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Child eating behaviours have consistently been linked to child weight status. Yet, changes in child eating behaviours during early obesity treatment are rarely evaluated. Psychometric evaluation of the Child Eating Behaviour Questionnaire (CEBQ) is common, but results are sample-dependent and included items may not capture the full range of the underlying traits. Rasch analysis can overcome these disadvantages. The aim of this paper was to assess child eating behaviours measured by the CEBQ after a 12-month obesity intervention applying the Rasch model for the validation of the CEBQ. The Rasch-based fit statistics were applied in children from two samples, Australian and Swedish (n = 1724). Changes in eating behaviours amongst children aged 4–6 years were examined in the More and Less RCT for obesity treatment (n = 177), which compared a parenting programme (with and without boosters) against standard treatment. Parents completed the CEBQ at four time points over 12-months. Linear mixed models were applied to estimate treatment effects on the CEBQ, refined according to Rasch, over time. We found that the validity of CEBQ was confirmed after removing 4 items (item fit statistics outside range 0.5–1.5). When the refined CEBQ was used in the assessment of the RCT, there were no differences in parental reports of changes in children's eating behaviours between the parenting programme and standard treatment (group-by-time interactions p > 0.05). However, in the total sample food approach behaviours decreased while fussy eating behaviours increased (p < 0.05). In conclusion, the refined CEBQ proved to be a valid tool for examining parent-reported child eating behaviours. Early obesity treatment may decrease eating behaviours associated with higher child weight. Future research should address the associations between changes in child weight status and eating behaviours.

Background: The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. Methods: Eligible randomised controlled trials (RCTs) published between 1975 and 2020 were identified by a systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses of eligible study outcomes were performed using statistical software. A multilevel random effects model was used with three significant random effects fitted using restricted maximum likelihood estimation. Results: This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change and 14 reporting no significant dietary change. Results from the meta-analyses (n = 29 studies) indicated that, compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (−194 kcal day−1, 95% confidence interval = −275.80 to −112.90 kcal day−1, P < 0.001) and up to 12 months (−112 kcal day−1 95% confidence interval = −218.92 to −5.83 kcal day−1) P = 0.038), increases in fruit and/or vegetable intakes over 2–12 months (n = 34, range +0.6 to +1.5 servings day−1) and reductions in consumption of sugar-sweetened beverages (n = 28, range −0.25 to −1.5 servings day−1) at 4–24 months follow-up. Conclusions: Obesity interventions with a dietary component have a modest but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.

Socio‐economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio‐economic and ethnic background. Sixty‐four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty‐one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family‐level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family‐level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.

Socio‐economic status and ethnic background are recognized as predictors of risk for the development of obesity in childhood. The present review assesses the effectiveness of treatment for children according to their socio‐economic and ethnic background. Sixty‐four systematic reviews were included, from which there was difficulty reaching general conclusions on the approaches to treatment suitable for different social subgroups. Eighty‐one primary studies cited in the systematic reviews met the inclusion criteria, of which five directly addressed differential effectiveness of treatment in relation to social disparities, with inconsistent conclusions. From a weak evidence base, it appears that treatment effectiveness may be affected by family‐level factors including attitudes to overweight, understanding of the causes of weight gain and motivation to make and maintain family‐level changes in health behaviours. Interventions should be culturally and socially sensitive, avoid stigma, encourage motivation, recognize barriers and reinforce opportunities and be achievable within the family's time and financial resources. However, the evidence base is remarkably limited, given the significance of social and economic disparities as risk factors. Research funding agencies need to ensure that a focus on social disparities in paediatric obesity treatment is a high priority for future research.

Self-rated health is a strong health marker. Migrants have been suggested to have poorer self-rated health than non-migrants (i.e., native-born). However, little is known about whether there are disparities in self-reported health in relation to pregnancy. Therefore, the aim of the current study was to examine the odds of poor self-rated health before, during and after pregnancy in migrant women as compared to women born in Sweden. We utilized population-based data from the Swedish Pregnancy Register containing 0.5 million women born in Sweden (i.e., non-migrant women) and migrant women between 2010 and 2018. Self-rated health was reported on a 5-point scale (from very poor to very good). Very poor and poor health were categorized as poor self-rated health. Logistic regression was utilized to calculate odds ratios (ORs) that were unadjusted and adjusted for covariates (age, parity, educational attainment and body mass index). The results demonstrate disparities in self-rated health across birth regions. In comparison to women born in Sweden, women born in Latin America and the Caribbean, South Asia as well as North Africa and the Middle East had consistently higher odds of poor self-rated health before, during and a

Background The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. Methods Eligible RCTs published between 1975 and 2020 were identified by a systematic search following PRISMA guidelines. Meta-analyses of eligible study outcomes was performed using R statistical software. A multi-level random effects model was used with three significant random effects fitted using Restricted Maximum Likelihood estimation. Results This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change, and 14 reporting no significant dietary change. Results from the meta-analyses (n= 29 studies) indicated that compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194kcal/day, 95%CI -275.80 to -112.90kcal/day, p<0.001) and up to 12 months (-112k cal/ day 95% CI -218.92 to -5.83kcal/ day)p=0.038), increases in fruit and/or vegetable intakes over 2-12 months (n=34, range +0.6 to +1.5 servings/day) and reductions in consumption of sugar-sweetened beverages (n=28, range -0.25 to -1.5 servings/day) at 4-24 months follow-up. Conclusions Obesity interventions with a dietary component have a modest, but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.

Background The impact of obesity interventions on dietary intake in children and adolescents with overweight or obesity is unclear. This systematic review aimed to investigate the impact of the dietary component of weight management interventions on the change in diet in children and adolescents with overweight or obesity. Methods Eligible RCTs published between 1975 and 2020 were identified by a systematic search following PRISMA guidelines. Meta-analyses of eligible study outcomes was performed using R statistical software. A multi-level random effects model was used with three significant random effects fitted using Restricted Maximum Likelihood estimation. Results This review identified 109 RCTs, including 95 that reported at least one statistically significant dietary outcome change, and 14 reporting no significant dietary change. Results from the meta-analyses (n= 29 studies) indicated that compared to control groups, intervention groups achieved significantly greater reductions in mean total energy intake at ≤6 months (-194kcal/day, 95%CI -275.80 to -112.90kcal/day, p<0.001) and up to 12 months (-112k cal/ day 95% CI -218.92 to -5.83kcal/ day)p=0.038), increases in fruit and/or vegetable intakes over 2-12 months (n=34, range +0.6 to +1.5 servings/day) and reductions in consumption of sugar-sweetened beverages (n=28, range -0.25 to -1.5 servings/day) at 4-24 months follow-up. Conclusions Obesity interventions with a dietary component have a modest, but sustained impact on reducing total energy intake and improving intakes of specific food groups in children and adolescents with overweight or obesity. High quality RCTs that are powered to detect change in diet as a primary outcome are warranted.

AimTo explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12months, adjusting for known early-life risk factors for subsequent childhood obesity. MethodsBaseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n=144/53) and parental education (n=57/139). Observational data on infant growth between 0 and 12months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12months and rapid weight gain 0-6months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking. ResultsRelative weight at 3, 6 and 12months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education. ConclusionLow parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year., QC 20140428

AimTo explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12months, adjusting for known early-life risk factors for subsequent childhood obesity. MethodsBaseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n=144/53) and parental education (n=57/139). Observational data on infant growth between 0 and 12months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12months and rapid weight gain 0-6months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking. ResultsRelative weight at 3, 6 and 12months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education. ConclusionLow parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year.

BACKGROUND: The Children's Eating Behaviour Questionnaire (CEBQ) is a multi-dimensional, parent-reported questionnaire measuring children's eating behaviours related to obesity risk, i.e. 'enjoyment of food', 'food responsiveness', 'slowness in eating' and 'satiety responsiveness'. It has not previously been validated in a Swedish population, neither on children under the age of 2 years. In the present study we examined the factor structure and the reliability of the Swedish version of the CEBQ, for use in an obesity intervention programme targeting preschool children 1-6 years. Further, the associations between eating behaviours and children's age, gender and relative weight (BMI SDS) and parental weight were investigated. METHODS: Parents to 174 children aged 1-6 years (50% girls, mean age 3.8 years), recruited from five kindergartens in Stockholm, completed the Swedish version of the CEBQ. Data on children's weight and height, parental weight, height and educational level was collected. Children's relative weight was calculated for a subpopulation (mean BMI SDS -0.4, n = 47). Factorial validation (Principal Component Analysis) on all CEBQ items was performed. Differences in eating behaviours by age, gender and parental weight were examined. Correlations between eating behaviours and the child's BMI SDS were analysed controlling for age, gender, parental weight and education in linear regression analyses. RESULTS: The factor analysis revealed a seven factor solution with good psychometric properties, similar to the original structure. The behaviour scales 'overeating'/'food responsiveness', 'enjoyment of food' and 'emotional undereating' decreased with age and 'food fussiness' increased with age. Eating behaviours did not differ between girls and boys. The children's relative weight was not related to any of the eating behaviours when controlling for age, gender, parental weight and education, and only associated with parental weight status. CONCLUSIONS: Our resul