Abigail Pickard

Objective: To explore the use, access, and motivations of individuals with eating disorders (EDs) attempting to access Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management in the UK.Method: A mixed-methods convergent parallel design was used. Eligible participants were aged 16+, had an ED, and had attempted to access GLP-1 RAs in the past two years. Seventy-two participants completed an online survey, with quantitative data analysed descriptively and qualitative data analysed thematically. Results: Ninety three percent (n=67) reported current or previous GLP-1 RA’s use and most common motivations were weight loss and binge eating reduction. The most frequent prescriber was online pharmacies (n=52, 74.3%). When prescribed, two thirds were asked about an ED but did not disclose this, one quarter were not asked about EDs. Thirty seven percent (n=25) of participants who received medication did not meet BMI prescription requirements and the approximately half did not receive ongoing monitoring. Qualitative themes found that motivations for using GLP-1 RAs were guided by ED cognitions and recovery, and uncertainty emerged surrounding intentions of long-term use.Conclusion: Despite screening of ED’s and BMI being recommended, most participants in this study obtained GLP-1 RAs for weight loss with little ongoing monitoring, suggesting the need for more robust regulation.

Food selectivity among neurodivergent children and adolescents is often discussed in terms of sensory sensitivity, restricted repertoires and nutritional risk, but less is known about how caregivers manage these difficulties in socioeconomically vulnerable settings. This qualitative study aimed to understand how caregivers of neurodivergent children and adolescents in small municipalities in Northeast Brazil narrate everyday feeding care in the face of food selectivity, material constraints and the ambivalent use of ultra-processed foods. Thirty-five parents and/or primary caregivers of 37 Autistic children and adolescents with or without attention-deficit/hyperactivity disorder and/or co-occurring neurodevelopmental conditions were interviewed in three municipalities in Ceará, Brazil. Data were generated through face-to-face semi-structured interviews, and contextual instruments on socioeconomic vulnerability and family food consumption. Interviews were transcribed, reviewed and analysed using an interpretative thematic approach. Six thematic categories were constructed: food as everyday care work; selectivity as a bodily and sensory experience; inventiveness and strain in managing feeding; material limits in feeding the child; ultra-processed foods as an ambivalent care resource; and the demand for specialised guidance. Caregivers described feeding as a relational, sensory and socially situated practice shaped by refusals, negotiations, economic constraints, school routines and limited access to professional support. Ultra-processed foods were recognised as nutritionally undesirable, but were also used pragmatically as predictable, accepted and practical resources in everyday care. The findings suggest that feeding interventions for neurodivergent children should move beyond individualised parental advice and address the material, sensory and institutional conditions that shape food choice and feeding care.

Context: In 2022, less than 18% of UK children aged 5-7 years consumed 5 portions of fruit and vegetables, with an average intake of 3 portions per day. Group settings (eg, schools or nurseries) present an opportunity to apply policies to encourage children’s consumption of novel and healthy foods. Objective: The extent and types of evidence regarding efforts to increase the consumption of fruits and vegetables by young children in group settings who reside in high-income countries was investigated in this scoping review. Data Sources: A systematic scoping review was conducted that followed the JBI guidelines and included articles, published from 2012 onward, about methods to increase consumption of novel and/or healthy foods by children aged 3-7 years in settings within local government control and who were residing in high-income countries. Data Extraction: A total of 7000 articles were initially identified, of which 114 were included in this review after screening. Data Analysis: Intervention methods included an array of different techniques from educational programs to repeated exposure, food modification, and behavioral modeling approaches. Conclusion: Interventions administered to children aged between 3 and 7 years in group-based settings have been shown to improve the consumption of healthy foods, specifically fruits and vegetables. Behavioral modeling and sensory play interventions, in particular, present the highest level of success.

Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 “full” days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t₁₁₆=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection.

Background: Children with avid eating behaviour display high food responsiveness, high emotional overeating and low sensitivity to fullness; behaviours which may increase the risk of obesity and are challenging for parents to manage. This study explores the situational predictors of coercive or indulgent feeding practices among parents of children with avid eating behaviours using Ecological Momentary Assessment (EMA). Methods: The study involved 109 parents of 3-5-year-old children exhibiting avid eating behaviour. Over 10 days, participants completed EMA surveys via a mobile app to report on their mood, stress, feeding goals, and feeding practices during eating occasions. Multilevel modelling was used to assess how parental mood, goals, and the eating context (e.g., meal versus snack, public versus private setting) influenced feeding practices. Results: Parents were more likely to use specific coercive or indulgent feeding practices when experiencing higher stress, when aiming to avoid mealtime conflict, and during meals versus snacks. A negative meal atmosphere and a public setting also increased the likelihood of certain indulgent practices. Notably, parents were more likely to report giving their child food to calm them down or help manage their behaviour when the meal atmosphere was perceived as negative and if they aimed to reduce conflict at the meal. The findings highlight that the context of feeding occasions significantly drives the use of coercive or indulgent feeding practices. Conclusions: Parental stress, goals, and the eating context are key determinants of coercive or indulgent feeding practices with children exhibiting avid eating behaviours. Interventions to support parents should consider these dynamic factors, promoting healthier feeding strategies tailored to real-life contexts.

Children’s avid eating behaviour is characterised by frequent snacking and food responsiveness. Parents need evidence-based advice on specific feeding practices, such as distraction techniques and portioning, that can be used to reduce children’s intake of high energy-dense snacks. This experimental laboratory study tested the effectiveness of these feeding practices. Parents and children (3-5 years; N=129) who were identified as having an avid or typical eating profile were recruited and randomly allocated to one of three conditions. Following a standardised meal, children’s energy intake (measured in kilocalories) in the absence of hunger was assessed. While children had access to a snack buffet, parents were asked to use one of the following feeding practices: (1) Distract – using distraction techniques to delay children’s snack intake; (2) Portion – allowing children to have snacks from pre-portioned pots; or (3) Control – allowing children to eat the type and number of snacks that their child wanted to. Results showed that children in the distraction condition consumed significantly less energy from snacks compared to children in the portion or control conditions. Energy intake in the portion and control conditions was not significantly different. There was also no difference in energy intake between children with avid versus typical eating profiles. These findings suggest that parental use of distraction techniques may be effective for reducing children’s intake of high energy-dense snacks and could be recommended for use to support the development of children’s healthy eating behaviour. Further research to examine the effectiveness of distraction in real-world settings is now needed.

BACKGROUND The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as Ecological Momentary Assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with a high food approach. OBJECTIVE The main objectives of this study were to: (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. METHODS Parents living in the UK with a child aged between 3 and 5 years with avid eating behavior were invited to participate in the 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. RESULTS Of those parents who completed the EMA study, 104 (87.4%) provided at least seven ‘full’ days of data (two signal surveys and one event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), three daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the ten days. Over the EMA period, a total of 2,524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD = 0.18, min = 1.7, max = 2.3). The majority of parents felt that the surveys made them more aware of their feelings (89%) and activities (79%). CONCLUSIONS This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection. INTERNATIONAL REGISTERED REPORT RR2-10.2196/55193

Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents’ daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children’s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers’ daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children’s avid eating behavior.