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Randomized Controlled Trial
. 2015 Sep;115(9):1400-7.
doi: 10.1016/j.jand.2015.03.009. Epub 2015 May 8.

Reduction in food away from home is associated with improved child relative weight and body composition outcomes and this relation is mediated by changes in diet quality

Myra Altman, Jodi Cahill Holland, Delaney Lundeen, Rachel P Kolko, Richard I Stein, Brian E Saelens, R Robinson Welch, Michael G Perri, Kenneth B Schechtman, Leonard H Epstein, Denise E Wilfley
Randomized Controlled Trial

Reduction in food away from home is associated with improved child relative weight and body composition outcomes and this relation is mediated by changes in diet quality

Myra Altman et al. J Acad Nutr Diet. 2015 Sep.

Abstract

Background: Reducing consumption of food away from home is often targeted during pediatric obesity treatment, given the associations with weight status and gain. However, the effects of this dietary change on weight loss are unknown.

Objective: Our aim was to evaluate associations between changes in dietary factors and child anthropometric outcomes after treatment. It is hypothesized that reduced consumption of food away from home will be associated with improved dietary intake and greater reductions in anthropometric outcomes (standardized body mass index [BMI] and percent body fat), and the relationship between food away from home and anthropometric outcomes will be mediated by improved child dietary intake.

Design: We conducted a longitudinal evaluation of associations between dietary changes and child anthropometric outcomes. Child diet (three 24-hour recalls) and anthropometric data were collected at baseline and 16 weeks.

Participants/setting: Participants were 170 overweight and obese children ages 7 to 11 years who completed a 16-week family-based behavioral weight-loss treatment as part of a larger multi-site randomized controlled trial conducted in two cohorts between 2010 and 2011 (clinical research trial).

Intervention: Dietary treatment targets during family-based behavioral weight-loss treatment included improving diet quality and reducing food away from home.

Main outcome measures: The main outcome measures in this study were child relative weight (standardized BMI) and body composition (percent body fat).

Statistical analyses: We performed t tests and bootstrapped single-mediation analyses adjusting for relevant covariates.

Results: As hypothesized, decreased food away from home was associated with improved diet quality and greater reductions in standardized BMI (P<0.05) and percent body fat (P<0.01). Associations between food away from home and anthropometric outcomes were mediated by changes in diet quality. Specifically, change in total energy intake and added sugars mediated the association between change in food away from home and standardized BMI, and change in overall diet quality, fiber, added sugars, and added fats mediated the association between change in food away from home and percent body fat. Including physical activity as a covariate did not significantly impact these findings.

Conclusions: These results suggest that reducing food away from home can be an important behavioral target for affecting positive changes in both diet quality and anthropometric outcomes during treatment.

Keywords: Diet quality; Food away from home; Obesity; Pediatric.

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Conflict of interest statement

Disclosure of conflicts of interest: None reported

Figures

Figure 1
Figure 1
Proposed mediation model assessing whether changes in diet quality mediate the relationship between changes in energy from food prepared away from home (FAFH) and changes in anthropometric outcomes (Standardized Body Mass Index (zBMI) and percent body fat). Path c indicates the total effect of the association between reduced FAFH and the outcome variables when no mediator is included in the model. Path a indicates the relation between reduced consumption of FAFH on the mediator (changes in diet quality/dietary intake, included in separate single mediation models). Path b indicates the relation between the mediator and the outcome variable (change in anthropometric outcomes). Path c’ indicates the association between reduced FAFH and anthropometric changes when the mediator is included in the model. a Food prepared away from home b Standardized Body Mass Index
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