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BackgroundInterventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers. ObjectiveThis systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement. MethodsA total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis. ResultsIn total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement. ConclusionsIn contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.

Background: This study examines gender differences in parental attitudes toward risky play for 5- to 11-year-old boys and girls in Britain. Methods: Analyses use data from the cross-sectional, nationally representative British Child Play Survey. Survey respondents were caregivers of primary-school-aged children living in Britain. Parent self-reported their risk tolerance in play via the Tolerance for Risk in Play Scale (TRiPS) and the Risk Engagement and Protection Survey (REPS). The REPS includes subscales that assess caregiver attitudes around "Protection from Injury" (PFI) and "Engagement with Risk" (EWR) in relation to children's play. Multiple linear regression compared caregiver gender differences in TRiPS, REPS-PFI, and REPS-EWR at the item level, and overall. Associations between child gender and these scales were also examined. Results: Among 1919 caregivers, no significant gender differences emerged in mean TRiPS (P =.72), REPS-EWR (P =.58), and REPS-PFI (P =.34) scores. Activity-specific differences were evident in caregivers' tolerance for individual risky play activities (15/31 activities). Parents of boys exhibited higher risk tolerance (B = −4.48, P <.01) and willingness for their child to engage in risky play (B = −0.63, P <.01) than parents of girls. Conclusions: While there was no difference between male and female caregivers overall attitudes, gender differences were prominent for specific play activities and attitudes, with male caregivers demonstrating higher tolerance for the riskiest activities. Parents of boys expressed more permissive attitudes toward engagement in risky play. Further work is needed to identify why there is gender-related variation in these attitudes and should be considered in interventions that support parents in enabling adventurous play opportunities for children. [ABSTRACT FROM AUTHOR]

Background: "Food fussiness" (FF) is the tendency to be highly selective about which foods one is willing to eat, and emerges in early childhood; "food neophobia" (FN) is a closely related characteristic but specifically refers to rejection of unfamiliar food. These behaviors are associated, but the extent to which their etiological architecture overlaps is unknown. The objective of this study was to quantify the relative contribution of genetic and environmental influences to variation in FF and FN in early childhood; and to establish the extent to which they share common genetic and environmental influences. Method: Participants were 1,921 families with 16-month-old twins from the Gemini birth cohort. Parents completed the Child Eating Behaviour Questionnaire which included three FF items and four FN items. Bivariate quantitative genetic modeling was used to quantify: (a) genetic and environmental contributions to variation in FF and FN; and (b) the extent to which genetic or environmental influences on FF and FN are shared across the traits. Results: Food fussiness and FN were strongly correlated (r = 0.72, p < 0.001). Proportions of variation in FF were equally explained by genetic (0.46; 95% CI: 0.41-0.52) and shared environmental influences (0.46; 95% CI: 0.41-0.51). Shared environmental effects accounted for a significantly lower proportion of variation in FN (0.22; 95% CI: 0.14-0.30), but genetic influences were not significantly different from those on FF (0.58, 95% CI: 0.50-0.67). FF and FN largely shared a common etiology, indicated by high genetic (0.73; 95% CI: 0.67-0.78) and shared environmental correlations (0.78; 95% CI: 0.69-0.86) across the two traits. Conclusions: Food fussiness and FN both show considerable heritability at 16 months but shared environmental factors, for example the home environment, influenced more interindividual differences in the expression of FF than in FN. FF and FN largely share a common etiology.

Objective: To explore on-package formula messaging with reference to legislation and government-issued guidance in Great Britain (GB). Design: Formula products were identified, pictures of all sides of packs collated and on-package text and images were coded. Compliance with both GB legislation and guidance issued by the Department of Health and Social Care (DHSC) was assessed. Setting: All formula packs that were available for sale over the counter in GB between April and October 2020. Participants: Formula packs (n 71) including infant formula, follow-on formula, growing-up formula and specialist formula were identified, coded and analysed. Results: In total, 41 % of formula packs included nutrition claims, and 18 % included health claims that may be considered non-permitted, according to DHSC guidance. Additionally, 72 % of products showed images considered 'non-permitted'. Breast Milk Substitute (BMS) legislation states infant and follow-on formula packs should be clearly distinguishable but does not provide criteria to assess similarity. Based on DHSC guidance, 72 % of infant and follow-on formula packs were categorised as showing a high degree of similarity. Marketing practices not covered by current legislation were widespread, such as 94 % of infant formula packs including advertisements for follow-on or growing-up formula. Conclusions: Text and images considered non-permitted according to DHSC guidance for implementing BMS legislation were widespread on formula products available in GB. As terms such as 'similarity' are not defined in BMS legislation, it was unclear if breaches had occurred. Findings support the WHO call for loopholes in domestic legislation to be closed as a matter of urgency. [ABSTRACT FROM AUTHOR]

Summary Background: Health Care Professionals struggle to initiate conversations about overweight in toddlerhood. A novel 3D body size scale (3D BSS) may facilitate engagement with this topic during pediatric appointments. Objectives: To explore barriers and facilitators to using the 3D BSS through a mixed‐methods design. Methods: For the qualitative phase, parents of toddlers (n = 38) participated in semi‐structured interviews introducing the 3D BSS of 4–5‐year‐old children. For the quantitative phase, pre‐ and post‐interview questionnaires were administered to ascertain the acceptability of the 3D BSS. Results: Parents rated the 3D BSS as "very" (n = 20, 52.6%) to "moderately" (n = 12, 31.6%) acceptable. Thematic analysis revealed four barriers to acceptability: i) the sensitive nature of child weight, ii) the belief that weight does not determine health, iii) the visual normalisation of overweight and iv) the need to account for individual variation in growth patterns. However, these barriers could be overcome through three facilitators: i) the provision of expert guidance ii) the value of simple tools, and iii) tailoring conversations to familial needs. Conclusions: Parents considered the 3D BSS an acceptable visual resource to discuss child weight during routine appointments. However, the acceptability of the tool was conditional on a sensitive, collaborative, and tailored delivery approach. [ABSTRACT FROM AUTHOR]

Summary Introduction Methods Results Conclusion Behavioral weight management interventions (BWMIs) are an evidence‐based strategy for addressing childhood obesity. Targeting eating behavior traits (EBTs; individual tendencies determining food intake/occasions) could play a pivotal role in improving the effectiveness of these behavioral interventions. The present study describes a systematic review and meta‐analysis of the impact of BWMIs on eating behavior traits in children with overweight or obesity.Seven databases were searched, and eligible studies included randomized controlled trials reporting EBT outcomes following BWMIs delivered to children with overweight or obesity (<18 years of age). Random effects meta‐analyses were conducted to compare EBT outcomes for intervention and control groups. Synthesis without meta‐analysis (SWiM) was applied for EBTs where meta‐analysis was not feasible.The review identified eight trials characterizing the impact of BWMIs on 15 EBTs. Meta‐analyses of data from three trials at intervention completion and post‐intervention (average of 28 weeks [±8]) revealed positive short‐term increases in dietary restraint (SMD random effect 0.42 [95% CI 0.13, 0.70]). However, these effects were not sustained at follow‐up. Improvements in emotional eating, external eating, food responsiveness, and enjoyment of food were shown in studies which could not be pooled quantitatively.BWMIs in children living with overweight/obesity are beneficial for the improvement of some EBTs at intervention completion including dietary restraint, emotional eating, external eating, food responsiveness, and enjoyment of food. However, this remains a relatively unexplored area and more research is needed to strengthen understanding of the multifaceted impact of child BWMIs on a comprehensive range of EBTs. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Food fussiness (FF) describes the tendency to eat a small range of foods, due to pickiness and/or reluctance to try new foods. A common behaviour during childhood, and a considerable cause of caregiver concern; its causes are poorly understood. This is the first twin study of genetic and environmental contributions to the developmental trajectory of FF from toddlerhood to early adolescence, and stability and change over time.Participants were from Gemini, a population‐based British cohort of n = 4,804 twins born in 2007. Parents reported on FF using the Child Eating Behaviour Questionnaire ‘FF’ scale when children were 16 months (n = 3,854), 3 (n = 2,666), 5 (n = 2,098), 7 (n = 703), and 13 years old (n = 970). A mixed linear model examined the trajectory of FF, and a correlated factors twin model quantified genetic and environmental contributions to variation in and covariation between trajectory parameters. A longitudinal Cholesky twin model examined genetic and environmental influences on FF at each discrete age.We modelled a single FF trajectory for all children, which was characterised by increases from 16 months to 7 years, followed by a slight decline from 7 to 13 years. All trajectory parameters were under strong genetic influence (>70%) that was largely shared, indicated by high genetic correlations. Discrete age analyses showed that genetic influence on FF increased significantly after toddlerhood (16 months: 60%, 95% CI: 53%–67%; 3 years: 83%; 81%–86%), with continuing genetic influence as indicated by significant genetic overlap across every age. Shared environmental influences were only significant during toddlerhood. Unique environmental influences explained 15%–26% of the variance over time, with some enduring influence from 5 years onwards.Individual differences in FF were largely explained by genetic factors at all ages. Fussy eating also shows a significant proportion of environmental influence, especially in toddlerhood, and may, therefore, benefit from early interventions throughout childhood. Future work needs to refine the FF trajectory and explore specific trajectory classes. [ABSTRACT FROM AUTHOR]