although their advice came from love and concern for the baby's health, the mothers knew some of the grandparents' recommendations could to lead to obesity and other health problems.

The mothers used two strategies to balance their child's healthy diet against preserving family harmony. They could agree to the relative's instructions in face-to-face interactions, but later, feed the child as they wished. They could also use the opportunity to educate the family member by saying "no" and explain why. Most mothers used both strategies in different situations and with different family members.

"It is difficult at times to tell the family, 'no.' But we are thinking of the well-being of our children. Because our (family) roots are very strong," one study participant said. "But families have to learn new ways too."

The authors concluded that government sponsored nutrition education programs, like Early Head Start nutrition education, prioritize nuclear family dynamics and identify parents as primary caregivers. The researchers recommend that nutrition education programs should recognize the diversity of families and acknowledge other family arrangements including extended families, and programs should incorporate extended families in addition to the child's parents.​

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